BW Online | December 13, 2000 | This Robot Turns out Cutting-Edge Surgeons

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DECEMBER 13, 2000

FROM LE MONDE INTERACTIF

This Robot Turns out Cutting-Edge Surgeons
Xitact's Virtual Patient, a computer-driven simulation of the human body, makes it simple and safe for doctors to perfect difficult techniques

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Everybody knows that practice makes perfect -- and few occupations demand quite as much perfection as surgery. Thanks to new techniques like endoscopic surgery, which involves long optical tubes threaded into the body, surgeons face the daunting challenge of performing difficult and precise moves while working with a limited sense of touch and only those visual cues that can be gleaned from a video screen.

That's why Swiss company Xitact has been at work since 1992 to develop its Virtual Patient, a robot-based training system that allows surgeons to perfect their techniques with complete safety. Its human-like characteristics not only replicate the surgical "feel" of a flesh-and-blood subject but Virtual Patient can simulate a variety of complications to make the experience even more realistic.

PROBING ORGANS. By manipulating tools attached to the robot, surgeons can observe their own moves -- and their mistakes -- on a screen. And thanks to the robot's sophistication, they can even experience the simulated resistance of virtual organs being probed with a variety of instruments. "It is, in fact, the robot that holds the surgeon's hand," quips Ronald Vuillemin, a member of the Xitact team that developed the simulation device.

Xitact's technology, which this year won a [European] Information Society Technologies Prize, taps enormous databases to update graphic anatomical images in real time from every possible angle. "This database was created using scans," explains Vuillemin. "The computers then handle the information using different mathematical algorithms according to how the robot is being manipulated. Our secret actually lies in the algorithms."

The system is fine-tuned to the extreme. At any given moment, it is able to calculate different positions, to know if an instrument is actually touching an organ, gliding gently over it, or pressing a little harder and actually cutting through the surface. As the surgeon makes his moves, the images are constantly renewed on the screen.

"LIVE TEXTURING." While there are other virtual reality environments, Xitact's stands apart. "First of all," explains Vuillemin, "our computers are powerful enough to create 25 images per second, which is necessary to obtain an illusion." That's only the start of the robot's wonders. "Surgeons need to see the texture of organs," Vuillemin adds. "We have, therefore, used an approach called 'live texturing,' by which we insert sequences of live videos into our synthetic images."

The user manipulates up to four instruments attached to the robot, which reproduces the reactions of organs and generates an uncanny tactile sense. "At each instant, the computer calculates the position of the tool and according to the parameters that have been recorded in the database, it determines the pressure that should be applied in return," says Vuillemin. "The difficulty was that we had to make the robot be able to react quickly and be capable of applying both soft and hard pressure, depending on whether the surgeon is cutting a thin membrane or lifting an organ that weighs three kilograms."

Over time, thanks to scanning techniques and X-ray photography, it will be possible to adapt databases to an individual patient's specific characteristics -- another virtual step along road to true perfection.