la robotica nella sala operatoria del futuro
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LA LA ROBOTICA NELLA ROBOTICA NELLA
SALASALA OPERATORIA DEL FUTUROOPERATORIA DEL FUTURO
NICOLA DI LORENZONICOLA DI LORENZO
Dipartimento di Chirurgia GeneraleDipartimento di Chirurgia Generale
UniversitUniversit degli studi di Roma degli studi di Roma TorTor VergataVergata
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UN UOMO SENZA MEMORIA UN UOMO SENZA MEMORIA EEUN UOMO SENZA FUTUROUN UOMO SENZA FUTURO
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The arrival point of traditionis the starting point of progress
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TIME
Rat
e of
Cha
nge
Technology
Society
Healthcare
Business
Sector
Differing responses to scientific discovery by various sectors
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Universit degli studi di RomaTor Vergata
TECNOLOGIATECNOLOGIA
Passato:Passato:
CRESCITA LINEARECRESCITA LINEARE
Futuro:Futuro:
CRESCITA ESPONENZIALECRESCITA ESPONENZIALE
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Universit degli studi di RomaTor Vergata
TECNOLOGIATECNOLOGIA
CRESCITA ESPONENZIALECRESCITA ESPONENZIALE
Information technologyInformation technologyDistribuzione globaleDistribuzione globale....
LL Information Age NON Information Age NON il Futuroil Futuro
LLInformation Age EInformation Age E il Presenteil Presente
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Universit degli studi di RomaTor Vergata
Il robot in chirurgia generaleIl robot in chirurgia generale
CHIRURGIA MININVASIVACHIRURGIA MININVASIVA
Le nuove tecnologieLe nuove tecnologie
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Universit degli studi di RomaTor Vergata
LA FILOSOFIA ROBOTICALA FILOSOFIA ROBOTICA
Era industrialeEra industriale
Era informaticaEra informatica
LaparoscopiaLaparoscopia(Meccanica)(Meccanica)
RoboticaRobotica(Elettronica)(Elettronica)
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Why robotics, imaging and modeling & simulation
Healthcare is the only industry without a computer representation of its product
A robot is not a machine . . .it is an information system with arms . . .
A CT scanner is not an imaging systemit is an information system with eyes . . .
thus
An operating room is an information system with . . .
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Total Integration of Surgical Care
Joel Jensen, SRI International, Menlo Park, CA
Minimally Invasive Surgery
Pre-operative planningIntra-operative navigation
Remote Surgery
Simulation & Training
Engines of Change3 Integrate education and assessment into clinical care
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Universit degli studi di RomaTor Vergata
PIATTAFORMAPIATTAFORMAERGONOMICAERGONOMICA
SYSTEMSSYSTEMSTECNOLOGYTECNOLOGY
ROBOTICS ROBOTICS TECNOLOGYTECNOLOGY
SALA OPERATORIA ROBOTICASALA OPERATORIA ROBOTICALA FILOSOFIA ROBOTICALA FILOSOFIA ROBOTICA
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Surgical Cockpit
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Robotic Medical Assistant
SATAVA 7 July, 1999DARPA
Nursing shortage crisis
Applicable at all levelsHospitalsClinicsNursing HomeAssisted living
Courtesy Yulun Wang, InTouch Technologies, Inc, Goleta, CA
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ELIMINAZIONE ELIMINAZIONE DIDI
AIUTIAIUTI STRUMENTISTISTRUMENTISTI
SALA OPERATORIA ROBOTICASALA OPERATORIA ROBOTICA
SOLO SURGERYSOLO SURGERY
Universit degli studi di RomaTor Vergata
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Integrating Surgical Systems for AutonomyThe Operating Room (personnel) of the Future
Surgeon Assistant Scrub Nurse Circulating nurse
Borrowing from the standard practices of other industries
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Penelope robotic scrub nurseMichael Treat MD, Columbia Univ, NYC. 2003
ROBOT SURGICAL TECHNOLOGIES, INC
Currently in Clinical Trials
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Velocit di esecuzione automatizzata
per procedure complesse
(Satava)
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ElettronicaElettronicaMicrocomponentiMicrocomponentiMateriali intelligenti Materiali intelligenti
LA FILOSOFIA ROBOTICALA FILOSOFIA ROBOTICA
Universit degli studi di RomaTor Vergata
MicrochirurgiaMicrochirurgia endoluminaleendoluminale5050--100100--.. cm. dal margine anale.. cm. dal margine anale con accesso con accesso percutaneopercutaneo pillolapillola
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Courtesy of Richard M. Satava, MD FACS-Professor of Surgery
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Courtesy Anita Flynn, MIT, 1995Courtesy of Richard M. Satava, MD FACS-Professor of Surgery
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Universit degli studi di RomaTor Vergata
Endoluminal technology for obesityEndoluminal technology for obesity
EMILEMIL
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Universit degli studi di RomaTor Vergata
Endoluminal technology for obesityEndoluminal technology for obesity
LAPAROSCOPIC GI SURGERYLAPAROSCOPIC GI SURGERYFLEXIBLE ENDOSCOPYFLEXIBLE ENDOSCOPY
NOTESNOTESTEAM APPROACHTEAM APPROACH
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So What ?
