Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor–trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons’ psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules

Real Virtuality: A Code of Ethical Conduct. Recommendations for Good Scientific Practice and the Consumers of VR-Technology

The goal of this article is to present a first list of ethical concerns that may arise from research and personal use of virtual reality (VR) and related technology, and to offer concrete recommendations for minimizing those risks. Many of the recommendations call for focused research initiatives. In the first part of the article, we discuss the relevant evidence from psychology that motivates our concerns. In Section “Plasticity in the Human Mind,” we cover some of the main results suggesting that one’s environment can influence one’s psychological states, as well as recent work on inducing illusions of embodiment. Then, in Section “Illusions of Embodiment and Their Lasting Effect,” we go on to discuss recent evidence indicating that immersion in VR can have psychological effects that last after leaving the virtual environment. In the second part of the article, we turn to the risks and recommendations. We begin, in Section “The Research Ethics of VR,” with the research ethics of VR, covering six main topics: the limits of experimental environments, informed consent, clinical risks, dual-use, online research, and a general point about the limitations of a code of conduct for research. Then, in Section “Risks for Individuals and Society,” we turn to the risks of VR for the general public, covering four main topics: long-term immersion, neglect of the social and physical environment, risky content, and privacy. We offer concrete recommendations for each of these 10 topics, summarized in Table 1

Multi-robot cooperative platform : a task-oriented teleoperation paradigm

This thesis proposes the study and development of a teleoperation system based on multi-robot cooperation under the task oriented teleoperation paradigm: Multi-Robot Cooperative Paradigm, MRCP. In standard teleoperation, the operator uses the master devices to control the remote slave robot arms. These arms reproduce the desired movements and perform the task. With the developed work, the operator can virtually manipulate an object. MRCP automatically generates the arms orders to perform the task. The operator does not have to solve situations arising from possible restrictions that the slave arms may have. The research carried out is therefore aimed at improving the accuracy teleoperation tasks in complex environments, particularly in the field of robot assisted minimally invasive surgery. This field requires patient safety and the workspace entails many restrictions to teleoperation. MRCP can be defined as a platform composed of several robots that cooperate automatically to perform a teleoperated task, creating a robotic system with increased capacity (workspace volume, accessibility, dexterity ...). The cooperation is based on transferring the task between robots when necessary to enable a smooth task execution. The MRCP control evaluates the suitability of each robot to continue with the ongoing task and the optimal time to execute a task transfer between the current selected robot and the best candidate to continue with the task. From the operator¿s point of view, MRCP provides an interface that enables the teleoperation though the task-oriented paradigm: operator orders are translated into task actions instead of robot orders. This thesis is structured as follows: The first part is dedicated to review the current solutions in the teleoperation of complex tasks and compare them with those proposed in this research. The second part of the thesis presents and reviews in depth the different evaluation criteria to determine the suitability of each robot to continue with the execution of a task, considering the configuration of the robots and emphasizing the criterion of dexterity and manipulability. The study reviews the different required control algorithms to enable the task oriented telemanipulation. This proposed teleoperation paradigm is transparent to the operator. Then, the Thesis presents and analyses several experimental results using MRCP in the field of minimally invasive surgery. These experiments study the effectiveness of MRCP in various tasks requiring the cooperation of two hands. A type task is used: a suture using minimally invasive surgery technique. The analysis is done in terms of execution time, economy of movement, quality and patient safety (potential damage produced by undesired interaction between the tools and the vital tissues of the patient). The final part of the thesis proposes the implementation of different virtual aids and restrictions (guided teleoperation based on haptic visual and audio feedback, protection of restricted workspace regions, etc.) using the task oriented teleoperation paradigm. A framework is defined for implementing and applying a basic set of virtual aids and constraints within the framework of a virtual simulator for laparoscopic abdominal surgery. The set of experiments have allowed to validate the developed work. The study revealed the influence of virtual aids in the learning process of laparoscopic techniques. It has also demonstrated the improvement of learning curves, which paves the way for its implementation as a methodology for training new surgeons.Aquesta tesi doctoral proposa l'estudi i desenvolupament d'un sistema de teleoperació basat en la cooperació multi-robot sota el paradigma de la teleoperació orientada a tasca: Multi-Robot Cooperative Paradigm, MRCP. En la teleoperació clàssica, l'operador utilitza els telecomandaments perquè els braços robots reprodueixin els seus moviments i es realitzi la tasca desitjada. Amb el treball realitzat, l'operador pot manipular virtualment un objecte i és mitjançant el MRCP que s'adjudica a cada braç les ordres necessàries per realitzar la tasca, sense que l'operador hagi de resoldre les situacions derivades de possibles restriccions que puguin tenir els braços executors. La recerca desenvolupada està doncs orientada a millorar la teleoperació en tasques de precisió en entorns complexos i, en particular, en el camp de la cirurgia mínimament invasiva assistida per robots. Aquest camp imposa condicions de seguretat del pacient i l'espai de treball comporta moltes restriccions a la teleoperació. MRCP es pot definir com a una plataforma formada per diversos robots que cooperen de forma automàtica per dur a terme una tasca teleoperada, generant un sistema robòtic amb capacitats augmentades (volums de treball, accessibilitat, destresa,...). La cooperació es basa en transferir la tasca entre robots a partir de determinar quin és aquell que és més adequat per continuar amb la seva execució i el moment òptim per realitzar la transferència de la tasca entre el robot actiu i el millor candidat a continuar-la. Des del punt de vista de l'operari, MRCP ofereix una interfície de teleoperació que permet la realització de la teleoperació mitjançant el paradigma d'ordres orientades a la tasca: les ordres es tradueixen en accions sobre la tasca en comptes d'estar dirigides als robots. Aquesta tesi està estructurada de la següent manera: Primerament es fa una revisió de l'estat actual de les diverses solucions desenvolupades actualment en el camp de la teleoperació de tasques complexes, comparant-les amb les proposades en aquest treball de recerca. En el segon bloc de la tesi es presenten i s'analitzen a fons els diversos criteris per determinar la capacitat de cada robot per continuar l'execució d'una tasca, segons la configuració del conjunt de robots i fent especial èmfasi en el criteri de destresa i manipulabilitat. Seguint aquest estudi, es presenten els diferents processos de control emprats per tal d'assolir la telemanipulació orientada a tasca de forma transparent a l'operari. Seguidament es presenten diversos resultats experimentals aplicant MRCP al camp de la cirurgia mínimament invasiva. En aquests experiments s'estudia l'eficàcia de MRCP en diverses tasques que requereixen de la cooperació de dues mans. S'ha escollit una tasca tipus: sutura amb tècnica de cirurgia mínimament invasiva. L'anàlisi es fa en termes de temps d'execució, economia de moviment, qualitat i seguretat del pacient (potencials danys causats per la interacció no desitjada entre les eines i els teixits vitals del pacient). Finalment s'ha estudiat l'ús de diferents ajudes i restriccions virtuals (guiat de la teleoperació via retorn hàptic, visual o auditiu, protecció de regions de l'espai de treball, etc) dins el paradigma de teleoperació orientada a tasca. S'ha definint un marc d'aplicació base i implementant un conjunt de restriccions virtuals dins el marc d'un simulador de cirurgia laparoscòpia abdominal. El conjunt d'experiments realitzats han permès validar el treball realitzat. Aquest estudi ha permès determinar la influencia de les ajudes virtuals en el procés d'aprenentatge de les tècniques laparoscòpiques. S'ha evidenciat una millora en les corbes d'aprenentatge i obre el camí a la seva implantació com a metodologia d'entrenament de nous cirurgians.Postprint (published version

