Prevalence of haptic feedback in robot-mediated surgery : a systematic review of literature

© 2017 Springer-Verlag. This is a post-peer-review, pre-copyedit version of an article published in Journal of Robotic Surgery. The final authenticated version is available online at: https://doi.org/10.1007/s11701-017-0763-4With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.Peer reviewe

Design of a novel bimanual robotic system for single-port laparoscopy

Abstract—This paper presents the design and fabrication of Single-Port lapaRoscopy bImaNual roboT (SPRINT), a novel tele-operated robotic system for minimally invasive surgery. SPRINT, specifically designed for single-port laparoscopy, is a high-dexterity miniature robot, able to reproduce the movement of the hands of the surgeon, who controls the system through a master interface. It comprises two arms with six degrees of freedom (DOFs) that can be individually inserted and removed in a 30-mm-diameter umbilical access port. The system is designed to leave a central lumen free during operations, thus allowing the insertion of other laparoscopic tools. The four distal DOFs of each arm are actuated by on-board brushless dc motors, while the two proximal DOFs of the shoulder are actuated by external motors. The constraints gen-erated by maximum size and power requirements led to the design of compact mechanisms for the actuation of the joints. The wrist is actuated by three motors hosted in the forearm, with a peculiar differential mechanism that allows us to have intersecting roll– pitch–roll axes. Preliminary tests and validations were performed ex vivo by surgeons on a first prototype of the system. Index Terms—Bimanual robot, miniature robotic arm, mini-mally invasive surgery, robotic surgery, single-port laparoscopy (SPL). I

Technical and Functional Validation of a Teleoperated Multirobots Platform for Minimally Invasive Surgery

Nowadays Robotic assisted Minimally Invasive Surgeries (R-MIS) are the elective procedures for treating highly accurate and scarcely invasive pathologies, thanks to their abil- ity to empower surgeons\u2019 dexterity and skills. The research on new Multi-Robots Surgery (MRS) platform is cardinal to the development of a new SARAS surgical robotic platform, which aims at carrying out autonomously the assistants tasks during R- MIS procedures. In this work, we will present the SARAS MRS platform validation protocol, framed in order to assess: (i) its technical performances in purely dexterity exercises, and (ii) its functional performances. The results obtained show a prototype able to put the users in the condition of accomplishing the tasks requested (both dexterity- and surgical-related), even with rea- sonably lower performances respect to the industrial standard. The main aspects on which further improvements are needed result to be the stability of the end effectors, the depth per- ception and the vision systems, to be enriched with dedicated virtual fixtures. The SARAS\u2019 aim is to reduce the main surgeon\u2019s workload through the automation of assistive tasks which would benefit both surgeons and patients by facilitating the surgery and reducing the operation time

A continuum robotic platform for endoscopic non-contact laser surgery: design, control, and preclinical evaluation

