COMPUTER AIDED SURGERY AND MICRO MACHINE

Takeyoshi DOHI
Graduate School and Faculty of Engineering The University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113 Japan In order to develop the field of computer aided surgery, it is necessary to apply three dimensional medical images, medical robots, medical mechatronics, micro machine, laser technology and so on.
2. Micro Machine in Minimally Invasive Surgery

Abstract: Computer aided surgery (CAS) is a new surgical field to realize minimally invasive surgical therapy, using various computer technologies which are three dimensional medical images, surgical robots and so on. Three dimensional medical images are new eyes of a surgeon, and surgical robots are new hands of a surgeon. Especially, in order to realize the minimally invasive therapy, it is necessary to develop new surgical devices which are needles for percutaneous puncture, manipulaters, fine endoscopes and so on using micro machine technology. The main applications of the CAS system are the liver cancer treatment therapy, the laparoscopic surgery, the endoscopic surgery, the stereotaxic neurosurgery, and corneal micro surgery. 1 Introduction . A number of the medical instruments have been developed as diagnostic, therapeutic and administrative tools. Recently the most advanced medical devices are equipped with microcomputers, sensors, electric and mechanical elements based on knowledge of mechatronics. On the other hand, it is very difficult to apply these advanced technologies to surgical operations. However, it means that there is much left to develop surgical devices using various advanced technologies. One of the most important problems in the surgical field is a minimally invasive therapy. To realize minimally invasive surgical therapy, it is necessary to use various computer technologies which are three dimensional medical images, surgical robots and so on. This new surgical field using computer technology is called Computer aided surgery (CAS).

2 1 Minimally Invasive Surgery .. The main purpose of the minimally invasive surgery is to realize reduction of patient's physical damage caused by a surgical operation. And the first characteristic of this surgery is not to make any big injury of incision to approach the diseased part. The minimally invasive surgery is expected as follows; 1)Reduction of patient's physical damage caused by a surgical operation. 2)Shortening of hospital stay and prompt recovery to daily life Avoidance of a bed-ridden elderly. Lessening or diminishing of rehabilitation. Reduction of medical costs. 3)More safety and accurate procedures compared with those in a conventional surgery. 4)Recovery of patients from incurable disease. 5)Surgeries without transfusions. 6)Reduction of physical, mental and labor burden for medical staffs. 7)Prevention of infection accidents caused by hepatitis virus and HIV virus. 8)Appropriate informed consent for a patient. 9)Completeness of medical and specialist education.

Sixth International Symposium on Micro Machine and Human Science 0-7803-2676-8/95 $4.00 0 1 9 9 5 IEEE.

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2.2. Micro Machine in Minimally Invasive Surgery A micro machine is one of the most expected technologies for the CAS. Especially, this technology provides a surgeon with a new hand to realize minimally invasive therapy. This technology is expected to advance micro surgery under a microscope, treatment under an endoscope or a laparoscope, operation using needles for percutaneous puncture, or manipulaters, and so on. Micro machine technologies in the medical field are the following 3 types.
l)A whole machine is a miniature size. 2)An operation part of a tool is a miniature size and operation action is small, but the size of a controller or a power source is not a problem. 3)The size of a machine itself is not a problem, but operation action of tool is small. In case of practical application of a medical micro machine, the size of machine is 10-3 10-4 meter. The machine whose size is 10-6 meter level is not realistic, because of this size a machine does not produce power.

3.2. Surgical Robot[2] As a device to let operation instruments reach the diseased part of a patient's body, robot technology is very important. However, philosophy to develop a surgical robot is to assist a surgeon to overcome more difficult procedures and thus help an incurable patient as much as possible. Therefore a surgical robot is a new hand of a surgeon, and it is not a machine to do the same action of a surgeon using scissors or a scalpel. The areas of medical robots are classified into therapy, inspection, research,education and nursing (Table 1).

Table 1 Classification of Medical Robot

3. Computer Aided Surgery System[l]

3.1. Three Dimensional Medical Image Three dimensional (3-0) organ structure of a patient in the CAS is reconstructed by using the information obtained from the X-ray CT, MRI, echography and so on. Three dimensional reconstructed medical image system in the CAS consists of an image acquisition system, a data processing system, and a graphic display. All information from this CAS system is displayed on graphical terminals. The reconstructed 3-D medical images are the most recognizable information for a medical doctor, and 3-D position data of tissues inside the patient's body are the most important data to control surgical robots and mechatronics devices. Main applications to the CAS system are liver cancer treatment therapy, stereotaxic neuro-surgery, laparosucopic surgery, endosucopic surgery, and partial liver transplantation.

