Robotics, virtual worlds meet medicine
Technology that combines computer models and images could revolutionize surgical training and surgical procedures. Manufacturers, especially those that supply laparoscopic instruments, are likely to begin developing a marketing strategy to capitalize on the potential medical breakthroughs.
Already being explored in surgical simulations, motion measurement and patient rehabilitation, virtual reality and telepresence offer exciting opportunities in health care.
Virtual reality is a technology that enables users to interact with three-dimensional computer worlds that resemble the real world. It combines computers and sensory mechanisms to create a controlled environment. Users can interact with the virtual environment through sight, sound or touch. The technology may not only empower patients by helping them to communicate, but also may help physicians better diagnose and treat patients in the future.
Telepresence extends sensory apparatus to a remote location through robotics. The user, from a distant site, could see, feel and touch objects in the real world.
For example, a surgeon in one location could have a similar hand control, visualization and touch as if he were actually at the operation site performing a surgical procedure. He or she could actually pick up an object from a remote location and feel its weight and texture. The technology has already found a niche in pathology diagnosis, whereby a surgical pathologist has immediate access to a microscope and a slide of a patient's biopsy at a remote site.
Telepresence is being investigated for use in laparoscopic surgery. Researchers are trying to commercialize the technology so surgeons performing minimally invasive surgery could have the same freedom of movement as in open surgery.
The real-time use virtual reality technology for direct patient care is years away, but telepresence may be used sooner, according to Dr. Eric Horvitz of Stanford University School of Medicine, Palo Alto, Calif., and president of Knowledge Industries, a Palo Alto company that produces real-world reasoning systems for physicians in a variety of medical specialty areas.
"Authentic or high-fidelity virtual reality is a long way off," he said. "Current virtual reality projects stimulate the imagination about the possibilities of using the technology in medicine decades from now.
Telepresence applications are likely to come to fruition earlier because the technology does not face the inherent computational problems associated with building rich, artificial worlds.
"For example, for generating realistic simulations of surgery, computers have great difficulty at simulating the look and feel of soggy, slippery tissue. But telepresence can make use of the world as it currently exists."
Horvitz likened the resolution and functionality of medical virtual reality systems today to that of video games. "But people are excited today about the possibilities, and today's toy-like demonstrations highlight the promise of future technology for training and patient care."
The technology involved in virtual reality and telepresence, Horvitz said, has applications in three areas: visualization of complex structures and anatomy; more efficient access to delicate structures; and visual integration of diverse information sources.
Through virtual reality, the user could view a high-definition image on a computer screen that mimics the actual operating field and specific anatomy. The technology could be used commercially in both surgical planning and an actual operation when its resolution is improved.
Wearing virtual reality head gear, the surgeon could have a view of the operating field that would closely represent the real thing. The surgeon could then better prepare for difficult operations and have an easier time navigating instruments during procedures.
reality is good for the 'three Ps'--planning, performing surgery and predicting
The prototype systems enable medical students and surgeons to don virtual reality gloves and headsets and to manipulate virtual surgical tools along with structures in the abdomen. But the low resolution of the images and other factors, Horvitz said, "make the simulation a distant shadow of a real surgical experience."
The second area involves using telepresence devices to plan or perform surgeries on delicate structures. The technology would be particularly advantageous in laparoscopic surgery, where clear visualization and effective control of surgical tools are crucial.
Using a version of telepresence called micropresence, a surgeon could work on a magnified image of the real anatomy. A micropresence system electronically amplifies the size of a structure and provides a different perspective of the anatomy as the physician moves his or her head.
"Micropresence is quite feasible because the essential components of the technology exist today," Horvitz said.
The technology involves the positioning of one or more miniature television cameras and related camera-control systems in hard-to-reach or compact areas of a patient's anatomy and to identify the exact position of teleoperated microsurgery tools, Horvitz said. The technology would enable the surgeon to enter and navigate through difficult anatomical regions.
As mentioned above, telepresence also could be used to perform surgery from a remote location or having experts guide a surgeon through a procedure from another site.
The third area involves overlaying of radiologic images on a patient's anatomy. This technique holds great promise for use in such tasks as surgical planning and radiation therapy. According to Horvitz, some of these methods are already in use.
At Scripps Research
"The future is rich with the possibilities for applying such anatomically keyed display technology," Horvitz said.
For example, computed tomography images could be overlaid onto live anatomy, allowing a surgeon to "see through" the patient and inspect a tumor, Horvitz said. "This technology could be used for highlighting the outlines of a malignancy or of delicate blood vessels during surgery," he added.
A fourth area
involving the use of computational methods in medicine is robotic conducted
surgery. Microcontrolled robotic scalpels are already
being tested at the
"The notion of a robot cutting tissue may initially frighten patients," Horvitz said. "However, for many delicate surgeries, a finely controlled robotic scalpel may be preferred to even the most steady human hand. Someday, patients may demand robotic precision for such surgeries."
Laparoscopic surgery aid
A number of
companies displayed and discussed their virtual reality-like systems at the
"Medicine Meets Virtual Reality" conference in
"The surgeon would sit at a console and look into the patient," he said. "He would reach into the patient with his instruments and perform complex surgical procedures. This is widely heralded as the coming thing in laparoscopic surgery."
Telepresence could be used in open surgery and microsurgery as well, along with surgical planning and training. The technology also would eliminate direct contact between the surgeon's hand, instruments and patient, therapy eliminating the risk of disease transmission.
middle of the decade, surgeries will routinely be performed this way. I believe
it to be very cost effective,"
Hands-on virtual reality
The patient with Parkinson's disease puts on the DataGlove, which has fiber optic cables along its surface. When the joints in the hand bend, the fibers bend, and sensors record the movement. The recordings are then digitized and forwarded to a computer, which calculates the angle at which each joint is bent. This can be done for 10 joints simultaneously.
An image of a
hand can move on the screen that represents the actual hand motion of the
application of the DataGlove at
The system was
used to treat a patient who had come out of a coma with brainstem encephalitis.
She could not open her eyes or make facial expressions. The DataGlove
was put on her hand, and she was told to make specific gestures--move her index
finger for yes, her pinky finger for no. Then she was asked questions such as,
"Are you feeling any pain?" When she gestured, the computer emitted
sounds that indicated that she was responding. This kind of situation,
New markets targeted
Greenleaf is aiming to expand its customer base to include medical and non-medical markets.
contacting key investigators for the DataGlove and
other motion enhancement products, the company also will target the
disabilities market, according to
Greenleaf will target therapists who work with people who are motion and/or temporarily vocally impaired. A sales force of about 40 reps will initially call on physical therapists at research labs.
for the products is the workplace, where upper extremity injuries frequently
The system adapts the DataGlove's fiber optics and links it with new software to quantitatively assess upper extremity function. Potential customers include orthopedic surgeons, physical therapists, occupational therapists and research clinics.
The system costs
$12,000, compared to competing video systems that cost up to three times as