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Sao Paulo 2014
Innovations in surgerySameh Shehata
Egypt
Sao Paulo 2014
Alexandria
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Alexandria
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Children hosp Alexandria
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EPSA
10,011 KM
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3000 years ago
Looking back !
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Trepanning
Extraction of the stone of madness !
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Hieronymus Bosch
Indications ?
• Epilepsy
• Mental disorders .
• Migraine
• Head trauma
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the National History Museum (Lausanne, France).
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• she survived the surgery !
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Egypt 2345 BC
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A keyhole to the future
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In the future
• Incisions .
• Imaging .
• Training / simulation .
• Operating Room.
• Remote control.
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In the future
• Brain machine interface
• Human Spare parts
• Anesthesia .
• Robots
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Surgery and incisions !
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• No surgery without incisions !!
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Big surgeons,
big incisions .
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Big surgeon
small multiple incisions
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Big surgeon
small single incision
SILS
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Big surgeon
No Incision
NOTES
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Modified Endoscope for Transgastric Surgery
Courtesy of N Reddy, Hyperbad India 20005
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Peroral Transgastric Endoscopic Surgery
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Need for development of modified accessories and endoscopes
Courtesy of N Reddy, Hyperbad India 2005
Suture Devices
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Eagle ClawApollo ProjectOlympus, Tokyo.
Courtesy of N Reddy, Hyperbad India 20005
Smart scalpel
• Lazer scalpel .• Shuts off at blood
vessels .• Smell cancer
tissue .
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So What Next?
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Classic Education and Examination
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c. Laparoscopic Simulator with tactile feedback Courtesy Murielle Launay, Xitact, Lausanne Switzerland
b. Laparoscopic hysterectomy Courtesy Michael vanLent, ICT, Los Angeles, CA
a. LapSim simulator tasks - abstract & texture mapped Courtesy Andres Hytland, Sugical Science, Gothenburg, Sweden, 2000
SurgicalSimulators
Simulation and Objective Assessment
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ENT Sinusoscopy Simulator Lockheed Martin 1999
HapticsFull System
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“Red Dragon”“Blue Dragon” passive recording device
Courtesy Blake Hannaford, PhD University of Washington, Seattle
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Hand motion tracking patterns Ara Darzi, MD. Imperial College, London, 2000
Novice
Intermediate
Expert
Objective Assessment
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Geomagic: Practicing on Computers, Not Patients
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Yale University study
• Training on simulators .
• Reduce time by 30%
• Reduce errors by 85%
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The OR
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Courtesy Eric LaPorte, MD Barcelona, Spain 2005Courtesy Takeo Kanade, PhD Pittsburg, PA 1999
l
“Black Box”
“Ubiquitous lights” and “Sea of Cameras”
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The Operating Room of the Future
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Total Integration of Surgical Care
Sao Paulo 2014 Joel Jensen, SRI International, Menlo Park, CA
Minimally Invasive Surgery
Pre-operative planning
Intra-operative navigation
Remote Surgery
Simulation & Training
Where is my remote control ?
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SATAVA 7 July, 1999DARPA
Fighter Pilots – until 2002 Fighter Pilots – Beyond 2003Predator 2003
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Pilots never got into aircraft !!
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How about surgeons?
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Yes We Can !
• ROUTINE telesurgery from
• Hamilton to North Bay
• 300 mile distant
• Dr. Mehran Anvari, MD
• McMaster Univ, Toronto CANAD
Sao Paulo 2014Prof. Jacques Marescaux, IRCAD A
“Operation Lindberg”
First remote and trans-AtlanticTelesurgery procedure
Recorded activity for intended movement to a briefly flashed target.
TARGET MOVEMENT
Time
PLAN
Courtesy Richard Andersen, Cal Tech, Pasadena, CA
Brain Machine Interface – Controlling motion with thoughts
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Thoughts into Action
Miguel Nicholai, Duke University, 2002
Direct brain implant control of robot arm
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Human spare parts !
