{"id":112,"date":"2013-10-12T19:53:33","date_gmt":"2013-10-12T23:53:33","guid":{"rendered":"http:\/\/jhumag.dev\/?p=112"},"modified":"2014-06-04T12:32:49","modified_gmt":"2014-06-04T16:32:49","slug":"surgical-precision","status":"publish","type":"post","link":"https:\/\/engineering.jhu.edu\/magazine-archive\/2013\/10\/surgical-precision\/","title":{"rendered":"Surgical Precision"},"content":{"rendered":"

Hailed as the \u201cfather of medical robotics,\u201dRuss Taylor marries man and machine to push the boundaries of medicine.<\/em><\/p>\n

\"Hailed
Photo by Dean Alexander<\/figcaption><\/figure>\n

With a thick shock of gray hair, walrus-like mustache, and glasses perched high on his nose, Russ Taylor cuts a more-than-passing resemblance to Geppetto, the woodcarver who brought Pinocchio to life. It is an analogy that verges on metaphor. His lab, like Geppetto\u2019s studio, is a world of magic where machines come to life. Russ Taylor makes robots, but these are not your everyday Roombas. Russ Taylor\u2019s robots perform surgery.<\/p>\n

\u201cWell, that\u2019s not entirely correct. It\u2019s easy to hear the term medical robotics and think that we\u2019re creating robots that perform the surgery itself, but what we are creating are robotically assisted devices where surgeon and machine work together to do things no human or machine could do alone,\u201d says Taylor, the John C. Malone Professor in the Whiting School of Engineering.<\/p>\n

Russ Taylor is widely known as the \u201cFather of Medical Robotics,\u201d a field that didn\u2019t exist 40 years ago and in which he has become the thought leader over the last three decades.
\n\u201cI believe that robots are changing medical practice the way they changed manufacturing over the last few decades. We\u2019re creating a partnership between humans and machines that has changed how and where surgeries can be performed,\u201d Taylor says.<\/p>\n

An ever-innovating engineer fused with a pure scientist, Taylor is the sort of man who is more interested in solving a difficult technical problem than in managing the day-to-day details of business, so he\u2019s not had much interest in launching a startup company.<\/p>\n

But he has been intimately involved in helping others to commercialize the things he creates, and his work is fundamental to many of today\u2019s most advanced medical robots\u2014a multibillion dollar industry. \u201cWe like to work with companies because they have the resources and expertise to get things into widespread clinical use,\u201d Taylor says.<\/p>\n

While with IBM, Taylor led the early development of Robodoc, the first surgical robot to perform hip and knee replacement surgeries. It was the first robot to perform a significant tissue modification process. Taylor has since played a central role in the development of robots that are used in brain, spinal, eye, ear, nose, and throat surgeries, and in craniofacial reconstructions. There is virtually no area of surgery that has not been touched by medical robotics.<\/p>\n

Taylor is the first to dispense credit to his many collaborators over the years. He drops the names of his colleagues at Johns Hopkins liberally in conversation\u2014Peter Kazanzides, Greg Hager, Louis Whitcomb, Iulian Iordachita, and many more. And yet, there is no escaping the fact that Taylor\u2019s engineering DNA is present in almost every major advance in the field.<\/p>\n

\u201cRuss Taylor is a giant of medical robotics, a field he virtually created from scratch,\u201d says Louis Whitcomb, a fellow professor at the Whiting School and frequent collaborator. \u201cAnd he is\u2014with Victor Scheinman, Richard Paul, and a very few others\u2014among the handful of pioneers who created the field of robotics research in the 1970s.\u201d
\n<\/p>\n

\"NEXT
NEXT GENERATION: Taylor observes as Paul Thienphrapa (middle) and Tutkun Sen (right) manipulate a minimally invasive surgical tool. Photo by Will Kirk\/homewood.jhu.edu<\/figcaption><\/figure>\n

