Smart Navigation in Surgical Robotics

La cirugía mínimamente invasiva, y concretamente la cirugía laparoscópica, ha supuesto un gran cambio en la forma de realizar intervenciones quirúrgicas en el abdomen. Actualmente, la cirugía laparoscópica ha evolucionado hacia otras técnicas aún menos invasivas, como es la cirugía de un solo puerto, en inglés Single Port Access Surgery. Esta técnica consiste en realizar una única incisión, por la que son introducidos los instrumentos y la cámara laparoscópica a través de un único trocar multipuerto. La principal ventaja de esta técnica es una reducción de la estancia hospitalaria por parte del paciente, y los resultados estéticos, ya que el trocar se suele introducir por el ombligo, quedando la cicatriz oculta en él. Sin embargo, el hecho de que los instrumentos estén introducidos a través del mismo trocar hace la intervención más complicada para el cirujano, que necesita unas habilidades específicas para este tipo de intervenciones. Esta tesis trata el problema de la navegación de instrumentos quirúrgicos mediante plataformas robóticas teleoperadas en cirugía de un solo puerto. En concreto, se propone un método de navegación que dispone de un centro de rotación remoto virtual, el cuál coincide con el punto de inserción de los instrumentos (punto de fulcro). Para estimar este punto se han empleado las fuerzas ejercidas por el abdomen en los instrumentos quirúrgicos, las cuales han sido medidas por sensores de esfuerzos colocados en la base de los instrumentos. Debido a que estos instrumentos también interaccionan con tejido blando dentro del abdomen, lo cual distorsionaría la estimación del punto de inserción, es necesario un método que permita detectar esta circunstancia. Para solucionar esto, se ha empleado un detector de interacción con tejido basado en modelos ocultos de Markov el cuál se ha entrenado para detectar cuatro gestos genéricos. Por otro lado, en esta tesis se plantea el uso de guiado háptico para mejorar la experiencia del cirujano cuando utiliza plataformas robóticas teleoperadas. En concreto, se propone la técnica de aprendizaje por demostración (Learning from Demonstration) para generar fuerzas que puedan guiar al cirujano durante la resolución de tareas específicas. El método de navegación propuesto se ha implantado en la plataforma quirúrgica CISOBOT, desarrollada por la Universidad de Málaga. Los resultados experimentales obtenidos validan tanto el método de navegación propuesto, como el detector de interacción con tejido blando. Por otro lado, se ha realizado un estudio preliminar del sistema de guiado háptico. En concreto, se ha empleado una tarea genérica, la inserción de una clavija, para realizar los experimentos necesarios que permitan demostrar que el método propuesto es válido para resolver esta tarea y otras similares

Robotic manipulators for single access surgery

This thesis explores the development of cooperative robotic manipulators for enhancing surgical precision and patient outcomes in single-access surgery and, specifically, Transanal Endoscopic Microsurgery (TEM). During these procedures, surgeons manipulate a heavy set of instruments via a mechanical clamp inserted in the patient’s body through a surgical port, resulting in imprecise movements, increased patient risks, and increased operating time. Therefore, an articulated robotic manipulator with passive joints is initially introduced, featuring built-in position and force sensors in each joint and electronic joint brakes for instant lock/release capability. The articulated manipulator concept is further improved with motorised joints, evolving into an active tool holder. The joints allow the incorporation of advanced robotic capabilities such as ultra-lightweight gravity compensation and hands-on kinematic reconfiguration, which can optimise the placement of the tool holder in the operating theatre. Due to the enhanced sensing capabilities, the application of the active robotic manipulator was further explored in conjunction with advanced image guidance approaches such as endomicroscopy. Recent advances in probe-based optical imaging such as confocal endomicroscopy is making inroads in clinical uses. However, the challenging manipulation of imaging probes hinders their practical adoption. Therefore, a combination of the fully cooperative robotic manipulator with a high-speed scanning endomicroscopy instrument is presented, simplifying the incorporation of optical biopsy techniques in routine surgical workflows. Finally, another embodiment of a cooperative robotic manipulator is presented as an input interface to control a highly-articulated robotic instrument for TEM. This master-slave interface alleviates the drawbacks of traditional master-slave devices, e.g., using clutching mechanics to compensate for the mismatch between slave and master workspaces, and the lack of intuitive manipulation feedback, e.g. joint limits, to the user. To address those drawbacks a joint-space robotic manipulator is proposed emulating the kinematic structure of the flexible robotic instrument under control.Open Acces

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

Magnetic Surgical Instruments for Robotic Abdominal Surgery.

This review looks at the implementation of magnetic-based approaches in surgical instruments for abdominal surgeries. As abdominal surgical techniques advance toward minimizing surgical trauma, surgical instruments are enhanced to support such an objective through the exploration of magnetic-based systems. With this design approach, surgical devices are given the capabilities to be fully inserted intraabdominally to achieve access to all abdominal quadrants, without the conventional rigid link connection with the external unit. The variety of intraabdominal surgical devices are anchored, guided, and actuated by external units, with power and torque transmitted across the abdominal wall through magnetic linkage. This addresses many constraints encountered by conventional laparoscopic tools, such as loss of triangulation, fulcrum effect, and loss/lack of dexterity for surgical tasks. Design requirements of clinical considerations to aid the successful development of magnetic surgical instruments, are also discussed

Development of An In Vivo Robotic Camera for Dexterous Manipulation and Clear Imaging

