Robotically assisted eye surgery : a haptic master console

Vitreo-retinal surgery encompasses the surgical procedures performed on the vitreous humor and the retina. A procedure typically consists of the removal of the vitreous humor, the peeling of a membrane and/or the repair of a retinal detachment. Operations are performed with needle shaped instruments which enter the eye through surgeon made scleral openings. An instrument is moved by hand in four degrees of freedom (three rotations and one translation) through this opening. Two rotations (? and ? ) are for a lateral instrument tip movement. The other two DoFs (z and ?) are the translation and rotation along the instrument axis. Actuation of for example a forceps can be considered as a fifth DoF. Characteristically, the manipulation of delicate, micrometer range thick intraocular tissue is required. Today, eye surgery is performed with a maximum of two instruments simultaneously. The surgeon relies on visual feedback only, since instrument forces are below the human detection limit. A microscope provides the visual feedback. It forces the surgeon to work in a static and non ergonomic body posture. Although the surgeon’s proficiency improves throughout his career, hand tremor may become a problem around his mid-fifties. Robotically assisted surgery with a master-slave system enhances dexterity. The slave with instrument manipulators is placed over the eye. The surgeon controls the instrument manipulators via haptic interfaces at the master. The master and slave are connected by electronic hardware and control software. Implementation of tremor filtering in the control software and downscaling of the hand motion allow prolongation of the surgeon’s career. Furthermore, it becomes possible to do tasks like intraocular cannulation which can not be done by manually performed surgery. This thesis focusses on the master console. Eye surgery procedures are observed in the operating room of different hospitals to gain insight in the requirements for the master. The master console as designed has an adjustable frame, a 3D display and two haptic interfaces with a coarse adjustment arm each. The console is mounted at the head of the operating table and is combined with the slave. It is compact, easy to place and allows the surgeon to have a direct view on and a physical contact with the patient. Furthermore, it fits in today’s manual surgery arrangement. Each haptic interface has the same five degrees of freedom as the instrument inside the eye. Through these interfaces, the surgeon can feel the augmented instrument forces. Downscaling of the hand motion results in a more accurate instrument movement compared to manually performed surgery. Together with the visual feedback, it is like the surgeon grasps the instrument near the tip inside the eye. The similarity between hand motion and motion of the instrument tip as seen on the display results in an intuitive manipulation. Pre-adjustment of the interface is done via the coarse adjustment arm. Mode switching enables to control three or more instruments manipulators with only two interfaces. Two one degree of freedom master-slave systems with force feedback are built to derive the requirements for the haptic interface. Hardware in the loop testing provides valuable insights and shows the possibility of force feedback without the use of force sensors. Two five DoF haptic interfaces are realized for bimanual operation. Each DoF has a position encoder and a force feedback motor. A correct representation of the upscaled instrument forces is only possible if the disturbance forces are low. Actuators are therefore mounted to the fixed world or in the neighborhood of the pivoting point for a low contribution to the inertia. The use of direct drive for ' and and low geared, backdriveable transmissions for the other three DoFs gives a minimum of friction. Disturbance forces are further minimized by a proper cable layout and actuator-amplifier combinations without torque ripple. The similarity in DoFs between vitreo-retinal eye surgery and minimally invasive surgery (MIS) enables the system to be used for MIS as well. Experiments in combination with a slave robot for laparoscopic and thoracoscopic surgery show that an instrument can be manipulated in a comfortable and intuitive way. User experience of surgeons and others is utilized to improve the haptic interface further. A parallel instead of a serial actuation concept for the ' and DoFs reduces the inertia, eliminates the flexible cable connection between frame and motor and allows that the heat of the motor is transferred directly to the frame. A newly designed z-?? module combines the actuation and suspension of the hand held part of the interface and has a three times larger z range than in the first design of the haptic interface

