robotics in orthopaedics recent advances
- 1. ROBOTIC SYSTEM AND NAVIGATION TECHNIQUE IN ORTHOPEDICS WELCOME BACK Melvin babu GMC, Thiruvananthapuram
- 2. ROBOT-ASSISTED MINIMALLY INVASIVE SURGERY (MIS) SYSTEMS Potential Benefits • Increased accuracy and precision in surgical outcomes • Enhanced reproducibility • Visualization • Reduced technical variability • Decreased pain • Faster recovery time • Evolving • Popular
- 3. • In orthopedic robotics, a robotic system refers to a mechanical device that assists surgeons in performing orthopedic procedures with a high degree of precision and control. • These systems typically consist of robotic arms equipped with specialized tools and sensors that aid in surgical tasks such as bone cutting, drilling, and implant placement. ROBOTIC SYSTEMS AND NAVIGATION TECHNIQUES ROBOTIC SYSTEMS
- 4. Navigation Techniques • use of advanced imaging technologies like CT scans or MRI to create 3D models of the patient's anatomy : patient specific 3D models • These models are then used by the robotic system to plan and execute surgical maneuvers accurately. • Navigation systems often incorporate real-time feedback mechanisms to ensure that the surgeon's actions align precisely with the pre-operative plan, enhancing surgical outcomes and patient safety.
- 5. ROBOTIC SYSTEMS AND NAVIGATION TECHNIQUES Robotic Systems • Autonomous RS • Hands-on RS • Teleoperated RS. computer-aided navigation systems (CANSs). • 3D modeling, • Registration • Navigation
- 6. WORKING PRINCIPLE OF ROBOTICS Preoperative Planning • Imaging: Utilization of advanced imaging techniques such as CT scans or MRI to create 3D models of the patient's anatomy • Virtual Surgery: Surgeons use specialized software to plan the surgical procedure virtually, including implant selection, placement, and trajectory Virtual Surgical Planning (VSP):
- 7. Navigation System Setup • Platform: robotic arm and specialized instruments is used during the surgery. • Registration: The 3D model from preoperative imaging is registered to the patient's actual anatomy in the operating room • Real-time Feedback: The robotic system provides real-time feedback to the surgeon, including visual and sometimes haptic (touch-based) feedback, to guide • system is equipped with sensors and cameras that track the position and movements of surgical instruments in real-time WORKING PRINCIPLE OF ROBOTICS
- 8. WORKING PRINCIPLE OF ROBOTICS Guidance Robot-Assisted Execution: • Instrumentation: Surgeons use robotic arms equipped with surgical instruments. These instruments can be controlled directly by the surgeon or through computer guidance. Guidance and Control: • The navigation system provides continuous feedback to the surgeon, displaying the precise location of instruments relative to the patient's anatomy. This helps ensure accurate execution of the preoperative plan
- 9. • Preoperative CT images :Imaging Technology • are used to construct a 3D model of the patient’s knee. • Then the 3D model is used by the surgeon to create a preoperative plan. • The preoperative plan and the 3D model are used to finalize an intraoperative plan at the beginning of the operation, which includes defining an exact cutting zone for the robot. • During the operation, the Robot or Surgeon assisted robot operates to perform bone resection while referencing the 3D bone model on a monitor. • The robot will provide haptic and auditory feedback, while tool (e.g., a rotating burr) to work only within the predefined cutting zone. • The robot will automatically stop if the burr is outside of the predefined zone, or the computer has detected more bone being resected than necessary. • Helps to monitor the operation, and provides necessary real-time data for accurate bone cutting and accurate components placement, thus potentially improving the outcomes of the UKA Patient specific 3D models as reference Example
- 10. History
- 11. UNIMATE • In 1954, Devol invented the first digitally operated and programmable robot
- 12. PUMA 560 • 1985 • First robotic surgical system • Used for neurosurgical biopsies guided by computed tomography (CT) images
- 13. MINERVA Mobile Robot 1990 • neurosurgical robot
- 14. ROBODOC • 1988, ROBODOC (Integrated Surgical Systems) was introduced in orthopedics • first robot that was clinically used in orthopedic surgery • PROBOT performed a clinical trial at Imperial College London with the earliest robotic procedure in urology.