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SALA OPERATORIA IDEALE
Ottimale integrazione delle nuove tecnologie
Ergonomia
Miglior gestione di magazzino
Riduzione dei tempi di cambio- Miglioramento dei flussi
Migliorare lefficienza ed i tempi di induzione anestesiologica
Connessione wireless tra le attrezzature
Migliorare la sicurezza dei pazienti
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Two major steps toward equipping the OR to help improve room turnover and reduce clutter:
- architectural arragements for suspending OR equipment from articulated ceiling-mounted booms
- to incorporate networked plug-and-play OR devices that interface equipment such as lights, the table, certain instruments and video from a single control source. Use of a sterile-field accessible touchpad
Two major steps toward equipping the OR to help improve room turnover and reduce clutter:
- architectural arragements for suspending OR equipment from articulated ceiling-mounted booms
- to incorporate networked plug-and-play OR devices that interface equipment such as lights, the table, certain instruments and video from a single control source. Use of a sterile-field accessible touchpad
Some concerns Some concerns
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Operating room
35 sqm. (min. side length 5 m). A 50-square-meter OR with ceilings higher than 8 feet is ideal for retrofitting. general conventional equipment specific equipment (depending on speciality)
Operating room
35 sqm. (min. side length 5 m). A 50-square-meter OR with ceilings higher than 8 feet is ideal for retrofitting. general conventional equipment specific equipment (depending on speciality)
General structural characteristicsGeneral structural characteristics
With the touch of a screen or a voice command, you can adjust surgical tables and lights or direct flat-screen monitors suspended from ceiling-mounted booms (thereby reducing the number of carts, cables, hoses and other equipment nurses and staff must work around).
Todays command-and-control systems eliminate the need for perioperative nurses to manually tweak knobs and buttons
With the touch of a screen or a voice command, you can adjust surgical tables and lights or direct flat-screen monitors suspended from ceiling-mounted booms (thereby reducing the number of carts, cables, hoses and other equipment nurses and staff must work around).
Todays command-and-control systems eliminate the need for perioperative nurses to manually tweak knobs and buttons
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Registration of the OR data
The OR-logbookRegistration of the OR data
The OR-logbook
Corporaci Parc Taul - Fundaci Parc Taul - Institut Universitari (UAB)Corporaci Parc Taul - Fundaci Parc Taul - Institut Universitari (UAB)
Enric Laporte,Bernat Sales, Jordi Prez, Josep PlanellProgramme of N Tech in Surgery
Enric Laporte,Bernat Sales, Jordi Prez, Josep PlanellProgramme of N Tech in Surgery Hospital de SabadellHospital de Sabadell
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The inteligent OR
MAIN GOAL:Patient and staff safety improvement
(risk and error analysis)(court appearances) OR-logbook
SECONDARY AIMS:Hospital organization enhancement
(incorporating patient data to Digital MR)Teaching and TrainingResearch
Automatic setup of all apparatusInteligent alarms and support
Automatic programing
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Patient parameters (+ 90):
source monitor (pulse, EKG, O2 saturation, ...)ventilator (respiratory freq, ET CO2 ...) keyboard (diuresis, SNG output, ...)
types measured (pulse, respiratory frequency, BP max ...)calculated (cardiac output, ...)
regularly (Body temp, invasive BP, ..)periodically (non-invasive BP, diuresis, ...)
Activity (audio-video)
What is recordable?
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Devices for source of signs of interest
Monitor of vital signs
Ventilator for anesthetic equipment
Endoscopy devices (insuflator, light source, video camera)
External cameras
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Which is the problem?
Output signals of any aparatus has an specific protocol
Staff do not like to be under control
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Core Characteristics
Universal driver: Scheme for the representation and implementation of thecommunication protocol of any monitoring device. Resample of the original signals up to any sample frequency, withspecial attention to their most important points. Synchronization of the different devices as well as their signals.
Totally customizable tool for signals monitorization.
Client-Server architecture.
Patent pending.
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Signal Capture and Analysis (I)
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Signal Capture and Analysis (III)
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Criteria to establish patient monitoring levels:
- Preoperative status (ASA classification)
- Possibility of hemodynamic instability during intervention
- Type of anesthesia and length of surgery
Introducing data in Digital MR
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Patient monitoring levels :
I.- NO forecast of instability- Ia (locoregional anesth. )
- Ib (general anesth. )
II.- Potential risk of hemodynamic instability
III.- Presence of obvious signs of hemodynamic instability
IV.- Special surgeries (neurosurgery, cardiac surgery ...)
