Computer and Robot-Assisted Medical Intervention

Abstract

Medical robotics includes assistive devices used by the physician in order to make his/her diagnostic or therapeutic practices easier and more efficient. This chapter focuses on such systems. It introduces the general field of Computer-Assisted Medical Interventions, its aims, its different components and describes the place of robots in that context. The evolutions in terms of general design and control paradigms in the development of medical robots are presented and issues specific to that application domain are discussed. A view of existing systems, on-going developments and future trends is given. A case-study is detailed. Other types of robotic help in the medical environment (such as for assisting a handicapped person, for rehabilitation of a patient or for replacement of some damaged/suppressed limbs or organs) are out of the scope of this chapter. Introduction: clinical context and objectivesInformatics and technology have dramatically transformed the clinical practice over the last decades. This technically oriented evolution was parallel to other specific evolutions of medicine:-Diagnostic and therapy procedures tend to be less and less invasive for the patient aiming at reducing pain, post-operative complications, hospital stay, and recovery time. Minimalinvasiveness results in smaller targets reached through narrow access (natural or not) with no direct sensing (vision, touch) and limited degrees of freedom. -More and more data are handled for each patient (e.g. images, signals) in order to prepare and to monitor the medical action and those multi-modality data have to be shared by several actors participating to this action. -As in many domains, quality control gets more and more important and quantitative indicators have to be made available. -Traceability becomes mandatory especially regarding the always increasing number of legal cases. Traceability is also of primary importance in cost management. These evolutions make the medical action more and more complex for the clinician both at the technical level and at the organisational one. Computer-assisted medical interventions may contribute a lot to those clinical objectives. They may provide quantitative and rational collaborative access to patient information, fusion of multi-modal data and their exploitation for planning and execution of medical actions. Computer-assisted medical interventionsThe development of this area from the early eighties results from converging evolutions in medicine, physics, materials, electronics, informatics, robotics, etc. This field and related subfields are given several names almost synonymous: computer-assisted medical interventions (the most general), augmented surgery, computer-assisted surgery, image-guided surgery, medical robotics, surgical navigation, etc. We will subsequently use "computer-assisted medical interventions" or "CAMI" to name the domain.Definition: CAMI aims at providing tools that allow the clinician to use multi-modality data in a rational and quantitative way in order to plan, to simulate a...

De l’imagerie médicale à la thérapie guidée par l’image

“…L'administration ciblée et contrôlée de molécules thé-rapeutiques (drug delivery) représente l'enjeu futur où la localisation de la cible apportée par l'image sera complétée par une activation optique, ultrasonore ou radiofréquence, etc. La convergence de ces approches nouvelles avec les procédures dites minimalement invasives et les techniques de thérapie assistée par l'image (la robotique médicale ou la chirurgie assistée par ordinateur, voir [26] pour une revue récente) ne pourra qu'augmenter leur portée.…”

Les centres d’investigation clinique–innovation technologique : des instruments pour les technologies pour la santé

“…Elles s'appuient sur les pôles de compétitivité centrés sur la santé 7 lorsqu'ils existent (ils sont ouverts à des partenariats extérieurs à ces régions) ou sur d'autres pôles, avec le soutien des centres de recherche, d'innovation et de transfert technologique (CRITT), où les technologies biomédicales se positionnent aux interfaces 8 .…”

“…Depuis plus de 20 ans, le laboratoire TIMC-IMAG 18 et le CHU de Grenoble ont été pionniers dans l'innovation technologique autour des gestes médicochirurgicaux assistés par ordinateur (GMCAO) [8] et la présence des industriels dès les premiers stades a joué un rôle important. Les GMCAO aident le médecin ou le chirurgien à mieux planifier et exécu-ter des gestes interventionnels complexes, par des systèmes de « navigation » ou de robotique chirurgicale fondés sur le traitement d'images multimodales.…”

Issues in image-guided therapy [A Look at . . .

“…A global view of the systems developed before 2003 is available in [2]. A more recent survey is provided by J Troccaz [4] where three main periods are sketched: (i) accurate positioning tasks, carried out by a robot using numerical data with main applications in neurosurgery and orthopaedics for simple trajectories and rigid structures (1985-1995) ; (2) interactive schemes for more complex interventions (endoscopic surgery for instance) dealing with deformable tissues (1990-2005); (3) miniaturized robots (from 2000 and up) capable to perceive, communicate and act inside the human body.…”

“…If we look at the current market situation, it must be recognized that if a lot of systems have been developed in research laboratories, only a few of them have really reached the clinical settings. In [4], an overview is provided that shows that even the number of the most well-known systems, DaVinci, Aesop is below one thousand over the world in 2008, while others such as Robodoc and Caspar are only approaching a few tens. Another feature, the number of interventions performed using these systems, would be of interest to measure their impact.…”