Planning and Real Time Control of a Minimally Invasive Robotic Surgery System

This paper introduces the planning and control software of a teleoperating robotic system for minimally invasive surgery. It addresses the problem of how to organize a complex system with 41 degrees of freedom including robot setup planning, force feedback control and nullspace handling with three robotic arms. The planning software is separated into sequentially executed planning and registration procedures. An optimal setup is first planned in virtual reality and then adapted to variations in the operating room. The real time control system is composed of hierarchical layers. The design is flexible and expandable without losing performance. Structure, functionality and implementation of planning and control are described. The robotic system provides the surgeon with an intuitive hand-eye-coordination and force feedback in teleoperation for both hands

Computer- and robot-assisted Medical Intervention

Medical robotics includes assistive devices used by the physician in order to make his/her diagnostic or therapeutic practices easier and more efficient. This chapter focuses on such systems. It introduces the general field of Computer-Assisted Medical Interventions, its aims, its different components and describes the place of robots in that context. The evolutions in terms of general design and control paradigms in the development of medical robots are presented and issues specific to that application domain are discussed. A view of existing systems, on-going developments and future trends is given. A case-study is detailed. Other types of robotic help in the medical environment (such as for assisting a handicapped person, for rehabilitation of a patient or for replacement of some damaged/suppressed limbs or organs) are out of the scope of this chapter.Comment: Handbook of Automation, Shimon Nof (Ed.) (2009) 000-00

Da Vinci Robot at Hospital Clinic. Haptic Devices and Performance in Robotic Tech

Treballs Finals de Grau d'Enginyeria Biomèdica. Facultat de Medicina i Ciències de la Salut. Universitat de Barcelona. Curs: 2020-2021. Director i Tutor: Manel Puig i VidalMinimally invasive surgery (MIS) is continuously evolving and improving its techniques due to the fact that is being more and more used given its numerous advantages, which may go from less pain and faster recovery to a better cosmetic outcome. A big advance in this technique has been the implementation of robotically assisted systems, which have loads of advantages as well. Nonetheless, they have some perks like the lack of tactile perception and loss of depth in the vision of the surgeon. Although clinicians have adopted some means to overcome these limitations, the lack of haptic feedback is still a big problem and it's frequent rupturing healthy tissues while suturing. Therefore, there is a huge urge and desire for the development of a robotically assisted surgical system that includes haptic feedback. The main goal of this project is to implement haptic feedback in a robotic arm to provide the surgeon with tactile perception during the interventions and therefore prevent damages to the patient

Localization of Interaction using Fibre-Optic Shape Sensing in Soft-Robotic Surgery Tools

Minimally invasive surgery requires real-time tool tracking to guide the surgeon where depth perception and visual occlusion present navigational challenges. Although vision-based and external sensor-based tracking methods exist, fibre-optic sensing can overcome their limitations as they can be integrated directly into the device, are biocompatible, small, robust and geometrically versatile. In this paper, we integrate a fibre Bragg grating-based shape sensor into a soft robotic device. The soft robot is the pneumatically attachable flexible (PAF) rail designed to act as a soft interface between manipulation tools and intra-operative imaging devices. We demonstrate that the shape sensing fibre can detect the location of the tools paired with the PAF rail, by exploiting the change in curvature sensed by the fibre when a strain is applied to it. We then validate this with a series of grasping tasks and continuous US swipes, using the system to detect in real-time the location of the tools interacting with the PAF rail. The overall location-sensing accuracy of the system is 64.6%, with a margin of error between predicted location and actual location of 3.75 mm

An intuitive surgical handle design for robotic neurosurgery.

