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

Virtual reality training platform for flexible ureterorenoscopy interventions with a minimally invasive surgical robot

The total number of ureteroscopy (URS) interventions during the past years has dramatically increased due to the ongoing technological advances and the benefits associated with these techniques. However, the current URS procedure presents some drawbacks to urologic surgeons. The LITHOS project was created with the main objective of developing a surgical robotic system for flexible ureterorenoscopic lithotripsy interventions, offering a technological solution that meets the real needs of both patients and surgeons in this type of procedures. In this paper, a virtual reality environment for flexible ureterorenoscopy interventions is presented. The proposed environment provides a suitable training platform for surgeons manipulating the surgical robotic system

A Survey on the Current Status and Future Challenges Towards Objective Skills Assessment in Endovascular Surgery

Minimally-invasive endovascular interventions have evolved rapidly over the past decade, facilitated by breakthroughs in medical imaging and sensing, instrumentation and most recently robotics. Catheter based operations are potentially safer and applicable to a wider patient population due to the reduced comorbidity. As a result endovascular surgery has become the preferred treatment option for conditions previously treated with open surgery and as such the number of patients undergoing endovascular interventions is increasing every year. This fact coupled with a proclivity for reduced working hours, results in a requirement for efficient training and assessment of new surgeons, that deviates from the “see one, do one, teach one” model introduced by William Halsted, so that trainees obtain operational expertise in a shorter period. Developing more objective assessment tools based on quantitative metrics is now a recognised need in interventional training and this manuscript reports the current literature for endovascular skills assessment and the associated emerging technologies. A systematic search was performed on PubMed (MEDLINE), Google Scholar, IEEXplore and known journals using the keywords, “endovascular surgery”, “surgical skills”, “endovascular skills”, “surgical training endovascular” and “catheter skills”. Focusing explicitly on endovascular surgical skills, we group related works into three categories based on the metrics used; structured scales and checklists, simulation-based and motion-based metrics. This review highlights the key findings in each category and also provides suggestions for new research opportunities towards fully objective and automated surgical assessment solutions

Bioengineering, augmented reality, and robotic surgery in vascular surgery: A literature review

Biomedical engineering integrates a variety of applied sciences with life sciences to improve human health and reduce the invasiveness of surgical procedures. Technological advances, achieved through biomedical engineering, have contributed to significant improvements in the field of vascular and endovascular surgery. This paper aims to review the most cutting-edge technologies of the last decade involving the use of augmented reality devices and robotic systems in vascular surgery, highlighting benefits and limitations. Accordingly, two distinct literature surveys were conducted through the PubMed database: the first review provides a comprehensive assessment of augmented reality technologies, including the different techniques available for the visualization of virtual content (11 papers revised); the second review collects studies with bioengineering content that highlight the research trend in robotic vascular surgery, excluding works focused only on the clinical use of commercially available robotic systems (15 papers revised). Technological flow is constant and further advances in imaging techniques and hardware components will inevitably bring new tools for a clinical translation of innovative therapeutic strategies in vascular surgery

CathSim: An Open-source Simulator for Autonomous Cannulation

Autonomous robots in endovascular operations have the potential to navigate circulatory systems safely and reliably while decreasing the susceptibility to human errors. However, there are numerous challenges involved with the process of training such robots such as long training duration due to sample inefficiency of machine learning algorithms and safety issues arising from the interaction between the catheter and the endovascular phantom. Physics simulators have been used in the context of endovascular procedures, but they are typically employed for staff training and generally do not conform to the autonomous cannulation goal. Furthermore, most current simulators are closed-source which hinders the collaborative development of safe and reliable autonomous systems. In this work, we introduce CathSim, an open-source simulation environment that accelerates the development of machine learning algorithms for autonomous endovascular navigation. We first simulate the high-fidelity catheter and aorta with the state-of-the-art endovascular robot. We then provide the capability of real-time force sensing between the catheter and the aorta in the simulation environment. We validate our simulator by conducting two different catheterisation tasks within two primary arteries using two popular reinforcement learning algorithms, Proximal Policy Optimization (PPO) and Soft Actor-Critic (SAC). The experimental results show that using our open-source simulator, we can successfully train the reinforcement learning agents to perform different autonomous cannulation tasks

