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

Supernumerary Robotic Arm for Three-Handed Surgical Application: Behavioral Study and Design of Human-Machine Interface

In surgical to industrial manipulation, the operator needs assistance for tasks requiring more than two hands. Teamwork may be the source of errors and inefficiency, especially if the assistant is a novice or unfamiliar with the main operator. The need for assistance may become problematic in case of lack of human resources e.g. in emergency surgical cases in the late hours of the night. Our objective is to improve the surgeon's autonomy and dexterity by a robotic arm under his own control. Although a number of robotic instrument holders have been developed, the best way to control such devices is still an open question. No behavioral study has been conducted on the best control strategy and human performance in three-handed tasks. We have selected the foot for commanding the third arm on the basis of a literature review. A series of experiments in virtual environments has been conducted to study the feasibility of this choice. The first experiment compares performance in the same task using two or three hands. Results show that three-handed manipulation is preferred to two-handed manipulation in demanding tasks. The second experiment investigated the type of tasks to be aimed in three-handed manipulation and the learning curve of users. Moving the hands and a foot simultaneously in opposite directions was perceived as difficult compared to a more active task with liberty in choosing the limbs coordination. Limbs were moved in parallel rather than serially. The performance improved within a few minutes of practice. Also, the sense of ownership improved constantly during the experiment. Two other experiments were aimed at handling the endoscope in laparoscopic surgery. Surgeons and medical students participated in these studies. Residents had a more positive approach towards foot usage and performed better compared to more experienced surgeons. This proves that the best training period for surgeons to use a foot controlled robotic arm is during their residency. A realistic virtual abdominal cavity has been developed for the last experiment. This had a positive influence on the participants' performance and emphasizes the importance of using a familiar context for training such a "three-handed surgery". Finally, two different foot interfaces were developed to investigate the most intuitive third arm commanding strategy. A robotic arm is hence controlled by the foot's translation or rotation in one interface (isotonic interface), and by force or torque in the other one (isometric interface). An experimental behavioral study was conducted to compare the two devices. Isometric rate control was preferred to isotonic position control due to the lower physical burden and higher movement accuracy of the robot. It was shown that the proposed device for isometric rate control could be used for intuitive control of four DoFs of a slave robotic arm. This thesis is the first step in a systematic investigation of a three-handed manipulation, two biological hands and a foot controlled robotic assistant. Findings suggest a high potential in using the foot to become more autonomous in surgery as well as other fields. Users can learn the control paradigm in a short period of time with little mental and physical burden. We expect the developed foot interfaces to be the basis of future development of more intuitive control interfaces. We believe that foot controlled robotic arms will be commonly used in various surgical as well as industrial applications