Design, simulation and evaluation of kinematic alternatives for Insertable Robotic Effectors Platforms in Single Port Access Surgery

This paper presents the task specifications for designing a novel Insertable Robotic Effectors Platform (IREP) with integrated stereo vision and surgical intervention tools for Single Port Access Surgery (SPAS). This design provides a compact deployable mechanical architecture that may be inserted through a single Ø15 mm access port. Dexterous surgical intervention and stereo vision are achieved via the use of two snake-like continuum robots and two controllable CCD cameras. Simulations and dexterity evaluation of our proposed design are compared to several design alternatives with different kinematic arrangements. Results of these simulations show that dexterity is improved by using an independent revolute joint at the tip of a continuum robot instead of achieving distal rotation by transmission of rotation about the backbone of the continuum robot. Further, it is shown that designs with two robotic continuum robots as surgical arms have diminished dexterity if the bases of these arms are close to each other. This result justifies our design and points to ways of improving the performance of existing designs that use continuum robots as surgical arms

Single-Site Colectomy With Miniature \u3ci\u3eIn Vivo\u3c/i\u3e Robotic Platform

There has been a continuing push to reduce the invasiveness of surgery by accessing the abdominal cavity through a single incision, such as with laparoendoscopic single-site (LESS) surgery. Although LESS procedures offer significant benefits, added complexities still inhibit the procedures. Robotic surgery is proving to be an excellent option to overcome these limitations. This paper presents the experimental results of the single-incision in vivo surgical robot (SISR), a multifunctional, dexterous, twoarmed robot capable of performing surgical tasks while overcoming the issues associated with manual LESS operations. In vivo surgical procedures have been used to demonstrate the efficacy of using a robotic platform over traditional laparoscopic tools. The most recent experimental test resulted in the first successful in vivo robotic LESS colectomy utilizing a robot completely contained within the abdominal cavity. In this test, SISR showed significant benefits including access to all quadrants in the peritoneal cavity and improved dexterity

Snake-Like Robots for Minimally Invasive, Single Port, and Intraluminal Surgeries

The surgical paradigm of Minimally Invasive Surgery (MIS) has been a key driver to the adoption of robotic surgical assistance. Progress in the last three decades has led to a gradual transition from manual laparoscopic surgery with rigid instruments to robot-assisted surgery. In the last decade, the increasing demand for new surgical paradigms to enable access into the anatomy without skin incision (intraluminal surgery) or with a single skin incision (Single Port Access surgery - SPA) has led researchers to investigate snake-like flexible surgical devices. In this chapter, we first present an overview of the background, motivation, and taxonomy of MIS and its newer derivatives. Challenges of MIS and its newer derivatives (SPA and intraluminal surgery) are outlined along with the architectures of new snake-like robots meeting these challenges. We also examine the commercial and research surgical platforms developed over the years, to address the specific functional requirements and constraints imposed by operations in confined spaces. The chapter concludes with an evaluation of open problems in surgical robotics for intraluminal and SPA, and a look at future trends in surgical robot design that could potentially address these unmet needs.Comment: 41 pages, 18 figures. Preprint of article published in the Encyclopedia of Medical Robotics 2018, World Scientific Publishing Company www.worldscientific.com/doi/abs/10.1142/9789813232266_000

Spider surgical system versus multiport laparoscopic surgery. Performance comparison on a surgical simulator

BACKGROUND: The rising interest towards minimally invasive surgery has led to the introduction of laparo-endoscopic single site (LESS) surgery as the natural evolution of conventional multiport laparoscopy. However, this new surgical approach is hampered with peculiar technical difficulties. The SPIDER surgical system has been developed in the attempt to overcome some of these challenges. Our study aimed to compare standard laparoscopy and SPIDER technical performance on a surgical simulator, using standardized tasks from the Fundamentals of Laparoscopic Surgery (FLS). METHODS: Twenty participants were divided into two groups based on their surgical laparoscopic experience: 10 PGY1 residents were included in the inexperienced group and 10 laparoscopists in the experienced group. Participants performed the FLS pegboard transfers task and pattern cutting task on a laparoscopic box trainer. Objective task scores and subjective questionnaire rating scales were used to compare conventional laparoscopy and SPIDER surgical system. RESULTS: Both groups performed significantly better in the FLS scores on the standard laparoscopic simulator compared to the SPIDER. Inexperienced group: Task 1 scores (median 252.5 vs. 228.5; p = 0.007); Task 2 scores (median 270.5 vs. 219.0; p = 0.005). Experienced group: Task 1 scores (median 411.5 vs. 309.5; p = 0.005); Task 2 scores (median 418.0 vs. 331.5; p = 0.007). Same aspects were highlighted for the subjective evaluations, except for the inexperienced surgeons who found both devices equivalent in terms of ease of use only in the peg transfer task. CONCLUSIONS: Even though the SPIDER is an innovative and promising device, our study proved that it is more challenging than conventional laparoscopy in a population with different degrees of surgical experience. We presume that a possible way to overcome such challenges could be the development of tailored training programs through simulation methods. This may represent an effective way to deliver training, achieve mastery and skills and prepare surgeons for their future clinical experience

Development of a slender continuum robotic system for on-wing inspection/repair of gas turbine engines

