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Robots That Perform Remote Surgery
April 29, 2014   
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Researchers and doctors from the Foundation for Cardiac Surgery Development in the southern city of Zabrze have built a range of heart surgery robots collectively known as the Robin Heart. Practical and cost-efficient, these robots can successfully compete with the most modern Intuitive Surgery devices developed in the United States. The prototypes of the Polish robots have proved successful during experimental operations on animals. The Polish project, which began in 2012 and is now at its halfway point, is the most advanced of its kind in Europe.

Paweł Kostka, Ph.D., a biomedical electronics engineer from the Silesian University of Technology in Gliwice, southern Poland, head of the TeleRobinSurgery project—which aims to develop and test new technology for remote-controlled surgery using Robin Heart robots—talks to Karolina Olszewska.

What kind of devices do surgeons need to be able to operate on patients from a distance?

Briefly put, such devices must be practical and safe, regardless of whether the surgeon is working from a short or long distance. And this takes a host of extremely complicated parts and components. Among the most important parts are so-called master-slave systems designed for remote surgery. These systems track the movement of the operator’s (master’s) hand or carry out his commands expressed through gestures or words, for example.

They are part of a very exciting field known as Man-Machine Interaction (MMI). The “slave” part, in our case the robot’s arm, is able to work at a site that is not easily accessible. Under a program that is called Tele-Manipulacje (Tele-Manipulation) for short, we are developing hardware and software solutions for the remote surgery system. We are studying important parameters related to its functionality and safety.

The surgeon/operator in his “command center” is in a less tiring position. He can be more focused than when standing directly at the operating table. He makes movements with the control device in his hands. Thanks to a scaling function, the tip of the instrument performs much smaller movements. This increases the precision of operations on very small blood vessels, such as bypasses, bridging procedures [for coronary heart disease patients] involving vessels that are a few millimeters in diameter or small organs in the abdominal cavity. In addition, the surgeon has at his disposal a three-dimensional image in good HD quality.

Such robots are already used around the world to support surgeons...

The only commercially operating system is the American Da Vinci robot. It makes it possible to conduct operations, including remotely. The Da Vinci robot is used to perform operations in many clinics around the world; its systems have very strong patent protection. Significantly, in this case the surgeon and the patient are usually in the same room.

How are the Polish robots different from the American system?

Our technology is different in that the system is divided into two modules, which can “see” each other even when they are miles apart and can exchange the necessary data with a frequency of 200 to 1,000 times per second. The software I write ensures continuous communication between the separated parts of a single control system.

Apart from medicine, can this technology be applied in other areas?

The Tele-Robin mechatronic and distributed control systems developed under the project will be useful in places that are difficult to access for humans, for example in nuclear power plants, or in military systems on land, sea and in the air—generally, wherever there is danger involved. Our systems can be used as equipment for rescue services. They will also come in handy in specialized laboratories, which must be sterile and where there is limited access for outsiders.

Since the system is expected to operate efficiently on a remote basis, in our project we need to meet the challenges of audio/video data transfer. The high definition (HD) dual-channel 3D image contains a large amount of data. This data must be sent from the operating table through an endoscopic system as fast as possible.

Is the speed at which the signal reaches the operator a key factor during a major operation?

Yes. And signal transmission itself is not the biggest source of delay. The change needed in the format of the signal from the original to one adapted to transmission via the Ethernet takes the most time. An image from a medical camera or a close-circuit television system must be converted without significant loss of quality either at the source or on the operator’s side. We performed an experiment between the southern Polish cities of Zabrze and Katowice. This was a remotely-controlled operation between the Foundation for Cardiac Surgery Development and the Experimental Center of the Medical University of Silesia. Pre-clinical tests have shown that the acceptable threshold for the delay between the video and the manipulation channels is 200-250 milliseconds. When the delay is greater, a doctor, like every human being, loses his hand-eye coordination. The brain has difficulty controlling the body when we see the result of these actions after too long a time.

The security of the system has been the subject of many of our studies. We want to predict all potential emergencies and breakdowns that may occur during a remote operation and to develop reaction algorithms. We introduce a security program into the system. All sensors, both those that read the position of the operator’s hand and those supervising the work of the robot’s arm, are duplicated, and their readings are compared on an ongoing basis. The system should be able to detect any failure and react with a safe stop, enabling the removal of the arm. Then the operation is continued in the traditional manner.

The project was co-financed with a zl.2.37 million grant from the National Center for Research and Development (NCBiR). How was this money spent?

