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5 years ago
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1 Lecture : Computing Assisted Surgery

3 Computer Aided (Assisted) Surgery : CAS Navigation Medical Robotics

panels and shroud box Spoilers Nose landing gear doors Main and centre landing gear doors Central Torsion Box Not shown: CFRP passenger

4 CFRP GFRP Hybrid (G+ C) Leading edge / J-nose Ailerons Flap track fairings Horizontal stabilizer outer boxes Vertical stabilizer Tail cone GLARE Outer flap Pressure bulkhead Apron Belly fairing skins Upper-deck floor beams Radome Overwing panel Trailing edge upper and lower panels and shroud box Spoilers Nose landing gear doors Main and centre landing gear doors Central Torsion Box Not shown: CFRP passenger floor panels and struts Main landing gear leg fairing door Pylon fairings and nacelles cowlings Computer aided design / Computer aided manufacturing

5 CAD/CAM CAD NC

6 CAS CAD/CAM Supervision Superbrain Supersensor( Superhand

7 Preoperative Planners

11 CAS CAD/CAM in OR Supervision Superbrain Supersensor( Superhand

14 Navigation

15 GPS in the OR

16 GPS in the OR

17 GPS in the OR

18 Socks Aid Reacher

21 Robotics ROBODOC 1980 THR revision THR, Primary TKR, and Uni-KR

22 ORTHODOC ROBODOC ROBODOC

23 ROBODOC 1980 THR CT-based Custom Implants

24 Custom-made hip from CAT scan images CAD-CAM Machining

25 Custom-made Hip 10 years

27 CAD-CAM Machining in the OR: ROBODOC

28 Previous varus osteotomy Preop. Plan Postop.

29 3 years

30 ROBODOC Group # ( Femora ) ( Men : Women ) ( yr ) Robotic milling 73 ( 78 ) 14 : ( 27 to 81 ) Hand-broaching 67 ( 78 ) 14 : ( 29 to 77 ) ( Chi-squared test ). ( Mann-Whitney U test ). Nishihara S, Sugano N; J Orthop Sci (in press)

31 X

32 Classification of Echogram Findings Grade 0 Grade 1 Grade 2 Grade 3 Pitto RP, CORR 1998

33 ROBODOC CONTROL Grade P-value * No.(%) of hips 4(8) (64) 8(32) 1(4) p<.0001 No.(%) of hips 18(36) (68) 4(16) 1(4) p<.0001 No.(%) of hips 29(58) 4(8) 0 13(52) 11(44) 1(4) p<.0001 * Mann-Whitney U test Hagio K, Acta Orthop Scand 2003

34 Fatal Marrow Embolization Following a Porous-coated Bipolar Hip Endoprosthesis Julian S.Arroyo, MD, Kevin L.Garvin, MD, Michael H. McGuire, MD J. Arthroplasty 1994

35 Controversy in Germany! Comparison of Robotic-Assisted and Manual Implantation of A Primary Total Hip Replacement Honl M, Schwieger K, Gauck CH, Carrero V, Dierk O, Dries S, Hille E, Morlock MM Department of Orthopaedic Surgery, Barmbeck General Hospital, Hamburg, Germany JBJS 2003 ROBODOC 11/61 (18%) 3/80 (4%) 9/61 (15%) 0/80 (0%) 1 WHY???

36 Initial ROBODOC FDA Multi-center Randomized Controlled Trial Dislocation rate ~4% in each group. (No diff.) 0% Revision Rate in both Groups. Better fit and alignment for ROBODOC group. No diff. in Hip Scores at 24 months. No Difference in Incidence of Limp or Use of Ambulatory Aids Bargar WL, CORR 1998 Bargar WL, ISTA 2003

37 The Reason:

38 ROBODOC

39 Minimum Invasive Surgery or Mini-Incision Surgery 10cm 1cm 0.5cm X 1cm 11:3

40 MIS THA Hype or Fact 25 Degree Driver 45 Degree Driver 25 Cup Introducer

41 Comparing Hip Replacement Procedures Incision Tissue Trauma Hospital Stay Zimmer MIS 2-Incision Two 1.5- to 2-inch Muscles and Tendons avoided or separated 1-2 days Traditional One 10- to 12-inch Muscles and Tendons cut 3-5 days

42 Two-Incision MIS THR 4cm 3cm

43 Learning Curve for the Two-Incision Total Hip Replacement Archibeck MJ and White RE, Jr, CORR % (35) 1.1% (9) 0.8% (7) 1.3% (11) 7.3%! 3.2% (27)

44 Learning Curve for the Two-Incision Total Hip Replacement Archibeck MJ and White RE, Jr, CORR % (8) : 3 0.9% (8) 0.2% (1, 1 ): 2 0.8% (7) : 3 and 4 Death (2) presented at the Hip Society 04 was not written in this paper

45 MIS? Mini-Incision Surgery? Minimally Invasive Surgery??,,?

47 Comparison of Primary Total Hip Replacements Performed with a Standard Incision or a Mini-Incision Woolson ST, et al. JBJS-Am 2004 Mini-incision [<10 cm] Standard incision No. of patients 50 (selected) 85 (remaining) BMI (p = 0.008), ASA rating (p = 0.006) No differences in surgical time, blood loss, in-hospital transfusion rate, length of hospital stay, or the patients' disposition after discharge. Wound complication (p = 0.02), Acetabular component malposition (p = 0.04), and Poor fit and fill of femoral components inserted without cement (p = ).

48 ? 10 years 20 years 30 years 3 days 1 year 2 weeks

49 MIS Meets CAOS

50 Approach: A Posterior Mini-Incision Approach (7cm)

51 CentPillar system based on CT study of Japanese hips

52 OR Setting

53 Approach: A Posterior Mini-Incision Approach (7cm)

54 Femoral Neck Osteotomy

62 Functional tilt 8 deg Navi Cup Abduction 40 deg Navi Cup Anteversion 22 deg Postop Cup Abduction 40 deg Postop Cup Anteversion 19 deg 1 TAN β Anatomical Anteversion = TAN ( ) SIN α

63 Cup Orientation : Navigation vs Postop X-ray Navi Navi Postop Cup Abduction Postop Cup Anteversion Personal Data

64 Robo Navi

65 MIS with ROBODOC Implant insertion access volume Curved Insertion Path Lateral Edge Insertion Access Volume Medial Edge <2.5 cm Implant in Seated Position

66 Beware of the hype because a fool with a tool is still a fool. Cost MIS

(Total Knee Arthroplasty : TKA) TKA UKA 5~10% /10 years TKA Gender Knee Yes! High-flex Knee 150 Registry

(Total Knee Arthroplasty : TKA) TKA UKA 5~10% /10 years TKA Gender Knee Yes! High-flex Knee 150 Registry Today s topics 1. 2. 3. 4. 5. 1. Cardiac Devices 38 Arthroplasty 29 Breast 9 Ophthalmological activities 6 Pumps 4 Cochlear implants 3 Tubes 3 Sacral neuromodulation 3 General Implant 2 Brain stimulation