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

The design and fabrication of a meso scale minimally invasive surgical robot

Minimally invasive robotic Single Port Laparoscopic Surgery (SPLS) is of high importance, due to its ability to reduce operation times, recovery times, postoperative infection rates and improve cosmesis while providing surgeons with greater dexterity and precision than traditional SPLS techniques. Previous approaches to robotic SPLS rely on modifications to devices meant for multi-port procedures. These approaches suffer from larger port sizes and triangulation problems. Here, we propose a scheme for SPLS involving 6 degree-of-freedom robot manipulators and lumen design that translates the dexterity and triangulation capabilities of the human arm to the internal operating field using an insertion scheme where four 9 mm tools can be passed through a single 18 mm lumen

Design of a Flexible Control Platform and Miniature in vivo Robots for Laparo-Endoscopic Single-Site Surgeries

Minimally-invasive laparoscopic procedures have proven efficacy for a wide range of surgical procedures as well as benefits such as reducing scarring, infection, recovery time, and post-operative pain. While the procedures have many advantages, there are significant shortcomings such as limited instrument motion and reduced dexterity. In recent years, robotic surgical technology has overcome some of these limitations and has become an effective tool for many types of surgeries. These robotic platforms typically have an increased workspace, greater dexterity, improved ergonomics, and finer control than traditional laparoscopic methods. This thesis presents the designs of both a four degree-of-freedom (DOF) and 5-DOF miniature in vivo surgical robot as well as a software architecture for development and control of such robots. The proposed surgical platform consists of a two-armed robotic prototype, distributed motor control modules, custom robot control software, and remote surgeon console. A plug-in architecture in the control software provides the user a wide range of user input devices and control algorithms, including a numerical inverse kinematics solver, to allow intuitive control and rapid development of future robot prototypes. A variety of experiments performed by a surgeon at the University of Nebraska Medical Center were used to evaluate the performance of the robotic platform. Adviser: Shane Farrito

Design of a Flexible Control Platform and Miniature in vivo Robots for Laparo-Endoscopic Single-Site Surgeries

Minimally-invasive laparoscopic procedures have proven efficacy for a wide range of surgical procedures as well as benefits such as reducing scarring, infection, recovery time, and post-operative pain. While the procedures have many advantages, there are significant shortcomings such as limited instrument motion and reduced dexterity. In recent years, robotic surgical technology has overcome some of these limitations and has become an effective tool for many types of surgeries. These robotic platforms typically have an increased workspace, greater dexterity, improved ergonomics, and finer control than traditional laparoscopic methods. This thesis presents the designs of both a four degree-of-freedom (DOF) and 5-DOF miniature in vivo surgical robot as well as a software architecture for development and control of such robots. The proposed surgical platform consists of a two-armed robotic prototype, distributed motor control modules, custom robot control software, and remote surgeon console. A plug-in architecture in the control software provides the user a wide range of user input devices and control algorithms, including a numerical inverse kinematics solver, to allow intuitive control and rapid development of future robot prototypes. A variety of experiments performed by a surgeon at the University of Nebraska Medical Center were used to evaluate the performance of the robotic platform. Adviser: Shane Farrito