Steady Hands for Microsurgery<\/h2>\n

One hurdle that the field of medical robotics has had to overcome is the surgeon\u2019s natural reluctance to cede control of the actual surgical device. Over time, surgeons are more likely to accept robotic assistance if they are still allowed to directly manipulate the instruments.
\n\u201cSo we developed a tool where both the robot and the surgeon manipulate a single tool together,\u201d says Taylor, referring to the \u201csteady-hand\u201d robots he\u2019s pioneered for microsurgery, which quell the natural tremors of even the surest surgical hand.<\/p>\n

The steady-hand robot senses forces exerted by the surgeon on the tool handle and moves to comply with the surgeon\u2019s wishes. The robot performs actual motion. The robot can also enforce safety barriers beyond which the surgical tool cannot go, in order to prevent surgical errors. Taylor refers to these as \u201cvirtual fixtures.\u201d The tool can likewise control the amount of force exerted by surgical tools on delicate tissues.<\/p>\n

\u201cSteady-hand eliminates the tremors. This can help surgeons perform current procedures and can enable them to perform procedures that are currently impossible for even the most expert surgeons,\u201d Taylor notes.<\/p>\n

There is a strong data component running throughout Taylor\u2019s work. Every movement during the surgery is recorded and folded into a database to improve the next similar surgery down the line. This reflects a tight synergy between technology and big data. \u201cComputers can help plan, perform, and verify what\u2019s been done in the operating room,\u201d Taylor says, likening the data capture function of his robots to the black-box flight data recorders found on airplanes.
\n\u201cWe\u2019re capturing data so that the surgeon knows what he or she did,\u201d Taylor says. \u201cYou can compare outcomes and improve surgical processes and improve consistency.\u201d<\/p>\n

Johns Hopkins ophthalmologist James Handa has worked with Taylor on systems to perform retinal surgery, and he is a true believer. \u201cWith Russ, not only have the robots transformed the way we do surgery, but the complete systems that he and the team have developed provide very detailed feedback that allows us to develop a more precise language for describing surgeries,\u201d says Handa, the Robert Bond Welch Professor of Ophthalmology at the Johns Hopkins School of Medicine. \u201cI think this will actually have its greatest benefit in surgical education and evaluation. The average surgeon can become excellent. The excellent surgeon can go where no one has gone before.\u201d<\/p>\n

Although Taylor and his colleagues have used the steady-hand concept for many applications\u2014including sinus, brain, ear, and orthopedic surgeries\u2014one of the most challenging environments is the human eye. Retinal surgeries are common to remove scar tissue, lesions, and tumors, or to inject drugs directly into diseased areas that would otherwise be out of reach of pharmaceuticals.<\/p>\n

As one might imagine, surgery in the eye is delicate work. The structures of the eye are almost incomprehensibly fragile, minute, and inaccessible. The price of an error is great. The retina does not regenerate. A mistake could cost the patient his or her eyesight.<\/p>\n

It takes just 7.5 millinewtons of force to tear the retina, Taylor says, an amount considerably below the amount the human hand can sense. His robots can provide the surgeon with that degree of feel. Likewise, his systems can help the surgeon see better, as well. A typical procedure could involve the removal of scar tissue on the retina, which might be just a thousandth of an inch thick, so small that the surgeon has difficulty even seeing the edge between the membrane and the retina.<\/p>\n

\u201cWe can sense where that edge is using an optical coherence tomography sensor built into the surgeon\u2019s tools and show him or her where to grasp the edge,\u201d he says. Taylor likens the problem to peeling sticky tape off tissue paper without tearing the paper.<\/p>\n

Few surgeons in the world have the dexterity to operate freehand in such an environment. Even the very best surgeons experience some degree of hand tremors, which severely limit
\nsurgical options and slow procedures to a crawl. Even when the surgeon can position an instrument with accuracy, doing so repeatedly and maintaining position for long periods of time become harder every minute a surgery drags on.<\/p>\n

\u201cThere is a limit of about 50 microns below which microsurgeons cannot insert needles into the small blood vessels of the retina,\u201d Handa says. \u201cThe robot can help breach that threshold and also help the surgeon keep the tiny needle inserted for extended periods of time.\u201d
\n<\/p>\n

