Robot Autonomy for Surgery

Autonomous surgery involves having surgical tasks performed by a robot operating under its own will, with partial or no human involvement. There are several important advantages of automation in surgery, which include increasing precision of care due to sub-millimeter robot control, real-time utilization of biosignals for interventional care, improvements to surgical efficiency and execution, and computer-aided guidance under various medical imaging and sensing modalities. While these methods may displace some tasks of surgical teams and individual surgeons, they also present new capabilities in interventions that are too difficult or go beyond the skills of a human. In this chapter, we provide an overview of robot autonomy in commercial use and in research, and present some of the challenges faced in developing autonomous surgical robots

Towards retrieving force feedback in robotic-assisted surgery: a supervised neuro-recurrent-vision approach

Robotic-assisted minimally invasive surgeries have gained a lot of popularity over conventional procedures as they offer many benefits to both surgeons and patients. Nonetheless, they still suffer from some limitations that affect their outcome. One of them is the lack of force feedback which restricts the surgeon's sense of touch and might reduce precision during a procedure. To overcome this limitation, we propose a novel force estimation approach that combines a vision based solution with supervised learning to estimate the applied force and provide the surgeon with a suitable representation of it. The proposed solution starts with extracting the geometry of motion of the heart's surface by minimizing an energy functional to recover its 3D deformable structure. A deep network, based on a LSTM-RNN architecture, is then used to learn the relationship between the extracted visual-geometric information and the applied force, and to find accurate mapping between the two. Our proposed force estimation solution avoids the drawbacks usually associated with force sensing devices, such as biocompatibility and integration issues. We evaluate our approach on phantom and realistic tissues in which we report an average root-mean square error of 0.02 N.Peer ReviewedPostprint (author's final draft

Prevalence of haptic feedback in robot-mediated surgery : a systematic review of literature

© 2017 Springer-Verlag. This is a post-peer-review, pre-copyedit version of an article published in Journal of Robotic Surgery. The final authenticated version is available online at: https://doi.org/10.1007/s11701-017-0763-4With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.Peer reviewe

Haptics-Enabled Teleoperation for Robotics-Assisted Minimally Invasive Surgery

The lack of force feedback (haptics) in robotic surgery can be considered to be a safety risk leading to accidental tissue damage and puncturing of blood vessels due to excessive forces being applied to tissue and vessels or causing inefficient control over the instruments because of insufficient applied force. This project focuses on providing a satisfactory solution for introducing haptic feedback in robotics-assisted minimally invasive surgical (RAMIS) systems. The research addresses several key issues associated with the incorporation of haptics in a master-slave (teleoperated) robotic environment for minimally invasive surgery (MIS). In this project, we designed a haptics-enabled dual-arm (two masters - two slaves) robotic MIS testbed to investigate and validate various single-arm as well as dual-arm teleoperation scenarios. The most important feature of this setup is the capability of providing haptic feedback in all 7 degrees of freedom (DOF) required for RAMIS (3 translations, 3 rotations and pinch motion of the laparoscopic tool). The setup also enables the evaluation of the effect of replacing haptic feedback by other sensory cues such as visual representation of haptic information (sensory substitution) and the hypothesis that surgical outcomes may be improved by substituting or augmenting haptic feedback by such sensory cues

