Computer- aided interven/onal medicine and surgery

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1 Computer- aided interven/onal medicine and surgery Bernard Bayle Télécom Physique Strasbourg 1

2 This course Introduc)on to computer aided surgery (CAS) and computer aided medicine (CAM) Introduc)on to DTMI curriculum and to the connec)ons between its courses Bernard Bayle 2

3 Computer- aided interven/onal medicine and surgery THE DA VINCI CASE 3

4 Chronological landmarks da Vinci in the history of robo)cs ª 1954 Raymond Goertz creates the first master- slave telemanipulator with electric actua/on ª 1969 The Stanford Arm is the first computer controlled robo/c arm ª 1987 P. Green and his team at SRI develop the telepresence surgery system, precursor to the da Vinci ª The Lenny, Leonardo and Mona prototypes lead to the da Vinci system ª 2000 The US FDA clears the da Vinci system for laparoscopic surgery 4

5 Chronological landmarks Intui)ve Surgical development ª early 1990s SRI prototype is funded by the NIH*, and later by the DARPA* ª 1995 AYer the nego/a/on of SRI's IP, Moll, Freund and Younge create Intui/ve Surgical Devices, Inc. with ini/al venture funds and Morgan Stanley ª Intui/ve Surgical begins marke/ng its system in Europe in 1999, while awai/ng FDA approval in the United States (obtained in 2000) ª 2000 The company raises $46 million but is sued for patent infringement by Computer Mo/on, its only rival, which already developed the ZEUS robo/c surgical system ª 2003 Intui/ve Surgical and Computer Mo/on merge and the ZEUS system is no longer developed in favor of the da Vinci system ª 2012 Intui/ve Surgical has more than 2300 employees worldwide Sales: $2178.8M (2012 growth: +24.0%). Net income: $656.6M (+32.6%) *NIH: US National Institute of Health DARPA: Defense Advanced Research Projects Agency 5

6 What is the da Vinci System? da Vinci is a master- slave robot for minimally invasive surgery University of Illinois - Engineering Wiki 6

7 What is the da Vinci System? da Vinci is a master- slave robot ª The console placed some meters away from the table is a bimanual unilateral master device associated to a stereoscopic 3D display. ª The slave robot has 4 robo/c arms: 1 stereoscopic endoscope holder and 3 arms holding tools which have their own mobili/es Intuitive Surgical 7

8 What is the da Vinci System? 2015 Intuitive Surgical 8

9 The da Vinci case: important facts da Vinci medical indica)ons (from ª Bladder Cancer ª Colorectal Cancer ª Coronary Artery Disease ª Endometriosis ª Gynecologic Cancer ª Heavy Uterine Bleeding ª Kidney Disorders ª Kidney Cancer ª Mitral Valve Prolapse ª Obesity ª Prostate Cancer ª Throat Cancer ª Uterine Fibroids ª Uterine Prolapse Physicians have used the da Vinci System successfully worldwide in approximately 1.5 million various surgical procedures to date. da Vinci is changing the experience of surgery for people around the world. 9

10 The da Vinci case: important facts da Vinci controversial benefits Dr. Le Normand, MD, head of the ins/tute of urology and nephrology at Nantes Hospital: «Le robot devrait nous perme2re de diminuer les séquelles éventuelles que sont l'incon8nence urinaire et l'impuissance. Nous espérons aussi perme2re ainsi une diminu8on de la perte sanguine liée à la vascularisa8on importante de la prostate et qui induit souvent une transfusion lors des interven8ons.» 2010, hsp:// nantes.fr/da- vinci- un- robot- unique- dans- l- ouest kjsp 10

