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A-1235 Robot assisted surgery
Philippe Liverneaux, France
Friday, June 15, 2018 · 4:51 p.m. · 18m 53s
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you very much for your kind invitation so i was very impressed by the previous talks
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so
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um i've got some conflict of interest to this quarter
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and uh
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so what we would like to to do is also to look at the future
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so you really think that in the future we will still put our
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hands inside the patients and maybe there is another solutions to
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put some robots inside the inside the patients and to
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remote the the the the search on outside
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so i'm not the only one there are a couple of guys actually more than one hundred fifty so jones
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all over the world who are as crazy as me to believe that robots will uh
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not we place but help us to improve our skills in in
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in more in my purse or g. than in hand surgery and
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the six founders of the society ran says society robotic assisted
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and my cassette doing and that's on the scope excel theresa safety arm
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conformance are germs mike right now stacey burner gustav amount of any with here from as you
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and myself and the other ones are you were just is you're probably
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getting and the jesse said there were is a plastic surgeon
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so
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um
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oh sorry i went back
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so actually what is micro surgery my considering is only a technique uh um
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it's not a special t. it was inspired by their watch makers
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and they but these guys they use only one i. n. only a
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one hand and the instruments that we use for micro surgery
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are are exactly the same but the one uh uh we
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use the or in in more than sixty years ago
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uh and the uh the microscopes all the same
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but now they are digits or and the instruments all the same
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but well they're made of titanium but nothing a vote
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in in in micro surgery of course a lot of different techniques
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i've been i've been described like f. writer flaps and a lot of things but
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the the technology itself did not evaluate in more than sixty years so
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what is the future in in micro surgery it should combine these uh
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three can set the or a micro surgery in the nineteen sixties
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and on task a big surgery in the nineteen eighties and
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robotic surgery delay surgery in the two thousand so
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maybe in the future if you combine everything we can
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make um i'll just go pick micro a surgery
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so incompatible micro surgery it's a human be with the optical
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magnification and the fine instruments and he can get only
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two of these are properties of course optical magnification
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and three d. vision because with the loops all with the microscopic um there is um
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you can see with the right and the left and right and the left eye
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and then in your brain there is a three d. reconstruction automatically but
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all the other features that i show here can only perform by robots i mean uh
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i pick sensation we got a nice or a nice lecture before um
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whereabouts we'll improve the attic sensation and maybe in the future
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will be able to to have a very good sensation of even
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the that's right going through a very very small vessel
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and there is a trend off filtration with the uh with the for example the that into robots that
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means that uh uh two eight two am doing a re presentation over a small finger uh
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if you get a tremor of retention of course it's a better and
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five hundred in and twenty degrees could be also very useful you know it's like when you are
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when you are driving a car if you move your your hands on may
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twenty degrees actually the wheels will move more and this could be useful
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for your lecture a gentle about uh during i'm i i'm improve the quality of
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of um art researchers in micro surgery your because sometimes what should you you just
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cross the quest the the wall other of the vessel with a needle then you checked the needle again
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and that to just that sometimes one of possible but sometimes too and when you are doing these these can
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uh put some that mange inside the the into my ah so if
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you can do this but actually the robot will do this
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this also can be safer for for uh for micro surgery um
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augmented reality yeah uh could be also very useful for neurosurgery
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uh and the other letter before about the uh the
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three d. reconstruction of or the backup lexus or
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could be inspired by these two no images when you are
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doing minimally invasive surgery in in in the backup exes
