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CASIT dry laboratory suite
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The Administrative and Dry Laboratory Suite
The administrative and dry lab suite represents the Surgical Education and Resource Center and is a key component of CASIT. Here, new ideas are explored, and beta testing of new technology for the operating rooms takes place, as do research and teaching programs. It also serves as the Center for State-of-the-art Video Conferencing and Telecommunications. Offices for fellows, engineering Ph.D. candidates, technicians, and engineers from industry are located here.
The cross-disciplinary nature of CASIT unites physicians, surgeons, laboratory investigators, biomedical engineers, computer scientists, physicists, operating room personnel, and corporate partners as well as communications experts who will interface in the Center. This endeavor will extend through all the Health Sciences, across campus, and beyond the University.
The Gonda/UCLA Robotic Surgery Center
Through a generous gift from the Gonda Family Foundation, CASIT was able to purchase two surgical robots from Intuitive Surgical. The surgeons and operating room nurses then underwent training in the use of the Da Vinci robots, and after the training was completed, they were able to begin the use of the Da Vinci robot in the operating room in spring 2004. Robotic procedures are now performed almost daily. Pre-clinical testing is being performed in Liver Surgery and Vascular Surgery. A second Da Vinci robot is used in the administrative dry lab for research programs, training, and teaching.
The Da Vinci robot has the advantage of three-dimensional vision, improved ergonomics, a software system that eliminates tremor, and the ability to significantly magnify the surgical field through a 3D image. The end-effecter instruments have seven degrees of freedom, which essentially means that a small 3 or 4 mm instrument can make all the movements of the human hand in a very small space. This capability greatly improves dexterity for surgeons and also allows them to do things they cannot do without the robot and to go places that were not possible before.
However, the current system is not perfect. It lacks haptic or tactile feedback and the ability to do telesurgery or remote surgery. Several of the CASIT research programs are designed to improve the Da Vinci robot platform in order to provide better image-directed surgery, simulation, augmented reality, and better tactile feedback. These developments require the use of microfabrication and nanotechnology, which are being developed in collaboration with the California Nanosystems Institute (CNSI) and UCLA Department of Bioengineering. The Center is exploring innovative approaches such as microelectromechanical systems (MEMS) located at the tips of the endoscopic instruments to detect tissue density, the adoption of 3D ultrasound, Doppler blood flow, microrobots to operate in cramped anatomical regions, and data mapping with a surgical robot to simulate an operation preoperatively.
Integrated Operating Rooms
The new interventional suite design (see video) will feature all traditional surgical disciplines as well as interventional radiology, interventional cardiology, and other medical interventional units in the same geographical area. Dr. James B. Atkinson, chair of the committee to design the new interventional suites, working with our corporate partners, was able to conceive and develop several new innovations, which include integration of all devices and technologies from the different companies. In addition, the operating room will be connected to surgeons’ offices by way of an internet connection, such that a surgeon can observe an operation and talk to the operating surgeon from his office or even from more remote sites.
Dr. Atkinson and his colleagues created a linkage between the technologies of the various companies. They established an academic neutral ground for industry to partner with the medical school and Bioengineering to fashion a seamless linkage between existing technologies and to test innovative concepts, ideas, and products. Industry partners have agreed to a completely open architecture, so that all devices will be served by one central computer mainframe. Therefore, by working with the vendors, CASIT was able to construct a highly integrated surgical suite, using common electrical communication connections for all devices within the operating room.
UCLA surgeons have relied heavily on Karl Storz Endoscopy’s OR1 concept in designing the new operating room. One of the many contributions of Karl Storz Endoscopy is an integrated system for video display with 18-inch flat-panel displays, with a wide range of video sources that can be selected for display, recording, archiving, and distribution. Hospital information can be viewed and accessed instantaneously, including PACS images, patient vital signs, and visuals of the operative field. In addition, images can be distributed throughout the operating room and various remote locations. Wireless and wired microphones are provided to support functions that require voice pick-up, such as audio conferencing, video conferencing, and voice note recording.
The graphical user interface, which includes 18-inch LCD flat-panels, will be located at the nurses station, and others will be mounted on a boom in the operative field. All features and functions can be independently accessed from either location. Other technologies available are telestration, screen splitter function that allows the viewing of up to four images at once, and a pre-set store and recall, which includes snapshots of current routing conditions. These technologies can be integrated with other vendors, including BrainLab’s Vector Vision Surgical Navigation System, the Intuitive Da Vinci Surgical Robotic System, the Berchtold system, and the BK Medical 3D Ultrasound.
Instead of running electrical cords along the floor to different outlets, the new surgical suites collect all the wires in booms that move within a large radius around the OR during surgery and can be docked away from the table when they are not needed. In keeping with the overall design concept, every piece of equipment is powered from the ceiling through the booms. Every room can be reconfigured for whatever type of operation will be performed. Through the efforts of CASIT, several corporate vendors are working together and building a relationship that cuts across proprietary lines. Karl Storz has integrated products from several vendors, including media recording devices, lighting systems, and medical equipment in one user interface, so surgeons can reconfigure a room for general or vascular surgery or urology and adjust the fine details of the operating room milieu.
As CASIT continues to work with its vendors in the dry lab, surgeons anticipate that they will develop, in the future, a true open-architecture controlled system, providing seamless integration of all technologies that exist within the operating room regardless of the vendor. Centralized campus-wide communication systems will allow for direct transfer to and from all departments, and direct access from the OR for retrieval and input to patient records and billing will be done wirelessly. Workflow and reporting systems can be integrated into the component of the Karl Storz OR1 system. All of these new technologies will move CASIT closer and closer to an error-free operating room and an error free hospital, and will eventually result in not only improved surgical results, but also lower costs for surgical procedures.
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