- 15. ZEUS ROBOTIC SURGICAL SYSTEM 1998 Da Vinci system 1998
- 16. RAVEN II • RAVEN II (University of Washington, and University of California, Santa Cruz, CA, USA) • for use in teleoperated laparoscopic surgery
- 18. CAOS
- 19. AUTONOMOUS RS Active • Robot can conduct the surgery completely on its own • surgeon can only interrupt it by using an emergency stop • Robo Doc, Caspar
- 20. HANDS-ON RS semi-autonomous Haptic • semi-active robots. • Surgeon and robot cooperatively move the surgical instrument installed on the robot end effector (EE) • Physical human–robot interaction (pHRI) • full control by the surgeon • Allows surgeon To use or drive robot to Perform procedure • Feedback Loop : Semiautonomous robot on ones hand Are controlled and manupulated by surgeons.while Surgeon control is modulated by robot to limit procedures in defined boundary Mako navio omnibiot
- 21. TELEOPERATED RS Passive • Leader–follower system • 2 robots are required. • The leader robot is physically operated by the surgeon, while a follower robot on the remote site (e.g., on the patient side) is controlled by the leader robot via the internet or Ethernet.
- 22. ROBOTIC SYSTEMS AND NAVIGATION TECHNIQUES Robotic Systems • Autonomous RS • Hands-on RS • Teleoperated RS. computer-aided navigation systems (CANSs). • 3D modeling, • Registration • Navigation
- 23. NAVIGATION TECHNIQUES Basic elements 1. 3D modeling 2. Registration 3. Navigation. • CANS are computer-assisted systems rather than robot-assisted systems • Navigation with the help of computers. • It can be either integrated with an RS or independent from an RS
- 24. NAVIGATION SYSTEM 1. Tracking 2. Registration 3. Visualization 4. Validation • Real timatch tion • Establish a common reference frame • Navigation images With respect to anatomy • Ensure updated Image smatch
- 25. Registration • Process of establishing a common reference frame • Registration is a core and compulsory procedure for any CANS system or RS system being used in orthopedic surgeries. • Both RS and CANS are heavily reliant on registration 3D Modeling • 3D model is reconstructed from preoperative images(e.g., CT, X-ray, MRI). • Previously introduced RSs conduct the 3D modeling based on preoperative CT scans. • (NAVIO) generate the 3D model by using bone- morphing techniques and intraoperative tracking data, then visualizing the 3D model in a graphical format.
- 26. CANS : REGISTRATION • Before the surgery in the operating room, registrations between the patient’s true bone, the corresponding 3D model, the robotic system (if applicable), and the surgical tool need to be conducted first 3 methods 1. Standard (fiducial)-based paired-point matchin 2. Surface-based/shape based / 3. 2D/3D–3D registration/intraoperative fluoroscopic
- 27. NAVIGATION • kernel element and function of a navigation system • 3 types 1. CT-based navigation 2. Imageless: surgeon-defined anatomy” technology “ 3. Fluoroscopic navigation • tracking devices • Robot coordinate system • Sensors: optical sensors or magnetic sensors • infrared (IR) light-tracking cameras and infrared light-reflecting markers
- 28. NAVIGATION SYSTEMS • Stryker Navigation system II Cart • OrthoPilot • Brainlab Knee3 • Feedback mechanisms to ensure that the surgeon’s actions align precisely with the pre- operative plan, enhancing surgical outcomes and patient safety.
- 29. ROBOTIC SYSTEM IN ORTHOPEDICS
- 30. ROBODOC surgical system • Autonomous robotic system • Initially designed for total hip arthroplasty (THA) • first robot that was clinically used in orthopedic surgery • whole system includes ORTHODOC (a 3D preoperative computer modeling and planning workstation) and ROBODOC surgical assistant (a 5-axis SACARA-type surgical robot)
- 31. TSolution One • next-generation robodoc system • Its applications have been expanded to total knee arthroplasty (TKA
- 32. CASPAR • CASPAR (computer-assisted surgical planning and robotics • autonomous 6-degree-of-freedom (DOF) robotic system • Used for THA and TKA
- 33. ACROBOT SYSTEM Active-Constraint RObot • ACROBOT system (Acrobot Co., Ltd., London, UK) is a semi-autonomous system • Designed for robot-assisted MIS for unicompartmental knee arthroplasty (UKA) • Prototype of modern haptic feedback system
- 34. CYBERKNIFE • image-guided robotic system • Designed specifically for radiosurgery and radiotherapy • Deliver stereotactic radiosurgery and radiation therapy anywhere in the body,including the spine and bone • CyberKnife System is commonly used to treat a wide range of cancers and metastases, throughout the body. • linear accelerator (linac) directly mounted on a robot to deliver the high-energy x-rays or photons used in radiation therapy.