11 The da Vinci case: important facts da Vinci controversial benefits Le Point, September 17th, Robots: gros profits, pe)ts progrès. Pr. J. Hubert, urologist at UH Nancy: «La chirurgie robo8que se développe en France sans évalua8on rigoureuse, constate- t- il. Plusieurs établissements acquièrent ce matériel pour doper leur image. Après neuf ans d'expérience dans notre hôpital, pa8ents ont été opérés. Disons que le robot améliore la vision, supprime le tremblement manuel du chirurgien, permet, grâce aux instruments ar8culés, des gestes à 360 degrés impossibles à réaliser par l'homme. La chirurgie robo8que présente donc les mêmes avantages que la chirurgie mini- invasive par endoscopie et permet une finesse supérieure. Est- ce un avantage majeur pour le pa8ent? Non, mais j'ai la convic8on que c'est un avantage indirect.» Pr. G. Vallancien, urologist at Ins/tut Montsouris, Paris: «[ ] Le vrai progrès, c'est la célioscopie, le robot n'en est qu'une extension. Le bénéfice pour le pa8ent est très discutable, ce n'est ni mieux ni moins bien. Par contre, nous constatons un bénéfice pour le chirurgien. Mieux installés, nous fa8guons moins.» 11

12 The da Vinci case: important facts da Vinci controversial benefits Le Point, September 17th, Robots: gros profits, pe)ts progrès. Pr. J.- N. Fabiani, chief of cardio- vascular surgery at Hospital Georges- Pompidou in Paris: «Nous avons acquis une machine en L'expérimenter a été une formidable aventure. Mais nous ne l'u8lisons plus. La robo8que entraîne un allongement des opéra8ons. Il faut toute une équipe pour faire fonc8onner la machine. Nous réalisions une opéra8on avec le robot quand dans le même temps nous en faisons deux ou trois par voie classique. Surtout, ça ne permet pas d'autre avantage qu'un gain cosmé8que, celui de la pe8te incision. On rend un service équivalent avec la chirurgie vidéo- assistée [ c est] une très bonne machine à coudre.» 12

13 The da Vinci case: important facts da Vinci controversial benefits Le Point, September 17th, Robots: gros profits, pe)ts progrès. «A2en8on à ne pas en faire un ou8l de promo8on commerciale, met en garde un urologue. Avant d'acheter leur robot, les chirurgiens d'une clinique ont dressé un plan de financement: ils doivent procéder à 150 interven8ons par an. Le risque est que ce type de calcul financier conduise à opérer abusivement.» Ar/cle conclusions: «Aucun des chirurgiens que nous avons rencontrés n'a connaissance d'accidents liés à la chirurgie robo8sée, et tous es8ment que c'est une voie d'avenir. La robot- chirurgie est inéluctable, prédit le Dr François Aubart, chirurgien et président de la Coordina8on médicale hospitalière, avec une généra8on de machines plus pe8tes, réservées à certains temps opératoires et moins chères.» 13

14 The da Vinci case: important facts da Vinci controversial benefits Bloomberg, March 5th Robosurgery suits detail injuries as death reports rise. Part of what s driven this market is people seeking out robo/c surgery; hospitals market it and the pa/ents seem to think it s beter, said Michael Matson, an analyst with Mizuho Securi/es USA in New York, in a telephone interview. The threat to the company is that the pa/ents would get scared. [ ] In 2011, an analysis published in the American Journal of Obstetrics & Gynecology found the complica/on occurs in almost two percent of robot hysterectomies, or more than twice the rate seen in conven/onal, less invasive surgery. Intui/ve s Curet [Chief Medical Advisor] disputes the 2011 finding. The study examined a much smaller subset of pa/ents and surgeons for robo/c surgery, so the data is less robust and may account for the lower rates in laparoscopy, she said. Minimally invasive surgery in general has higher rates of the vaginal- wound complica/ons, not just with the robots, Curet said.. 14

15 The da Vinci case: important facts da Vinci controversial benefits ª General device used in a small number of applica/ons (urology, gynecology) ª Long and difficult procedure to assess the medical service and the pa/ent benefits ª No par/cular authoriza/on for robo/c surgery (at least in France) ª Training given by Intui/ve Surgical, but no official skill evalua/on ª Difficult to evaluate the effects of lobbying policies for/against the system ª Difficult to assess the economic benefit ª No reimbursement in France (whereas if the robot saves one pa/ent s day at hospital, the extra cost is reimbursed) vs. reimbursement by some US insurances 15