Haptics in Robot-Assisted Surgery: Challenges and Benefits

Robotic surgery is transforming the current surgical practice, not only by improving the conventional surgical methods but also by introducing innovative robot-enhanced approaches that broaden the capabilities of clinicians. Being mainly of man-machine collaborative type, surgical robots are seen as media that transfer pre- and intra-operative information to the operator and reproduce his/her motion, with appropriate filtering, scaling, or limitation, to physically interact with the patient. The field, however, is far from maturity and, more critically, is still a subject of controversy in medical communities. Limited or absent haptic feedback is reputed to be among reasons that impede further spread of surgical robots. In this paper objectives and challenges of deploying haptic technologies in surgical robotics is discussed and a systematic review is performed on works that have studied the effects of providing haptic information to the users in major branches of robotic surgery. It has been tried to encompass both classical works and the state of the art approaches, aiming at delivering a comprehensive and balanced survey both for researchers starting their work in this field and for the experts

The future of robotic surgery

© 2018 Royal College of Surgeons.For 20 years Intuitive Surgical’s da Vinci® system has held the monopoly in minimally invasive robotic surgery. Restrictive patenting, a well-developed marketing strategy and a high-quality product have protected the company’s leading market share.1 However, owing to the nuances of US patenting law, many of Intuitive Surgical’s earliest patents will be expiring in the next couple of years. With such a shift in backdrop, many of Intuitive Surgical’s competitors (from medical and industrial robotic backgrounds) have initiated robotic programmes – some of which are available for clinical use now. The next section of the review will focus on new and developing robotic systems in the field of minimally invasive surgery (Table 1), single-site surgery (Table 2), natural orifice transluminal endoscopic surgery (NOTES) and non-minimally invasive robotic systems (Table 3).Peer reviewedFinal Published versio

The Role of Visualization, Force Feedback, and Augmented Reality in Minimally Invasive Heart Valve Repair

New cardiovascular techniques have been developed to address the unique requirements of high risk, elderly, surgical patients with heart valve disease by avoiding both sternotomy and cardiopulmonary bypass. However, these technologies pose new challenges in visualization, force application, and intracardiac navigation. Force feedback and augmented reality (AR) can be applied to minimally invasive mitral valve repair and transcatheter aortic valve implantation (TAVI) techniques to potentially surmount these challenges. Our study demonstrated shorter operative times with three dimensional (3D) visualization compared to two dimensional (2D) visualization; however, both experts and novices applied significantly more force to cardiac tissue during 3D robotics-assisted mitral valve annuloplasty than during conventional open mitral valve annuloplasty. This finding suggests that 3D visualization does not fully compensate for the absence of haptic feedback in robotics-assisted cardiac surgery. Subsequently, using an innovative robotics-assisted surgical system design, we determined that direct haptic feedback may improve both expert and trainee performance using robotics-assisted techniques. We determined that during robotics-assisted mitral valve annuloplasty the use of either visual or direct force feedback resulted in a significant decrease in forces applied to cardiac tissue when compared to robotics-assisted mitral valve annuloplasty without force feedback. We presented NeoNav, an AR-enhanced echocardiograpy intracardiac guidance system for NeoChord off-pump mitral valve repair. Our study demonstrated superior tool navigation accuracy, significantly shorter navigation times, and reduced potential for injury with AR enhanced intracardiac navigation for off-pump transapical mitral valve repair with neochordae implantation. In addition, we applied the NeoNav system as a safe and inexpensive alternative imaging modality for TAVI guidance. We found that our proposed AR guidance system may achieve similar or better results than the current standard of care, contrast enhanced fluoroscopy, while eliminating the use of nephrotoxic contrast and ionizing radiation. These results suggest that the addition of both force feedback and augmented reality image guidance can improve both surgical performance and safety during minimally invasive robotics assisted and beating heart valve surgery, respectively

Advances in Minimally Invasive Surgery

The minimally invasive approach in medicine is one of the most common areas of interest in surgery.Advances in Minimally Invasive Surgery describes the latest trends, indications, techniques, and approaches in minimally invasive surgery. It provides step-by-step instructions for both routine and diagnostic procedures via illustrations and video collection