IDEASInnovation, Design, and Emerging Alliances in Surgery

March 28, 2015BOSTON, MA

www.ideasprojectharvard.org

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Surgical Robotics: Defining Grand Challenges for Surgery and Robotics

IDEAS is a program of the Roberta and Stephen R. Weiner Department of Surgery at Beth Israel Deaconess Medical Center

Welcome to the fifth annual IDEAS Symposium

As the name suggests, IDEAS fosters and provides an interactive forum for innovation at the interface of surgery and other disciplines—whether the social, biological, or physical sciences—with the goal of improving the lives of patients worldwide.

This year’s symposium, “Surgical Robotics: Defining Grand Challenges for Surgery and Robotics,” is a unique event that brings together surgeons, engineers, and thought leaders from across the United States and Europe. Our speakers will share cutting-edge ideas and research that we hope will spark innovation, original concepts, and novel ideas.

Topics will include government priorities in robotics, tissue modeling and steering, and more. The day’s discussions will also touch on the use of robotics in clinical practice, the barriers to its use, and the next generation of surgery systems.

This year we will feature an engaging poster session. Relax at the end of a full day with complimentary cocktails and hors d’oeuvres while learning about the cutting-edge research occurring in the field of surgical robotics. Poster categories include: Robotic-Surgeon Interface, Human-Machine Replacement and Assistive Bioprosthetics, and Robotics in Surgical Practice.

Thank you for attending and welcome to Boston.

Elliot Chaikof, MD, PhD Henrik Christensen, PhD Co-Leader Co-Leader

IDEASINNOVATION, DESIGN, AND EMERGING ALLIANCES IN SURGERY

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IDEAS™ (Innovation, Design, and Emerging Alliances in Surgery) Symposium

Surgical Robotics: Defining Grand Challenges for Surgery and Robotics

Saturday, March 28, 2015

Joseph B. Martin Conference Center at Harvard Medical SchoolRotunda Room, 3rd Floor77 Avenue Louis Pasteur

Boston, Massachusetts 02115

7:30 – 8:25 AM Breakfast and Registration

8:25 – 8:30 AM Introduction Henrik Christensen, PhD (Georgia Institute of Technology) and Elliot Chaikof, MD, PhD (BIDMC/Harvard)

8:30 – 9:15 AM Keynote Presentation: Robotics, Science, and Society: Views from Washington • Jeffrey Trinkle, PhD (Rensselaer Polytechnic Institute/NSF) l NSF Priorities in Robotics

9:15 – 10:30 AM Session 1: The Robot-Surgeon Interface • Ken Goldberg, PhD (UC Berkeley) l Learning by Observation for Surgical Subtasks: Multilateral Cutting of 3D Viscoelastic and 2D Orthotropic Tissue Phantoms • Stefano Stramigioli, PhD (University of Twente) l Robotic Endoscopy

10:30 – 11 AM Break

11 AM – 12:30 PM Session 2: Human-Machine Replacement and Assistive Bioprosthetics • Brenna Argall, PhD (Northwestern) l Turning Assistive Machines into Assistive Robots • Michael Goldfarb, PhD (Vanderbilt) l Next Generation Exoskeleton Systems • Brian Scassellati, PhD (Yale) l Using Robots in the Diagnosis and Treatment of Autism

12:30 – 2:00 PM Buffet Lunch and Poster Session

2 – 3:30 PM Session 3: Robotics in Practice: Realizing Clinically Meaningful Advances • A. James Moser, MD (BIDMC/Harvard) l Challenges in Robotic GI Surgery • Alan Lumsden, MD (Houston Methodist DeBakey Heart & Vascular Center) l Robotic Technology in Endovascular Surgery • Yusef Kudsi, MD, MBA (Tufts) l The Robot as a Surgical Assistant

3:30 – 4 PM Discussion and Closing Remarks: Defining the Grand Challenges for Surgery and Robotics

4 – 6 PM Poster Session and Reception

IDEASTM (Innovation, Design, and Emerging Alliances in Surgery)

Surgical Robotics: Defining Grand Challenges for Surgery and Robotics

Saturday, March 28, 2015

Boston, MA

Poster Session

I. Robotic-Surgeon Interface

Live Stream, Remote Telementoring, Teamwork & Training with Multisensory Surgical Vismemes

