Kitaro Yoshimitsu

Scrub nurse robot system-intraoperative motion analysis of a scrub nurse and timed-automata-based model for surgery

The goal of the project described in this paper is to develop a human-adaptive Scrub Nurse Robot (SNR) that can adapt to surgeons with various levels of skill and experience in order to compensate for the present severe shortage of scrub nurses. To determine the specifications of the SNR, we analyzed real intraoperative behavior of a scrub nurse, and then modeled the entire surgical procedure with key participants by a multilevel modeling approach using the extended timed-automata-based formalism of Uppaal. Specifically, first, we videotaped the intraoperative motions of a scrub nurse and a surgeon in a thoracoscopic surgery performed on an infant pig, and analyzed their motions during the skin incision. Second, the motions of the nurses right wrist, elbow, and shoulder were modeled with the timed automata. Third, the entire surgical procedure as well as actions and statuses of key participants was also modeled. Finally, it is shown that the proposed multilevel modeling approach also facilitates the model checking that is considered efficient in the SNR motion analysis and its adaptive motion planning.

Information-Guided Surgical Management of Gliomas Using Low-Field-Strength Intraoperative MRI

BACKGROUND Contemporary technological developments revolutionized management of brain tumors. The experience with information-guided surgery of gliomas, based on the integration of the various intraoperative anatomical, functional, and histological data, is reported. METHODS From 2000 to 2009, 574 surgeries for intracranial gliomas were performed in our clinic with the use of intraoperative MRI (ioMRI) with magnetic field strength of 0.3T, updated neuronavigation, neurochemical navigation with 5-aminolevulinic acid, serial intraoperative histopathological investigations of the resected tissue, and comprehensive neurophysiological monitoring. Nearly half of patients (263 cases; 45.8%) were followed more than 2 years after surgery. FINDINGS Maximal possible tumor resection, defined as radiologically complete tumor removal or subtotal removal leaving the residual neoplasm within the vital functionally-important brain areas, was attained in 569 cases (99.1%). The median resection rate constituted 95%, 95%, and 98%, for WHO grade II, III, and IV gliomas, respectively. Actuarial 5-year survival was significantly worse in WHO grade IV gliomas (19%), but did not differ significantly between WHO grade III and II tumors (69% vs. 87%). CONCLUSIONS Information-guided management of gliomas using low-field-strength ioMRI provides a good opportunity for maximal possible tumor resection, and may result in survival advantage, particularly in patients with WHO grade III neoplasms.

Recognition of the Surgeon's Motions During Endoscopic Operation by Statistics Based Algorithm and Neural Networks Based ANARX Models

Abstract The problem of recognition and short time prediction of the surgeons hand motions during surgical endoscopic operation are approached in the present contribution using neural network based nonlinear modeling techniques and statistics based segmentation of the operating room. It is shown that proposed technique provide precise recognition of surgeons motions.

Intraoperative multichannel audio-visual information recording and automatic surgical phase and incident detection

Identification, analysis, and treatment of potential risk in surgical workflow are the key to decrease medical errors in operating room. For the automatic analysis of recorded surgical information, this study reports multichannel audio visual recording system, and its review and analysis system. Motion in operating room is quantified using video file size without motion tracking. Conversation among surgical staff is quantified using fast Fourier transformation and frequency filter without speech recognition. The results suggested the progression phase of surgical procedure.

Development of modified Intraoperative Examination Monitor for Awake Surgery (IEMAS) system for awake craniotomy during brain tumor resection

Gliomas represent the most frequent type of primary intracranial tumors, which originate from the brain tissue itself, have infiltrative growth, unclear borders, and usually affect functionally-important cerebral structures. From March 2000 till March 2010, 839 neurosurgical procedures directed on resection of such neoplasms were performed in the intelligent operating theater of Tokyo Womens Medical University with the use of intraoperative MRI, real-time updated neuronavigation system, and Hi-vision operative microscope. To facilitate maximal possible tumor resection with minimal risk of neurological morbidity a special device, called Intraoperative Examination Monitor for Awake Surgery (IEMAS) was developed by us. It provides an opportunity to visualize a wide spectrum of inraoperative information related to condition of the patient, nuances of the surgical procedure, and details of the cortical mapping. The wide set of both anatomical and functional parameters, such as view of the patients mimic and face movements during answering on the specific questions, type of examination test, position of the surgical instruments, parameters of the bispectral index monitor, and general view of the surgical field through the operating microscope and/or endoscope, is presented compactly in one screen with several displays, which allows fast integrated real-time analysis of the multiple data, nearly without interruption of the surgical manipulations. All members of the surgical team can share this information using several in-room liquid crystal displays. However, the initially designed IEMAS system was occasionally affected by interruption or detachment of the connecting cables, which could interfere with effective advancement of the surgical procedure. To avoid this problem a modified device was created. Its specific feature is wireless information transmitting function attained by incorporation of transmitters with a frequency range of 2.4 GHz. The clinical testing of this system was initiated on February 1, 2010, but quickly revealed crossed line effect between transmitters and receivers. To overcome this obstacle and to isolate transmitters, one channel was changed from wireless connection into wired, which resulted in significant improvement of the clearness of both transmitted images and sounds, and provides an opportunity for effective clinical use of the device. In perspective we wish to make IEMAS system fully wireless, using several types of frequency range transmitters.

Development and initial clinical testing of "OPECT": an innovative device for fully intangible control of the intraoperative image-displaying monitor by the surgeon.