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a) Rheo Bionic knee Ossur, Reyknavik, Iceland b) C-leg Otto Bock, Minneapolis, MN
Intelligent Prostheses
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Artificial Retina
a) Multi-disciplinary team from USC Doheny Retinal Institute, Oak Ridge National Labs, North Carolina State University and Johns Hopkins University
Courtesy Jim Weiland, USC Doheny Retina Institute,Los Angeles, CA
Ethical question
• Could we replace a “normal “ part
• With a better “mechanical “ one ???
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Tissue Engineering
Liver Scaffolding
Artificial Blood VesselJ. Vacanti, MD MGH March, 2000
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Artificial bladder
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Genetic engineering
• transgenic genetic engineering .
• Extended abilities .
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Can you see in the dark ?
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• Who will get the advantage ?
• Enhanced individuals ??
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Extending Longevity
A strain of mice that have lived . . .
. . . more than three normal lifespans
Should humans live 200 years?
Life extension
Life extension consists of attempts to extend human life beyond the natural lifespan. So far none has been proven successful in humans. Several aging mechanisms are known, and anti-aging therapies aim to correct one or more of these: Dr. Leonard Hayflick discovered that mammalian cells divide only a fixed number of times. This "Hayflick limit" was later proven to be caused by telomeres on the ends of chromosomes that shorten with each cell-division. When the telomeres are gone, the DNA can no longer be copied, and cell division ceases. In 2001, experimenters at Geron Corp. lengthened the telomeres of senescent mammalian cells by introducing telomerase to them. They then became youthful cells. Sex and some stem cells regenerate the telomeres by two mechanisms: Telomerase, and ALT (alternative lengthening of telomeres). At least one form of progeria (atypical accelerated aging) is caused by premature telomeric shortening. In 2001, research showed that naturally occurring stem cells must sometimes extend their telomeres, because some stem cells in middle-aged humans had anomalously long telomeres.
April 14, 2004
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CAN I REPLACE MY
B O D Y ?
If I replace 95% of my body . . .
. . . Am I still “human”?
Artificial organs
Smart Prostheses
Genetic engineering
Regeneration
?Sao Paulo 2014
Can I replace my body ?
What does it mean to be human ?
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Any better way ?
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Sep Oct Nov Dec Jan Feb Mar Apr Mayb
od
y t
em
pe
ratu
re (oC
)-5
0
5
10
15
20
25
30
35
40
45arctic ground squirrel
Brian M. Barnes, Institute of Arctic Biology , University of Alaska Fairbanks 11/02
Institute of Arctic Biology’s
Toolik Field Station,
Alaska's North Slope
SuspendedAnimation
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metabolic rate 0.5 0.01 (2%)
active hibernating
body temp. 37oC -2oC
gene ongoing transcription function and translation suppressed
heart rate 300 3
resp. rate 150 <1 (breaths/min)
(beats/min)
(mlO2/g/h) Sao Paulo 2014
Ideal situation for surgery !
• No heart beat .
• Slow circulation (bloodless surgery)
• No Pain
• No movement.
• Reversible .
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Fetal surgery
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Open Fetal Surgery
EUROPEAN COLLABORATIVE PROGRAMME FOR INTRAUTERINE TREATMENT OF CDH
Fetoscopic access 26 - 27 w. gestation
SEVERE CONGENITAL DIAPHRAGMATIC HERNIA
Nose
Mouth
Intrauterin view
SPINA BIFIDA
Fetal Surgery OPEN SURGERY
ROBOTS are coming !
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“Penelope” – robotic scrub nurse
Michael Treat MD, Columbia Univ, NYC. 2003Sao Paulo 2014
Robotic Nurse
I prefer classical !
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Robotic Medical Assistant
Sao Paulo 2014 SATAVA 7 July, 1999DARPA
Nursing shortage crisis
Applicable at all levelsHospitalsClinicsNursing HomeAssisted living
Courtesy Yulun Wang, InTouch Technologies, Inc, Goleta, CA
I see you !
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………………………………………………………………………………………………………………………………………
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To all of you
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Sao Paulo 2014