Towards transparent telepresence

It is proposed that the concept of transparent telepresence can be closely approached through high fidelity technological mediation. It is argued that the matching of the system capabilities to those of the human user will yield a strong sense of immersion and presence at a remote site. Some applications of such a system are noted. The concept is explained and critical system elements are described together with an overview of some of the necessary system specifications

Myoelectric forearm prostheses: State of the art from a user-centered perspective

User acceptance of myoelectric forearm prostheses is currently low. Awkward control, lack of feedback, and difficult training are cited as primary reasons. Recently, researchers have focused on exploiting the new possibilities offered by advancements in prosthetic technology. Alternatively, researchers could focus on prosthesis acceptance by developing functional requirements based on activities users are likely to perform. In this article, we describe the process of determining such requirements and then the application of these requirements to evaluating the state of the art in myoelectric forearm prosthesis research. As part of a needs assessment, a workshop was organized involving clinicians (representing end users), academics, and engineers. The resulting needs included an increased number of functions, lower reaction and execution times, and intuitiveness of both control and feedback systems. Reviewing the state of the art of research in the main prosthetic subsystems (electromyographic [EMG] sensing, control, and feedback) showed that modern research prototypes only partly fulfill the requirements. We found that focus should be on validating EMG-sensing results with patients, improving simultaneous control of wrist movements and grasps, deriving optimal parameters for force and position feedback, and taking into account the psychophysical aspects of feedback, such as intensity perception and spatial acuity