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

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

Multi-robot cooperative platform : a task-oriented teleoperation paradigm

This thesis proposes the study and development of a teleoperation system based on multi-robot cooperation under the task oriented teleoperation paradigm: Multi-Robot Cooperative Paradigm, MRCP. In standard teleoperation, the operator uses the master devices to control the remote slave robot arms. These arms reproduce the desired movements and perform the task. With the developed work, the operator can virtually manipulate an object. MRCP automatically generates the arms orders to perform the task. The operator does not have to solve situations arising from possible restrictions that the slave arms may have. The research carried out is therefore aimed at improving the accuracy teleoperation tasks in complex environments, particularly in the field of robot assisted minimally invasive surgery. This field requires patient safety and the workspace entails many restrictions to teleoperation. MRCP can be defined as a platform composed of several robots that cooperate automatically to perform a teleoperated task, creating a robotic system with increased capacity (workspace volume, accessibility, dexterity ...). The cooperation is based on transferring the task between robots when necessary to enable a smooth task execution. The MRCP control evaluates the suitability of each robot to continue with the ongoing task and the optimal time to execute a task transfer between the current selected robot and the best candidate to continue with the task. From the operator¿s point of view, MRCP provides an interface that enables the teleoperation though the task-oriented paradigm: operator orders are translated into task actions instead of robot orders. This thesis is structured as follows: The first part is dedicated to review the current solutions in the teleoperation of complex tasks and compare them with those proposed in this research. The second part of the thesis presents and reviews in depth the different evaluation criteria to determine the suitability of each robot to continue with the execution of a task, considering the configuration of the robots and emphasizing the criterion of dexterity and manipulability. The study reviews the different required control algorithms to enable the task oriented telemanipulation. This proposed teleoperation paradigm is transparent to the operator. Then, the Thesis presents and analyses several experimental results using MRCP in the field of minimally invasive surgery. These experiments study the effectiveness of MRCP in various tasks requiring the cooperation of two hands. A type task is used: a suture using minimally invasive surgery technique. The analysis is done in terms of execution time, economy of movement, quality and patient safety (potential damage produced by undesired interaction between the tools and the vital tissues of the patient). The final part of the thesis proposes the implementation of different virtual aids and restrictions (guided teleoperation based on haptic visual and audio feedback, protection of restricted workspace regions, etc.) using the task oriented teleoperation paradigm. A framework is defined for implementing and applying a basic set of virtual aids and constraints within the framework of a virtual simulator for laparoscopic abdominal surgery. The set of experiments have allowed to validate the developed work. The study revealed the influence of virtual aids in the learning process of laparoscopic techniques. It has also demonstrated the improvement of learning curves, which paves the way for its implementation as a methodology for training new surgeons.Aquesta tesi doctoral proposa l'estudi i desenvolupament d'un sistema de teleoperació basat en la cooperació multi-robot sota el paradigma de la teleoperació orientada a tasca: Multi-Robot Cooperative Paradigm, MRCP. En la teleoperació clàssica, l'operador utilitza els telecomandaments perquè els braços robots reprodueixin els seus moviments i es realitzi la tasca desitjada. Amb el treball realitzat, l'operador pot manipular virtualment un objecte i és mitjançant el MRCP que s'adjudica a cada braç les ordres necessàries per realitzar la tasca, sense que l'operador hagi de resoldre les situacions derivades de possibles restriccions que puguin tenir els braços executors. La recerca desenvolupada està doncs orientada a millorar la teleoperació en tasques de precisió en entorns complexos i, en particular, en el camp de la cirurgia mínimament invasiva assistida per robots. Aquest camp imposa condicions de seguretat del pacient i l'espai de treball comporta moltes restriccions a la teleoperació. MRCP es pot definir com a una plataforma formada per diversos robots que cooperen de forma automàtica per dur a terme una tasca teleoperada, generant un sistema robòtic amb capacitats augmentades (volums de treball, accessibilitat, destresa,...). La cooperació es basa en transferir la tasca entre robots a partir de determinar quin és aquell que és més adequat per continuar amb la seva execució i el moment òptim per realitzar la transferència de la tasca entre el robot actiu i el millor candidat a continuar-la. Des del punt de vista de l'operari, MRCP ofereix una interfície de teleoperació que permet la realització de la teleoperació mitjançant el paradigma d'ordres orientades a la tasca: les ordres es tradueixen en accions sobre la tasca en comptes d'estar dirigides als robots. Aquesta tesi està estructurada de la següent manera: Primerament es fa una revisió de l'estat actual de les diverses solucions desenvolupades actualment en el camp de la teleoperació de tasques complexes, comparant-les amb les proposades en aquest treball de recerca. En el segon bloc de la tesi es presenten i s'analitzen a fons els diversos criteris per determinar la capacitat de cada robot per continuar l'execució d'una tasca, segons la configuració del conjunt de robots i fent especial èmfasi en el criteri de destresa i manipulabilitat. Seguint aquest estudi, es presenten els diferents processos de control emprats per tal d'assolir la telemanipulació orientada a tasca de forma transparent a l'operari. Seguidament es presenten diversos resultats experimentals aplicant MRCP al camp de la cirurgia mínimament invasiva. En aquests experiments s'estudia l'eficàcia de MRCP en diverses tasques que requereixen de la cooperació de dues mans. S'ha escollit una tasca tipus: sutura amb tècnica de cirurgia mínimament invasiva. L'anàlisi es fa en termes de temps d'execució, economia de moviment, qualitat i seguretat del pacient (potencials danys causats per la interacció no desitjada entre les eines i els teixits vitals del pacient). Finalment s'ha estudiat l'ús de diferents ajudes i restriccions virtuals (guiat de la teleoperació via retorn hàptic, visual o auditiu, protecció de regions de l'espai de treball, etc) dins el paradigma de teleoperació orientada a tasca. S'ha definint un marc d'aplicació base i implementant un conjunt de restriccions virtuals dins el marc d'un simulador de cirurgia laparoscòpia abdominal. El conjunt d'experiments realitzats han permès validar el treball realitzat. Aquest estudi ha permès determinar la influencia de les ajudes virtuals en el procés d'aprenentatge de les tècniques laparoscòpiques. S'ha evidenciat una millora en les corbes d'aprenentatge i obre el camí a la seva implantació com a metodologia d'entrenament de nous cirurgians.Postprint (published version