Neurophysiological models of gaze control in Humanoid Robotics

This work present a robotic implementation of a neurophysiological model of rapid orienting gaze shifts in humans, with the final goal of model parameters validation and tuning. The quantitative assessment of robot performance confirmed a good ability to foveate the target with low residual errors around the desired target position. Furthermore, the ability to maintain the desired position was good and the gaze fixation after the saccadic movement was executed with only few oscillations of the head and eye. This is because the model required a very high dynamic. 9.1. Robotic point of view The head and eye residual oscillations increase linearly with increasing amplitude. In Fig. 16 is evident that the residual gaze oscillation is less than head. This is explained with the compensation introduced by the eye oscillations which compensate the gaze which becomes more stable. We explain these findings by observing that the accelerations required to execute (or stopand-invert) the movement are very high especially for the eye movement. Even if the robotic head was designed to match the human performances (in terms of angle and velocities) in its present configuration it is still not capable produce such accelerations. This is particularly evident for the movement of the eye because the motor has to invert its rotation when the fixation point is first achieved. With respect to the timing of the movement it has been found that the results of the experiments are in close accordance to the data available on humans (Goossens and Van Opstal, 1997). The same conclusion may be drawn for the shapes of the coordinated movement that can be directly compared to the typical examples reported in Fig. 14. Figure 16, 17 show that the model is capable of providing inadequate control of the redundant platform. The system response is very fast, due to the robotic head platform design. TGst time take into account the problem of eye-head coordination and the very high acceleration. The head is voluntarily delayed less than 30 millisecond after eye movement, according to human physiology, by means of Ph block (Goossens and Van Opstal ,1997). 9.2. Neurophysiological point of view A typical robotic eye-head movement is shows in Fig. 14

A Portable Bio-Inspired Architecture for Efficient Robotic Vergence Control

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Design, Control, and Evaluation of a Human-Inspired Robotic Eye

Schulz S. Design, Control, and Evaluation of a Human-Inspired Robotic Eye. Bielefeld: Universität Bielefeld; 2020.The field of human-robot interaction deals with robotic systems that involve humans and robots closely interacting with each other. With these systems getting more complex, users can be easily overburdened by the operation and can fail to infer the internal state of the system or its ”intentions”. A social robot, replicating the human eye region with its familiar features and movement patterns, that are the result of years of evolution, can counter this. However, the replication of these patterns requires hard- and software that is able to compete with the human characteristics and performance. Comparing previous systems found in literature with the human capabili- ties reveal a mismatch in this regard. Even though individual systems solve single aspects, the successful combination into a complete system remains an open challenge. In contrast to previous work, this thesis targets to close this gap by viewing the system as a whole — optimizing the hard- and software, while focusing on the replication of the human model right from the beginning. This work ultimately provides a set of interlocking building blocks that, taken together, form a complete end-to-end solution for the de- sign, control, and evaluation of a human-inspired robotic eye. Based on the study of the human eye, the key driving factors are identified as the success- ful combination of aesthetic appeal, sensory capabilities, performance, and functionality. Two hardware prototypes, each based on a different actua- tion scheme, have been developed in this context. Furthermore, both hard- ware prototypes are evaluated against each other, a previous prototype, and the human by comparing objective numbers obtained by real-world mea- surements of the real hardware. In addition, a human-inspired and model- driven control framework is developed out, again, following the predefined criteria and requirements. The quality and human-likeness of the motion, generated by this model, is evaluated by means of a user study. This frame- work not only allows the replication of human-like motion on the specific eye prototype presented in this thesis, but also promotes the porting and adaption to less equipped humanoid robotic heads. Unlike previous systems found in literature, the presented approach provides a scaling and limiting function that allows intuitive adjustments of the control model, which can be used to reduce the requirements set on the target platform. Even though a reduction of the overall velocities and accelerations will result in a slower motion execution, the human characteristics and the overall composition of the interlocked motion patterns remain unchanged

Physiological Targets of Artificial Gravity: The Sensory-Motor System

This chapter describes the pros and cons of artificial gravity applications in relation to human sensory-motor functioning in space. Spaceflight creates a challenge for sensory-motor functions that depend on gravity, which include postural balance, locomotion, eye-hand coordination, and spatial orientation. The sensory systems, and in particular the vestibular system, must adapt to weightlessness on entering orbit, and again to normal gravity upon return to Earth. During this period of adaptation, which persists beyond the actual gravity-level transition itself the sensory-motor systems are disturbed. Although artificial gravity may prove to be beneficial for the musculoskeletal and cardiovascular systems, it may well have negative side effects for the neurovestibular system, such as spatial disorientation, malcoordination, and nausea