The maintenance works (e.g. inspection, repair) of aero-engines while still attached on the airframes requires a desirable approach since this can significantly shorten both the time and cost of such interventions as the aerospace industry commonly operates based on the generic concept “power by the hour”. However, navigating and performing a multi-axis movement of an end-effector in a very constrained environment such as gas turbine engines is a challenging task. This paper reports on the development of a highly flexible slender (i.e. low diameter-to-length ratios) continuum robot of 25 degrees of freedom capable to uncoil from a drum to provide the feeding motion needed to navigate into crammed environments and then perform, with its last 6 DoF, complex trajectories with a camera equipped machining end-effector for allowing in-situ interventions at a low-pressure compressor of a gas turbine engine. This continuum robot is a compact system and presents a set of innovative mechatronics solutions such as: (i) twin commanding cables to minimise the number of actuators; (ii) twin compliant joints to enable large bending angles (±90°) arranged on a tapered structure (start from 40 mm to 13 mm at its end); (iii) feeding motion provided by a rotating drum for coiling/uncoiling the continuum robot; (iv) machining end-effector equipped with vision system. To be able to achieve the in-situ maintenance tasks, a set of innovative control algorithms to enable the navigation and end-effector path generation have been developed and implemented. Finally, the continuum robot has been tested both for navigation and movement of the end-effector against a specified target within a gas turbine engine mock-up proving that: (i) max. deviations in navigation from the desired path (1000 mm length with bends between 45° and 90°) are ±10 mm; (ii) max. errors in positioning the end-effector against a target situated at the end of navigation path is 1 mm. Thus, this paper presents a compact continuum robot that could be considered as a step forward in providing aero-engine manufacturers with a solution to perform complex tasks in an invasive manner

Arquitectura de Control de una Plataforma Robótica sin Realimentación de Posición Articular para Cirugía Minimamente Invasiva

Rivas-Blanco, I.; Muñoz, V.F.; García-Morales, I.; Tortora, G.; Menciassi, A., "Arquitectura de Control de una Plataforma Robótica sin Realimentación de Posición Articular para Cirugía Minimamente Invasiva," Actas de las XXXVI Jornadas de Automática, Bilbao, Spain, pp.793-800, Sep. 2015Este trabajo presenta una plataforma robótica para cirugía mínimamente invasiva (CMI) compuesta por diferentes unidades robóticas miniaturizadas ancladas a una estructura magnética. El artículo describe las características hardware de la plataforma, así como la arquitectura de control maestro/esclavo que permite el manejo de dos unidades robóticas. El acoplamiento cinemático entre el maestro y el esclavo hace más intuitivo el sistema, haciendo posible que se maneje con destreza mediante dos dispositivos Phantoms Omni. Con el objeto de evaluar la viabilidad del esquema de control propuesto, se han llevado a cabo experimentos de “pick and place” y, a través de sesiones experimentales con cinco usuarios diferentes, se ha determinado la curva de aprendizaje del sistema. Debido a que las unidades robóticas miniaturizadas no están provistas de sensores, se ha desarrollado un método de autocalibración inicial basado en análisis de imagen con el objeto de evitar errores de posición de las articulaciones. La arquitectura de control propuesta muestra un adecuado funcionamiento en términos de control de velocidad.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

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

A Stiffness-Adjustable Hyperredundant Manipulator Using a Variable Neutral-Line Mechanism for Minimally Invasive Surgery

In robotic single-port surgery, it is desirable for a manipulator to exhibit the property of variable stiffness. Small-port incisions may require both high flexibility of the manipulator for safety purposes, as well as high structural stiffness for operational precision and high payload capability. This paper presents a new hyperredundant tubular manipulator with a variable neutral-line mechanisms and adjustable stiffness. A unique asymmetric arrangement of the tendons and the links realizes both articulation of the manipulator and continuous stiffness modulation. This asymmetric motion of the manipulator is compensated by a novel actuation mechanism without affecting its structural stiffness. The paper describes the basic mechanics of the variable neutral-line manipulator, and its stiffness characteristics. Simulation and experimental results verify the performance of the proposed mechanism.Samsung Advanced Institute of Technolog

Anthropomorphic surgical system for soft tissue robot-assisted surgery

Over the past century, abdominal surgery has seen a rapid transition from open procedures to less invasive methods such as laparoscopy and robot-assisted minimally invasive surgery (R-A MIS). These procedures have significantly decreased blood loss, postoperative morbidity and length of hospital stay in comparison with open surgery. R-A MIS has offered refined accuracy and more ergonomic instruments for surgeons, further minimising trauma to the patient.This thesis aims to investigate, design and prototype a novel system for R-A MIS that will provide more natural and intuitive manipulation of soft tissues and, at the same time, increase the surgeon's dexterity. The thesis reviews related work on surgical systems and discusses the requirements for designing surgical instrumentation. From the background research conducted in this thesis, it is clear that training surgeons in MIS procedures is becoming increasingly long and arduous. Furthermore, most available systems adopt a design similar to conventional laparoscopic instruments or focus on different techniques with debatable benefits. The system proposed in this thesis not only aims to reduce the training time for surgeons but also to improve the ergonomics of the procedure.In order to achieve this, a survey was conducted among surgeons, regarding their opinions on surgical training, surgical systems, how satisfied they are with them and how easy they are to use. A concept for MIS robotic instrumentation was then developed and a series of focus group meetings with surgeons were run to discuss it. The proposed system, named microAngelo, is an anthropomorphic master-slave system that comprises a three-digit miniature hand that can be controlled using the master, a three-digit sensory exoskeleton. While multi-fingered robotic hands have been developed for decades, none have been used for surgical operations. As the system has a human centred design, its relation to the human hand is discussed. Prototypes of both the master and the slave have been developed and their design and mechanisms is demonstrated. The accuracy and repeatability of the master as well as the accuracy and force capabilities of the slave are tested and discussed