Professor of Pediatric Research, The Georgia Institute of Technology

Abstract: Mitral regurgitation is a common heart valve disease. Current approaches for mitral valve repair include open heart surgery (which carries the risk of post-operative complications) and transcatheter mitral valve repair (TMVR). TMVR is a relatively new approach that is performed on a beating heart using a catheter that is guided to the target location to implant the device to reduce or eliminate mitral regurgitation. Given the tortuosity of the path that needs to be taken to reach the mitral valve, TMVR is a clinically challenging procedure. The first part of the talk will focus on our work in developing a highly articulated, intravascular meso-scale robot that can be guided to deploy the mitral valve implant under image guidance.

The second part of the talk will focus on the area of micro-scale robotic systems involving steerable guidewires. One of the primary requirements of an endovascular robotic system is to be able to successfully steer the guidewire towards the target location with minimal or no harm to the vessel. Chronic total occlusions (CTOs) remain the riskiest, most challenging, and least successful vascular lesions to treat with traditional endovascular devices. Peripheral artery disease (PAD) in particular, is one of the most common causes of cardiovascular deaths worldwide. Procedural complexity in treating CTOs are attributed to multiple causes. The second part of the talk will present our work on the development of 400 microns (~0.016”) robotically steerable guidewire as a potential solution to this challenging clinical problem.

Biography: Dr. Jaydev P. Desai is currently a Professor at Georgia Tech in the Wallace H. Coulter Department of Biomedical Engineering and holds the G.P. “Bud” Peterson and Valerie H. Peterson Faculty Professorship in Pediatric Research. He is the founding Director of the Georgia Center for Medical Robotics (GCMR) and an Associate Director of the Institute for Robotics and Intelligent Machines (IRIM). He completed his undergraduate studies from the Indian Institute of Technology, Bombay, India, in 1993. He received his M.A. in Mathematics in 1997 and M.S. and Ph.D. in Mechanical Engineering and Applied Mechanics in 1995 and 1998 respectively, all from the University of Pennsylvania.

He was also a Post-Doctoral Fellow in the Division of Engineering and Applied Sciences at Harvard University. He is a recipient of several NIH R01 grants, NSF CAREER award, and was the lead inventor on the “Outstanding Invention in the Physical Science Category” at the University of Maryland, College Park, where he was formerly employed. He is also the recipient of the Ralph R. Teetor Educational Award and the 2021 IEEE Robotics and Automation Society Distinguished Service Award.

He has been an invited speaker at the National Academy of Sciences “Distinctive Voices” seminar series and also invited to attend the National Academy of Engineering’s U.S. Frontiers of Engineering Symposium. He has over 195 publications, is the founding Editor-in-Chief of the Journal of Medical Robotics Research, and Editor-in-Chief of the four-volume Encyclopedia of Medical Robotics. At 2018 ICRA, his prior work was the finalist for “IEEE RAS Award for the Most Influential Paper from ICRA 1998”.

His research group has received several accolades including the best student paper award, best symposium paper award, cover image of IEEE Transactions on Biomedical Engineering, and featured article in the IEEE Transactions on Biomedical Engineering. His research interests are primarily in the areas of image-guided surgical robotics, pediatric robotics, endovascular robotics, and rehabilitation and assistive robotics. He is a Fellow of IEEE, ASME, and AIMBE.

Funding Panel:

• Dr Françoise Siepel, Operational Coordinator, Digital Innovation Hubs in Healthcare Robotics (DIH HERO), University of Twente, the Netherlands
• Ms Philippa Hemmings, Head of Healthcare Technologies, EPSRC, UK
• Mr Michael Wolfson, Program Director, Division of Discovery Science & Technology (Bioengineering), NIH, USA

Related Content:

• EPSRC UK RAS 2021 White Paper: "Surgical Robotics: Towards Measurable Patient Benefits and Widespread Adoption"

Professor of Biomedical Engineering and Neurological Surgery, University of California at Davis

Abstract: This presentation overviews a clinically-compatible label-free multispectral fluorescence lifetime imaging (FLIM) technique developed in our laboratory and its applications in surgical oncology. Emphasis is placed on the integration of FLIM in surgical robotics and the potential of this approach to improve surgical decision-making during trans-oral robotic surgery (TORS). We demonstrate the straightforward coupling of FLIM apparatus with the da Vinci surgical platform and innovative methods for real-time dynamic augmentation of imaging parameters on the surgical field of view as seen on the da Vinci console. Current results demonstrate the utility of FLIM-derived parameters detecting tissue biochemical and metabolic characteristics to distinguish oral and oropharyngeal cancer in real-time from surrounding normal tissue in patients in-situ during TORS. Current findings suggest that label-free FLIm-based tissue assessment, characterized by simple, fast and flexible data acquisition and display, could find applications in a variety of robotic procedures.

