If this effort follows other open source trajectories, there should be some significant progress around future surgical robotics developments. Giving research organizations a standard platform to build upon and fostering a more open exchange of ideas and design sharing can only serve to unearth far more compelling procedures and applications for the robotics systems.
This is an interesting looking device for something that is going to cut you. I saw an ad this morning for prostate cancer, and there was a picture of a robotic surgeon (a da Vinci, I think). It is all a bit intimidating. I guess that some surgeons can be as well.
It is interesting to see open source applied in this realm, though. The vision system and its interaction with the actuators must be interesting. This would make it easier to develop specific lighting and processing applications.
Thanks for your comments. Beth, I agree, the open source development platform is exciting. naperlou, I don't know what tools human surgeons use and don't want to. You're right, this is a bit scary looking.
Your verbal imagery makes me double over in anticipatory pain, Naperlou. However, I think that as robotics R&D as applied to automated surgery and/or telemedicine increases, the (perhaps irrational) thought that I for one have, namely, what the heck happens if these things make a mistake, will disappear and they'll become a valuable part of the spectrum of options available to physicians and surgeons.
One thing is if the robot makes a mistake. My fear is of mechanical failure during the operation. I try not to think about what would happen if during mid operation a servo goes out or a bearring siezes up. Would you call a maintenance tech to work on it? It truly brings to light the need for a top notch PM program.
Surgical robots like the DaVinci are of course not autonomous -- they're under direct control of the surgeon(s), usually in the same room as the patient, and act as "enhanced" versions of tools they've used for decades or centuries: scalpels, cauterizers, retractors, etc. They have to undergo the same VERY rigorous validation processes that any other medical device does, including failure-mode analysis and risk management. They are designed to fail safely -- like surgeons themselves, the operating principle is "do no harm." In the event the device stops working, the surgical team can quickly remove the robot and perform the surgery manually.
Intuitive Surgical's DaVinci is a brilliantly designed and built tool, the first successful second-generation surgical robot (previous ones were primarily surgical assistants). Its very high price tag reflects the research and care that company put into making it so good. Applying the open-source idea will almost certainly allow the next generation to be developed faster and produced more cheaply.
Tim, I think you've got a really good point. I'll bet that the makers of da Vinci, the leading commercial surgical robot, have some extremely high QA standards. Think of the lawsuits! OTOH, whether it's a bearing failing in a robot, or your surgeon arriving drunk, without enough sleep, or having just had a fight with his/her spouse, seems to me like a tossup.
I'm a consultant engineer and I work from my home.
Someday surgeons will be able to work from their homes. In fact, they will be able to perform a surgery any place from any place. I saw a city to city test on this - I can't remember off hand. Now this concept is WIDE.
Just don't give me a robotic nurse in the recovery room! If all I saw was machines when I came to after my surgery, I wouldn't have made it. You need to see those recovering angels at this low point.
Considering the Open Source development of Medical Devices, such as surgical robotics or others even less complicated, the most difficult hurdle to realization of such a goal is the integration of the development process in an open sense with the requirements of the FDA. The typically tight controls and meticulous documentation and process standards imposed on PMA medical devices may render truly open source development, such as that found in the software world, an unreachable star.
I agree, Kevin. I think the area where OS techniques will affect medical devices is in the research and development arena, rather than FDA-qualified products. Anything that can speed up and simplify the realization of such complex and critical systems is a Good Thing.
Anyone that thinks the DaVinci robot looks intimidating in a picture should see it as they climb from the gurny on to the table below it. I looked about to see thet the surgeon we really there. He was!
The results are wonderful. The work was done through only a few very small incisions. I compared notes with another individual that had the same surgery in the conventional manner. The difference in collateral damage is fantastic. His incisions are much larger, his recovery was longer and painful, and his lasting affects are much more extensive. I was out in less than 24 hours and had essentually no pain. He was out in three days and had a week of pain.
As they develop these robots to be smaller they will be able to work on only the tissue needing and the rest they can avoid. This is the biggest difference.
twk, thanks for sharing your experience and the comparisons with the other guy who had surgery in the conventional manner. I've noticed that a lot of the promo material for surgery da Vinci style claims it's less invasive and has less collateral damage, which you've confirmed. The reasons why that should be so, however, don't immediately come to mind, unless it's smaller instruments. But I'm not sure, since I avoid looking at pictures of surgical instruments because they give me the creeps. To what do you attribute this lack of damage? Are smaller instruments the answer?