16 The da Vinci case: important facts da Vinci surgery is surgery, as recalled by the company warning All surgery presents risk, including da Vinci Surgery. Results, including cosme/c results, may vary. Serious complica/ons may occur in any surgery, up to and including death. Examples of serious and life- threatening complica/ons, which may require hospitaliza/on, include injury to /ssues or organs; bleeding; infec/on, and internal scarring that can cause long- las/ng dysfunc/on or pain. Temporary pain or nerve injury has been linked to the inverted posi/on oyen used during abdominal and pelvic surgery. Pa/ents should understand that risks of surgery include poten/al for human error and poten/al for equipment failure. Risk specific to minimally invasive surgery may include: a longer opera/ve /me; the need to convert the procedure to other surgical techniques; the need for addi/onal or larger incision sites; a longer opera/on or longer /me under anesthesia than your surgeon originally predicts. Conver/ng the procedure to open could mean a longer opera/ve /me, long /me under anesthesia, and could lead to increased complica/ons. Research suggests that there may be an increased risk of incision- site hernia with single- incision surgery. Pa)ents who bleed easily, have abnormal blood clo_ng, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery. Other surgical approaches are available. Pa)ents should review the risks associated with all surgical approaches. They should talk to their doctors about their surgical experience and to decide if da Vinci is right for them. For more complete informa/on on surgical risks, safety and indica/ons for use, please refer to hsp:// vinci- surgery/safety- informa)on.php 16

17 The da Vinci case: important facts Intui)ve Surgical facing lawsuits 2013 The New York Times (Salesmen in the Surgical Suite, 25 March 2013), reports the case of F. Taylor arrived at Harrison Medical Center in Silverdale, Wash., for a rou/ne prostatectomy, he expected the best medical care new technology had to offer: robo/c surgery, billed as safer, less painful and easier on the body than tradi/onal surgery. The opera/on took 13 hours and ley the pa/ent incon/nent and with a colostomy bag, and leading to kidney and lung damage, sepsis and a stroke. Mr. Taylor survived his injuries but died last year. The ar)cle suggest proac)ve sale policy from the company, and limited training. According to Bloomberg, (Intui)ve Wins Trial, Defeats Negligent Training Claims, 24 May 2013), the case was the first to go to trial of at least 26 lawsuits against Intui/ve [Intui)ve Surgical won ader the company could prove that Taylor s] urologist ignored specific instruc)ons that for his first several procedures with the da Vinci, he should choose simple cases and pa/ents with a low body- mass index. Taylor was morbidly obese. 17

18 The da Vinci case: conclusion Despite the controversy ª More than 2500 da Vinci Systems are installed in approximately 2000 hospitals worldwide at the end of [Haidegger, Milan WS 2012] 18

19 The da Vinci case: conclusion Despite the controversy ª More than 2500 da Vinci Systems are installed in approximately 2000 hospitals worldwide at the end of ª 80 % of the radical prostatectomies in the US are performed with the da Vinci system. ª Search a da Vinci surgeon in Houston, Texas? 44 answers! ª Intui/ve Surgical holds ownership/exclusive rights to over 1250 (resp. 1150) U.S. and foreign patents (resp. patent applica/ons). The product is unanimously considered as an outstanding technological achievement, developed ayer the research contribu/ons of experts from SRI, MIT and JHU. 19

20 Computer- aided interven/onal medicine and surgery A MULTIDISCIPLINARY FIELD 20

21 Big picture Computer aided medical interven)ons and surgery techniques consist in: ª Medical imaging guidance ª Hospital/health informa/on systems ª Hardware and soyware components 21

22 Big picture UE1 : TECHNIQUES D'IMAGERIE ET DE VISION EN MEDECINE Traitement d'images médicales Problèmes inverses Traitement d'images médicales : méthodes et applications Estimation de pose Recalage médical 3D DTMI curriculum UE2 : INSTRUMENTS ET SYSTEMES THERAPEUTIQUES Instruments et technologies thérapeutiques Gestes médicaux chirurgicaux assistés par ordinateur Qualité & sécurité des systèmes électromédicaux UE3 : INFORMATIQUE ET INTERFACES Informatique hôpital Visualisation 2D & 3D IHM UE4 : MODELISATION DES SYSTEMES VIVANTS ET SIMULATION Modélisation des systèmes vivants Simulation temps-réel Haptique 22

