Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Workflow-based Context-aware Control of Surgical Robots

Surgical assistance system such as medical robots enhanced the capabilities of medical procedures in the last decades. This work presents a new perspective on the use of workflows with surgical robots in order to improve the technical capabilities and the ease of use of such systems. This is accomplished by a 3D perception system for the supervision of the surgical operating room and a workflow-based controller, that allows to monitor the surgical process using workflow-tracking techniques

Transoral robotic surgery: development and challenges

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Development of a Novel Handheld Device for Active Compensation of Physiological Tremor

In microsurgery, the human hand imposes certain limitations in accurately positioning the tip of a device such as scalpel. Any errors in the motion of the hand make microsurgical procedures difficult and involuntary motions such as hand tremors can make some procedures significantly difficult to perform. This is particularly true in the case of vitreoretinal microsurgery. The most familiar source of involuntary motion is physiological tremor. Real-time compensation of tremor is, therefore, necessary to assist surgeons to precisely position and manipulate the tool-tip to accurately perform a microsurgery. In this thesis, a novel handheld device (AID) is described for compensation of physiological tremor in the hand. MEMS-based accelerometers and gyroscopes have been used for sensing the motion of the hand in six degrees of freedom (DOF). An augmented state complementary Kalman filter is used to calculate 2 DOF orientation. An adaptive filtering algorithm, band-limited Multiple Fourier linear combiner (BMFLC), is used to calculate the tremor component in the hand in real-time. Ionic Polymer Metallic Composites (IPMCs) have been used as actuators for deflecting the tool-tip to compensate for the tremor

Design and Evaluation of a Contact-Free Interface for Minimally Invasive Robotics Assisted Surgery

Robotic-assisted minimally invasive surgery (RAMIS) is becoming increasingly more common for many surgical procedures. These minimally invasive techniques offer the benefit of reduced patient recovery time, mortality and scarring compared to traditional open surgery. Teleoperated procedures have the added advantage of increased visualization, and enhanced accuracy for the surgeon through tremor filtering and scaling down hand motions. There are however still limitations in these techniques preventing the widespread growth of the technology. In RAMIS, the surgeon is limited in their movement by the operating console or master device, and the cost of robotic surgery is often too high to justify for many procedures. Sterility issues arise as well, as the surgeon must be in contact with the master device, preventing a smooth transition between traditional and robotic modes of surgery. This thesis outlines the design and analysis of a novel method of interaction with the da Vinci Surgical Robot. Using the da Vinci Research Kit (DVRK), an open source research platform for the da Vinci robot, an interface was developed for controlling the robotic arms with the Leap Motion Controller. This small device uses infrared LEDs and two cameras to detect the 3D positions of the hand and fingers. This data from the hands is mapped to the da Vinci surgical tools in real time, providing the surgeon with an intuitive method of controlling the instruments. An analysis of the tracking workspace is provided, to give a solution to occlusion issues. Multiple sensors are fused together in order to increase the range of trackable motion over a single sensor. Additional work involves replacing the current viewing screen with a virtual reality (VR) headset (Oculus Rift), to provide the surgeon with a stereoscopic 3D view of the surgical site without the need for a large monitor. The headset also provides the user with a more intuitive and natural method of positioning the camera during surgery, using the natural motions of the head. The large master console of the da Vinci system has been replaced with an inexpensive vision based tracking system, and VR headset, allowing the surgeon to operate the da Vinci Surgical Robot with more natural movements for the user. A preliminary evaluation of the system is provided, with recommendations for future work

Impact of Ear Occlusion on In-Ear Sounds Generated by Intra-oral Behaviors

We conducted a case study with one volunteer and a recording setup to detect sounds induced by the actions: jaw clenching, tooth grinding, reading, eating, and drinking. The setup consisted of two in-ear microphones, where the left ear was semi-occluded with a commercially available earpiece and the right ear was occluded with a mouldable silicon ear piece. Investigations in the time and frequency domains demonstrated that for behaviors such as eating, tooth grinding, and reading, sounds could be recorded with both sensors. For jaw clenching, however, occluding the ear with a mouldable piece was necessary to enable its detection. This can be attributed to the fact that the mouldable ear piece sealed the ear canal and isolated it from the environment, resulting in a detectable change in pressure. In conclusion, our work suggests that detecting behaviors such as eating, grinding, reading with a semi-occluded ear is possible, whereas, behaviors such as clenching require the complete occlusion of the ear if the activity should be easily detectable. Nevertheless, the latter approach may limit real-world applicability because it hinders the hearing capabilities.</p

AUGMENTED REALITY AND INTRAOPERATIVE C-ARM CONE-BEAM COMPUTED TOMOGRAPHY FOR IMAGE-GUIDED ROBOTIC SURGERY

Minimally-invasive robotic-assisted surgery is a rapidly-growing alternative to traditionally open and laparoscopic procedures; nevertheless, challenges remain. Standard of care derives surgical strategies from preoperative volumetric data (i.e., computed tomography (CT) and magnetic resonance (MR) images) that benefit from the ability of multiple modalities to delineate different anatomical boundaries. However, preoperative images may not reflect a possibly highly deformed perioperative setup or intraoperative deformation. Additionally, in current clinical practice, the correspondence of preoperative plans to the surgical scene is conducted as a mental exercise; thus, the accuracy of this practice is highly dependent on the surgeon’s experience and therefore subject to inconsistencies. In order to address these fundamental limitations in minimally-invasive robotic surgery, this dissertation combines a high-end robotic C-arm imaging system and a modern robotic surgical platform as an integrated intraoperative image-guided system. We performed deformable registration of preoperative plans to a perioperative cone-beam computed tomography (CBCT), acquired after the patient is positioned for intervention. From the registered surgical plans, we overlaid critical information onto the primary intraoperative visual source, the robotic endoscope, by using augmented reality. Guidance afforded by this system not only uses augmented reality to fuse virtual medical information, but also provides tool localization and other dynamic intraoperative updated behavior in order to present enhanced depth feedback and information to the surgeon. These techniques in guided robotic surgery required a streamlined approach to creating intuitive and effective human-machine interferences, especially in visualization. Our software design principles create an inherently information-driven modular architecture incorporating robotics and intraoperative imaging through augmented reality. The system's performance is evaluated using phantoms and preclinical in-vivo experiments for multiple applications, including transoral robotic surgery, robot-assisted thoracic interventions, and cocheostomy for cochlear implantation. The resulting functionality, proposed architecture, and implemented methodologies can be further generalized to other C-arm-based image guidance for additional extensions in robotic surgery