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

Development of a New Single Port Surgery Robot with Increased Torque and Workspace

This paper presents the development of a new single port surgery robot, Plat spring driven mech-anism equipped robot for single port LAparoscopic Surgery (PLAS), with plate spring driven mechanism. Recently, the number of single port laparoscopic surgery (SILS) that can easily conceal postoperative scars is increasing, and robotic SILS platforms are being developed for solving inconvenient maneuverability of manual SILS. However, the drive mechanism of most robotic SILS platforms existing consists of wire, therefore cannot afford to deliver sufficient force, and the wire is mechanically deformed, thus causing negative effects on movement accuracy. Due to this limitation, a precious operation cannot be conducted by using conventional robotic SILS platforms. Accuracy and force are reduced as the workspace is ex-panding. The purpose of proposed robot is to increase tissue handling force of forceps by using plate spring driven mechanism, and to conduct more stable and precious operations in an expanded area. Eval-uations of PLAS were performed and its feasibility as a new effective robotic SILS platform was proved ⓒ 2013 DGISTI. INTRODUCTION 1 -- 1.1 Introduction to Single Incision Laparoscopic Surgery (SILS) 1 -- 1.2 Previous researches of robotic SILS 5 -- 1.3 Advantages and disadvantages of current SILS robots 7 -- 1.4 Plate spring driven mechanism 10 -- 1.5 Research contents and goals 13 -- II. DESIGN 15 -- 2.1 Ideal robotic SILS platform 15 -- 2.2 New robotic SILS platform 17 -- 2.1.1 Force requirement 18 -- 2.1.2 Considerations on work Space and degree of freedom 19 -- 2.3 Mechanical implementation of joints 23 -- III. DIRECT AND INVERSE POSITION ANALYSIS 36 -- 3.1 Direct Kinematics 40 -- 3.2 Inverse Kinematics 41 -- IV. VELOCITY AND JACOBIAN ANALYSIS 45 -- 4.1 Direct and Inverse Velocity Problem 47 -- 4.2 Singularity Analysis 48 -- V. EXPERIMENTAL METHODS AND RESULTS 49 -- 5.1 Measuring forces and results 49 -- 5.2 Assessment for reliability of movements and its results 57 -- VI. CONCLUSION AND FURTHER WORKS 61본 연구에서는 판 스프링을 구동 메커니즘으로 하는 새로운 형태의 단일공복강경 수술 로봇을 개발하였다. 최근, 복부에 3~5개의 상처를 남기는 기존의 복강경 수술의 대안으로 수술 후 상처를 쉽게 숨길 수 있는 배꼽을 통한 단일 공 복강경 수술(single port laparoscopic surgery)의 수요가 증가하는 추세이다. 하지만 단일 공 복강경 수술은 내시경과 두 개의 겸자(forceps)가 단 하나의 침습 구로 삽입되어 시술 중 도구간의 충돌을 피하기 어려우며, 작업 공간을 확보하기도 힘들다. 이러한 문제를 해결하기 위해 여러 가지 단일 공 복강경 수술 로봇이 개발 되고 있지만 수술을 하기에 충분한 힘을 전달하지 못하는 문제가 있다. 이 논문에서는 위와 같은 문제를 해결하고, 수술에 필요한 충분한 힘과 넓은 작업영역을 확보하기 위해 판 스프링으로 구동되는 단일 공 수술로봇을 설계, 제작한 후 성능평가를 실시했다. 국내에서는 처음 개발되는 Y 타입 단일 공 수술로봇을 개발하기 위해 매뉴얼 단일 공 복강경 수술의 임상적인 제한 사항과 기존에 개발된 단일 공 복강경 수술로봇의 장단점을 심도 있게 분석하여 기구 설계에 적용시켰다. 특히 의사들의 현장 경험과 의견을 수용하여 기구설계에 적극 반영하였으며, 기존 단일 공 수술 로봇들보다 넓은 작업공간을 갖는 단일 공 수술 로봇을 개발할 수 있었다. ⓒ 2013 DGISTMasterdCollectio

Initial Experience of Robot-Assisted Adrenalectomy in Japan: What is the Optimal Selection of Robotic Forceps for Adrenalectomy?