Jim Smurrol, George Haleblian2, and Shaan Gandhi3

1VisMedX, 2Prime Biomedical Consulting, 3Harvard Medical School and Harvard Business School

H. Human-Machine Replacement and Assistive Bioprosthetics

Restoring Hand Function By Designing Implantable Artificial Tendon Networks for Surgery

Kamin Beyer", Taymaz Homayouni2, Ravi Balasubramanian2, and Christopher H. Allan3

'School of Chemical, Biological, and Environmental Engineering, Oregon State University; School of Mechanical,

Industrial, and Manufacturing Engineering, Oregon State University; 3Department of Orthopaedic Surgery, University of Washington Medical Center

A New Concept of Complex Single Step Skull Reconstruction in Osteolytic Skull Diseases

Victoria Ohla1'2, Ahmed B. Bayoumi2, Markus Hefty3, Matthew Anderson3, and Ekkehard Kasper?

'Department of Neurochirurgie, Universitatsklinikum Essen, Germany; Division of Neurosurgery, Beth Israel

Deaconess Medical Center; 3Department of Pathology, Beth Israel Deaconess Medical Center

Shape Deposition Manufacturing of a "Smart," Atraumatic, Deployable Grasper for Minimally Invasive Pancreas

Surgery

Ammara A. Watkins1'3, Courtney Barrows13, Joshua Gafford2, Ye Ding2, Andrew Harris2, Terrence McKenna2, Panagiotis Polygerinos2, Donald Hollands, Conor Walsh2'4, and A. James Moser1'3

'Pancreas and Liver Institute, Beth Israel Deaconess Medical Center; 2Harvard University Schools of Engineering

and Applied Sciences; 3Harvard Medical School; 4Wyss Institute for Biologically-Inspired Engineering; 5Trinity

College, Dublin, Ireland

III. Robotics in Surgical Practice

Design and Control of a Robotic System for Microsurgery

Alperen Degirmencil, Frank L. Hammond 1111, Joshua Gafford2, Conor J. Walshl'3, Robert J. Wood1'3, and Robert D.

Howe'

'Harvard School of Engineering and Applied Sciences; 2BioDesign Lab, Harvard University; 3Wyss Institute for

Biologically Inspired Engineering

Progress towards a Clinically-Ready Transnasal Concentric Tube System

Hunter B. Gilbert', Ray A. Lathrop', Richard J. Hendrick', and Robert J. Webster 1111

Vanderbilt Initiative in Surgery and Engineering, Vanderbilt University

Page 1 of 2

IDEASTM (Innovation, Design, and Emerging Alliances in Surgery)

Surgical Robotics: Defining Grand Challenges for Surgery and Robotics

Saturday, March 28, 2015

Boston, MA

Poster Session

I. Robotic-Surgeon Interface

Live Stream, Remote Telementoring, Teamwork & Training with Multisensory Surgical Vismemes

Jim Smurrol, George Haleblian2, and Shaan Gandhi3

1VisMedX, 2Prime Biomedical Consulting, 3Harvard Medical School and Harvard Business School

H. Human-Machine Replacement and Assistive Bioprosthetics

Restoring Hand Function By Designing Implantable Artificial Tendon Networks for Surgery

Kamin Beyer", Taymaz Homayouni2, Ravi Balasubramanian2, and Christopher H. Allan3

'School of Chemical, Biological, and Environmental Engineering, Oregon State University; School of Mechanical,

Industrial, and Manufacturing Engineering, Oregon State University; 3Department of Orthopaedic Surgery, University of Washington Medical Center

A New Concept of Complex Single Step Skull Reconstruction in Osteolytic Skull Diseases

Victoria Ohla1'2, Ahmed B. Bayoumi2, Markus Hefty3, Matthew Anderson3, and Ekkehard Kasper?

