3,155 research outputs found
A methodology for design and appraisal of surgical robotic systems
Surgical robotics is a growing discipline, continuously
expanding with an influx of new ideas and research.
However, it is important that the development of new devices
take account of past mistakes and successes. A structured
approach is necessary, as with proliferation of such research,
there is a danger that these lessons will be obscured,
resulting in the repetition of mistakes and wasted effort
and energy. There are several research paths for surgical
robotics, each with different risks and opportunities and
different methodologies to reach a profitable outcome. The
main emphasis of this paper is on a methodology for ‘applied
research’ in surgical robotics. The methodology sets out a
hierarchy of criteria consisting of three tiers, with the most
important being the bottom tier and the least being the top tier.
It is argued that a robotic system must adhere to these criteria
in order to achieve acceptability. Recent commercial systems
are reviewed against these criteria, and are found to conform
up to at least the bottom and intermediate tiers, the most
important first two tiers, and thus gain some acceptability.
However, the lack of conformity to the criteria in the top
tier, and the inability to conclusively prove increased clinical
benefit, is shown to be hampering their potential in gaining
wide establishment
Control techniques for mechatronic assisted surgery
The treatment response for traumatic head injured patients can be improved by
using an autonomous robotic system to perform basic, time-critical emergency neurosurgery,
reducing costs and saving lives. In this thesis, a concept for a neurosurgical robotic system is proposed to perform three specific emergency neurosurgical procedures; they are the placement of an intracranial pressure monitor, external
ventricular drainage, and the evacuation of chronic subdural haematoma. The control
methods for this system are investigated following a curiosity led approach. Individual problems are interpreted in the widest sense and solutions posed that are general in nature. Three main contributions result from this approach: 1)
a clinical evidence based review of surgical robotics and a methodology to assist in their evaluation, 2) a new controller for soft-grasping of objects, and 3) new propositions and theorems for chatter suppression sliding mode controllers. These contributions directly assist in the design of the control system of the neurosurgical robot and, more broadly, impact other areas outside the narrow con nes of the target application. A methodology for applied research in surgical robotics is proposed. The methodology sets out a hierarchy of criteria consisting of three tiers, with the most important being the bottom tier and the least being the top tier. It is argued that
a robotic system must adhere to these criteria in order to achieve acceptability. Recent commercial systems are reviewed against these criteria, and are found to conform up to at least the bottom and intermediate tiers. However, the lack of
conformity to the criteria in the top tier, combined with the inability to conclusively
prove increased clinical benefit, particularly symptomatic benefit, is shown to be hampering the potential of surgical robotics in gaining wide establishment. A control scheme for soft-grasping objects is presented. Grasping a soft or fragile object requires the use of minimum contact force to prevent damage or deformation. Without precise knowledge of object parameters, real-time feedback
control must be used to regulate the contact force and prevent slip. Moreover, the controller must be designed to have good performance characteristics to rapidly modulate the fingertip contact force in response to a slip event. A fuzzy sliding mode controller combined with a disturbance observer is proposed for contact force control and slip prevention. The robustness of the controller is evaluated through
both simulation and experiment. The control scheme was found to be effective and robust to parameter uncertainty. When tested on a real system, however, chattering phenomena, well known to sliding mode research, was induced by the
unmodelled suboptimal components of the system (filtering, backlash, and time delays). This reduced the controller performance. The problem of chattering and potential solutions are explored. Real systems using sliding mode controllers, such as the control scheme for soft-grasping, have a tendency to chatter at high frequencies. This is caused by the sliding mode
controller interacting with un-modelled parasitic dynamics at the actuator-input
and sensor-output of the plant. As a result, new chatter-suppression sliding mode controllers have been developed, which introduce new parameters into the system. However, the effect any particular choice of parameters has on system performance
is unclear, and this can make tuning the parameters to meet a set of performance
criteria di cult. In this thesis, common chatter-suppression sliding mode control
strategies are surveyed and simple design and estimation methods are proposed.