Minimally invasive surgeriy (MIS) techniques are becoming more popular as replacements for traditional open surgeries. These methods benefit patients with lowering blood loss and post-operative pain, reducing recovery period and hospital stay time, decreasing surgical area scarring and cosmetic issues, and lessening the treatment costs, hence greater patient satisfaction would be earned. Manipulating surgical instruments from outside of abdomen and performing surgery needs precise hand-eye coordination which is provided by insertable cameras. The traditional MIS insertable cameras suffer from port complexity and reduced manipulation dexterity, which leads to defection in Hand-eye coordination and surgical flow. Fully insertable robotic camera systems emerged as a promising solution in MIS. Implementing robotic camera systems faces multiple challenges in fixation, manipulation, orientation control, tool-tissue interaction, in vivo illumination and clear imaging.In this dissertation a novel actuation and control mechanism is developed and validated for an insertable laparoscopic camera. This design uses permanent magnets and coils as force/torque generators in an external control unit to manipulate an in vivo camera capsule. The motorless design of this capsule reduces the, wight, size and power consumption of the driven unit. In order to guarantee the smooth motion of the camera inside the abdominal cavity, an interaction force control method was proposed and validated.Optimizing the system\u27s design, through minimizing the control unit size and power consumption and extending maneuverability of insertable camera, was achieved by a novel transformable design, which uses a single permanent magnet in the control unit. The camera robot uses a permanent magnet as fixation and translation unit, and two embedded motor for tilt motion actuation, as well as illumination actuation. Transformable design provides superior imaging quality through an optimized illumination unit and a cleaning module. The illumination module uses freeform optical lenses to control light beams from the LEDs to achieve optimized illumination over surgical zone. The cleaning module prevents lens contamination through a pump actuated debris prevention system, while mechanically wipes the lens in case of contamination. The performance of transformable design and its modules have been assessed experimentally

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

sCAM: An Untethered Insertable Laparoscopic Surgical Camera Robot

Fully insertable robotic imaging devices represent a promising future of minimally invasive laparoscopic vision. Emerging research efforts in this field have resulted in several proof-of-concept prototypes. One common drawback of these designs derives from their clumsy tethering wires which not only cause operational interference but also reduce camera mobility. Meanwhile, these insertable laparoscopic cameras are manipulated without any pose information or haptic feedback, which results in open loop motion control and raises concerns about surgical safety caused by inappropriate use of force.This dissertation proposes, implements, and validates an untethered insertable laparoscopic surgical camera (sCAM) robot. Contributions presented in this work include: (1) feasibility of an untethered fully insertable laparoscopic surgical camera, (2) camera-tissue interaction characterization and force sensing, (3) pose estimation, visualization, and feedback with sCAM, and (4) robotic-assisted closed-loop laparoscopic camera control. Borrowing the principle of spherical motors, camera anchoring and actuation are achieved through transabdominal magnetic coupling in a stator-rotor manner. To avoid the tethering wires, laparoscopic vision and control communication are realized with dedicated wireless links based on onboard power. A non-invasive indirect approach is proposed to provide real-time camera-tissue interaction force measurement, which, assisted by camera-tissue interaction modeling, predicts stress distribution over the tissue surface. Meanwhile, the camera pose is remotely estimated and visualized using complementary filtering based on onboard motion sensing. Facilitated by the force measurement and pose estimation, robotic-assisted closed-loop control has been realized in a double-loop control scheme with shared autonomy between surgeons and the robotic controller.The sCAM has brought robotic laparoscopic imaging one step further toward less invasiveness and more dexterity. Initial ex vivo test results have verified functions of the implemented sCAM design and the proposed force measurement and pose estimation approaches, demonstrating the technical feasibility of a tetherless insertable laparoscopic camera. Robotic-assisted control has shown its potential to free surgeons from low-level intricate camera manipulation workload and improve precision and intuitiveness in laparoscopic imaging

Cable-driven parallel robot for transoral laser phonosurgery

Transoral laser phonosurgery (TLP) is a common surgical procedure in otolaryngology. Currently, two techniques are commonly used: free beam and fibre delivery. For free beam delivery, in combination with laser scanning techniques, accurate laser pattern scanning can be achieved. However, a line-of-sight to the target is required. A suspension laryngoscope is adopted to create a straight working channel for the scanning laser beam, which could introduce lesions to the patient, and the manipulability and ergonomics are poor. For the fibre delivery approach, a flexible fibre is used to transmit the laser beam, and the distal tip of the laser fibre can be manipulated by a flexible robotic tool. The issues related to the limitation of the line-of-sight can be avoided. However, the laser scanning function is currently lost in this approach, and the performance is inferior to that of the laser scanning technique in the free beam approach. A novel cable-driven parallel robot (CDPR), LaryngoTORS, has been developed for TLP. By using a curved laryngeal blade, a straight suspension laryngoscope will not be necessary to use, which is expected to be less traumatic to the patient. Semi-autonomous free path scanning can be executed, and high precision and high repeatability of the free path can be achieved. The performance has been verified in various bench and ex vivo tests. The technical feasibility of the LaryngoTORS robot for TLP was considered and evaluated in this thesis. The LaryngoTORS robot has demonstrated the potential to offer an acceptable and feasible solution to be used in real-world clinical applications of TLP. Furthermore, the LaryngoTORS robot can combine with fibre-based optical biopsy techniques. Experiments of probe-based confocal laser endomicroscopy (pCLE) and hyperspectral fibre-optic sensing were performed. The LaryngoTORS robot demonstrates the potential to be utilised to apply the fibre-based optical biopsy of the larynx.Open Acces