Researchers at the UCLA Henry Samueli School of Engineering and Applied Science, working with laparoscopic surgeons, have developed a new method of guided surgery that will permit experienced surgeons to guide surgeries in remote locations, such as battlefield hospitals.
“Laparoscopic surgery is a specialized field that requires a lot of practice,” noted Greg Carman, professor of mechanical and aerospace engineering. “To develop a way in which the best surgeon in the world can assist with a surgery remotely holds the potential to revolutionize the field.”
Laparoscopic surgery is a minimally invasive procedure in which surgeons use a video camera to view the area in which they are working. The two-dimensional field of vision and limited range of movement make it a more difficult type of surgery.
The new telementoring system developed by the UCLA Engineering researchers allows highly trained surgeons to aid battlefield surgeons with laparoscopic procedures using video conferencing tools to provide live guidance.
“Our system replaces robotic surgery tools, which pose challenges associated with power supplies, ease of use, space constraints, and cost,” said mechanical engineering graduate student researcher Vasile “Licã” Nistor. “Using this new method, a highly qualified surgeon could provide guidance from a remote location to an on-site generalist at a much lower cost.”
Because of the considerable variation from operation to operation, it’s critical to have an expert surgeon available who can offer guidance and advice in real time. A modified video conferencing system offers a way to present information to the on-site surgeon in a useful way that does not interrupt the surgery.
“We’ve found that because laparoscopic surgery is 2-D and not 3-D, it’s analogous to playing video games,” said computer science graduate student Brian Allen. “We’d like to find a way to use the graphic technologies that enhance video games to enhance the surgical procedure.”
The system developed at UCLA also can be used to train residents and new surgeons in laparoscopic surgery.
“We have not radically altered the training process, and have modified tools that are routinely used by surgeons,” said Allen. “Our system is affordable, easy to set up and use, and needs less space than current training methods.”
“Our goal is to replicate airline training, providing a high quality virtual environment and realistic simulations,” explained Nistor. “Right now, the medical industry is about 20-30 years behind the airlines, and we’d like to provide a system that can quantify a trainee’s skill level.”
To create practice simulations for medical residents, the team has developed a program to track the movement of the surgical tools that have been modified with a set of seamlessly integrated motion tracking sensors. The sensors measure rotation, position of the instruments, and other movement. By tracking both the expert and the novice, they can see where someone learning might have difficulties, or need more training during the
“We have been working closely with UCLA surgeon Dr. Erik Dutson, an expert in laparoscopic surgery,” said computer science professor Petros Faloutsos. “By recording his movements, we have an expert benchmark that we can use for training.”
The system tracks motion over time, showing both movement and steadiness in the hand that is not in use.
“It’s very difficult to not move the off-hand,” said Allen, “but critical since a wrong movement can accidentally cause a cut in the surrounding tissue out of sight of the camera, creating a chance of infection.”
To counter what is statistically the major cause of failure for this type of surgery, the group has added a kinesthetic force feedback component to the system that will help constrain accidental movement outside areas designated by an expert surgeon. A surgeon would feel resistance if he or she accidentally moved their off-hand into a critical area, for instance, the liver to one side of a gall bladder.
The guided laparoscopic surgery project is funded by the U.S. Army’s Telemedicine and Advanced Technologies Research Center. The UCLA Engineering researchers are collaborating with members of UCLA’s Center for Advanced Surgical and Interventional Technology (CASIT). The facility includes a da Vinci surgical robotic surgery system, a human patient simulator, and laparoscopic surgical simulators and tools.
Main Image: Mechanical engineering graduate research Vasile Nistor and professor Greg Carman, computer science professor Petros Faloutsos, and Dr. Eric Dutson. Inset Image: Dr. Eric Dutson and mechanical and aerospace engineering professor Greg Carman practice on the guided surgery demonstration. Photos by Don Liebig.