23 DTMI curriculum (1) Medical image processing (3 courses) C. Heinrich et al. UE1 Image processing and computer vision techniques in medicine Pose es)ma)on F. Nageote 3D medical registra)on F. Nageote 23

24 Medical image processing [Siemens An image of the anatomical details of the brain] Télécom Physique Strasbourg, TIC Santé 3A 24

25 Pose es/ma/on and 3D medical registra/on [PhD. B. Maurin, ICube, 2005] 25

26 DTMI curriculum (2) Therapeu)c instruments and technologies J.- P. Dillenseger, V. Schuh UE2 Instruments and therapeu)c systems Computer- aided interven)onal medicine and surgery B. Bayle, F. Nageote, O. Piccin, P. Renaud 26

27 Therapeu/c instruments and technologies 27

28 Computer- aided medicine and surgery [ICube, AVR team projects, ] Télécom Physique Strasbourg, TIC Santé 3A 28

29 DTMI curriculum (3) Hospital informa)on systems F. Guerder, J. Moreau UE3 Computers, networks and interfaces Visualiza)on S. Théry Human machine interfaces A. Habed 29

30 Hospital informa/on systems [Osirix 2013] 30

31 Visualiza/on Rowan University: visualizing the human body in a CAVE environment Télécom Physique Strasbourg, TIC Santé 3A 31

32 Human machine interfaces Anatomy 3D app for Android 32

33 DTMI curriculum (4) Living systems modeling and simula)on D. Baumgartner, I. Peterlik Real- )me simula)on H. Courtecuisse UE4 Living systems modeling and simula)on Hap)cs B. Bayle, L. Barbé 33

34 Living systems modeling and simula/on SOFA Framework 34

35 Real- /me simula/on [SOFA, INRIA SHACRA, GPU real- )me simula)on with CUDA 2013] 35

36 Hap/cs Hansen Magellan teleoperated system 36

37 Computer- aided interven/onal medicine and surgery MEDICAL ROBOTS FUNCTIONALITIES with Michel de Mathelin 37

38 What robotics can do to assist doctors 1. Registra)on: localiza/on of the instrument with respect to the pa/ent using intra- opera/ve imaging and 3D measurement devices 2. Posi)oning: 3D posi/oning of instruments with respect to the pa/ent 3. Trajectory tracking: tracking with the instrument of a planned trajectory with respect to the pa/ent 4. Collabora)ve manipula)on: manual manipula/on of an instrument constrained in posi/on, velocity or force, by a robo/c device 5. Telemanipula)on: remote manipula/on of an instrument 6. Explora)on: explora/on of a par/ally unknown environment 7. Simula)on: execu/on of the previous tasks in a virtual environment with a physical human- machine interface Bernard Bayle 38

39 Registra/on Localiza)on of the instrument with respect to the pa)ent, with reference to the pre- opera)ve planning, using intra- opera)ve imaging and measurements. Devices: 3D measurement ª Cameras (ex. Polaris) ª Magne/c sensors ª Medical imaging NDI Polaris Research issues ª Physiological mo/on compensa/on ª Mul/ple modali/es ª OR integra/on ª Accuracy and robustness Main medical applica)ons ª Orthopedics ª Neurosurgery ª Radiotherapy TIMC Praxiteles Renishaw Neuromate Bernard Bayle 39

40 Posi/oning 3D posi)oning of instruments with respect to the pa)ent. Also, 3D posi)oning of the pa)ent with respect to the instrument or tracking of the instrument by the imaging device. Devices: 3D measurement + robot holding the instrument Main medical applica)ons ª Orthopedics ª Neurosurgery ª Radiotherapy ª Radiology ª Minimally invasive surgery Research issues ª Safety in the OR ª Physiological mo/on compensa/on ª HMI ª Robot structures Freehand robo)c tool holder Accuray Cyberknife Procure Proton therapy center Siemens Ar)s Zeego Bernard Bayle 40