Biography: Dr. Laura Marcu is Professor of Biomedical Engineering and Neurological Surgery at the University of California at Davis. She received her Ph.D. in biomedical engineering in 1998 from the University of Southern California, Los Angeles. Her research interest is in the area of biomedical optics, with a particular focus on research for the development of optical techniques for tissue diagnostics including applications in oncology, interventional cardiology, and tissue engineering. Since 2007 she has served as co-director of the Comprehensive Cancer Center – Biomedical Technology Program, at the UC Davis Medical Center. She authored over 200 articles (120 peer-reviewed). Currently, she serves as a member of the Editorial Board for the Journal of Biophotonics and the Translational Biophotonics, and was the Associate Editor for Biomedical Optics Express. She is a Fellow of AAAS, AIMBE, BMES, OSA, SPIE, and NAI.

Professor of Orthopaedic Surgery, University College London

Abstract: This lecture will review the current trends and use of surgical robots in orthopaedic practice. Clinical outcomes and results will be discussed alongside the challenges and obstacles to adoption of innovative robot assisted surgical solutions. The introduction and dissemination of robotic surgery can be costly and difficult to justify initially, particularly in universal healthcare systems. This can hamper widespread use ahead of the accumulation of long term outcome data.

Robots are popular with patients and increasingly so with surgeons. Professor Skinner will give an overview of these issues along with some ideas on the necessary governance, data collection requirements and safeguards that will be essential for the safe and responsible adoption of this exciting technology.

Biography

Professor John A Skinner MBBS, FRCS, FRCS(Orth) – is Professor of Orthopaedic surgery at University College London and Consultant Orthopaedic Surgeon at the Royal National Orthopaedic Hospital, Stanmore (RNOH). He is President of the British Orthopaedic Association. He sits on the Council of the Royal College of Surgeons of England and chairs the Future Surgeons Forum.

He is a hip and knee arthroplasty surgeon and is the Director of Research and Innovation at the Royal National Orthopaedic Hospital. He was awarded an orthopaedic American British Canadian Travelling Fellowship and is a member of the International Hip Society. He has served as President of the British Hip Society and worked on the NICE guideline committee for joint replacement surgery. He jointly established the London Implant Retrieval Centre in 2007, which has collected 8000 failed orthopaedic implants and has published 130 papers on this subject, including reasons for failure. He provided clinical leadership on metal bearing hips for patients and surgeons and chaired the UK MHRA Expert Advisory Committees on Metal bearing hips for 10 years. This work contributed to advice that is followed worldwide and applies to 1.5 million patients with metal bearing hips. He has advised the Federal Drug Administration (FDA) USA on matters related to Hip Arthroplasty surgery. He has worked on custom CAD CAM arthroplasty implant design, surgical planning and patient specific instrument design. He has introduced 4 surgical robotic systems at the RNOH for arthroplasty and spine surgery. His Research interests focus on optimising outcomes for patients undergoing joint replacement surgery.

Industry Panel:

• Mr Jim Nevelos, Vice President of Advanced Technology and Research (Joint Replacement), Stryker Corp.
• Mr Ori Hadomi, Vice President of Strategic Initiatives and Partnerships, Medtronic Inc.
• Mr Brian Uthgenannt, Global Marketing Manager, Corin Group.
• Mr Branko Jaramaz, Senior Director, Research and Development, Smith and Nephew
• Mr Thomas Küenzi, Senior Director Velys R&D, DePuy Synthes
• Mr Felix Wandel, Vice President of Robotics and Technology (EMEA), Zimmer Biomet

