RICERCA ITALIANA     

Centro per l'Innovazione Tecnologica in Chirurgia (Centro I.T.C.)

Università degli Studi di Napoli "Federico II"

Principal Investigator

Giovanni PERSICO Università degli Studi di NAPOLI "Federico II"

Research Objectives

IntroductionMinimally invasive video-assisted surgery is a revolutionary approach in different surgical specialties. This kind of surgery is performed inserting surgical instruments and optical devices, inside the patient, through small incisions to obtain the same results that can be obtained from the wide incisions of the open surgery techniques.The use of minimally invasive video-assisted surgery gives as a result the minimization of the surgical trauma and damage of the healthy tissues leading to a shorter ospedalization and shorter recovery time. The disadvantages of the technique are: the need of a major manual skill, the discomfort for the position of the operator and the reduced sensory input to the surgeon which is only available through a single video image. The application of minimally invasive robotic devices can avoide some of these disadvantages allowing wider fields of application and better results. Robotics becomes part of this surgical discipline as an integration between mechanics, electronics, computer science, sensorystic and controlistic, useful for the development of the motion control of the robotic devices , for the manipulation of the optical devices and for the positioning of the devices. Robotic science offers an aid to surgery through the precision, repeatibility and documentability of the procedures. A second aspect regards (by the new communication technologies such as cable, satellite or even modem) the possibility of controlling the robotic devices from a remote position(robotic tele-surgery). Telesurgery, today, offers amazing possibilities due to the fact that the transmission of data, images, and control is available in very short time and even with a long distance between the operators and manipulators . Telesurgery, on the other hand, requires a great skill and precision: the main character is the patient, a man, so any procedures led through the robotic device requires maximum reliability. Third relevant aspect of telerobotic surgery is the possibility of allowing remote operators to interact (knowledge share) in an integrated network (each one in front of is terminal can interact with the others and act through the robot) and also to be an aid to surgery in high risk operations where the interaction between operator and patient can be dangerous or risky: patient with infective diseases (AIDS, hepatitis ecc…), patients exposed to radiations or patients in hazardous envivironments (islands, war zones, airplanes, space ships…).Short and long term objectivesThe development of the minimally invasive surgery structure equipped with the instruments and the knowledge for robotic and telerobotic applications, is a critical point for advanced technologies. With the birth of the ITC Centre (Technical innovations in surgery) we are willing to create an appropriate environment for the excellence applicant groups, catalysing the tight junction between human and technological resources, to develop the application of robotics to the various surgical specialities.The four levels on which the activities of the Centre will develop will be the applications of Computer aided surgery in Laparoscopy , Orthopedic surgery, Neurosurgery and Intraopertaive Diagnostic and Therapeutic Radiation Adoption. Robotic surgery represents the common base for the approach and the modulation of surgical procedures developed by the applicants. Computer assisted experimental microsurgery represents the base for the inter-/intra- disciplinary research that will draw the pathway for the development of applicative surgical areas. The activities of the ITC Centre will base on the past experience of the applicants, who have an old tradition of collaboration and on the development of technological procedures through the verification of experimental models.The centre will, as a first objective, offer a context of "high technology" to the applicants, equipped with the available technologies and the ones that will be acquired with the help of MIUR and from the interaction of Universitary and not-Universitary structures, collaborating with the Centre (scientific and industrial). On this high-tech basis, fixed the ‘know-how' and the evaluation methods for the various softwares the Centre will conduct transdisciplinary research in the field of robotic surgery, using as main approach the video assisted surgery. Within this objective we will develop two areas of technological development.- A first objective is to acquire instruments to verify the possibility of applying telesurgery to the most common surgical procedures, to research the sentnel node and to apply IORT for locally abdominal advanced primary or recurrent tumours affected patients for improving local control of disease and increasing their survival and quality of life;- A second technological area, we are willing to develop, aims to integrate diagnostic procedures (US, TC, RM, virtual-TC, 3D imaging ecc..) with video-assisted surgery therapeutic solutions (abdominal, orthopedic , neurological, experimental ecc..). Moreover, to verify the real application of the IORT because some phase-II studies point out a relevant advantage of such method along with conventional therapeutic approaches. The structure of the centre and the qualification of the applicants will allow an interactive development between, clinical research and experimental research (with the help of the knowledge offered by faculties of engineering and veterinary), in critical sectors like neuro-surgery and oncological-surgery.Major attention will be given to the interaction and industrial transfering with the field of national productive biomedics, through patents and creations finalized to the market; all this will place the Centre in an industrial and scientific partnership position.Other objective of the Centre will be the development of Virtual reality simulators for minimally invasive surgery. The aquisition of the laparoscopic procedures is surely more difficult than the ‘open' tecnique. Nowadays surgery schools have long and elaborated training courses in the surgery room that eaven if organized with rules and procedures, increases the risk for the patient and increases the leangth of the operation and the costs too. Experimental training on different animals is expensive and cannot riproduce the human anatomy but can only be usefull to improve dextrity and skill of the surgical gesture. Computer assisted training has many advantages: it's interactive, the presence of the tutor is necessary but not indispensable so it can be done in free time, it is possible to simulate anatomo-pathological situations, normal or abnormal. Positions and movements can be recorded for a successive evaluation of the learning and the skill aquired.Anatomical view can be the same of a real operation or programmed to give different points of view from different angles.Third objective of the Centre is to transfer the knowledge and the instruments inside the Centre itself.- A first transferring effort will have as main object the utilization in surgery of the knowledge and the skill gained inside the Centre- A second direction will be towards Industrial partners. Applicant groups have already spotted individual industrial partners interested in the development of the application of tele-robotic surgery in specific fields through finalized investiments software and devices patents compatible with the market of video-assisted surgery. Giving particular attention to the applicative side of the project, the ITC Centre wills to become a catalyser for new projects to submit to the biomedic industryOther medium-term objectives of the Centre are:a) high-level training of clinical and research staff (graduated), with specific knowledge in video-assisted surgery.b) Recruitment of young group-leaders that can start clinical and experimental research within the Centre. <<<