Oculomotor responses and 3D displays

This thesis investigated some of the eye movement factors related to the development and use of eye pointing devices with three dimensional displays (stereoscopic and linear perspective). In order for eye pointing to be used as a successful device for input-control of a 3D display it is necessary to characterise the accuracy and speed with which the binocular point of foveation can locate a particular point in 3D space. Linear perspective was found to be insufficient to elicit a change in the depth of the binocular point of fixation except under optimal conditions (monocular viewing, accommodative loop open and constant display paradigm). Comparison of the oculomotor responses made between a stereoscopic 'virtual' and a 'real' display showed there were no differences with regards to target fixational accuracy. With one exception, subjects showed the same degree of fixational accuracy with respect to target direction and depth. However, close target proximity (in terms of direction) affected the accuracy of fixation with respect to depth (but not direction). No differences were found between fixational accuracy of large and small targets under either display conditions. The visual conditions eliciting fast changes in the location of the binocular point of foveation, i.e. saccade disconjugacy, were investigated. Target-directed saccade disconjugacy was confirmed, in some cases, between targets presented at different depths on a stereoscopic display. However, in general the direction of saccade disconjugacy was best predicted by the horizontal direction of the target. Leftward saccade disconjugacy was more divergent than rightward. This asymmetry was overlaid on a disconjugacy response, which when considered in relative terms, was appropriated for the level of vergence demand. Linear perspective depth cues did not elicit target-directed disconjugate saccades

A Non-Inductive Magnetic Eye-Tracker: From Dipole Tracking to Gaze Retrieval

We analyze the information that can be retrieved from the tracking parameters produced by an innovative wearable eye tracker. The latter is based on a permanent-magnet marked corneal lens and by an array of magnetoresistive detectors that measure the magnetostatic field in several positions in the eye proximity. We demonstrate that, despite missing information due to the axial symmetry of the measured field, physiological constraints or measurement conditions make possible to infer complete eye-pose data. Angular precision and accuracy achieved with the current prototypical device are also assessed and briefly discussed. The results show that the instrumentation considered is suitable as a new, moderately invasive medical diagnostics for the characterization of ocular movements and associated disorders

Hand eye coordination in surgery

The coordination of the hand in response to visual target selection has always been regarded as an essential quality in a range of professional activities. This quality has thus far been elusive to objective scientific measurements, and is usually engulfed in the overall performance of the individuals. Parallels can be drawn to surgery, especially Minimally Invasive Surgery (MIS), where the physical constraints imposed by the arrangements of the instruments and visualisation methods require certain coordination skills that are unprecedented. With the current paradigm shift towards early specialisation in surgical training and shortened focused training time, selection process should identify trainees with the highest potentials in certain specific skills. Although significant effort has been made in objective assessment of surgical skills, it is only currently possible to measure surgeons’ abilities at the time of assessment. It has been particularly difficult to quantify specific details of hand-eye coordination and assess innate ability of future skills development. The purpose of this thesis is to examine hand-eye coordination in laboratory-based simulations, with a particular emphasis on details that are important to MIS. In order to understand the challenges of visuomotor coordination, movement trajectory errors have been used to provide an insight into the innate coordinate mapping of the brain. In MIS, novel spatial transformations, due to a combination of distorted endoscopic image projections and the “fulcrum” effect of the instruments, accentuate movement generation errors. Obvious differences in the quality of movement trajectories have been observed between novices and experts in MIS, however, this is difficult to measure quantitatively. A Hidden Markov Model (HMM) is used in this thesis to reveal the underlying characteristic movement details of a particular MIS manoeuvre and how such features are exaggerated by the introduction of rotation in the endoscopic camera. The proposed method has demonstrated the feasibility of measuring movement trajectory quality by machine learning techniques without prior arbitrary classification of expertise. Experimental results have highlighted these changes in novice laparoscopic surgeons, even after a short period of training. The intricate relationship between the hands and the eyes changes when learning a skilled visuomotor task has been previously studied. Reactive eye movement, when visual input is used primarily as a feedback mechanism for error correction, implies difficulties in hand-eye coordination. As the brain learns to adapt to this new coordinate map, eye movements then become predictive of the action generated. The concept of measuring this spatiotemporal relationship is introduced as a measure of hand-eye coordination in MIS, by comparing the Target Distance Function (TDF) between the eye fixation and the instrument tip position on the laparoscopic screen. Further validation of this concept using high fidelity experimental tasks is presented, where higher cognitive influence and multiple target selection increase the complexity of the data analysis. To this end, Granger-causality is presented as a measure of the predictability of the instrument movement with the eye fixation pattern. Partial Directed Coherence (PDC), a frequency-domain variation of Granger-causality, is used for the first time to measure hand-eye coordination. Experimental results are used to establish the strengths and potential pitfalls of the technique. To further enhance the accuracy of this measurement, a modified Jensen-Shannon Divergence (JSD) measure has been developed for enhancing the signal matching algorithm and trajectory segmentations. The proposed framework incorporates high frequency noise filtering, which represents non-purposeful hand and eye movements. The accuracy of the technique has been demonstrated by quantitative measurement of multiple laparoscopic tasks by expert and novice surgeons. Experimental results supporting visual search behavioural theory are presented, as this underpins the target selection process immediately prior to visual motor action generation. The effects of specialisation and experience on visual search patterns are also examined. Finally, pilot results from functional brain imaging are presented, where the Posterior Parietal Cortical (PPC) activation is measured using optical spectroscopy techniques. PPC has been demonstrated to involve in the calculation of the coordinate transformations between the visual and motor systems, which establishes the possibilities of exciting future studies in hand-eye coordination