The estimation methods predict convergence, chattering amplitude, settling time,
and maximum output bounds (overshoot) using harmonic linearizations and invariant
ellipsoid sets
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Disruptive design innovation: reflections on the relationship of design, science and art
The title of designer conveys a large number of historical, cultural, philosophical drivers and working practises that effectively range from the traditional engineer through to the individual interested in personal expression. The considerable differences originate and have evolved for a variety of reasons. The range is from capitalist necessity through to social inclusion. Today, the designer needs to have the ability to understand significant changes in technology, art and science as well as being an astute observer of human behaviour. Ultimately, the designer will need to convert ideas into objects and systems that people can understand and use. It is important to consider serendipitous design and disruptive design as it often involves risk taking and may be unpredictable in character. Disruptive design innovation can improve a design in ways that the customer or a market does not expect. The authors suggest a refreshing approach to design that is inclusive in purpose to enrich the act of designing and advocate a greater correlation between the art, sciences and design in reflecting the values, virtues and methods of working and the principles that guide the methodologies and processes which can be correlated into a coherent whole and with a clearer focus
Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer : a systematic review and mixed treatment comparison meta-analysis
© 2013 The Authors. BJU International © 2013 BJU International.Peer reviewedPublisher PD
The Use of Tactile Sensors in Oral and Maxillofacial Surgery: An Overview
Background: This overview aimed to characterize the type, development, and use of haptic technologies for maxillofacial surgical purposes. The work aim is to summarize and evaluate current advantages, drawbacks, and design choices of presented technologies for each field of application in order to address and promote future research as well as to provide a global view of the issue. Methods: Relevant manuscripts were searched electronically through Scopus, MEDLINE/PubMed, and Cochrane Library databases until 1 November 2022. Results: After analyzing the available literature, 31 articles regarding tactile sensors and interfaces, sensorized tools, haptic technologies, and integrated platforms in oral and maxillofacial surgery have been included. Moreover, a quality rating is provided for each article following appropriate evaluation metrics. Discussion: Many efforts have been made to overcome the technological limits of computed assistant diagnosis, surgery, and teaching. Nonetheless, a research gap is evident between dental/maxillofacial surgery and other specialties such as endovascular, laparoscopic, and microsurgery; especially for what concerns electrical and optical-based sensors for instrumented tools and sensorized tools for contact forces detection. The application of existing technologies is mainly focused on digital simulation purposes, and the integration into Computer Assisted Surgery (CAS) is far from being widely actuated. Virtual reality, increasingly adopted in various fields of surgery (e.g., sino-nasal, traumatology, implantology) showed interesting results and has the potential to revolutionize teaching and learning. A major concern regarding the actual state of the art is the absence of randomized control trials and the prevalence of case reports, retrospective cohorts, and experimental studies. Nonetheless, as the research is fast growing, we can expect to see many developments be incorporated into maxillofacial surgery practice, after adequate evaluation by the scientific community
Validation of the STN-DBS intervention as a treatment for Parkinson's disease by studying the accuracy of electrode placement and possible correlation with motor symptoms
Treballs Finals de Grau d'Enginyeria Biomèdica. Facultat de Medicina i Ciències de la Salut. Universitat de Barcelona. Curs: 2020-2021. Director: Jordi Rumià Arboix. Tutor: Agustí Gutiérrez Gálvez.Parkinson’s disease is present approximately in 10 million individuals all over the world, being
one of the most common neurodegenerative diseases, and statistics denote that its prevalence
will raise in the coming years. Deep brain stimulation is an effective surgical treatment for patients
who do not improve with drug treatment and who present many motor symptoms. Deep brain
stimulation constitutes the implantation of electrodes in specific brain structures, nevertheless,
this study has focused on the subthalamic nucleus, being the main target region for Parkinson’s
disease. In order to have satisfactory post-surgical results, where the patient has a considerable
reduction in motor symptoms, it is essential to present a correct lead placement accuracy, which
corresponds with what has been planned before surgery by terms of using the neuronavigator.
