Interview with Dr. Richard Satava.

I talked with Dr. Richard Satava, currently a professor in the Department of Surgery at the University of Washington Medical Center. Dr. Satava has more than 200 publications in fields which encompass areas such as Surgery in the Space Environment, Video and 3-D imaging, Telepresence Surgery, Virtual Reality Surgical Simulation, and Objective Assessment of Surgical Competence and Training. He has had 23 years of military surgery experience, and his prestigious appointments include being the Program Manager of Advanced Biomedical Technology at the Defense Advanced Research Projects Agency (DARPA).

I approached Dr. Satava as a graduate student at Stanford University researching in haptics and medical robotics. I am particularly interested in the merger of sensorized minimally invasive tools and robotic control and medical imaging. I would like to understand how to go from research to starting a company in the surgical robotics field. I contacted Dr. Satava in order to learn more about the tele-surgery problem space and how I can make my ideas real.

Questions on the Future of Robotic Surgery

• How do/will doctors “see” and “feel” the patients anatomy during MIS?

• What are current challenges with tele-operations?

• What are some current advances in medical imaging?

• How can force-feedback benefit surgeons?

• What are some opportunities in surgical planning?

• What are the promoters of new technology?

Opportunities:

Dr. Satava pointed out that medical robotics is a slowly growing field. Intuitive Surgical, the developers of the most-widely used medical robot, the Da Vinci system, “is chocking up the market.” If I want to learn more, I should start with them. There probably will be a need for haptics in robotics and simulators, but will there be a need in industry?

There are not many companies that currently exist in the haptics and robotics fields. There also are no monopolies in other industries, unlike Intuitive Surgical and the medical robotic industry.

Image guided surgery is not as difficult a problem as haptics. Other larger players are into improving image guided surgery, such as Phillips and GE. These companies could provide protection to smaller ventures.

There is a big hope that simulation will take off. Now, surgical simulation is a requirement for robotic operation training programs. The requirement was announced in 2005 and was instigated in July, 2008. Training programs are reviewed every 3 years, and hospitals are rushing to set up simulation centers in order to prevent probation. Training programs are reviewed every three years.

Needs:

The current system (Da Vinci) would be improved by smaller systems, more dexterity, and lower costs. Today, the system is large and leads to procedural inefficiency. Medical personnel must move all around the robot during operations.

The system could also be improved if it had some autonomy. Currently sewing, clamping, etc. are done manually. It may be safer and time saving to have the robot do some of these procedures automatically.

Academics need a new system for research. In order to find more needs and truly understand the current drawbacks, try to use the modern Da Vinci system. See how it feels, learn what it can and cannot do.

About Surgery & Haptic Feedback:

Currently, medical robotics in the market do not use haptic feedback, yet the Da Vinci is still doing well. Therefore, it can be asked, is haptics needed?

Haptics adds cost and complexity to a system. In order to do touch sensing well, sampling must be done at 1kHz to gain enough information without degrading the signal. The high bandwidth of information, needs to be transferred at the 1kHz range. Feedback is harder than forward data. The system can chatter. Chatter is reduced when the console and robot (Master/Slave) are in the same room.

At present, there are no good haptic displays. Gloves, joysticks, etc. out there is nowhere near what is necessary to be successful for surgery. There is a need for a good sensor display, to be able to “feel” remotely. It must send information rapidly to get the large bandwidth across.

The sense of touch incorporates some 23 sensors: pressure, tension, shear, vibration…. Do we need dozens of sensors, updated rapidly, to recreate touch accurately? Currently, we do not know if mimicking even two or three sensor types is enough. We need to know how much fidelity is necessary to reconstruct feeling of touch to improve surgery.

There is a need for “cheap” haptic device for robotic systems.

Follow-up

Dr. Satava listed a group of experts in the field to talk to. Prof. Kevin Montgomery, Dept of Bio-Engineering at Stanford University, has been working for 15-20years in haptics for biomedical engineering applications. He would also know where to get funding. (DARPA no longer funds tele-operation research.) Others to talk to include: Rob Howe, at Havard; Russ Taylor, at Johns Hopkins; Blake Hannaford, at the University of Washington; and Jim Osborne, at Carnegie Melon.

-- SanthiElayaperumal - 12 Nov 2008