Vitreo-retinal eye surgery robot : sustainable precision

Vitreo-retinal eye surgery encompasses the surgical procedures performed on the vitreous humor and the retina. A procedure typically consists of the removal of the vitreous humor, the peeling of a membrane and/or the repair of a retinal detachment. Vitreo-retinal surgery is performed minimal invasively. Small needle shaped instruments are inserted into the eye. Instruments are manipulated by hand in four degrees of freedom about the insertion point. Two rotations move the instrument tip laterally, in addition to a translation in axial instrument direction and a rotation about its longitudinal axis. The manipulation of the instrument tip, e.g. a gripping motion can be considered as a fifth degree of freedom. While performing vitreo-retinal surgery manually, the surgeon faces various challenges. Typically, delicate micrometer range thick tissue is operated, for which steady hand movements and high accuracy instrument manipulation are required. Lateral instrument movements are inverted by the pivoting insertion point and scaled depending on the instrument insertion depth. A maximum of two instruments can be used simultaneously. There is nearly no perception of surgical forces, since most forces are below the human detection limit. Therefore, the surgeon relies only on visual feedback, obtained via a microscope or endoscope. Both vision systems force the surgeon to work in a static and non ergonomic body posture. Although the surgeon’s proficiency improves throughout his career, hand tremor will become a problem at higher age. Robotically assisted surgery with a master-slave system can assist the surgeon in these challenges. The slave system performs the actual surgery, by means of instrument manipulators which handle the instruments. The surgeon remains in control of the instruments by operating haptic interfaces via a master. Using electronic hardware and control software, the master and slave are connected. Amongst others, advantages as tremor filtering, up-scaled force feedback, down-scaled motions and stabilized instrument positioning will enhance dexterity on surgical tasks. Furthermore, providing the surgeon an ergonomic body posture will prolong the surgeon’s career. This thesis focuses on the design and realization of a high precision slave system for eye surgery. The master-slave system uses a table mounted design, where the system is compact, lightweight, easy to setup and equipped to perform a complete intervention. The slave system consists of two main parts: the instrument manipulators and their passive support system. Requirements are derived from manual eye surgery, conversations with medical specialists and analysis of the human anatomy and vitreo-retinal interventions. The passive support system provides a stiff connection between the instrument manipulator, patient and surgical table. Given the human anatomical diversity, presurgical adjustments can be made to allow the instrument manipulators to be positioned over each eye. Most of the support system is integrated within the patient’s headrest. On either the left or right side, two exchangeable manipulator-support arms can be installed onto the support system, depending on the eye being operated upon. The compact, lightweight and easy to install design, allows for a short setup time and quick removal in case of a complication. The slave system’s surgical reach is optimized to emulate manually performed surgery. For bimanual instrument operation, two instrument manipulators are used. Additional instrument manipulators can be used for non-active tools e.g. an illumination probe or an endoscope. An instrument manipulator allows the same degrees of freedom and a similar reach as manually performed surgery. Instrument forces are measured to supply force feedback to the surgeon via haptic interfaces. The instrument manipulator is designed for high stiffness, is play free and has low friction to allow tissue manipulation with high accuracy. Each instrument manipulator is equipped with an on board instrument change system, by which instruments can be changed in a fast and secure way. A compact design near the instrument allows easy access to the surgical area, leaving room for the microscope and peripheral equipment. The acceptance of a surgical robot for eye surgery mostly relies on equipment safety and reliability. The design of the slave system features various safety measures, e.g. a quick release mechanism for the instrument manipulator and additional locks on the pre-surgical adjustment fixation clamp. Additional safety measures are proposed, like a hard cover over the instrument manipulator and redundant control loops in the controlling FPGA. A method to fixate the patient’s head to the headrest by use of a custom shaped polymer mask is proposed. Two instrument manipulators and their passive support system have been realized so far, and the first experimental results confirm the designed low actuation torque and high precision performance