pulseoxigen saturationEKG (3 derivations)non-invasive blood pressurebody temperature
id Ia + 3 ventilator parameters (+ Et CO2)
monitor
Introducing data in Digital MR
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Digital Report: the OR-logbook
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ERGONOMIAERGONOMIA
La chirurgia laparoscopica ha modificato favorevolmente il decorso postoperatorio, al prezzo di molti inconvenienti per gli operatori: - sala operatoria sovraffollata- posizione scomoda- scarsi gradi di libert- qualit visiva limitata
La chirurgia laparoscopica ha modificato La chirurgia laparoscopica ha modificato favorevolmente il decorso postoperatorio, al favorevolmente il decorso postoperatorio, al prezzo di molti inconvenienti per gli operatori: prezzo di molti inconvenienti per gli operatori: -- sala operatoria sovraffollatasala operatoria sovraffollata-- posizione scomodaposizione scomoda-- scarsi gradi di libertscarsi gradi di libert-- qualitqualit visiva limitatavisiva limitata
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1, 2 posizione del chirurgoA, B spostamento dei supporti1, 2 posizione del chirurgoA, B spostamento dei supporti
22
11
AA
BB
A B
22
BA
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AB
CentralizedCO2
CentralizedCO2
SAISAI
Cuttingdevices ?Cuttingdevices ?
pressurizedairpressurizedair
?
Flat pannel ?Flat pannel ?
34 sqm34 sqm
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Lighting
the Operating Field
Lighting
the Operating Field
Corporaci Parc Taul - Fundaci Parc Taul - Institut Universitari (UAB)Corporaci Parc Taul - Fundaci Parc Taul - Institut Universitari (UAB)
Enric LaporteProgramme of N Tech in SurgeryEnric LaporteProgramme of N Tech in Surgery Hospital de SabadellHospital de Sabadell
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About Surgical LampsAbout Surgical Lamps
The main goal using a surgical lamp is a powerfullighted operating field, without shadows norexternal flashes disturbing the surgeon's view.
Light beam has to be:- cool & powerful enough- well directed and- concentrated on a defined area
There are some operations requiring changes focusing the surgical field (oesophagus, v.v. stripping, knee surgery, laparoscopy, ...)
Ceiling mounted lamps manipulation can be difficult (some models have no sterile grip)
The main goal using a surgical lamp is a powerfullighted operating field, without shadows norexternal flashes disturbing the surgeon's view.
Light beam has to be:- cool & powerful enough- well directed and- concentrated on a defined area
There are some operations requiring changes focusing the surgical field (oesophagus, v.v. stripping, knee surgery, laparoscopy, ...)
Ceiling mounted lamps manipulation can be difficult (some models have no sterile grip)
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LED technology appliedLED technology applied
5w - 600 lumen5w - 600 lumen
RIMSA - D900(LumiledsTM )pentaled lamp (600 lumen - 50.000 lux - 25W)
RIMSA - D900(LumiledsTM )pentaled lamp (600 lumen - 50.000 lux - 25W)- cold light- use of the lamp to last up to 25 times longer than halogen products- cold light- use of the lamp to last up to 25 times longer than halogen products
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The OR_IntelsunThe OR_Intelsun
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Design includes:
- cell collimator- zoom optic- cell concentrator
Design includes:
- cell collimator- zoom optic- cell concentrator
System architectureSystem architecture
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Studio dei flussi di sala operatoriaStudio dei flussi di sala operatoria
Tecnologia Rfid sistemi per lidentificazione a radiofrequenza
RESISTENZE DEL PERSONALE INFERMIERISTICORESISTENZE DEL PERSONALE INFERMIERISTICOE DEGLI ANENSTESISTIE DEGLI ANENSTESISTI
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Courtesy of Richard M. Satava, MD FACS-Professor of Surgery
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Universit degli studi di RomaTor Vergata
3-D Modeling of the Liver Jacques Marescaux EITS, Strasbourg, France
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CHIRURGIA ENDOVASCOLARECHIRURGIA ENDOVASCOLARE
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Highcomplexity
Lowcomplexity
Hospital
Common support devices
Changing rooms Changing roomsAdministrative SupportSterilization
storagecleaning
Prosthetic Surg.neurosurgery
Major onc. surgery
Endoscopic Surg.Endoluminal Endoscopic Surg.
Radiology interv.Pacemaker,scatheterisms...
New facilities for Invasive TherapeuticsNew facilities for Invasive Therapeutics
+OpenSurgeryEndoscopic
Surgery
Interventional MRI
EndoluminalEndoscopy
ANESTHESIAANESTHESIAANESTHESIA
Ambulatory Centres
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Nuove sale operatorieNuove sale operatorieNuove sale operatorie
Decisione critica: cosa integrare ?.Decisione critica: cosa integrare ?.
Aspetti principali:Esperienza della ditta costruttriceNumero di attrezzature previsteRobotic workstationSoftware necessario per la gestioneStrumentazioni diagnostiche (TC,RMN)Registrazione e comunicazione a distanza
Aspetti principali:Aspetti principali:Esperienza della ditta costruttriceEsperienza della ditta costruttriceNumero di attrezzature previsteNumero di attrezzature previsteRobotic Robotic workstationworkstationSSoftware neoftware necessario cessario per la gestioneper la gestioneStrumentazioni diagnostiche (TC,RMN)Strumentazioni diagnostiche (TC,RMN)Registrazione e comunicazione a distanzaRegistrazione e comunicazione a distanza
RUOLO CENTRALE DEL CHIRURGORUOLO CENTRALE DEL CHIRURGO
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GRAZIE !GRAZIE !
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