Minimally invasive adrenalectomy is the preferred technique for managing adrenal tumors. Laparoscopic adrenalectomy is widely performed and covered by insurance in Japan, but robot-assisted adrenalectomy is not. To investigate the best forceps combinations for performing robot-assisted adrenalectomy safely, we performed robot-assisted adrenalectomy for two left and two right adrenal adenomas using different robotic forceps combinations (bipolar forceps, monopolar curved scissors, Vessel Sealer Extend, and SynchroSeal) for each case. Although we evaluated a small number of RAs, lower blood loss was observed in patients where the vessel sealing devices were used. The extent of dissection is small for adrenalectomy, and robotic bipolar vessel sealing tools may not be necessary, especially for the small adrenal tumors. However, considering the risk benefits, the combination of forceps with Vessel Sealer Extend (by the left arm) and monopolar curved scissors (by the right arm) will become one of the best forceps combinations for performing robot-assisted adrenalectomy safely

Auto-tracking camera for dry-box laparoscopic training

While laparoscopic surgery is less invasive than open surgery and is now common in various medical fields, laparoscopic surgery often requires more time for the operator to achieve mastery. Dry box training is one of the most important methods for developing laparoscopic skill. However, the camera is usually fixed to a particular point, which is different from practical surgery, during which the operational field is constantly adjusted by an assistant. Therefore, we introduced a camera for dry box training that can be moved by surgeons as desired by using computer vision. By detecting the ArUco marker, the camera attached onto the servomotor successfully tracked the forceps automatically. This system could easily be modified and become operable by a foot switch or voice, and collaborations between surgeons and medical engineers are expected

A novel locally operated master-slave robot system for single-incision laparoscopic surgery

Purpose: Single-incision laparoscopic surgery (SILS) provides more cosmetic benefits than conventional laparoscopic surgery but presents operational difficulties. To overcome this technical problem, we have developed a locally operated master-slave robot system that provides operability and a visual field similar to conventional laparoscopic surgery. Material and methods: A surgeon grasps the master device with the left hand, which is placed above the abdominal wall, and holds a normal instrument with the right hand. A laparoscope, a slave robot, and the right-sided instrument are inserted through one incision. The slave robot is bent in the body cavity and its length, pose, and tip angle are changed by manipulating the master device; thus the surgeon has almost the same operability as with normal laparoscopic surgery. To evaluate our proposed system, we conducted a basic task and an ex vivo experiment. Results: In basic task experiments, the average object-passing task time was 9.50 sec (SILS cross), 22.25 sec (SILS parallel), and 7.23 sec (proposed SILS). The average number of instrument collisions was 3.67 (SILS cross), 14 (SILS parallel), and 0.33 (proposed SILS). In the ex vivo experiment, we confirmed the applicability of our system for single-port laparoscopic cholecystectomy. Conclusion: We demonstrated that our proposed robot system is useful for single-incision laparoscopic surgery.ArticleMINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES. 23(6):326-332 (2014)journal articl

Robocatch: Design and Making of a Hand-Held Spillage-Free Specimen Retrieval Robot for Laparoscopic Surgery

Specimen retrieval is an important step in laparoscopy, a minimally invasive surgical procedure performed to diagnose and treat a myriad of medical pathologies in fields ranging from gynecology to oncology. Specimen retrieval bags (SRBs) are used to facilitate this task, while minimizing contamination of neighboring tissues and port-sites in the abdominal cavity. This manual surgical procedure requires usage of multiple ports, creating a traffic of simultaneous operations of multiple instruments in a limited shared workspace. The skill-demanding nature of this procedure makes it time-consuming, leading to surgeons’ fatigue and operational inefficiency. This thesis presents the design and making of RoboCatch, a novel hand-held robot that aids a surgeon in performing spillage-free retrieval of operative specimens in laparoscopic surgery. The proposed design significantly modifies and extends conventional instruments that are currently used by surgeons for the retrieval task: The core instrumentation of RoboCatch comprises a webbed three-fingered grasper and atraumatic forceps that are concentrically situated in a folded configuration inside a trocar. The specimen retrieval task is achieved in six stages: 1) The trocar is introduced into the surgical site through an instrument port, 2) the three webbed fingers slide out of the tube and simultaneously unfold in an umbrella like-fashion, 3) the forceps slide toward, and grasp, the excised specimen, 4) the forceps retract the grasped specimen into the center of the surrounding grasper, 5) the grasper closes to achieve a secured containment of the specimen, and 6) the grasper, along with the contained specimen, is manually removed from the abdominal cavity. The resulting reduction in the number of active ports reduces obstruction of the port-site and increases the procedure’s efficiency. The design process was initiated by acquiring crucial parameters from surgeons and creating a design table, which informed the CAD modeling of the robot structure and selection of actuation units and fabrication material. The robot prototype was first examined in CAD simulation and then fabricated using an Objet30 Prime 3D printer. Physical validation experiments were conducted to verify the functionality of different mechanisms of the robot. Further, specimen retrieval experiments were conducted with porcine meat samples to test the feasibility of the proposed design. Experimental results revealed that the robot was capable of retrieving masses of specimen ranging from 1 gram to 50 grams. The making of RoboCatch represents a significant step toward advancing the frontiers of hand-held robots for performing specimen retrieval tasks in minimally invasive surgery