- 35. ROBOTIC ARM INTERACTIVE ORTHOPEDIC SYSTEM (RIO) RIO • Semi autonomous • Tactile guidance system) • haptic and auditory feedback
- 36. New generation of the RIO • MAKOplasty received FDA approval in 2014 for use in THA • haptic technology named AccuStop that provides the auditory beep alert, tactile vibration feedback, and visual feedback with color changes MAKO
- 37. NAVIOPFS/NAVIO • NavioPFS (precision freehand sculpting) (Blue Belt Technologies) • computer-aided orthopedic navigation and surgical burring system • Semi-autonomous • hand-held • image-free system • optical-based navigation system via • Passive infrared (IR) tracking camera and trackers. • Intraoperative data from the trackers are collected and displayed in a graphical format, and together with anatomic landmarks and surface painting techniques, a 3D model of the patient’s femur and tibia can be created; thus, a surgical plan can be made by the surgeon intraoperatively
- 38. MBARS/HYBAR Mini bone-attached robotic system • Semi-autonomous robot • Small • Bone-mounted robots • More efficient and cost effective than large robotic system HyBAR (hybrid bone-attached robot) autonomous system
- 39. OMNIBOTICS KNEE SYSTEM Praxiteles → iBlock • semiautonomous system • iBlock is imageless navigation • OmniBiotics computer station can generate a 3D digital model of the patient’s knee by using patented bone-morphing technology and intraoperative anatomic data • No haptic feedback
- 40. ROSA: ROBOTIC SURGICAL ASSISTANT
- 41. ROSA (ROBOTIC SURGICAL ASSISTANT) ROSA hip system • CT-free, fluoroscopic guided system that can be used to assist surgeons in accurately positioning and implanting hip components, while the robotic arm is used to assist in the guidance of the surgical Tools. • Fluoroscopic images, intraoperatively acquired by a C-arm, will be used to determine the surgical tools’ orientation in relation to the patient’s anatomy and as a guide for bone component orientation. • The system provides pre-, intra-, and post-operative measurements relative to the patient’s anatomy. • The robotic arm is kept stationary to keep the instruments in a fixed orientation during bone component implanting ROSA knee system 1. Preoperative 3D virtual bone model needs to be generated preoperatively, which can be used by the surgeon to make a preoperative surgical plan. 2. For the imageless option, the landmarks data on the patient’s bony anatomy are collected intraoperatively and used to create an intraoperative surgical plan. • The accuracy of the resections, knee state evaluation, and soft tissue assessment are the same between the two options since both of them are always based on intraoperative landmarks. • The robotic arm can assist in precisely positioning the component relative to the implantation plan.
- 42. ROSA Spine • Pedicle screw placement • spinal fusion • Percutaneous Endoscopic lumbar discectomy, • Intracorporeal implant positioning • Radiofrequency ablation
- 43. TiRobot • spine surgery • Pedicle screw fixation • intramedullary nail fixation for intertrochanteric fractures • Real time 3D navigation • Facet or sacroiliac joint injections • VELYS robotic-assisted solution (VRAS-TKA) • Spine Assist Mazor Robotics • Excelsius GPS-Spine surgery • Innomotion robotic assistance For intraarticular injection in foot and ankle
- 45. TELEOPERATED RS DA VINCI SURGICAL SYSTEM • MIS • microvascular surgery • robot-assisted heart bypass procedure • robot-assisted radical prostatectomy • laparoscopic surgery • mitral valve repair • Gynecological surgery • 2 patient-side manipulators (PSMs), 1 endoscopic camera manipulator (ECM), and 2 master tool manipulators (MTMs). • The surgeon will remotely control the PSMs by physically operating on the MTMs, while the remote scene on the PSM site will be presented to the surgeon via a console by using the ECM. • Da Vinci system can translate the surgeon’s hands manipulation movements from MTMs to PSMs via the console in real time, such as bending,rotating, grasping, palpating, and cutting, while providing haptic feedback to the surgeon for an immersive experience
- 46. DA VINCI SYSTEM IN ORTHOPEDICS Limited • soft tissues surgery • Nerves related surgery • Ulnar nerve decompression at the elbow • supraclavicular brachial plexus dissection • nerve root grafting at the shoulder • Some cases of anterior lumbar interbody fusion (ALIF) in spine surgery • Navigating entrypoint and distal locking bolt in intramedullary nail • Reduction of femoral and tibial fracture • system is designed to be more suitable for manipulating soft tissues (e.g., suturing, ablation, needle insertion) than rigid bones (e.g., cutting, burring)
- 47. Da Vinci surgical system
- 48. TRAUMA POD • Semi automated • Tele robotic • Surgical stabilization Of critically wounded
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