EH 2_2016

Main Themes  Medical Imaging  Computed Maxillofacial Imaging  Image Processing and Visualization  PACS and IHE  Telemedicine and E-Health  Computer Aided Diagnosis  Computer Assisted Radiation Therapy  Image and Model Guided Therapy  Personalized Medicine  Surgical Navigation  Surgical Robotics and Instrumentation  Surgical Simulation and Education  Computer Assisted Orthopaedic and Spinal Surgery  Computer Assisted Head and Neck, and ENT Surgery  Image Guided Neurosurgery  Minimally Invasive Cardiovascular and Thoracoabdominal Surgery  Digital Operating Room June 21–25, 2016 Convention Center Heidelberg, Germany COMPUTER ASSISTED RADIOLOGY AND SURGERY CARS 2016 30th International Congress and Exhibition Honorary President Davide Caramella, MD (I) Congress Organizing Committee Christos Angelopoulos, DDS (USA) Stanley Baum, MD (USA) Elizabeth Beckmann, BSc (UK) Leonard Berliner, MD (USA) Ulrich Bick, MD (D) Davide Caramella, MD (I) Kevin Cleary, PhD (USA) Takeyoshi Dohi, PhD (J) Kunio Doi, PhD (USA) Volkmar Falk, MD (D) Allan G. Farman, PhD, DSc (USA) Hubertus Feussner, MD (D) Guy Frija, MD (F) Stephen Golding, FRCR, MD (UK) Olga Golubnitschaja, MD (D) Makoto Hashizume, MD, PhD, FACS (J) Yoshihiko Hayakawa, PhD (J) Javier Herrero Jover, MD, PhD (E) David Hilderbrand (USA) Kiyonari Inamura, PhD (J) Pierre Jannin, PhD (F) Leo Joskowicz, PhD (IL) Heinz U. Lemke, PhD (D) (Chair) Hans-Peter Meinzer, PhD (D) Hironobu Nakamura, MD, PhD (J) Nassir Navab, PhD (D) Emanuele Neri, MD (I) Terry M. Peters, PhD (CDN) Osman M. Ratib, MD, PhD (CH) Hans G. Ringertz, MD, PhD (S) Ramin Shahidi, PhD (USA) Hiroyuki Yoshida, PhD (USA) www.cars-int.org SURGERY Advances and Controversies in Reconstructive Microsurgery (ACRM) 2016 Lighting up medical procedures Robots hold a steadying role in microsurgery The smart Italian LED lamp Leading hand and peripheral nerve specialist Professor Philippe Liverneaux believes using robots will not only enhance patient outcomes and improve cosmetic appearance but also bring significant cost ben- efits to health systems. As Professor of Orthopaedics & Hand Surgery in the Hand Surgery Department at Strasbourg University Hospitals, he outlines his vision for bringing robotics and microsur- gery closer together at the Advances and Controversies in Reconstructive Microsurgery (ACRM) 2016 confer- ence (5-6 May. Norwich, UK). During his presentation ‘New horizons in robotic nerve microsur- gery,’ he discusses how the future of peripheral nerve microsurgery should be robotic and bring addi- tional benefits within minimally invasive surgery (MIS). Speaking in our pre-conference interview Professor Liverneaux said: ‘The goal is for microsurgery to become endoscopic super-micro- surgery; we want to highlight the attraction of robotics for microsur- gery within the philosophy of MIS.’ He also points to RAMSES (Robotic Assisted Microsurgical & Endoscopic Society) – a group of plastic, hand and orthopaedic specialists - which advocates the future benefits of microsurgery being robotic. A particular aspect of this is the work of plastic surgeon Jesse Selber, who directs clinical research and is an Associate Professor in the Department of Plastic Surgery at the University of Texas MD Anderson Cancer Center in Houston, Texas. A pioneer of robotics use in harvest- ing flaps, primarily from the latissi- mus dorsi and the rectus abdominis, to provide substance to cover other injured body regions, at the con- ference he tackles the subject of simultaneous skull, scalp, kidney, pancreas transplants. Professor Liverneaux: ‘Usually you have to make very large incisions to harvest these muscles but, with the robot, we can make small incisions. This is important from a cosmetic point of view and patients will be happy with a small incision. A sec- ond advantage with small incisions is that patients will have less com- plications and recover faster, which will be cost effective because they will stay fewer days in hospital.’ A robot improves the sur- geons’ skill As a hand micro-surgeon, Liverneaux finds the advances of robotic con- trol offer particular benefits when patients sustain deep nerve injuries, such as a tear of the brachial plexus nerve network from the neck and shoulder down the arm, or injuries sustained by babies during some difficult births. He explains that the operation to restore movement by making a nerve graft in the brachial plexus traditionally requires a large incision often of 20-30cm. ‘These incisions are very bad from a cosmetic point of view and for nerve recovery,’ he said. ‘The goal of robotic microsur- gery in peripheral nerve surgery is to avoid this large incision.’ While data comparing robotic surgery to conventional techniques remains limited, Liverneaux says common sense suggests it’s prefer- able to make smaller, rather than larger, incisions. Another area in which robotic surgery has benefits is in the long thoracic nerve responsible for the motion of muscle that gives stability of the scapula. ‘With the robot, incisions are small and precise, fractionally away from the nerve to ensure when we suture we don’t affect the nerve,’ he adds. Micro-surgeons still often use large incisions to carry out the finely detailed surgery within the body but Liverneaux suggests the robot can conduct this with small incisions and precise instruments within the body. With the robot, instruments can move in three dimensions and have 3-D vision within the body, offering excellent optical magnifi- cation – currently one-to-five but potentially one-to-100 in the future – underlining the importance of imaging in robotic microsurgery. A critical advantage of a robot in microsurgery is the facility of motion scaling and tremor filtra- tion. ‘In microsurgery, because all the tissues that you are dealing with are so small, less than 1mm, if you can increase the scaling of our movement this will increase the surgeon’s precision. Motion scaling is very important for micro-surgeon because it makes the operation eas- ier,’ Liverneaux points out. ‘Motion scaling and tremor filtra- tion are two key features provided by robots compared to conventional human skills. The future of micro- surgery is to make the technique easier and what else than a robot can do it.’ Soled15-F, which supplements the Starled range of lamps manufactured by ACEM Medical Company, is a focusable LED examination light for diagnostics, minor precision surgery, intensive care, recovery room and first aid. The lamp provides a ‘…uniform distribution of light and can focus the light beam with per- fect illumination both on the surface and in depth providing the operator with the best working conditions,’ the company reports. ‘The high technological level combined with the use of high-powered LEDs allow the lamp to have a very linear yield and a negligible performance decay for its entire life duration.’ The light beam is IR-free. Light intensity is 50,000 Lux (large spot light beam) increasable up to 77.000 lux (small spot light beam) and with low power consumption (24 W). Colour temperature (CCT) is 4.500°K. The colour-rendering index (CRI) is 95. ‘The LEDs layout gives visual comfort and produces a uniform, homogeneous and shadow-less light,’ ACEM reports, adding,‘The high tech- nological level combined with the use of high-powered LEDs allow the lamp to have a very linear yield and a negligible performance decay for its entire life duration. The lamp’s round shape also makes it handy and functional when in use and being moved, and so the struc- ture fits well with work in diagnos- tics, test labs and dental surgery. With an iSense touch panel to con- trol all functions, the lamp also has an easy-to-grip removable and sterilis- able handle, making it suitable even for critical sanitary applications. Embracing robotic technology in the realms of microsurgery will have significant benefits for patients, clinicians and hospitals, Mark Nicholls reports Professor Philippe Liverneaux has been Professor of Orthopaedics & Hand Surgery in the Hand Surgery Department of Strasbourg University Hospitals since 2006. He is also General Secretary of the French Society for Surgery of the Hand, and Past President of the French Society for Microsurgery and the Robotic Assisted Microsurgery & Endoscopic Surgery Society. His research projects include minimally invasive surgery and nerve transfer and elbow flexion restoration, using robotic techniques. 28 EUROPEAN HOSPITAL  Vol 25 Issue 2/16

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