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you don't see the you don't see the nerve so you don't have a
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direct feature of the nerves and uh it's very difficult to notice or
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were you are exactly you know in a minimally invasive techniques so
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we need the materiality set you on the good way
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the the one presented the the paper before
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and uh also in in with rubber to can get more that two hands
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three hands and maybe more in the future you know the guys who play
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all guns deeply organs with their hands but also with actually it's
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so all we started we don't use our feet we're so if it wanted
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to press a paid out to for the talk quite relation why
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don't we use an extra instruments and it'll not a very important instrument
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but to uh you know like like a red tractor sometimes your
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your assistant is sleepy at two am and other so it could be useful to use or low photo we have
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four hands somewhere so why don't we we use it so with what we will be able to do these
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and motion scanning is also a very very important you know in
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micro surgery you you need you know you between two dreamer
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to do your gesture of course for also don't like me you you don't care because you
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wanna use but for young young sons of we the you you will not accept that
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and so with motion scanning mike that means that if i move my for my my hand from here to
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here if there is ten centimetres there were both can move only one centimetre and maybe one day
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uh one edmund centimetres so and this increase the the the
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the the accuracy of the of the jester make that just is more precise
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and also what is interesting is that on those copy you know it might cross surgeons are macro surgeons
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and to make my my corset when you make large
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incisions big you know why because the the the
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the microscopes and the loops they are exhaust cops you can't put
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the microscope inside the body so you need large incisions
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the same with your hands in with the instruments the hand user you know
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it's a bulky with the instrument so you can't put it inside
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well the lab rescue picket directors come pick such of they they can
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do this because they have long instruments with at the cheap very
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small instruments they can move in the three planes of the space all
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the this concept of or on those topic my course surgery
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you need to rob party without the rubber to chance to it remote control i don't believe so much
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the same in a you know if you are in singapore yeah fire i mean france uh
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i don't need to control the your your operation because you are your a good surgeon so
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you don't need me so maybe for training in some uh uh a very uh
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in some countries and also developed country sometimes attack can take the control although
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or of the oppression but i think it's not so not so useful
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so we need to worry about but what kind of robots do we
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have nobody so a lot of problems have been designed surgery but
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the what is there is only one use the in by a
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lot of certainly the diving she some other ones like uh
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what uh from titan company another one in the telly
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um and there is one which is very interesting is this use one designed by some fun would move can
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this guy is a handset or my christian plastic surgery netherlands any develop um
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a a robot for micro surgery it's not then i'll just copy excel exhaust cop you
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you have a microscope and then you just like the instruments on the microscope and you can
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without any tremor with the motion scanning your temper formal micro surgery just to
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so this is that good stat the next step is on those copy
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so uh uh one of the main interest off on those come
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pick my course agrees to go from beast lot incisions to
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these small incisions so is it possible to to do it we
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are it's only the beginning of course because his uh
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it's a very very difficult to this is an example in there
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in the latter we've done this um meeting years ago
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uh in in strasbourg and so this is a cadaver or
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for our and we get inside the for all
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the the quality of the video is not good because at that time we didn't have the
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or um h. d. but we are in the form and this is the this is the median or here and me
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we make it this section around the around the major in the row put to look around the median
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or and then we decide to get it imagine you have a nerve graft to to perform
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and uh then you introduce throughout work are the ten or should sure and then you can make this should
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to ask if you were in an open field uh the here the operating she'll be is a room
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use lot because we inject some gas sums you to a c.