\"TEST
TEST TIME: Taylor tests a new robot that will eliminate hand tremor in head-and-neck surgery. Photo by Will Kirk\/homewood.jhu.edu<\/figcaption><\/figure>\n

Robotic Minimally Invasive Surgery<\/h2>\n

Taylor has similarly helped develop robotic systems that are designed to be minimally invasive to reduce incisions, pain, blood loss, and scarring, while producing faster recoveries.
\nOne example sits in the Swirnow Mock Operating Room set up in a glassed-in room at Hackerman Hall on the Homewood campus. Passersby can watch Johns Hopkins surgeons honing their incising, retracting, clamping, and suturing skills on a da Vinci Surgical System, a commercial robot manufactured by Intuitive Surgical, which employs several of Taylor\u2019s IBM patents. Da Vinci allows complex and fine surgical operations to be performed laparoscopically with only a few tiny incisions.<\/p>\n

Sometimes the surgeons in the mock operating room practice on animal tissue, other times they work on an array of colorful rubber dollops meant to represent the surgical targets the surgeons might encounter in an actual surgery. Taylor refers to the colorful practice environment as \u201cWhoville.\u201d<\/p>\n

The robotic end of da Vinci has four arms that control various medical instruments. One arm positions a stereoscopic endoscope that allows the surgeon to see in three dimensions. The other three are fitted with medical tools as needed\u2014scalpels, scissors, forceps, retractors, and the like. With finely pointed ends and fully articulated wrists, elbows, and shoulders, da Vinci\u2019s instrumented arms come to resemble the forelegs of one of Maryland\u2019s famed blue crabs\u2014but with pincers much smaller than its crustacean counterpart.<\/p>\n

The surgeon\u2019s hands never touch the instruments. In fact, the surgeon sits across the operating room peering into a specially designed stereoscopic microscope that resembles an oversized View-Master of old. The images the surgeon sees are fed from an endoscope inside the patient and projected on high-definition screens, one screen per eye, that allow the surgeon to see in three dimensions and at 10-times magnification what the machine sees inside the body.<\/p>\n

Directly below the viewfinder, the thumbs, index, and middle fingers of both the surgeon\u2019s hands control electromechanical arms that sense the surgeon\u2019s every move, conveying that information through the robot\u2019s central processor to a second machine that performs the surgery at the other side of the room. The da Vinci essentially uses the motion of the control handles to control the action of the surgical tools held by the manipulator on the patient side of the robotic system. In robotics, this two-tiered system is known as telerobotics.
\nTaylor\u2019s research interest in the da Vinci is in finding ways to exploit the fact that there is a computer between the surgeon and the surgeon\u2019s instruments to create a human-machine partnership to improve surgery.<\/p>\n

\u201cThe humans provide judgment and intelligence. The robots allow surgeons to transcend human physical limits, providing an order-of-magnitude greater sensitivity than even the best surgical hand can feel. Together, they make surgery less invasive, more precise, more consistent, and safer,\u201d Taylor says.<\/p>\n

Taylor and his colleagues have also explored similar ideas for other robotic systems. They have used a da Vinci master console to control one of their eye surgery robots with the idea of enabling an expert surgeon to assist a surgeon-in-training. Although the robots are mostly intended for use where both surgeons are at the same location, there are other possibilities on the horizon.<\/p>\n

\u201cSuch robots will also enable advances in so-called telesurgery,\u201d Handa says. \u201cI might be able to assist a surgeon in South America by using a robot here in Baltimore, initiating and guiding movements half a world away.\u201d<\/p>\n

Another of Taylor\u2019s minimally invasive surgical projects is a new collaboration with Vanderbilt University and Carnegie Mellon University funded by the National Science Foundation. In this effort Taylor and his collaborators\u2014including his former postdoc, the principal investigator Nabil Simaan, now of Vanderbilt\u2014will create a new paradigm in robotics known as \u201ccomplementary situational awareness.\u201d In this concept, the robot will take in sensory information as it performs surgery and use that information to build up a computer representation of the patient that can be used to help the surgeon perform the task. One of the robots for this project is based on a highly dexterous snake-like prototype that Simaan and Taylor developed at Johns Hopkins.
\n<\/p>\n