Realization of a demonstrator slave for robotic minimally invasive surgery

Robots for Minimally Invasive Surgery (MIS) can improve the surgeon’s work conditions with respect to conventional MIS and to enable MIS with more complex procedures. This requires to provide the surgeon with tactile feedback to feel forces executed on e.g. tissue and sutures, which is partially lost in conventional MIS. Additionally use of a robot should improve the approach possibilities of a target organ by means of instrument degrees of freedom (DoFs) and of the entry points with a compact set-up. These requirements add to the requirements set by the most common commercially available system, the da Vinci which are: (i) dexterity, (ii) natural hand-eye coordination, (iii) a comfortable body posture, (iv) intuitive utilization, and (v) a stereoscopic ’3D’ view of the operation site. The purpose of Sofie (Surgeon’s operating force-feedback interface Eindhoven) is to evaluate the possible benefit of force-feedback and the approach of both patient and target organ. Sofie integrates master, slave, electronic hardware and control. This thesis focusses on the design and realization of a technology demonstrator of the Slave. To provide good accuracy and valuable force-feedback, good dynamic behavior and limited hysteresis are required. To this end the Slave includes (i) a relatively short force-path between its instrument-tips and between tip and patient, and (ii) a passive instrument-support by means of a remote kinematically fixed point of rotation. The incision tissue does not support the instrument. The Slave is connected directly to the table. It provides a 20 DoF highly adaptable stiff frame (pre-surgical set-up) with a short force-path between the instrumenttips and between instrument-tip and patient. During surgery this frame supports three 4 DoF manipulators, two for exchangeable 4 DoF instruments and one for an endoscope. The pre-surgical set-up of the Slave consists of a 5 DoF platform-adjustment with a platform. This platform can hold three 5 DoF manipulator-adjustments in line-up. The set-up is compact to avoid interference with the team, entirely mechanical and allows fast manual adjustment and fixation of the joints. It provides a stiff frame during surgery. A weight-compensation mechanism for the platformadjustment has been proposed. Measurements indicate all natural frequencies are above 25 Hz. The manipulator moves the instrument in 4 DoFs (??, , ?? and Z). Each manipulator passively supports its instrument with a parallelogram mechanism, providing a kinematically fixed point of rotation. Two manipulators have been designed in consecutive order. The first manipulator drives with a worm-wormwheel, the second design uses a ball-screw drive. This ball-screw drive reduces friction, which is preferred for next generations of the manipulator, since the worm-wormwheel drive shows a relatively low coherence at low frequencies. The compact ??Zmanipulator moves the instrument in ?? by rotating a drum. Friction wheels in the drum provide Z. Eventually, the drum will be removable from the manipulator for sterilization. This layout of the manipulator results in a small motion-envelope and least obstructs the team at the table. Force sensors measuring forces executed with the instrument, are integrated in the manipulator instead of at the instrument tip, to avoid all risks of electrical signals being introduced into the patient. Measurements indicate the separate sensors function properly. Integrated in the manipulator the sensors provide a good indication of the force but do suffer from some hysteresis which might be caused by moving wires. The instrument as realized consists of a drive-box, an instrument-tube and a 4 DoF tip. It provides the surgeon with three DoFs additional to the gripper of conventional MIS instruments. These DoFs include two lateral rotations (pitch and pivot) to improve the approach possibilities and the roll DoF will contribute in stitching. Pitch and roll are driven by means of bevelgears, driven with concentric tubes. Cables drive the pivot and close DoFs of the gripper. The transmissions are backdriveable for safety. Theoretical torques that can be achieved with this instrument approximate the requirements closely. Further research needs to reveal the torques achieved in practice and whether the requirements obtained from literature actually are required for these 4 DoF instruments. Force-sensors are proposed and can be integrated. Sofie currently consists of a master prototype with two 5 DoF haptic interfaces, the Slave and an electronic hardware cabinet. The surgeon uses the haptic interfaces of the Master to manipulate the manipulators and instruments of the Slave, while the actuated DoFs of the Master provide the surgeon with force-feedback. This project resulted in a demonstrator of the slave with force sensors incorporated, compact for easy approach of the patient and additional DoFs to increase approach possibilities of the target organ. This slave and master provide a good starting point to implement haptic controllers. These additional features may ultimately benefit both surgeon and patient

Observer based dynamic control model for bilaterally controlled MU-lapa robot: Surgical tool force limiting

During laparoscopic surgeries, primary surgical tool insertion is the demanding and strenuous task. As the surgeon is unaware of the type of the tissue and associated parameters to conduct the insertion, therefore, to ease the procedure, the movement of the surgical tool needs to be controlled. It’s the operational capabilities that are to be manipulated to perform a smooth surgery even from a distant location. In this study, a robot system is being introduced for laparoscopic primary surgical tool insertion. It will incorporate a novel observer based dynamic control along with robot assisted bilateral control. Moreover, a virtual spring damper force lock system is introduced through which the slave system will notify the master regarding the target achieved and excessive force. The validation of the proposed control system is experimented with bilaterally controlled MU-LapaRobot. The experiment is comprising 3 cases of bilateral control criteria which are non-contact motion, contact motion, and limit force locking. The results defined the same value for contact and non-contact motion by 0.3N. The results depicted a force error of 3.6% and a position error of 5.8% which validated the proposed algorithm