41 Posi/oning Siemens Ar)s Zeego Bernard Bayle 41

42 Trajectory tracking Tracking of a planned instrument trajectory with respect to the pa)ent (trajectory tracking: posi)on, velocity, accelera)on control). Devices: 3D measurement + robot holding the instrument Main medical applica)ons ª Orthopedics ª Neurosurgery ª Radiology Curexo Robodoc Research issues ª Physiological mo/on compensa/on ª Safety in the OR ª Robot architectures Mazor Robo)cs Mars spine surgery robot Prosurgics Path Finder Bernard Bayle 42

43 Collabora/ve manipula/on Manual manipula)on of an instrument constrained in posi)on, velocity or force, by a robo)c device. Devices: 3D measurement + robot manipula/ng the instrument in synergy with the doctor Main medical applica)ons ª Orthopedics ª Neurosurgery ª Interven/onal radiology PI Galileo Research issues ª Physiological mo/on compensa/on ª Robot architectures ª Force feedback Innomedic Innomo)on ISIS SurgiScope Bernard Bayle 43

44 Telemanipula/on Robo)c manipula)on at a distance of an instrument held by a slave robot. Devices: 3D measurement + slave robot + master interface Main medical applica)ons ª Minimally invasive surgery ª Interven/onal radiology ª Echography Intui)ve Surgical da Vinci system Research issues ª Physiological mo/on compensa/on ª Robot architectures ª Instrumenta/on ª Force/hap/c feedback ª HMI Hansen medical Sensei robo)c catheter system Robotsod Estele Bernard Bayle 44

45 Computer- aided interven/onal medicine and surgery SPECIFITIES & KEYS FOR SUCCESS with Michel de Mathelin 45

46 Specific issues: safety The robot is expected to create no injuries to the pa)ent/medical staff Redundant sensors Workspace, velocity, force constraints Safe mechanical design SoYware, electronic and mechanical fuses Manual procedure remains possible Automa/c docking Limited rela/ve increase of the dura/on of the surgery Surgeon in the loop Bernard Bayle 46

47 Specific issues: OR constraints The OP Room constrains should be taken into account Available space Human- machine interface and ergonomics Training of the medical staff Interoperability with other equipment Cer/fica/on Bernard Bayle 47

48 Specific issues: sterility The robo)c device should be compa)ble with sterility procedures The parts in contact with the pa/ent should go into an autoclave or should be disposable or could go through a chemical cleansing The other part in the sterile area should be wrapped in sterile bags in order to avoid contamina/on of the medical staff performing the surgical act Bernard Bayle 48

49 Keys for successful medical assistance There are expected added- values for robo)cs and automa)on Accuracy and repeatability Speed Added dexterity Tremor filtering Gravity compensa/on Force, velocity and posi/oning constraints Telemanipula/on, scaling of mo/ons and forces Hos/le environment Automa/c planned trajectory tracking Automa/c registra/on with pre- opera/ve data Simula/on Augmented reality (visual, hap/cs, ) Real- /me integra/on and recording of intra- opera/ve data Bernard Bayle 49

50 Keys for successful medical assistance Technological success is different from medical or commercial success, and there are essen)al condi)ons for success The 3 specific issues are taken into account: safety, sterility and OP room constraints Several compe//ve advantages of robot over human are demonstrated The doctor remains in the loop There is a significant improvement for the pa/ent (clinical valida/on) Bernard Bayle 50

51 Computer- aided interven/onal medicine and surgery MEDICAL ROBOTS FROM THE LAB TO THE MARKET 51

52 Medical robots from the lab to the market FIRST, LEARN FROM THE PAST 52

53 Medical robots evolu/on First genera)on (1985 ) Systems inspired by industrial robots and dedicated to simple tasks requiring high accuracy 1985 Puma 560 industrial robot used in neurosurgery for CT- guided biopsies, 22 pa/ents 1989 IMMI Neuromate first pa/ent 1992 IBM (now Curexo) Robodoc, first robo/c system used in orthopedics for hip replacement 1993 IMMI (now ISIS) robo/zed microscope handler SurgiScope Neuromate ini)al version è orthopedic and neurosurgery applica/ons è rigid environments Robodoc 53