The application of laser technologies in surgical interventions has been accepted in the clinical domain due to their atraumatic properties. In addition to manual application of fibre-guided lasers with tissue contact, non-contact transoral laser microsurgery (TLM) of laryngeal tumours has been prevailed in ENT surgery. However, TLM requires many years of surgical training for tumour resection in order to preserve the function of adjacent organs and thus preserve the patient’s quality of life. The positioning of the microscopic laser applicator outside the patient can also impede a direct line-of-sight to the target area due to anatomical variability and limit the working space. Further clinical challenges include positioning the laser focus on the tissue surface, imaging, planning and performing laser ablation, and motion of the target area during surgery. This dissertation aims to address the limitations of TLM through robotic approaches and intraoperative assistance. Although a trend towards minimally invasive surgery is apparent, no highly integrated platform for endoscopic delivery of focused laser radiation is available to date. Likewise, there are no known devices that incorporate scene information from endoscopic imaging into ablation planning and execution. For focusing of the laser beam close to the target tissue, this work first presents miniaturised focusing optics that can be integrated into endoscopic systems. Experimental trials characterise the optical properties and the ablation performance. A robotic platform is realised for manipulation of the focusing optics. This is based on a variable-length continuum manipulator. The latter enables movements of the endoscopic end effector in five degrees of freedom with a mechatronic actuation unit. The kinematic modelling and control of the robot are integrated into a modular framework that is evaluated experimentally. The manipulation of focused laser radiation also requires precise adjustment of the focal position on the tissue. For this purpose, visual, haptic and visual-haptic assistance functions are presented. These support the operator during teleoperation to set an optimal working distance. Advantages of visual-haptic assistance are demonstrated in a user study. The system performance and usability of the overall robotic system are assessed in an additional user study. Analogous to a clinical scenario, the subjects follow predefined target patterns with a laser spot. The mean positioning accuracy of the spot is 0.5 mm. Finally, methods of image-guided robot control are introduced to automate laser ablation. Experiments confirm a positive effect of proposed automation concepts on non-contact laser surgery.Die Anwendung von Lasertechnologien in chirurgischen Interventionen hat sich aufgrund der atraumatischen Eigenschaften in der Klinik etabliert. Neben manueller Applikation von fasergeführten Lasern mit Gewebekontakt hat sich die kontaktfreie transorale Lasermikrochirurgie (TLM) von Tumoren des Larynx in der HNO-Chirurgie durchgesetzt. Die TLM erfordert zur Tumorresektion jedoch ein langjähriges chirurgisches Training, um die Funktion der angrenzenden Organe zu sichern und damit die Lebensqualität der Patienten zu erhalten. Die Positionierung des mikroskopis chen Laserapplikators außerhalb des Patienten kann zudem die direkte Sicht auf das Zielgebiet durch anatomische Variabilität erschweren und den Arbeitsraum einschränken. Weitere klinische Herausforderungen betreffen die Positionierung des Laserfokus auf der Gewebeoberfläche, die Bildgebung, die Planung und Ausführung der Laserablation sowie intraoperative Bewegungen des Zielgebietes. Die vorliegende Dissertation zielt darauf ab, die Limitierungen der TLM durch robotische Ansätze und intraoperative Assistenz zu adressieren. Obwohl ein Trend zur minimal invasiven Chirurgie besteht, sind bislang keine hochintegrierten Plattformen für die endoskopische Applikation fokussierter Laserstrahlung verfügbar. Ebenfalls sind keine Systeme bekannt, die Szeneninformationen aus der endoskopischen Bildgebung in die Ablationsplanung und -ausführung einbeziehen. Für eine situsnahe Fokussierung des Laserstrahls wird in dieser Arbeit zunächst eine miniaturisierte Fokussieroptik zur Integration in endoskopische Systeme vorgestellt. Experimentelle Versuche charakterisieren die optischen Eigenschaften und das Ablationsverhalten. Zur Manipulation der Fokussieroptik wird eine robotische Plattform realisiert. Diese basiert auf einem längenveränderlichen Kontinuumsmanipulator. Letzterer ermöglicht in Kombination mit einer mechatronischen Aktuierungseinheit Bewegungen des Endoskopkopfes in fünf Freiheitsgraden. Die kinematische Modellierung und Regelung des Systems werden in ein modulares Framework eingebunden und evaluiert. Die Manipulation fokussierter Laserstrahlung erfordert zudem eine präzise Anpassung der Fokuslage auf das Gewebe. Dafür werden visuelle, haptische und visuell haptische Assistenzfunktionen eingeführt. Diese unterstützen den Anwender bei Teleoperation zur Einstellung eines optimalen Arbeitsabstandes. In einer Anwenderstudie werden Vorteile der visuell-haptischen Assistenz nachgewiesen. Die Systemperformanz und Gebrauchstauglichkeit des robotischen Gesamtsystems werden in einer weiteren Anwenderstudie untersucht. Analog zu einem klinischen Einsatz verfolgen die Probanden mit einem Laserspot vorgegebene Sollpfade. Die mittlere Positioniergenauigkeit des Spots beträgt dabei 0,5 mm. Zur Automatisierung der Ablation werden abschließend Methoden der bildgestützten Regelung vorgestellt. Experimente bestätigen einen positiven Effekt der Automationskonzepte für die kontaktfreie Laserchirurgie

