Surgeries Flashcards
Minimal Invasive and Robotic Surgeries
How does MIS (minimally invasive surgery) compare to open surgery?
MIS:
- uses surgical instruments that insert into natural holes or small incision in the body
- causes less dmg to body
- faster recovery time
- less pain
- less risk of infection + scarring
- 30 to 50% shorter patient stay
What are Arthroscopy usage and risks?
used to diagnose and treat joint problems
- loose bone fragments
- damaged / torn cartilage
- inflamed joint linings
- torn ligaments
- scarring within joints
risks:
- tissue / nerve dmg
- infection
- blood clot
What are 2 major challenges that surgeons face when performing MIS?
- No Depth perception
- looking at a 2D screen (usually away from their hands) but performing a 3D tasks
(can’t see sides or behind structures) - No Haptic feedback
- can’t tell how much force they are applying by the equipment on the body
What are 4 examples of laparoscopic surgeries
Laparoscopy: small incision made to access the belly for surgery
- Appendectomy
- more than 95% of appendectomies are laparoscopic
- longer, more expensive, resource intensive than regular appendectomies - Cholecystectomy
- gallbladder removal due to gallstones, inflammation or cancer - Hernia Repair
- retracting the intestine and sewing abdominal wall - Gastric Bypass Surgery
- sew small intestine onto pouch made from top of stomach
What are the 8 laparscopic surgical tools
- Laparascope
- used to examine organs inside the pelvis and abdomen - needle driver
- stapler
- bowel grasper
- surgical mesh
- trochar
- small hollow tip used to enter instruments into or drain blood / water - forceps
- used to grasp, retract, or stabilize tissue - scissors
Compare and contrast Endoscopy and Laparoscopy
endoscopy: inserts into nose, mouth or anus (naturally occurring cavities)
- used to image and sample deep structures
laparscopy: inserts into incision into belly and other relatively superficial organs
Describe an endoscope design and its 5 features
- Control section
- held in left hand used to manoeuvre the tube and introduce accessories
- suction, air insufflation + lens washing, freeze + record images, select wavelength of light, change camera focus
-twin dials deflect tip up/down, left/right - Insertion tube
- enters body to provide a working channel
- made from multiple layers of polymer (durable and flexible)
- spiral metal bounds wound in opp dir to transmit force and torque from end of tube to tip
- contains CCD signal wires (charged couple detector) –> sensitive to low light, energy efficient, high quality image - Tip
- CCD device unit and objective lens (obj lens takes and processes images)
- illumination system
- air and water insufflation
- biopsy forceps
How are fiber optics used (transmited) in endoscopes
Refraction and reflection
n2 sin(A) = n1 sin(B)
sin(C) = n2 / n1 = critical angle
- used to calulate the numerical aperature of the fiber
- ensures that if light hits at an angle > critical angle, light gets totally reflected
- therefore light can travel through wire
Describe the image acquisiton process (3) of an endoscope?
- bright xenon lamp produces white light
- white light is transmitted through a filter to provide illumination
- reflected light is processed by CCD to an image on monitor
Explain why CO2 gas is prefereed for gas insufflation in laparoscopy?
- high diffusion coeff
- normal metabolic end product (rapidly cleared from body)
- highly soluble in blood and tissues
- does not support combustion
- low risk of gas embolism
What are physical contraints with MIS?
- motion
- restricted DOF
- reversed
scaled by distance to incision
- fixed angle approach
- far from hands - instrument
- backlash
- flexibility
- size
- 1 per incision
What are some common difficulties with human experiences in performing MIS ?
- Lost …
- depth / tactile perception
- proprioception
- visual navigational control
- peripheral vision - altered …
- visual transformation
- head position - communication
What are some advantages (4) that robotic MIS systems have over manual system
2improved control, dexterity, safety
- compensation for loss of wrist articulation
- hand tremor elimination
- motion scaling
- motion of surgeon matches deformation - visuomotor integration
- able to watch surgery in front of them
What are some challenges with manual MIS? (7)
- loss of writst articulation
- fulcrum effect
- affected force perception
- tissue deformation
(can’t see) - restricted workspace
- limited field-of-view
(only see what comes out of cameras) - separate visuomotor axes (looking at screen away from hands)
What are some current trends in robotic MIS? (3)
- integrating multiple control modalities
- enhancing visualization
- intra-operative image guidane
How do you distinguish between different types of robotic systems (3)
- interaction mode / level of autonomy
- autonomous = performs simple task by itself
- master-slave = copies mvmt of surgeon to assist in complex tasks - clinical application
- role played by robot
- passive vs active (interacts w/ patient)
- computer-assisted surgery vs surgical assistants.
What are Surgical Assistive Systems (SAS) and what are their advantages?
- SAS is often coupled with CAD/CAM systems to make preoperative plans or help with intraoperative execution
- used in orthopaedic surgery / neurosurgery for precise optimal surgical pathways
2 types: (frame-based vs frameless)
frame-based: guides placement of screws
frameless: displays beams of light for frameless tracking
Adv:
1. reliability and high accuracy in registration to medical images
2. capability of operating in restrictive environments (allows surgeons to work remote
3. ability to precisely and rapidly relocate surgical tools
What are some drawbacks of master-slave robotic surgery (4)?
- physical separation - surgeon and patient
2 - 4. precision and safety suffer due to:
- tissue deformation (manual haptic feedback is better + provides more clear info)
- restricted workspace (can only use tools available to surgeon / robot)
- restricted visibility
What are some requirements of position sensors (5)?
- position and orientation accuracy
- 1 - 2mm, 0.5 - 2 degrees
- (x,y,z) + roll, pitch, yaw orientations relative to ref - update freq
- 5 - 20 Hz
- higher for powered end-effectors - working volume
- 500mm x 500mm x 500mm - applied components
- at least 3 trackers: anatomy of interest, instrumentation and imaging device
- dimensions and weight if attached to the end effector - electrical and biocompatibilty
- wireless,sterilizable, electrically isolated
What is perceptual docking for synergistic controls and how can it be improved?
Refers to human-machine (master slave) interaction where visual and sensory feedback are used to align robots’ action with surgeon’s
To improve, one can use visual fixtures (VF) to enhance operator’s motor abilities
- forbidden-regions: prevent mvmt into dangerous areas
- guidance VFs: aid surgeon down an optimal path
- active dynamic constraints
ex, gaze-contingenet motor channeling: transforming visual sensory information into physical constraints that can interact with the motor sensory channel
- framework for haptic feedback and VF