54 Medical robots evolu/on Second genera)on (1994 ) Mul)- purpose telerobo)c systems dedicated to minimally invasive surgery, through a fixed point 1994 Computer Mo/on Aesop (and later Zeus) 2000 Intui/ve Surgical da Vinci Computer mo)on AESOP è laparoscopic surgery applica/ons è soy environments è cumbersome and expensive, but s/ll in use, and the only big success! Intui)ve Surgical da Vinci 54

55 Medical robots evolu/on Third genera)on (2000 ) The era of dedicated robo)c systems è every poten/al medical/surgical applica/on è costs reduc/on è custom designed systems Mazor Robo)cs Mars spine surgery robot Endocontrol Jaimy 55

56 Medical robots from the lab to the market SECOND, BE ABLE TO DESIGN A COMPLETE SOLUTION 56

57 Methodology Step 1: Defini)on on the medical task, general case, limita)ons Requires capacity to understand the medical procedures and to ask the "good" ques/ons to the medical staff. Step 2: Defini)on of the robo)c task Requires to translate the instruments mobility for mechanical design. Step 3: Robo)c specifica)ons with full list of specifica)ons Requires to be able to take into account many constraints, highly interdisciplinary and technological task. Bernard Bayle 57

58 Methodology Step 1: Defini)on on the medical task, general case, limita)ons Requires capacity to understand the medical procedures and to ask the "good" ques/ons to the medical staff. Step 2: Defini)on of the robo)c task Requires to translate the instruments mobility for mechanical design. Step 3: Robo)c specifica)ons with full list of specifica)ons Requires to be able to take into account many constraints, highly interdisciplinary and technological task. Bernard Bayle 58

59 Example: nonvascular interven/onal radiology 59

60 Example: nonvascular interven/onal radiology A complex environment ª Limited room within the gantry (and outside the gantry ) ª Non trivial asepsis constraints 60

61 Example: nonvascular interven/onal radiology Instruments, environment constraints ª Very different needle shaped tools ª Importance of hap/cs in the radiologist percep/on ª Different possible modali/es 2 Force (N) Time (s) 61

62 Example: nonvascular interven/onal radiology Manual procedure schedule ª Diagnosis and interven)on planning ª Entry point registra/on ª Pa/ent prepara/on: steriliza/on, anesthesia, etc. ª Incision at the entry point ª Inser/on, treatment and needle removal 62

63 Example: nonvascular interven/onal radiology Manual procedure schedule ª Diagnosis and interven/on planning ª Entry point registra)on ª Pa/ent prepara/on: steriliza/on, anesthesia, etc. ª Incision at the entry point ª Inser/on, treatment and needle removal 63

64 Example: nonvascular interven/onal radiology Manual procedure schedule ª Diagnosis and interven/on planning ª Entry point registra/on ª Pa)ent prepara)on: steriliza)on, anesthesia, etc. ª Incision at the entry point ª Inser/on, treatment and needle removal 64

65 Example: nonvascular interven/onal radiology Manual procedure schedule ª Diagnosis and interven/on planning ª Entry point registra/on ª Pa/ent prepara/on: steriliza/on, anesthesia, etc. ª Incision at the entry point ª Inser)on, treatment and needle removal 65

66 Methodology Step 1: Defini)on on the medical task: general case, limita)ons Require to have capacity to understand the medical procedures, to be able to ask the "good" ques/ons to the medical staff Step 2: Defini)on of the robo)c task Require to translate the tools mobility into the mechanism mobility Step 3: Robo)c specifica)ons for this task with full list of specifica)ons. Require to be able to take into account many constraints. Highly interdisciplinary and technological task to be con)nued in the next courses Bernard Bayle 66

67 Medical robots from the lab to the market FINALLY: DEVELOP THE PRODUCT AND COMPLY WITH THE REGLEMENTATIONS 67

68 Product development Keys for product development First: have a good idea, and a prototype, as developed as possible Include patented innova/on Find necessary funding Built adequate industrial partnership Comply with cer/fica/on requirements ISO is the French label (extension of ISO 9001) for a company which develops medical devices CE marking is required to develop commercial products in EU FDA approval is the main step to develop products in the US and worldwide Bernard Bayle 68