The principal objective of this study is to validate the accuracy of the actual technique used in the
Hospital Clínic of Barcelona, which is guided exclusively by image, as well as to establish a
possible relationship between the patient's clinic, following the UPDRS scale type III, once it has
undergone surgery and the accuracy of the electrodes, to verify that it essential to achieve its
maximum effectiveness. Thus, objective arguments of the image-guided and image-verified
technique can also be given as well as providing assertion of completing the procedure with the
patient completely anaesthetised, since currently in Catalonia most centres do so with the patient
awake and with microelectrode recording..
Embedding robotic surgery into routine practice and impacts on communication and decision making: A review of the experience of surgical teams
While an increasing number of healthcare providers are purchasing surgical robots because of anticipated improvements in patient outcomes, their implementation into practice is highly variable. In robotic surgery, the surgeon is physically separated from the patient and the rest of the team with the potential to impact communication and decision making in the operating theatre and subsequently patient safety. Drawing on the approach of realist evaluation, in this article we review reports of the experience of surgical teams that have introduced robotic surgery to identify how and in what contexts robotic surgery is successfully integrated into practice and how and in what contexts it affects communication and decision making. Our analysis indicates that, while robotic surgery might bring about a number of benefits, it also creates new challenges. Robotic surgery is associated with increased operation duration, which has implications for patient safety, but strategies to reduce it can be effective with appropriate support from hospital administration and nursing management. The separation of the surgeon from the team can compromise communication but may be overcome through use of standardised communication. While surgeon situation awareness may be affected by the separation, the ergonomic benefits of robotic surgery may reduce stress and tiredness and enhance surgeon decision making. Our review adds to the existing literature by revealing strategies to support the introduction of robotic surgery and contextual factors that need to be in place for these to be effective
Ethical implications of AI in robotic surgical training: A Delphi consensus statement
CONTEXT: As the role of AI in healthcare continues to expand there is increasing awareness of the potential pitfalls of AI and the need for guidance to avoid them. OBJECTIVES: To provide ethical guidance on developing narrow AI applications for surgical training curricula. We define standardised approaches to developing AI driven applications in surgical training that address current recognised ethical implications of utilising AI on surgical data. We aim to describe an ethical approach based on the current evidence, understanding of AI and available technologies, by seeking consensus from an expert committee. EVIDENCE ACQUISITION: The project was carried out in 3 phases: (1) A steering group was formed to review the literature and summarize current evidence. (2) A larger expert panel convened and discussed the ethical implications of AI application based on the current evidence. A survey was created, with input from panel members. (3) Thirdly, panel-based consensus findings were determined using an online Delphi process to formulate guidance. 30 experts in AI implementation and/or training including clinicians, academics and industry contributed. The Delphi process underwent 3 rounds. Additions to the second and third-round surveys were formulated based on the answers and comments from previous rounds. Consensus opinion was defined as ≥ 80% agreement. EVIDENCE SYNTHESIS: There was 100% response from all 3 rounds. The resulting formulated guidance showed good internal consistency, with a Cronbach alpha of >0.8. There was 100% consensus that there is currently a lack of guidance on the utilisation of AI in the setting of robotic surgical training. Consensus was reached in multiple areas, including: 1. Data protection and privacy; 2. Reproducibility and transparency; 3. Predictive analytics; 4. Inherent biases; 5. Areas of training most likely to benefit from AI. CONCLUSIONS: Using the Delphi methodology, we achieved international consensus among experts to develop and reach content validation for guidance on ethical implications of AI in surgical training. Providing an ethical foundation for launching narrow AI applications in surgical training. This guidance will require further validation. PATIENT SUMMARY: As the role of AI in healthcare continues to expand there is increasing awareness of the potential pitfalls of AI and the need for guidance to avoid them.In this paper we provide guidance on ethical implications of AI in surgical training
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