\""Russ
“Russ Taylor is a giant of medical robotics, a field he virtually created from scratch.” -Louis Whitcomb. Photo by Will Kirk\/homewood.jhu.edu<\/figcaption><\/figure>\n

A Life in Engineering<\/h2>\n

Taylor\u2019s remarkable professional achievements are evident in a flip through his curriculum vitae, which stretches 44 pages. There are the requisite journal articles\u201495 at last count\u2014and another 249 refereed conference papers. There are the invited colloquia. There is, of course, a textbook, Computer-Integrated Surgery, as well as chapters in numerous others. Taylor owns or shares at least 30 patents, with more pending.<\/p>\n

Taylor has helped raise untold millions in research funding, most notably the roughly $30 million National Science Foundation grant that underwrote the Engineering Research Center on Computer-Integrated Surgical Systems and Technology (CISST ERC) that he now directs at the Whiting School.<\/p>\n

Staggering as that total is, it doesn\u2019t include another $35 million of additional funding raised for the center, or the $14 million or so of in-kind contributions that bring total funding for CISST to a whopping $79 million. He is also the director of the Laboratory for Computational Sensing and Robotics, which does about $4.3 million per year in sponsored research.<\/p>\n

The accolades have flooded in, too. He is a fellow of the IEEE, among the highest honors in engineering. He has won the Robotics and Automation Society Pioneer Award \u201cfor pioneering work in medical robotics\u201d and the Third Millennium Medal from the IEEE, as well as the Enduring Impact Award from the Medical Image Computing and Computer Assisted Surgery (MICCAI) Society. And he is a fellow of the Engineering School of the University of Tokyo.<\/p>\n

\u201cRuss Taylor is ahead of his time not only because he invents things that no one ever imagined, but also because he realizes things other people have imagined but believed were impossible,\u201d says Greg Hager, who has collaborated with Taylor on numerous engineering efforts at the Whiting School. \u201cHe has a unique sort of brilliance to be able to imagine where he wants to go and to know how to assemble the pieces\u2014in this case experts from various disciplines\u2014that can make a thing real. Russ connects the dots.\u201d<\/p>\n

The professional standing so apparent in the rewards and recognition and in the praise of his colleagues invites the question: What led Russ Taylor into medical robotics in the first place?<\/p>\n

Taylor earned an interdisciplinary undergraduate engineering degree at Johns Hopkins University back in 1970 before heading to Stanford University for his doctorate. His dissertation, written in 1976, focused on methods for combining sensing and programming to enable not-so-accurate robots to perform very precise tasks such as mechanical assembly. That work led to a job in research at IBM, where he rose through the ranks working on automated systems, mostly for manufacturing applications. He eventually became a middle manager in the Research Division at IBM.<\/p>\n

Taylor has a picture on his wall of his first \u201crobot.\u201d It looks like a glorified workbench with an arcade-game-style pincher device at the end of a rigid arm suspended from above on a movable track.<\/p>\n

In the late 1980s, two surgeons from the veterinary school at the University of California, Davis, approached IBM about developing a robot that could help them in hip replacement surgery. The two wondered if IBM could create a surgical robot that would help them make the procedure more exact.<\/p>\n

At this point in his story, Taylor rises from his desk and goes to a box of assorted medical instruments. He shuffles through the synthetic bones, medical instruments, and other paraphernalia of his profession, talking all the while. He produces a large piece of inscrutable dull-gray metal. It looks like a stake for a circus tent. It looks positively medieval.<\/p>\n

\u201cDo you know what this is?\u201d he asks. \u201cThis is a standard instrument for hip replacement surgery. The surgeon cuts off the top part of the femur and pounds this in with a hammer to make a hole the shape of the implant,\u201d Taylor says. \u201cIt\u2019s a rather ungraceful and inexact way to seat an implant, don\u2019t you think? Plus, there is about a 5 percent chance of cracking the femur for cementless implants, where the implant must fit the hole exactly.\u201d<\/p>\n