PURPOSE: The expanded endoscopic endonasal approach, a representative example of keyhole brain surgery, allows access to the pituitary gland and surrounding areas through the nasal and sphenoid cavities. Manipulating rigid instruments through these constrained spaces makes this approach technically challenging, and thus, a handheld robotic instrument could expand the surgeon's capabilities. In this study, we present an intuitive handle prototype for such a robotic instrument. METHODS: We have designed and fabricated a surgical instrument handle prototype that maps the surgeon's wrist directly to the robot joints. To alleviate the surgeon's wrist of any excessive strain and fatigue, the tool is mounted on the surgeon's forearm, making it parallel with the instrument's shaft. To evaluate the handle's performance and limitations, we constructed a surgical task simulator and compared our novel handle with a standard neurosurgical tool, with the tasks being performed by a consultant neurosurgeon. RESULTS: While using the proposed handle, the surgeon's average success rate was [Formula: see text], compared to [Formula: see text] when using a conventional tool. Additionally, the surgeon's body posture while using the suggested prototype was deemed acceptable by the Rapid Upper Limb Assessment ergonomic survey, while early results indicate the absence of a learning curve. CONCLUSIONS: Based on these preliminary results, the proposed handle prototype could offer an improvement over current neurosurgical tools and procedural ergonomics. By redirecting forces applied during the procedure to the forearm of the surgeon, and allowing for intuitive surgeon wrist to robot-joints movement mapping without compromising the robotic end effector's expanded workspace, we believe that this handle could prove a substantial step toward improved neurosurgical instrumentation

Robotic technology and endoluminal surgery in digestive surgery

BACKGROUND. Colorectal cancer (CRC) is the third most common cancer in males and second in females, and the fourth most common cause of cancer death worldwide. The implementation of screening programs has allowed to the identification of an increasing number of early-stage neoplastic lesions. Presently, superficial colorectal neoplasms (including precancerous lesions and early cancer) can be resected in the colon by Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD), while in the rectum by Transanal Endoscopic Microsurgery (TEM). They are the preferred choices inside of the minimally invasive panorama regarding the CRC treatment. TEM technique offers more advantages than EMR and ESD, but it can’t overcome the recto-sigmoid junction. Many authors, research institutes and biomedical industries have proposed different solutions for microsurgery dissection of early lesions in the colon, but all these proposals have in common the development of platforms expressly designed for this use, with significant purchasing and management costs. The aim of our research project is to develop a robotic platform that allows to treat lesions throughout the colon limiting the costs of management and purchasing. This new robotic platform, developed in collaboration with Scuola Superiore Sant’Anna in Pisa, is called RED (Robot for Endoscopic Dissection). At the tip of a standard endoscope a hood (RED) is placed. RED is equipped by two extractable teleoperated robotic arms (i.e., diathermic hook and gripper); their motion is provided by onboard miniaturized commercial motors and a dedicated external platform. The endoscopist holds the endoscope near the lesion, while the operator drives the robotic arms through a remote control. MATERIALS AND METHODS. Several preliminary studies have been conducted in the following order. A first test was conducted for identification of force value for lifting and pulling maneuvers using a modified TEM instrument. A CAD study was conducted to determine the maximum size that the hood must have in order to overcome the critical angle represented by the splenic flexure. Several tests were conducted to determine the degrees of freedom of each robotic arm, starting with the CAD drawing to make subsequently the mock-ups of each configuration. Finally, a 3D mock-up was produced that was assembled on an endoscope to perform the in vitro test to evaluate the workspace and field of view using a pelvic trainer for TEM. RESULTS. The first test shown that the minimum force that the gripper will have to develop with the push-pull is 1.5N. The CAD study shown that the maximum dimensions the hood must have to overcome splenic flexure are: maximum diameter 28mm, maximum length 57mm. After several configurations was been tested, the final prototype features are: gripper arm with pitch sliding and open/close of the tip and diathermic hook arm with pitch, roll and sliding. There will be 6 such distributed motors: 3 external motors for the gripper arm that will operate through cables contained in a sheath adherent to colonscope and 3 embedded motors for diathermic hook arm (one integrated on the hood for the sliding degree of motion and the other two inside of the arm). The in-vitro test has been carried out to evaluate the workspace and they proved that the operating field vision is not obstructed by the hood and the working range is sufficiently wide to perform a dissection. CONCLUSION. Tests conducted up to this point have allowed us to identify the overall layout of the RED: dimensions, degrees of freedom, number and distribution of motors needed for the operation of robotic arms; moreover, it is proved that the device, once assembled, maintained the visual and operational field characteristics necessary to perform an accurate dissection. The next step will be to realize a RED steel final prototype and in-vivo tests will be carry out to replicate an endoscopic dissection into the colon

A spherical joint robotic end-effector for the Expanded Endoscopic Endonasal Approach

