Deep Reinforcement Learning in Surgical Robotics: Enhancing the Automation Level

Surgical robotics is a rapidly evolving field that is transforming the landscape of surgeries. Surgical robots have been shown to enhance precision, minimize invasiveness, and alleviate surgeon fatigue. One promising area of research in surgical robotics is the use of reinforcement learning to enhance the automation level. Reinforcement learning is a type of machine learning that involves training an agent to make decisions based on rewards and punishments. This literature review aims to comprehensively analyze existing research on reinforcement learning in surgical robotics. The review identified various applications of reinforcement learning in surgical robotics, including pre-operative, intra-body, and percutaneous procedures, listed the typical studies, and compared their methodologies and results. The findings show that reinforcement learning has great potential to improve the autonomy of surgical robots. Reinforcement learning can teach robots to perform complex surgical tasks, such as suturing and tissue manipulation. It can also improve the accuracy and precision of surgical robots, making them more effective at performing surgeries

Smart Camera Robotic Assistant for Laparoscopic Surgery

The cognitive architecture also includes learning mechanisms to adapt the behavior of the robot to the different ways of working of surgeons, and to improve the robot behavior through experience, in a similar way as a human assistant would do. The theoretical concepts of this dissertation have been validated both through in-vitro experimentation in the labs of medical robotics of the University of Malaga and through in-vivo experimentation with pigs in the IACE Center (Instituto Andaluz de Cirugía Experimental), performed by expert surgeons.In the last decades, laparoscopic surgery has become a daily practice in operating rooms worldwide, which evolution is tending towards less invasive techniques. In this scenario, robotics has found a wide field of application, from slave robotic systems that replicate the movements of the surgeon to autonomous robots able to assist the surgeon in certain maneuvers or to perform autonomous surgical tasks. However, these systems require the direct supervision of the surgeon, and its capacity of making decisions and adapting to dynamic environments is very limited. This PhD dissertation presents the design and implementation of a smart camera robotic assistant to collaborate with the surgeon in a real surgical environment. First, it presents the design of a novel camera robotic assistant able to augment the capacities of current vision systems. This robotic assistant is based on an intra-abdominal camera robot, which is completely inserted into the patient’s abdomen and it can be freely moved along the abdominal cavity by means of magnetic interaction with an external magnet. To provide the camera with the autonomy of motion, the external magnet is coupled to the end effector of a robotic arm, which controls the shift of the camera robot along the abdominal wall. This way, the robotic assistant proposed in this dissertation has six degrees of freedom, which allow providing a wider field of view compared to the traditional vision systems, and also to have different perspectives of the operating area. On the other hand, the intelligence of the system is based on a cognitive architecture specially designed for autonomous collaboration with the surgeon in real surgical environments. The proposed architecture simulates the behavior of a human assistant, with a natural and intuitive human-robot interface for the communication between the robot and the surgeon

Learning of Surgical Gestures for Robotic Minimally Invasive Surgery Using Dynamic Movement Primitives and Latent Variable Models

Full and partial automation of Robotic Minimally Invasive Surgery holds significant promise to improve patient treatment, reduce recovery time, and reduce the fatigue of the surgeons. However, to accomplish this ambitious goal, a mathematical model of the intervention is needed. In this thesis, we propose to use Dynamic Movement Primitives (DMPs) to encode the gestures a surgeon has to perform to achieve a task. DMPs allow to learn a trajectory, thus imitating the dexterity of the surgeon, and to execute it while allowing to generalize it both spatially (to new starting and goal positions) and temporally (to different speeds of executions). Moreover, they have other desirable properties that make them well suited for surgical applications, such as online adaptability, robustness to perturbations, and the possibility to implement obstacle avoidance. We propose various modifications to improve the state-of-the-art of the framework, as well as novel methods to handle obstacles. Moreover, we validate the usage of DMPs to model gestures by automating a surgical-related task and using DMPs as the low-level trajectory generator. In the second part of the thesis, we introduce the problem of unsupervised segmentation of tasks' execution in gestures. We will introduce latent variable models to tackle the problem, proposing further developments to combine such models with the DMP theory. We will review the Auto-Regressive Hidden Markov Model (AR-HMM) and test it on surgical-related datasets. Then, we will propose a generalization of the AR-HMM to general, non-linear, dynamics, showing that this results in a more accurate segmentation, with a less severe over-segmentation. Finally, we propose a further generalization of the AR-HMM that aims at integrating a DMP-like dynamic into the latent variable model

Automation of Manual Tasks for Minimally Invasive Surgery

Abstract—We have developed an experimental system for minimally invasive surgery providing force feedback and au-tomation of recurring task. The system consists of four robotic arms, which can be equipped with either minimally invasive instruments or a stereo camera. The master console provides a stereo view of the field of operation and two input devices can feed back forces to the user. We have utilized this system to assess the possibility of automating difficult handling tasks like surgical knot tying. In order to achieve this, a novel approach for human-machine skill transfer was developed. It constitutes an extension to learning by demonstration, which is a well known paradigm of robotic learning. Index Terms—learning by demonstration, skill transfer, robotic surgery I