Motion analysis of a robotic assisted surgery and microsurgery system - experimental verification

Motion analysis of a parallel robot assisted minimally invasive surgery/microsurgery system (PRAMiSS) and the control structures enabling it to achieve milli/micromanipulations under the constraint of moving through a fixed penetration point or so-called remote centre-of-motion (RCM) are presented in this article. Two control algorithms are proposed suitable for minimally invasive surgery (MIS) with submillimeter accuracy and for minimally invasive micro-surgery (MIMS) with submicrometer accuracy. The RCM constraint is performed without having any mechanical constraint. Control algorithms also apply orientation constraint preventing the tip to orient relative to the soft tissues due to the robot movements. Experiments were conducted to verify accuracy and effectiveness of the proposed control algorithms for MIS and MIMS operations. The experimental results demonstrate accuracy and performance of the proposed position control algorithms

From Concept to Market: Surgical Robot Development

Surgical robotics and supporting technologies have really become a prime example of modern applied information technology infiltrating our everyday lives. The development of these systems spans across four decades, and only the last few years brought the market value and saw the rising customer base imagined already by the early developers. This chapter guides through the historical development of the most important systems, and provide references and lessons learnt for current engineers facing similar challenges. A special emphasis is put on system validation, assessment and clearance, as the most commonly cited barrier hindering the wider deployment of a system

Smart Navigation in Surgical Robotics

La cirugía mínimamente invasiva, y concretamente la cirugía laparoscópica, ha supuesto un gran cambio en la forma de realizar intervenciones quirúrgicas en el abdomen. Actualmente, la cirugía laparoscópica ha evolucionado hacia otras técnicas aún menos invasivas, como es la cirugía de un solo puerto, en inglés Single Port Access Surgery. Esta técnica consiste en realizar una única incisión, por la que son introducidos los instrumentos y la cámara laparoscópica a través de un único trocar multipuerto. La principal ventaja de esta técnica es una reducción de la estancia hospitalaria por parte del paciente, y los resultados estéticos, ya que el trocar se suele introducir por el ombligo, quedando la cicatriz oculta en él. Sin embargo, el hecho de que los instrumentos estén introducidos a través del mismo trocar hace la intervención más complicada para el cirujano, que necesita unas habilidades específicas para este tipo de intervenciones. Esta tesis trata el problema de la navegación de instrumentos quirúrgicos mediante plataformas robóticas teleoperadas en cirugía de un solo puerto. En concreto, se propone un método de navegación que dispone de un centro de rotación remoto virtual, el cuál coincide con el punto de inserción de los instrumentos (punto de fulcro). Para estimar este punto se han empleado las fuerzas ejercidas por el abdomen en los instrumentos quirúrgicos, las cuales han sido medidas por sensores de esfuerzos colocados en la base de los instrumentos. Debido a que estos instrumentos también interaccionan con tejido blando dentro del abdomen, lo cual distorsionaría la estimación del punto de inserción, es necesario un método que permita detectar esta circunstancia. Para solucionar esto, se ha empleado un detector de interacción con tejido basado en modelos ocultos de Markov el cuál se ha entrenado para detectar cuatro gestos genéricos. Por otro lado, en esta tesis se plantea el uso de guiado háptico para mejorar la experiencia del cirujano cuando utiliza plataformas robóticas teleoperadas. En concreto, se propone la técnica de aprendizaje por demostración (Learning from Demonstration) para generar fuerzas que puedan guiar al cirujano durante la resolución de tareas específicas. El método de navegación propuesto se ha implantado en la plataforma quirúrgica CISOBOT, desarrollada por la Universidad de Málaga. Los resultados experimentales obtenidos validan tanto el método de navegación propuesto, como el detector de interacción con tejido blando. Por otro lado, se ha realizado un estudio preliminar del sistema de guiado háptico. En concreto, se ha empleado una tarea genérica, la inserción de una clavija, para realizar los experimentos necesarios que permitan demostrar que el método propuesto es válido para resolver esta tarea y otras similares