'Department of Neurochirurgie, Universitatsklinikum Essen, Germany; Division of Neurosurgery, Beth Israel

Deaconess Medical Center; 3Department of Pathology, Beth Israel Deaconess Medical Center

Shape Deposition Manufacturing of a "Smart," Atraumatic, Deployable Grasper for Minimally Invasive Pancreas

Surgery

Ammara A. Watkins1'3, Courtney Barrows13, Joshua Gafford2, Ye Ding2, Andrew Harris2, Terrence McKenna2, Panagiotis Polygerinos2, Donald Hollands, Conor Walsh2'4, and A. James Moser1'3

'Pancreas and Liver Institute, Beth Israel Deaconess Medical Center; 2Harvard University Schools of Engineering

and Applied Sciences; 3Harvard Medical School; 4Wyss Institute for Biologically-Inspired Engineering; 5Trinity

College, Dublin, Ireland

III. Robotics in Surgical Practice

Design and Control of a Robotic System for Microsurgery

Alperen Degirmencil, Frank L. Hammond 1111, Joshua Gafford2, Conor J. Walshl'3, Robert J. Wood1'3, and Robert D.

Howe'

'Harvard School of Engineering and Applied Sciences; 2BioDesign Lab, Harvard University; 3Wyss Institute for

Biologically Inspired Engineering

Progress towards a Clinically-Ready Transnasal Concentric Tube System

Hunter B. Gilbert', Ray A. Lathrop', Richard J. Hendrick', and Robert J. Webster 1111

Vanderbilt Initiative in Surgery and Engineering, Vanderbilt University

Page 1 of 2

TITLE: Surgical Telementoring, Teamwork & Training with Interactive Streaming Video & Multisensory Augmented Reality

AUTHORS: Jim Smurro, MS, MBA; George Haleblian, MD; and Shaan Gandhi MD, MBA (2015)

ABSTRACT:

Surgeons learn by mimicking the actions of their mentors. True collaboration in surgery involves not merely knowing when and where

to cut, but also with what force, speed, and direction. We approached this problem by combining the video of a traditional

telemedicine application with the physics engine of a 3D medical simulation. This allowed us to recreate an object from a medical

image as a live stream interactive, virtualized object on the computer. Surgeons can use virtual scalpels and forceps to annotate live

and recorded surgical video as if they were manipulating actual tissue. This is not simply surgical simulation, but rather, true surgical

demonstration. Rather than simply describing the surgical maneuver, surgeons can virtually ‘show & share’ the procedure with others

- remotely, in real time, in a realistic manner, on a live patient, with haptic feedback that mimics human tissue response.

We tested SurgiStreams™ with several surgical cases, including live stream telementoring of a retroperitoneal lymph node dissection

with the daVinci Si surgical platform. SurgiStreams™ enabled surgical telecollaboration with mentors while performing the RPLND.

The mentor was able to virtually demonstrate the use of the daVinci forceps, scalpel, and suture, and could visually describe the force,

speed and direction of the instrument maneuvers to the primary surgeon in a natural way.

SurgiStreams™ 2.0 capabilities have been extended with clinical trial and use, and now include: surgeon voice-activated command;

audio annotation & tagging for clinical notation; multipoint audio for both in-theater and networked telementors; secure data stream

encryption for high resolution, low latency broadcast over LAN & WAN; multi-channel live stream; archived (relevant prior) surgical

video available for intraoperative consultation; perioperative [pre, post & intraoperative] imagery integration with multimodal

imaging, waveforms & video; haptic tissue/video manipulation with Hydra joysticks.

SurgiStreams™ 2.0 can now record, annotate, tag and save multisensory surgical vismemes as packetized “sight-touch-sound”

teaching files for “See One. Do One. Teach One.” augmented reality instruction.

Telementoring, teamwork and training with virtualized haptic devices such as SurgiStreams™ can redefine “See One. Do One. Teach

One.” surgical instruction. Networked training programs can live stream surgery cases, utilizing them as interactive surgical

whiteboards when training residents or testing new operative techniques. Multimodal cognitive instruction with multisensory surgical

vismemes can enhance pre-operative surgical planning, intraoperative surgical decision-making, and post-operative clinical review,

accelerating the acquisition of specialist surgical skills.

ŦL’Esperance JO et al. Telementoring in Robotic Surgery. Curr Opin Urol 2013, 23:141–145

The authors wish to thank the surgeons and clinical teams at USC Keck Norris Comprehensive Cancer Hospital, USN Naval Medical

Center San Diego, Kaiser Foundation Hospital and Seattle Children’s Hospital for their cooperation, feedback and helpful suggestions.