3.3. Safety of Medical Robot The robots for nursing, care and therapy (especially surgical robots) are quite different from industrial robots in the following 4 aspects.
1)These robots contact human body directly. 2)Functions required for these robots are different according to their purpose; nursing, care, operation and therapy. 3)When these robots are used in practice, trial movement or doing again are not allowed. 4)These robots can be operated easily, even if an operator is not a specialist. In other words, safety of industrial robots keeps dividing work areas between man and robots. On the other hand, the purpose of robots can not be achieved if these robots are not in contact with a patient or a cared person. The safety measures

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against accidents should be considered from both sides, hardware and software, and industrial robots should not be applied to these purposes. Therefore, in order to develop therapy robots and nursing robots for practical use, it is very importanttodesign man-machine interface safely. But it becomes illogical that an airplane which can not fly is the safest airplane, if one emphasize the safety of the robots too much. Engineers should pursue safety and simple operation of robots to his best always using high technologies.

The most suitable applications of micro machine in this therapy is a micro laser scanner on the end of the laser fiber needle. Big power is not necessary for this scanning of laser.

4. Clinical Application of the CAS 4.1. Laser Surgery in Liver Cancer[3] The first application of the CAS system is the resection and the spherical laser coagulation treatment for liver cancer. The reconstructed 3-D data of liver by the CAS system are used to calculate the best approach direction of the laser probe to avoid damage of the large vessels in the liver. The result of calculation is mapped on the surface of liver model or the surface of patient's body model. The mapping on the patient's body is used to insert the needle percutaneously under the guide of echography or treatment with a manipulator for needle puncture.

4.2. Stereotaxic Surgery[4] Stereotaxic surgery is a kind of neuro-surgery which needs precise positioning of the surgical apparatus and uses pre-determined location information. It includes biopsy, injection of medicine, fiber scope laser surgery, radiant ray treatment and positioning of electrodes. According to the positional information of the tumor(or any target) in the brain taken by the X-ray CT(or MRI) sliced images, the coordinates of the instruments are set manually, and a cannulation needle is inserted into the tumor. It is obvious that introduction of cannulation manipulator to the surgery will provide more precise location of the needle and make surgery safer. When the CAS system is used for the cannulation of needle to brain tumor, the optimum path of the needle toward the tumor is calculated so as not to damage the functional area of brain and the major brain vessels. The manipulator inserts the needle to the tumor through the planned path.

Fig. 1 A manipulator for percutaneously needle puncture controlled by the CAS system
Fig.2 A manipulator for stereotaxic surgery controlled by the CAS system

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Aided Surgery System : Three-Dimensional Graphic Reconstruction for Treatment of Liver Cancer, Surgery, 589, May 1991 -4IH.Nozaki et al.; Development of a Computer Aided Surgery(CAS) Sytem for Neurologic Surgery, Proc. of the 31st Conference of the Japan Soc.,ME&BE, vo1.30,532, 1992

Fig.3 X-ray CT image of cannulation to a phantom of wax

gourd by a manipulator for stereotactic surgery

S. Conclusion
The applications of micro machine, mechatronics and robotics in medicine are widely spread in clinical use. An expected area of medical micro machine is minimally invasive surgery, especially laser radiation therapy, stereotaxic surgery and laparoscopic surgery. As a new concept of robots and mechatronics system in medicine, it is necessary to integrate 3-D medical images and micro machine technology. By this integration, so far impossible or difficult surgical treatments will be enabled or facilitated. At the beginning of the next century, the CAS will make progress as the virtual reality micro surgery for minimally invasive therapy.

References
[l]T.Dohi et al.; Computer Aided Surgery System(CAS) -Development of Surgical Simulation and Planning System with Three 1st Dimensional Graphic Reconstruction, Conference on Visualization in Biomedical Computing, IEEE, 458, 1990 [2]T.Dohi et al.; Robotics in Computer Aided Surgery System: Journal of Compuer Aided Surgery, Vol.1 No.l,4, 1995 [3]D.Hashimoto et al.; Development of a Computer-

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