The instruments that a DaVinci uses are not too different from conventional laparoscopic types. Certainly, laparoscopic surgery itself is a big improvement over conventional "open" surgery in terms of collateral damage. Two things come to mind regarding robotic surgery's further advantage: 3D video imaging, and instrument movement and articulation that is scaled to the image magnification.
3D imaging's advantages over 2D hardly need much explanation: we all depend on our two eyes for accurate navigation and movement. Lack of depth perception with conventional (2D) laparoscopy seems to result in slower procedures with more "feeling around" for the precise spot to cut or stitch.
All laparoscopic video systems magnify the area of interest for better detail. The DaVinci system (and possibly others) provides a scaled sense of movement from the surgeon's hands to the instruments' working points. While actual stitches, say, may be only millimeters long, they may appear many times larger on the video screen. The instrument movements are then electromechanically scaled so that the surgeon doesn't need to move his fingers fractions of a millimeter, but can have a larger and more natural range of motion. This no doubt means greater accuracy and less fatigue, leading to better outcomes.
Ann, RJ2K gave a good description of basic differences but one of the biggest is that it is "laproscopic" surgery where the surgical field is not open to the surgeons unaided view therefore not open to contamination. In conventional surgry the operating field is accessed by opening some area of the body much like opening a book. There is a big long cut, it is pulled back, and the work is done where all the world can see what is happening. In a lapriscopic procedure only a very amall incision is made and the instruments go in totally out of sight of the others in the room. Often the body cavity is slightly pressurized (inflated) to create working room but the actual cutting to gain access is extremly small. In my case the Davinci needed four incisions about 3/4 inch long for instruments and optics then because the prostate that was coming out had cancer and they did not cut it up inside the body to come out those small holes they made one more about two inch incision to remove it. As was incdicated the optics are three D and quite sophisticated so the surgeon has a view as though he was actually inside the body himself while the body is not really cut wide open. As they perfect smaller and better surgical instruments and optics the invasion of the body can become even less making surgery less damaging less subject to infection and easier on the patient. Hope this helps understanding.
Thanks twk. Laparoscopic surgery performed by human surgeons with tiny camera probes has been around for a few decades now. I had it way back in the late 1970s and early 80s. The advantages claimed then were the same you claim now for robot-assisted versions of this surgical technique. And it is certainly less invasive than the older fish-filet style. So it sounds like, from what you and AJ2X describe, that the primary advantage to da Vinci and similar robot surgical equipment is better laparoscopic surgery because of better optics that more realistically portray depth and detail, along with smaller instruments, increasing accuracy. That sounds like a big improvement, indeed.
Ann, Excellent article. I think using an "open source model" is a very interesting approach to this type of product development. The lack of availability and limited access to proprietary robotic software solutions definitely inhibits this type of research and development work. Since each lab starts with an identical, fully operational system, sharing new developments and algorithms, while retaining IP rights innovations makes sense. Other than regulations, any other roadblocks to this model working?
Al, it depends on what you mean by "working," since research interests and commercialization interests generally have different goals. For research purposes, this setup is ideal, as is usually the case in open source development, and of course why UCSC and U of Washington have decided on this course. But da VInci, for example, even though not the only surgical robot maker, clearly has much of the market cornered and competition will of course diminish their market share. OTOH, Motoman and Willow Garage worked fairly closely with SwRI to help establish the ROS-Industrial Software Repository. So it depends on a company's philosophy. And far as what benefits the engineer, I don't see any roadblocks offhand--do you?
Ann, One potential roadblock I see is if companies innovating in this space don't think the open source model as viable (or profitable) for them. Unless there is significant advancements from open source developers and academic researchers, it might not gain traction? Hard to say.
Al, that's a good point, but I think it depends on a partcular company's business model. Years ago I worked at Forth Inc., which did not invent the open-source Forth programming language, but managed to make a profitable business selling products and services based on it. In the early days of Linux, many pundits said no one would ever make money off of it and it therefore could not survive, but now it's considered a respectable alternative to Windows. Also, the whole point of this effort is to kick-start university-level and independent developer innovation, not to immediately form a basis for a profit-making company. To me, it looks like the same model used by many other Silicon Valley efforts that have been successful.
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