Special workstations need to be prepared to measure the delays. We create them by buying components and feeding into their “brains” the control software we have developed. This makes it possible to obtain unique research results that will determine the final shape of the remote system and check how it works.

An innovative remotely-controlled arm is being developed as part of the project, as the main item for testing. The arm is made from lightweight composite materials. It comes with a set of modern motion sensors to examine the accuracy with which the arm can mimic a movement by a remote operator. The arm is less susceptible to vibration and more easily controllable. Its cost is about zl.400,000 together with the accompanying tools.

In the project, simulators are also needed, much as in the automotive industry or aviation. Such a trainer system allows the surgeon or operator in industry, for example, to learn how to control the robotic arm with a pre-set and regulated delay.

The costs of preparing these workstations for research are very high. Professional video converters are similar to those used in live broadcasts of sporting or cultural events on television. Reliable motors with controller units etc. cost hundreds of thousands of zlotys. Performing a remote operation over a long distance also requires preparations and the booking of space and capacity on telecommunication systems. To reduce expenses, we are trying to secure the support of key operators on the market in this field. Simulator systems used globally to train surgeons to carry out minimally invasive operations are very expensive and not always practical. We have our own solutions. These include simulators with natural tissues and animal-derived organs, mainly from pigs. Surgeons and experts help us design these simulators.

When will the prototypes go into production?

We want to apply for patent protection, for both the mechanical and the control systems, which can be disassembled into modules and positioned in different places around the world. At the same time, we have designed a machine-vision robot that has also been financed by the National Center for Research and Development, and we also have several patent solutions for the EU market as well as the United States. Patent applications as part of this project will be filed a year from now.

We’re going to prepare a business proposal, aiming to ensure our designs are used in medicine and industry. However, we have a problem with finding a manufacturer with enough capital. On the basis of our research into models and prototypes, he will have to develop effective technology for this complex bio-mechatronic design. And, of course, a business plan is needed for its implementation and operation.

For now, a robot that can remotely manipulate the video sensor is the closest to the production stage. The full RH MC2 system, a model of which has been developed at the Foundation for Cardiac Surgery Development, comes with two additional miniaturized surgical instruments. Preparations for putting this arm into use are also financed by the NCBiR as part of another project being carried out at the same time by Zbigniew Nawrat, Ph.D., at the Foundation for Cardiac Surgery Development.

A potential partner here is the EMSI company from Siemianowice Śląskie. However, launching production of such a complex medical product for highly invasive surgery is quite a challenge for one small company. The tips of the instruments and of the video sensor enter the patient’s body endoscopically through the skin layers or natural orifices. Such medical devices must meet the highest requirements in order to be certified. It seems that a good idea would be collaboration by several partners specializing in different areas. Although we have already had offers of cooperation from Germany, from research and industrial centers, we are working to make sure that production, and most importantly the know-how, remain in Poland.

The concept of medical robotics is increasingly popular in Poland. Scientific and academic facilities working in this new field are developing fast. The Foundation for Cardiac Surgery Development has been holding conferences focusing on medical robots for 12 years; the International Association for Medical Robotics has been established. Therefore, we hope that the Polish—in fact, European—surgical robot can be manufactured in Poland.


Factfile
The Foundation for Cardiac Surgery Development in Zabrze was set up in 1991 as an initiative by the late Prof. Zbigniew Religa, a pioneering Polish heart transplant surgeon. It aims to support the development of Polish cardiac surgery and bring modern techniques and technologies to clinical practice in heart disease treatment.

Over the years, the foundation has grown into an innovative hi-tech center that conducts various research programs, including research into new types of biological heart valves, heart prostheses, an artificial heart, surgical robots, biotechnology and biocybernetics. The research and development work is conducted in four laboratories: the Artificial Heart Laboratory, the Biological Heart Laboratory, the Biocybernetics Laboratory and the Bioengineering Laboratory. The foundation uses subsidies, research grants and donations from private individuals, firms and institutions interested in the development of Polish cardiac surgery.

Work to develop a range of surgical robots at the Foundation for Cardiac Surgery Development began in 2000. It is coordinated by Zbigniew Nawrat, Ph.D., who is also the originator and designer of many of the mechatronic systems for the robots.

The robot projects involve teams led by Prof. Leszek Podsędkowski at the Łódź University of Technology and Krzysztof Mianowski, Ph.D., at the Warsaw University of Technology.

The National Center for Research and Development has been financing work on all the components for Robin Heart robots from the beginning, including robotic arm models, control systems and instruments.
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