I would like to present to you the TeleFLEX project. In Teleflex our focus is on designing a robot that is able to steer flexible instruments. It is my PhD project and I am involved in it for 2 years now. I want to show some of the results till now.
Industry, science and the clinic is involved in this project. Demcon advanced mechatronis is project manager in this project and responsible for the technologial output. In total 4 PhD’s are working on this project from different departments of the University of Twente.. It is a multidisciplinairy team. I belong to design, production and management and am as an industrial designer responsible for the system layout and the user interface. Two hospitals are project partner and they provide together with a user groep of medical experts the medical requirements. We received A pieken in the delta grant Planning of the project is from beginning 2009 –until end 2012 to realize a prototype ready for clinical tests.
Technical developments are focussed on reducing discomfort of the patient. Main goal is to reduce the number and size of incisions The original situation of open surgery wasn’t that bad for surgeons. Good eye-hand coordination and the working posture was OK. Endoscopic surgery or key-hole surgery was introduced to reduce trauma. Surgeons had to manipulate their instruments through small holes. Additionally the surgery area was diplayed on a monitor. Introducing the surgical robot took a lot of usability problems away. Instrument control was intuitive and easy again. Currently a new trend is to operate with flexible instruments. This are flexible endoscopes that are used to inspect the digestive tract. The situation for surgeons is dramatic again. These flexible endoscopes are very hard to steer. Especially when these are used for an intervention instead of inspection. And this is where TeleFLEX pops up. We are going to robotize flexible instruments to make the life of surgeon’s easier.
As allready mentioned the most problematic part of surgery with flexible instruments is control of the instruments. The current endoscopes have limited degrees of freedom. The ornage instruments kan only translate and rotate. In total 2 degrees of freedom. Additionally the wheels to control the tip at the distal end of the endoscope are not user friendly. The wheels are to large and a rotational movement is transferred to a translation of the camera image. In cuurent practice the endoscope is often controlled with two persons, although it should be possible with one. The user interface is not suitable for single operation a team of higly qualified doctors is needed to control the device for advanced manipulation tasks.
Currently worldwide many groups are working on the redesign of the instrument. They all implement triangulation , so that the tools come from aside into vision. By adding additional degres of freedom the surgeon can manipulate the tools like a crab. Our group doesn’t focus on the instruments but on the control of it, to make it intuitive an easy to use.
We think that manipulation offers a very good solution to control flexible endoscopes. The surgeon is standing at a console, the master, that provides all necessary data and controls devices to steer an instrument that is attached to a slave. The slave contains the actuators and sensors. In this situation the surgeon and the instrument are mechanically decoupled. Master optimized for surgeon, slave optimized for intervention.
Two approaches are possible to execute an intervention with flexible instruments: 1. In endoluminal the body is entered through a natural body opening, e.g. the mouth. The intervention will be performed in the digestive trac. 2. In transluminal the body is also entered through a natural body opening, but an incision is made in e.g. the stomach to enter the abdomen. Than an intervention is executed in the non-sterile area. 3. We focus on ………but the complete setup has to be prepared for non-sterile interventions.
In the Netherlands there is an discussion to screen elderly for colorectal cancer. A Colonoscopie is the most reliable method. However, because of costs involved it is not implemented yet. Our system could contribute to faster and easier, and as a consequence cheaper screening. Our system will also be able to do interventies in early detection cases. We expect there is large market for our system in the near future.
We think robots have added value. But is that opion shared by patients. We have to prove in clinical tests that medical practice is improved with our system. I will show some of the interesting contributions that robotics can add.
Main improvement is that surgeon and instrument is mechanically decoupled and that there is a computer in between. - We can optimize the body posture by adding additional body supports, like arm rests. - Tremor filtering options to keep the instruments steady. - Motion scaling for micro surgery. Large movements by the surgeon are translated to small precise movements of the instruments.
This is one of the results of TeleFLEX. It is automatic guidance of the endoscope into the patient. The tip is actuated with two motors that steer the tip based on a vision algorithm. The system tries to center the tip, while introducing the endoscope manually. The vision algorithm looks to light and dark, the center is typically dark since there is no reflection.
It should solve the ergonomic problems. So the physician doen’t need an assistant to control the endoscope. Instead of turning wheels, he uses a touchpad as input device.
We like to control two articulating instruments from a console. The user interface is dramatically improved and instead of 3 or 4 persons only one physician can perform the intervention.
In the third pop we will design an build an device to automatically insert an endoscope and to guide a surgeon to prevent looping inside the body and abiltity to track and trace the endoscope inside the body. It should take away discomfort of the patient.
In the fourth PoP we try to solve the problem of data overload. We will create a multimodal user interface that triggers different kind of human sensors dependent on the information that needs to be transferred.
Finally we will realize an integrated setup in which all functionality is combined. First we will do our techical and scientific experiments, afterwards it will be approved in clinical tests. We hope that we can improve clinical care for patiens and increase the capabilities of surgeons.
I hope you all see now the opportunities of TeleFLEX and robotics.
Presentatie Dhr Ruiter
TeleFLEX: Telemanipulation for
flexible surgical endoscopes
11 november 2010
– DEMCON advanced mechatronics
– University Twente: - Control Engineering
- Mechanical automation
- Design, production and management
- Technical medicine
– Meander Medical Centre Amersfoort, Prof. Dr. I.A.M.J. Broeders
– University Medical Centre Groningen, Prof. Dr. M.A. Mariani
– User group of medical specialists
‘Pieken in de delta’ grant
Planning 2009 – end 2012
Project structure TeleFLEX TeleFLEX
Introduction TeleFLEX TeleFLEX
Comfort patient improves
Current instruments not suitable for advanced tasks
Problem area TeleFLEX
Limited degrees of
Bad ergonomics Large teams
Master optimized for surgeon, slave optimized for intervention
Endoluminal Transluminal (NOTES)
Focus area: Endoluminal non-sterile interventions with advanced
manipulation in a limited space, e.g. removal of superficial tumors
in the colon.
Prepared for sterile interventions.