Opportunities for using eye tracking technology in manufacturing and logistics: Systematic literature review and research agenda

Workers play essential roles in manufacturing and logistics. Releasing workers from routine tasks and enabling them to focus on creative, value-adding activities can enhance their performance and wellbeing, and it is also key to the successful implementation of Industry 4.0. One technology that can help identify patterns of worker-system interaction is Eye Tracking (ET), which is a non-intrusive technology for measuring human eye movements. ET can provide moment-by-moment insights into the cognitive state of the subject during task execution, which can improve our understanding of how humans behave and make decisions within complex systems. It also enables explorations of the subject’s interaction mode with the working environment. Earlier research has investigated the use of ET in manufacturing and logistics, but the literature is fragmented and has not yet been discussed in a literature review yet. This article therefore conducts a systematic literature review to explore the applications of ET, summarise its benefits, and outline future research opportunities of using ET in manufacturing and logistics. We first propose a conceptual framework to guide our study and then conduct a systematic literature search in scholarly databases, obtaining 71 relevant papers. Building on the proposed framework, we systematically review the use of ET and categorize the identified papers according to their application in manufacturing (product development, production, quality inspection) and logistics. Our results reveal that ET has several use cases in the manufacturing sector, but that its application in logistics has not been studied extensively so far. We summarize the benefits of using ET in terms of process performance, human performance, and work environment and safety, and also discuss the methodological characteristics of the ET literature as well as typical ET measures used. We conclude by illustrating future avenues for ET research in manufacturing and logistics

Neural Dynamics of Delayed Feedback in Robot Teleoperation: Insights from fNIRS Analysis

As robot teleoperation increasingly becomes integral in executing tasks in distant, hazardous, or inaccessible environments, the challenge of operational delays remains a significant obstacle. These delays are inherent in signal transmission and processing and can adversely affect the operators performance, particularly in tasks requiring precision and timeliness. While current research has made strides in mitigating these delays through advanced control strategies and training methods, a crucial gap persists in understanding the neurofunctional impacts of these delays and the efficacy of countermeasures from a cognitive perspective. Our study narrows this gap by leveraging functional Near-Infrared Spectroscopy (fNIRS) to examine the neurofunctional implications of simulated haptic feedback on cognitive activity and motor coordination under delayed conditions. In a human-subject experiment (N=41), we manipulated sensory feedback to observe its influences on various brain regions of interest (ROIs) response during teleoperation tasks. The fNIRS data provided a detailed assessment of cerebral activity, particularly in ROIs implicated in time perception and the execution of precise movements. Our results reveal that certain conditions, which provided immediate simulated haptic feedback, significantly optimized neural functions related to time perception and motor coordination, and improved motor performance. These findings provide empirical evidence about the neurofunctional basis of the enhanced motor performance with simulated synthetic force feedback in the presence of teleoperation delays.Comment: Submitted to Frontiers in Human Neuroscienc

An Intelligent Robot and Augmented Reality Instruction System

Human-Centered Robotics (HCR) is a research area that focuses on how robots can empower people to live safer, simpler, and more independent lives. In this dissertation, I present a combination of two technologies to deliver human-centric solutions to an important population. The first nascent area that I investigate is the creation of an Intelligent Robot Instructor (IRI) as a learning and instruction tool for human pupils. The second technology is the use of augmented reality (AR) to create an Augmented Reality Instruction (ARI) system to provide instruction via a wearable interface. To function in an intelligent and context-aware manner, both systems require the ability to reason about their perception of the environment and make appropriate decisions. In this work, I construct a novel formulation of several education methodologies, particularly those known as response prompting, as part of a cognitive framework to create a system for intelligent instruction, and compare these methodologies in the context of intelligent decision making using both technologies. The IRI system is demonstrated through experiments with a humanoid robot that uses object recognition and localization for perception and interacts with students through speech, gestures, and object interaction. The ARI system uses augmented reality, computer vision, and machine learning methods to create an intelligent, contextually aware instructional system. By using AR to teach prerequisite skills that lend themselves well to visual, augmented reality instruction prior to a robot instructor teaching skills that lend themselves to embodied interaction, I am able to demonstrate the potential of each system independently as well as in combination to facilitate students\u27 learning. I identify people with intellectual and developmental disabilities (I/DD) as a particularly significant use case and show that IRI and ARI systems can help fulfill the compelling need to develop tools and strategies for people with I/DD. I present results that demonstrate both systems can be used independently by students with I/DD to quickly and easily acquire the skills required for performance of relevant vocational tasks. This is the first successful real-world application of response-prompting for decision making in a robotic and augmented reality intelligent instruction system