BACKGROUND: During surgery, various images as well as other relevant visual information are usually shown upon request with the help of operating staff. However, the lack of direct control over the display may represent a source of stress for surgeons, particularly when fast decision making is needed. OBJECTIVE: To present the development and initial clinical testing of an innovative device that enables surgeons to have direct intangible control of the intraoperative image-displaying monitor with standardized free-hand movements. METHODS: The originally developed intangible interface named “OPECT” is based on the commercially available gaming controller KINECT (Microsoft) and dedicated action-recognizing algorithm. The device does not require any sensors or markers fixed on the hands. Testing was done during 30 neurosurgical operations. After each procedure, surgeons completed the 5-item questionnaire for evaluation of the system performance, scaling several parameters from 1 (bad) to 5 (excellent). RESULTS: During surgical procedures, OPECT demonstrated high effectiveness and simplicity of use, excellent quality of visualized graphics, and precise recognition of the individual user profile. In all cases, the surgeons were well satisfied with performance of the device. The mean score value of answers to the questionnaire was 4.7 ± 0.2. CONCLUSION: OPECT enables the surgeon to easily have intangible control of the intraoperative image monitor by using standardized free-hand movements. The system has promising potential to be applied for various kinds of distant manipulations with the displaying visual information during human activities.

Development of automatic acquisition system of surgical-instrument informantion in endoscopic and laparoscopic surgey

To compensate for severe shortage of scrub nurses, we have been developing the Scrub Nurse Robot (SNR) system that is capable of functioning as a skilled human scrub nurse, who is able to accurately predict which surgical instrument a surgeon will request next and to give it to the surgeon without any delay. In order to achieve this accurate prediction, we have been acquiring surgical-instrument information in laparoscopic and endoscopic surgery (ELS). To facilitate the acquisition, we developed an automatic acquisition system of surgical-instrument information (AASSI) using RFID technology, and evaluated it. The main components of the RFID hardware were an RFID antenna connecting to a trocar cannula and an RFID tag attaching to a surgical instrument. The AASSI detected insertion of the tagged instrument into the RFID-antenna trocar cannula and its extraction as well because the insertion started RF communication between the tag and antenna and the extraction ended the communication. However, electrocautery used frequently in ELS can interrupt the RF communication, thereby resulting in false recognition of insertion and extraction. We investigated and specified the conditions under which the electromagnetic interference occurred. Next, to prevent such incorrect recognition, we proposed a software-based solution, developed an algorithm against electromagnetic interference and verified that it worked in a laboratory setting. In conclusion, the AASSI is able to facilitate acquisition of intraoperative information on surgical instruments and also contribute to creation of extremely precise and accurate operative records.

Hybrid approach to detection of the surgeon's hand motions during endoscope surgery

Present paper explores possibilities to apply hybrid recognition technique to detect different types of surgeonss write hand motions during endoscope surgery. Proposed technique uses finite time automata which switches between three different detection techniques; neural networks based detection, statistical based method and Kohonen-map based technique. Such approach allows to avoid errors peculiar to certain technique.

Information-Guided Surgery of Intracranial Gliomas: Overview of an Advanced Intraoperative Technology

The objective of this paper is to provide an overview of advanced information-guided surgical management technology of intracranial gliomas implemented in Japan, represented by the Intelligent Operating Theater at the Tokyo Women’s Medical University, established in 2000, where more than 1000 patients with various intracranial pathology have received neurosurgical treatment with application of the intraoperative MRI, updated neuronavigation, and advanced neurophysiological and histopathological monitoring. Additionally, a dedicated computer-based system for accumulating, storing, integrating, and analyzing various surgical data was developed, which provided an opportunity for adequate risk management and prediction of the surgical results. Application of these modalities and tools led to significant improvements in both surgical outcome and long-term patients’ prognosis. Further technological developments, such as new therapeutic robot, dedicated laser, and high intensity focused ultrasound are currently under investigation. The final goal is to integrate all these devices and systems into comprehensive neurosurgical framework.

Advanced Surgical Management of Gliomas: Technological Requirements, Concept of Information-Guided Resection, and Clinical Results

Contemporary technological developments revolutionized surgical management of intracranial gliomas. In fact, decades of the previous clinical experience clearly demonstrated that in such cases routine surgical technique usually does not permit to perform aggressive resection of the lesion without significant risk of the permanent postoperative neurological morbidity. The main associated surgical problem is evident. Arising from the cerebral tissue itself the majority of these tumors has a propensity for invasive growth, therefore their boarders could not be clearly distinguished and precisely differentiated from the adjacent functionally important brain structures, which may preserve their function even in presence of tumor infiltration. It typically led to incomplete resection of the neoplasm, which, however, may have significant negative impact on prognosis. Nowadays, the availability of the intraoperative MRI (iMRI) and related updated neuronavigation permits for neurosurgeons to perform resection of glioma under precise anatomical guidance. Moreover, the efficacy and safety of surgery is further enhanced by use of comprehensive neurophysiological monitoring, cortical and subcortical brain mapping, particularly performed during awake craniotomy, neurochemical navigation with 5-aminolevulinic acid (5-ALA), and regular histopathological characterization of the resected tissue. Combined application of these techniques provides an opportunity for aggressive removal of the intraaxial brain lesions with minimal risk of neurological complications. Surgery performed under such conditions can be designated as “information-guided procedure” (Iseki et al., 2008; Muragaki et al., 2011).