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o. two gas and then uh we can perform the uh
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the the no structure as if we were in our convention or
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my course surgeries said that and it's not so bad
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so all we can do our other things like a little bit
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more difficult like a into cost on over augustine which is
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one of my favourites or operations i operated uh
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warm about ten patients i'm not the only one there is a one guy in in uh
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in japan that to make any and also another such a plastic
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surgery in in germany it was doing this operation so all
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your going inside the tour x. and then you know where is the pied piper are the prior type around then you
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notice where all the intent darkest on ours and then you
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make this section of course the speed is very fast
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but because of the video that because of our of me and then you can get the into cost one knows as
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or the same length even longer than the one you can you can get with an open proxy do so
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of course the recovery is a faster we don't have a nowadays
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enough cases to demonstrate that it is better with and larger
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uh incision but okay it what we are like
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thirty years ago for lacrosse copy i would say in in in my course surgery so on and
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have a trial in the wintertime now they do a lot of c. seven crossover transfer for
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uh for draco prices and uh we designed the uh
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technique with the only only can have underwear days
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so all you can do with or a crossover transfer with with only
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with this small six incisions one centimetre long and view instead that
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the that the pro car and then um and he's in the
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in the lab in the l. c. close to stress group
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and we are here in the right side of the breakup taxes and this
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is the first uh rated and then we separate the skin from the
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from the other t. shoes and then well you know we don't know where we are so it's your that we need a
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your system of you all off or of or multi reality
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where is the nerve i'll finally we find the nerve
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no you here it's only a couple of seconds but it looks almost
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a one hour to find the backup lexus in this case
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so all with a friend acknowledgement all the woods so because this we this is the don't know side we're
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are here across to the traffic all the spinal cord is here and then we get the c. seven
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as far as possible to the tropical here you are they also five
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years and they and this is a a spinal call so we
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are pushing buffy seven just to be all the is of like is
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as far as possible and now we are going to the
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um to the other side to the left side and again we uh
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de sac the backup places and finally this is the friend ignore
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and the woods and now we will cut the there and uh see seven close to the spinal
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cord in a in a second so that this section take some time off all of calls
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and uh then we get the c. seven also we use your too
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and now you can see here the c. seven from the right
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side ideas off like yours and here the spinal cord and
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then we can uh approach the the other rights uh c.
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seven to the ledge c. seven and in this case
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we could make it even use a cadaver with the re
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g. t. we could perform a direct situ without uh
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graph so we introduce here the us should sure we were in the
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lab we didn't have a ten all so this is probably a
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six four and then we will perform the structure of the to uh
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see seven right and the left side so and the um
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um and i i was a bit stressed to do the suppression but actually it's
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not so not so difficult will and if you
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and if you take care of the use of i guess which is a potent of course to preserve
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and the then you can see here the the structure which is not so
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do so it's important to get this the uh all the
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six uh portals and they here we used a baseball
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tore from the right side and we just inserted an
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instrument to uh as of a tractor because uh
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uh sometimes you know it's it's here it's very teeny so it's difficult to
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get a good you and you need the next prime simmons too
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put it uh to get a good uh a good vision
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so and these all of the file incisions unusual it
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is uh that kind of er of a incisions are so
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uh you can do also other things like um
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a free flaps augustine and the a here is also in the latter in uh in the
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life big and uh uh because in our course we also invite plastic surgeons so all
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we perform uh the opposite of a wreck to set the minis
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so all the old make a hole in the in the bladder of course
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but here because the pig uh will be sacrifice we it's uh
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it's faster to do it so this is a menu so
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the previously the the pretty cool now it's the muscle
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um and the other and you can see here the robots moving
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a a loan so it's a little bit difficult to
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to to choose the good the portals so issue you put your bottles
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here is that means that you will almost to the opposite side
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uh because we aren't going your it's a real going to the opposite side of the of the
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baby and then when you got all the mess when you use an on the back
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uh like lepers come pick such a news and then you can neither of
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us to the the um timers or when you can use it for
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different procedures and the the last i show the yes to the you
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know the the another session it's a typical case of uh
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um um let us ms dos see a very very bad case on
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these patients she has been a great many times and a room
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so um uh she wanted the kind of cosmetic or um
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a cosmetic improvement of this shoulders all by uh because you got um
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i'm sure the fusion i use the the lettuce muse so
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you saw various morning incision here and uh through these incisions
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we notice where is that pretty cool put to look around the political and then we closed infusions and we
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not the robot and the we so we can with gas yeah perform the
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uh all vesting of the letter theme is still you have to start with the the player because if
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you start with the superficial leather layer the the pressure of the gas will push the muscle
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on the other we cage and then uh you you you can see here that the
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the incisions are very very very small so
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uh it's not maybe we can do many many things uh with uh
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with robots it's only an overview we designed a many other procedures
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and um so if you if you are interested in this uh
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in this uh uh technology so we organise or uh
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robotic microsoft re master class c. in uh in l. c. so it's
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about a one hundred and fifty kilometres away from stress work
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and uh you can train during a one week uh to perform
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the any kind of proceed as you want and the
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i would be happy to interested just to send
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