69 [PhD Lebossé, ICube 2008] [Axilum robo)cs, 2013] 69

70 References Robo/que médicale, J. Troccaz coordinator, Hermes (exis/ng English version at Wiley). Ask B. Bayle if not at library. Ar/cles from the main biomedical engineering robo/c journals. To be con)nued Bernard Bayle 70

71 Mapping of medical robo/cs industry France: Computer- aided interven)onal medicine and surgery 150M, very high strategic level Adept, Aesculap, AS2I, Axilum Robo/cs, BA Healthcare, Collin, Endocontrol, GE medical systems, ISIS, KOELIS, Medtech, Praxim, RobosoY, Staubli, SurgiQual, Variant Reeduca)on and rehabilita)on robo)cs, help to disabled or elderly people 100M, very high strategic level Aldebaran, Fatronik, Hap/on, ISIS Robo/cs, Magellium, RobosoY [GDR- Robo)que 2010] Bernard Bayle 71

72 Mapping of medical robo/cs industry Worldwide: Computer- aided interven)onal medicine and surgery Intui/ve Surgical, Mazor Robo/cs, Renishaw, Procure, ISIS, Accuray, Curexo technology, Medtronic, Synthes, Hansen robo/cs, Siemens Healthcare, GE Medical systems, Philips Healthcare, Olympus, Karl Storz, Bernard Bayle 72

73 Mapping of medical robo/cs academic research (robo)zed medical interven)ons and surgery only) France: ICube/IRCAD/IHU Strasbourg; TIMC, Grenoble; ISIR, Paris; LIRMM, Montpellier Worldwide: USA: Johns Hopkins (Taylor, Stoianovici, Hager), Harvard (Howe, Dupont), Washington (Hannaford), Stanford (Okamura), Maryland (Desai), Case Western (Cavusoglu), Vanderbilt (Simaan, Webster), UCSC (Rosen), Carnegie Mellon (Riviere) Canada: Bri/sh Columbia (Salcudean), Western Ontario (Patel), Queens (Fich/nger) Germany: DLR (Albu- Schäffer), Munich (Luth, Navab), Hannover (Ortmaier) Japan: Tokyo (Dohi, Mitsuishi, Masamune, Nakamura, Sugita), Waseda (Fujie, Iwata), Hashizume (Kyushu) Switzerland: ETHZ (Nelson), EPFL (Baur, Bleuler) and of course many others. Bernard Bayle 73

74 Computer- aided interven/onal medicine and surgery COURSE ORGANIZATION AND EVALUATION 74

75 Course organiza/on Schedule Introduc/on to CAS/CAM (this course, 3h30, B. Bayle) Robo/zed diges/ve surgery (3h30, F. Nageote) Robo/zed cardiac surgery (3h30, P. Renaud) Robo/zed interven/onal radiology (3h30, O. Piccin) Scien/fic publica/on analysis and presenta/on (8h, B. Bayle, including prepara/on course, 1h) Competences Understand the background and the maturity of technologies in computer- integrated medical interven)ons and surgery Be ini)ated to medical robo)cs by research specialists Scien)fic literature reading and technology issues understanding Bernard Bayle 75

76 Course organisa/on Methods ª 3 courses/lab (robo)zed diges)ve surgery, robo)zed interven)onal radiology, robo)zed cardiac surgery) Duty: 1 ar)cle to read before each course, which will be used in the lab The courses present the associated medical applica/ons, the problems to be solved and exis/ng solu/ons, including the speakers own research The labs develop interac/ons between the students and the professor, based on a brainstorm or a research project about the course and the studied ar/cle Bernard Bayle 76

77 Course organisa/on Evalua)on ª 50%: presenta)on of a recent scien)fic ar)cle, or a collec)on of less scien)fic ar)cles Oral presenta)on (ppt or pdf, in French, slides in English) x2 students (+1 student alone if necessary) Self- organized selec)on of the ar)cles ader the last course 4 hours reserved for the reading (not added to the week schedule) ª 50%: final exam based on the fast analysis of a problem (possibly presented by an ar)cle, a technical note, or a brief descrip)on) Bernard Bayle 77

78 The end Ques)ons? 78

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