Thus was born IBM\u2019s Robodoc, Taylor\u2019s first venture into medical robotics. In Robodoc, the surgeon uses CT images of the patient\u2019s femur to select an appropriate implant and plan where it is to be placed. In the operating room, the surgeon does most of the procedure manually, but the robot moves a surgical cutter to ream a cavity in the bone that is almost an exact match for the implant shape. This ensures that the implant is placed exactly where the surgeon wants it to go and improves the grafting of the implant into the patient\u2019s bone. The process is also less likely to produce an accidental fracture of the bone.<\/p>\n

\u201cI hated the name, but Robodoc was and is a good system,\u201d he says.<\/p>\n

One of the surgeons, Howard Paul, was a veterinarian, and Taylor led an IBM\/UC Davis team that produced a prototype system for use on Paul\u2019s animal patients. Subsequently, a company was formed to produce a version of Robodoc for use on humans.<\/p>\n

Fearing the confines of working at a startup, however, Taylor instead built a research group within IBM to support the Robodoc company and to develop novel robots for minimally invasive surgery. He formed collaborations with several leading medical schools, including Harvard, New York University, and Johns Hopkins.<\/p>\n

After a few years, he realized that it would be much easier to pursue his vision if he were in the same institution as the surgeons who were using his technology. Taylor searched for a university, preferably on the East Coast, with both a top engineering school and a top medical school. Ultimately, there was no better fit than his undergraduate alma mater, Johns Hopkins.
\n\u201cThere was no place more ideal for me. The faculty of the engineering school is just incredible. The medical school is second to none. It was the absolute best place for me and what I do,\u201d Taylor explains.<\/p>\n

One factor he likes in particular about the camaraderie at Johns Hopkins is the presence of undergraduates in advanced research labs. There are few other institutions that do as good a job in teaching undergraduates by involving them in research, says Taylor, who says he himself profited greatly by his own undergraduate research work with Mandell Bellmore, in the Operations Research Department at Johns Hopkins.<\/p>\n

\u201cIt\u2019s an amazingly easy place to work, where everyone has this shared passion for what we do and there is little departmental friction to stand in the way of cutting-edge research,\u201d Taylor says.<\/p>\n

Though older now, Taylor still seems just as curious as a grad student and excited at the thought of what lies ahead.<\/p>\n

Medical robotics remains far from perfect, says Taylor, and many challenges still stand in the way. In particular, he is intent on refining his instruments to work in ever-smaller places at the extreme edge of scale.<\/p>\n

\u201cThere\u2019s more work to be done, for sure,\u201d Taylor says, as he provides a guided tour around his lab.<\/p>\n

During the tour he seems a bit whimsical showing off all the latest things he\u2019s working on and a few he worked on long ago. He describes in detail the particular talents and peculiarities of each robot. He gestures to each affectionately, as if to a child. In this moment, Russ Taylor is every bit the Geppetto, and each robot a Pinocchio\u2014machines dreamed up and brought to life by a master artisan.<\/p>\n","protected":false},"excerpt":{"rendered":"

Hailed as the \u201cfather of medical robotics,\u201dRuss Taylor marries man and machine to push the boundaries of medicine. With a thick shock of gray hair, walrus-like mustache, and glasses perched high on his nose, Russ Taylor cuts a more-than-passing resemblance to Geppetto, the woodcarver who brought Pinocchio to life. It is an analogy that verges…<\/p>\n","protected":false},"author":4,"featured_media":541,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[28],"tags":[],"class_list":["post-112","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-features","issue-winter-2014"],"acf":[],"yoast_head":"\nSurgical Precision - JHU Engineering Magazine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/engineering.jhu.edu\/magazine-archive\/2013\/10\/surgical-precision\/\" \/>\n<link rel=\"next\" href=\"https:\/\/engineering.jhu.edu\/magazine-archive\/2013\/10\/surgical-precision\/2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Surgical Precision - JHU Engineering Magazine\" \/>\n<meta property=\"og:description\" content=\"Hailed as the \u201cfather of medical robotics,\u201dRuss Taylor marries man and machine to push the boundaries of medicine. 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