Flexible robotic device for spinal surgery

Surgical robots have proliferated in recent years, with well-established benefits including: reduced patient trauma, shortened hospitalisation, and improved diagnostic accuracy and therapeutic outcome. Despite these benefits, many challenges in their development remain, including improved instrument control and ergonomics caused by rigid instrumentation and its associated fulcrum effect. Consequently, it is still extremely challenging to utilise such devices in cases that involve complex anatomical pathways such as the spinal column. The focus of this thesis is the development of a flexible robotic surgical cutting device capable of manoeuvring around the spinal column. The target application of the flexible surgical tool is the removal of cancerous tumours surrounding the spinal column, which cannot be excised completely using the straight surgical tools in use today; anterior and posterior sections of the spine must be accessible for complete tissue removal. A parallel robot platform with six degrees of freedom (6 DoFs) has been designed and fabricated to direct a flexible cutting tool to produce the necessary range of movements to reach anterior and posterior sections of the spinal column. A flexible water jet cutting system and a flexible mechanical drill, which may be assembled interchangeably with the flexible probe, have been developed and successfully tested experimentally. A model predicting the depth of cut by the water jet was developed and experimentally validated. A flexion probe that is able to guide the surgical cutting device around the spinal column has been fabricated and tested with human lumber model. Modelling and simulations show the capacity for the flexible surgical system to enable entering the posterior side of the human lumber model and bend around the vertebral body to reach the anterior side of the spinal column. A computer simulation with a full Graphical User Interface (GUI) was created and used to validate the system of inverse kinematic equations for the robot platform. The constraint controller and the inverse kinematics relations are both incorporated into the overall positional control structure of the robot, and have successfully established a haptic feedback controller for the 6 DoFs surgical probe, and effectively tested in vitro on spinal mock surgery. The flexible surgical system approached the surgery from the posterior side of the human lumber model and bend around the vertebral body to reach the anterior side of the spinal column. The flexible surgical robot removed 82% of mock cancerous tissue compared to 16% of tissue removed by the rigid tool.Open Acces

A Scalable, High-Performance, Real-Time Control Architecture with Application to Semi-Autonomous Teleoperation

A scalable and real-time capable infrastructure is required to enable high-performance control and haptic rendering of systems with many degrees-of-freedom. The specific platform that motivates this thesis work is the open research platform da Vinci ReResearch Kit (dVRK). For the system architecture, we propose a specialized IEEE-1394 (FireWire) broadcast protocol that takes advantage of broadcast and peer-to-peer transfers to minimize the number of transactions, and thus the software overhead, on the control PC, thereby enabling fast real-time control. It has also been extended to Ethernet via a novel Ethernet-to-FireWire bridge protocol. The software architecture consists of a distributed hardware interface layer, a real-time component-based software framework, and integration with the Robot Operating System (ROS). The architecture is scalable to support multiple active manipulators, reconfigurable to enable researchers to partition a full system into multiple independent subsystems, and extensible at all levels of control. This architecture has been applied to two semi-autonomous teleoperation applications. The first application is a suturing task in Robotic Minimally Invasive Surgery (RMIS), that includes the development of virtual fixtures for the needle passing and knot tying sub-tasks, with a multi-user study to verify their effectiveness. The second application concerns time-delayed teleoperation of a robotic arm for satellite servicing. The research contribution includes the development of a line virtual fixture with augmented reality, a test for different time delay configurations and a multi-user study that evaluates the effectiveness of the system