Professor of Neurosurgery and Professor of Radiology, Harvard Medical School 

Abstract: Treating patients with brain tumors requires balancing the need for aggressive oncologic therapy with preservation of neurologic function. Treatment for nearly all brain tumor patients starts with surgical resection of the lesion. Maximal removal of tumor tissue–if it can be accomplished without causing additional neurologic deficit–provides the best prognosis and sets the stage for efficacious adjuvant treatment. Achieving maximal safe surgical resection however can be challenging. In order to perform optimal surgery, the surgeon must have a patient specific understanding of the location and extent of the tumor as well as of adjacent and at-risk eloquent structures in the brain. Multimodal imaging now allows the delineation of individual functional anatomy including cortical (grey matter) and subcortical (white matter) eloquent areas as well as the relationship to the tumor. Bringing this data into the operating room and coordinating it with the surgical gesture is critical to make it most informative for guiding surgical decision making. As the surgery progresses, brain shift changes the configuration of these critical anatomic relationships and efforts to measure brain shift, tissue resection, and other intraoperative changes are essential to maintain the accuracy of mapping. At the completion of surgery, creating and exporting a data file which includes surgical observations, locations of tissue samples and other critical information from the surgery can best inform post-operative adjuvant therapy including novel strategies to deliver agents directly to the tumor.

Biography: My research focuses on the translation of a broad range of neuroimaging techniques to neurosurgical planning and intraoperative guidance. The overarching goal of this work is to help surgeons perform optimal brain surgery by defining and visualizing critical brain structures and pathologic tissue to be removed.

Since 1998, I have worked on the development and validation of fMRI for the pre-operative evaluation of patients with lesions in and near critical areas of the brain. This has been a translational research effort which adapted fMRI, initially developed as a neuroscience technique to be applied in groups of subjects to make statistical inferences about populations, to the vastly different scenario of clinical decision-making for individual patients. Since our research program began at BWH in 2003, we have developed new techniques for the use of fMRI in single subject analyses necessary for surgical planning. In addition, we have developed numerous acquisition strategies geared towards accommodating the limited neurologic functions of some patients as well as analytic approaches to maximize the utility of fMRI for surgical planning. Presurgical fMRI has the potential to bring meaningful pre-operative individualized functional anatomy mapping to neurosurgeons around the world as an alternative to awake mapping, a technique which is demanding and remains limited to very specialized centers.

I have also worked extensively on the translation of diffusion MRI (dMRI) including tensor imaging (DTI) to map white matter anatomy in neurosurgical patients. Diffusion MRI allows the in vivo depiction of the location, course and integrity of macroscopic white matter tracts in the brain through a process known as tractography. As with fMRI, the translation of this technology to clinical decision-making has required numerous fundamentally novel approaches. We have developed segmentation approaches for defining tracts based on high dimensional clustering as well as statistical atlases which allow labeling of individual patient tracts even in the setting of mass effect and peritumoral edema. My group works collaboratively with MRI physics and MRI analysis groups to continue to be at the forefront of technical innovation. We have released many of our tools to the public via 3D Slicer (slicer.org) and we have organized several international challenge workshops to apply diffusion techniques to real world clinical data.

With both these methods, translation of the technology required understanding of clinical needs, constraints, and opportunities for improved clinical care. Specific analysis techniques needed to be developed to adopt these techniques so that they were applicable to single subject data, and, in particular, to neurologic patients who have structural lesions and often are limited by their neurological deficits. In these efforts, we work closely and collaboratively with scientists in radiology and computer science to translate emerging technical innovations into the operating room.

Another major area of translational investigation is in the development of intraoperative imaging techniques. I was the lead surgeon in developing the AMIGO (Advanced Multi-modality Image-Guided Operating Suite) at BWH and serve as the Co-director of AMIGO. AMIGO is one of the key resources of the National Center for Image Guided Therapy funded by NIH. This suite contains all contemporary imaging methods within an operating room environment and was specifically designed to support translational research. The suite is the site of many of surgical procedures in which we are developing strategies for intraoperative imaging and guidance.

Several of our important research efforts are built on the AMIGO platform. These include the intra-operative use of high field MRI including development of intra-operative dMRI tractography. We have also leveraged the resources of the AMIGO suite to develop novel strategies to simplify intraoperative imaging using techniques such as ultrasound and stereovision to give surgeons information in near real time to guide surgery. Another area of research leveraging the resources of AMIGO is the development of tissue level molecular imaging.We have funded collaborative projects using mass spectrometry, Raman spectroscopy, and fluorescence imaging.Our eventual goal is to give surgeons in most settings tools that will help them to perform safer and more effective surgery.

Poster Awards Chair: Elena De Momi (Politecnico di Milano, Italy)

Podium Awards Chair: Daniel Elson (Imperial College London, UK)