The endonasal transsphenoidal approach allows surgeons to access the pituitary gland through the natural orifice of the nose. Recently, surgeons have also described an Expanded Endoscopic Endonasal Approach (EEEA) for the treatment of other tumours around the base of the brain. However, operating in this way with nonarticulated tools is technically very difficult and not widely adopted. The goal of this study is to develop an articulated end-effector for a novel handheld robotic tool for the EEEA. We present a design and implementation of a 3.6mm diameter, three degrees-of-freedom, tendon-driven robotic end-effector that, contrary to rigid instruments which operate under fulcrum, will give the surgeon the ability to reach areas on the surface of the brain that were previously inaccessible. We model the end-effector kinematics in simulation to study the theoretical workspace it can achieve prior to implementing a test-bench device to validate the efficacy of the end-effector. We find promising repeatability of the proposed robotic end-effector of 0.42mm with an effective workspace with limits of ±30∘, which is greater than conventional neurosurgical tools. Additionally, although the tool’s end-effector has a small enough diameter to operate through the narrow nasal access path and the constrained workspace of EEEA, it showcased promising structural integrity and was able to support approximately a 6N load, despite a large deflection angle the limiting of which is scope of future work. These preliminary results indicate the end-effector is a promising first step towards developing appropriate handheld robotic instrumentation to drive EEEA adoption

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Cooperative Object Manipulation with Force Tracking on the da Vinci Research Kit

The da Vinci Surgical System is one of the most established robot-assisted surgery device commended for its dexterity and ergonomics in minimally invasive surgery. Conversely, it inherits disadvantages which are lack of autonomy and haptic feedback. In order to address these issues, this work proposes an industry-inspired solution to the field of force control in medical robotics. This approach contributes to shared autonomy by developing a controller for cooperative object manipulation with force tracking utilizing available manipulators and force feedback. To achieve simultaneous position and force tracking of the object, master and slave manipulators were assigned then controlled with Cartesian position control and impedance control respectively. Because impedance control requires a model-based feedforward compensation, we identified the lumped base parameters of mass, inertias, and frictions of a three degree-of-freedom double four-bar linkage mechanism with least squares and weighted least squares regression methods. Additionally, semidefinite programming was used to constrain the parameters to a feasible physical solution in standard parameter space. Robust stick-slip static friction compensation was applied where linear Viscous and Coulomb friction was inadequate in modeling the prismatic third joint. The Robot Operating System based controller was tested in RViz to check the cooperative kinematics of up to three manipulators. Additionally, simulation with the dynamic engine Gazebo verified the cooperative controller applying a constant tension force on a massless spring-damper virtual object. With adequate model feedback linearization, the cooperative impedance controller tested on the da Vinci Research Kit yielded stable tension force tracking while simultaneously moving in Cartesian space. The maximum force tracking error was +/- 0.5 N for both a compliant and stiff manipulated object

On Neuromechanical Approaches for the Study of Biological Grasp and Manipulation

Biological and robotic grasp and manipulation are undeniably similar at the level of mechanical task performance. However, their underlying fundamental biological vs. engineering mechanisms are, by definition, dramatically different and can even be antithetical. Even our approach to each is diametrically opposite: inductive science for the study of biological systems vs. engineering synthesis for the design and construction of robotic systems. The past 20 years have seen several conceptual advances in both fields and the quest to unify them. Chief among them is the reluctant recognition that their underlying fundamental mechanisms may actually share limited common ground, while exhibiting many fundamental differences. This recognition is particularly liberating because it allows us to resolve and move beyond multiple paradoxes and contradictions that arose from the initial reasonable assumption of a large common ground. Here, we begin by introducing the perspective of neuromechanics, which emphasizes that real-world behavior emerges from the intimate interactions among the physical structure of the system, the mechanical requirements of a task, the feasible neural control actions to produce it, and the ability of the neuromuscular system to adapt through interactions with the environment. This allows us to articulate a succinct overview of a few salient conceptual paradoxes and contradictions regarding under-determined vs. over-determined mechanics, under- vs. over-actuated control, prescribed vs. emergent function, learning vs. implementation vs. adaptation, prescriptive vs. descriptive synergies, and optimal vs. habitual performance. We conclude by presenting open questions and suggesting directions for future research. We hope this frank assessment of the state-of-the-art will encourage and guide these communities to continue to interact and make progress in these important areas