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

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

REAL-TIME 4D ULTRASOUND RECONSTRUCTION FOR IMAGE-GUIDED INTRACARDIAC INTERVENTIONS

Image-guided therapy addresses the lack of direct vision associated with minimally- invasive interventions performed on the beating heart, but requires effective intraoperative imaging. Gated 4D ultrasound reconstruction using a tracked 2D probe generates a time-series of 3D images representing the beating heart over the cardiac cycle. These images have a relatively high spatial resolution and wide field of view, and ultrasound is easily integrated into the intraoperative environment. This thesis presents a real-time 4D ultrasound reconstruction system incorporated within an augmented reality environment for surgical guidance, whose incremental visualization reduces common acquisition errors. The resulting 4D ultrasound datasets are intended for visualization or registration to preoperative images. A human factors experiment demonstrates the advantages of real-time ultrasound reconstruction, and accuracy assessments performed both with a dynamic phantom and intraoperatively reveal RMS localization errors of 2.5-2.7 mm, and 0.8 mm, respectively. Finally, clinical applicability is demonstrated by both porcine and patient imaging

Image-Guided Robot-Assisted Techniques with Applications in Minimally Invasive Therapy and Cell Biology

There are several situations where tasks can be performed better robotically rather than manually. Among these are situations (a) where high accuracy and robustness are required, (b) where difficult or hazardous working conditions exist, and (c) where very large or very small motions or forces are involved. Recent advances in technology have resulted in smaller size robots with higher accuracy and reliability. As a result, robotics is fi nding more and more applications in Biomedical Engineering. Medical Robotics and Cell Micro-Manipulation are two of these applications involving interaction with delicate living organs at very di fferent scales.Availability of a wide range of imaging modalities from ultrasound and X-ray fluoroscopy to high magni cation optical microscopes, makes it possible to use imaging as a powerful means to guide and control robot manipulators. This thesis includes three parts focusing on three applications of Image-Guided Robotics in biomedical engineering, including: Vascular Catheterization: a robotic system was developed to insert a catheter through the vasculature and guide it to a desired point via visual servoing. The system provides shared control with the operator to perform a task semi-automatically or through master-slave control. The system provides control of a catheter tip with high accuracy while reducing X-ray exposure to the clinicians and providing a more ergonomic situation for the cardiologists. Cardiac Catheterization: a master-slave robotic system was developed to perform accurate control of a steerable catheter to touch and ablate faulty regions on the inner walls of a beating heart in order to treat arrhythmia. The system facilitates touching and making contact with a target point in a beating heart chamber through master-slave control with coordinated visual feedback. Live Neuron Micro-Manipulation: a microscope image-guided robotic system was developed to provide shared control over multiple micro-manipulators to touch cell membranes in order to perform patch clamp electrophysiology. Image-guided robot-assisted techniques with master-slave control were implemented for each case to provide shared control between a human operator and a robot. The results show increased accuracy and reduced operation time in all three cases

Virtual and Augmented Reality Techniques for Minimally Invasive Cardiac Interventions: Concept, Design, Evaluation and Pre-clinical Implementation

While less invasive techniques have been employed for some procedures, most intracardiac interventions are still performed under cardiopulmonary bypass, on the drained, arrested heart. The progress toward off-pump intracardiac interventions has been hampered by the lack of adequate visualization inside the beating heart. This thesis describes the development, assessment, and pre-clinical implementation of a mixed reality environment that integrates pre-operative imaging and modeling with surgical tracking technologies and real-time ultrasound imaging. The intra-operative echo images are augmented with pre-operative representations of the cardiac anatomy and virtual models of the delivery instruments tracked in real time using magnetic tracking technologies. As a result, the otherwise context-less images can now be interpreted within the anatomical context provided by the anatomical models. The virtual models assist the user with the tool-to-target navigation, while real-time ultrasound ensures accurate positioning of the tool on target, providing the surgeon with sufficient information to ``see\u27\u27 and manipulate instruments in absence of direct vision. Several pre-clinical acute evaluation studies have been conducted in vivo on swine models to assess the feasibility of the proposed environment in a clinical context. Following direct access inside the beating heart using the UCI, the proposed mixed reality environment was used to provide the necessary visualization and navigation to position a prosthetic mitral valve on the the native annulus, or to place a repair patch on a created septal defect in vivo in porcine models. Following further development and seamless integration into the clinical workflow, we hope that the proposed mixed reality guidance environment may become a significant milestone toward enabling minimally invasive therapy on the beating heart

On the Application of Mechanical Vibration in Robotics-Assisted Soft Tissue Intervention

Mechanical vibration as a way of transmitting energy has been an interesting subject to study. While cyclic oscillation is usually associated with fatigue effect, and hence a detrimental factor in failure of structures and machineries, by controlled transmission of vibration, energy can be transferred from the source to the target. In this thesis, the application of such mechanical vibration in a few surgical procedures is demonstrated. Three challenges associated with lung cancer diagnosis and treatment are chosen for this purpose, namely, Motion Compensation, tumor targeting in lung Needle Insertion and Soft Tissue Dissection: A robotic solution is proposed for compensating for the undesirable oscillatory motion of soft tissue (caused by heart beat and respiration) during needle insertion in the lung. An impedance control strategy based on a mechanical vibratory system is implemented to minimize the tissue deformation during needle insertion. A prototype was built to evaluate the proposed approach using: 1) two Mitsubishi PA10-7C robots, one for manipulating the macro part and the other for mimicking the tissue motion, 2) one motorized linear stage to handle the micro part, and 3) a Phantom Omni haptic device for remote manipulation. Experimental results are given to demonstrate the performance of the motion compensation system. A vibration-assisted needle insertion technique has been proposed in order to reduce needle–tissue friction. The LuGre friction model is employed as a basis for the study and the model is extended and analyzed to include the impact of high-frequency vibration on translational friction. Experiments are conducted to evaluate the role of insertion speed as well as vibration frequency on frictional effects. In the experiments conducted, an 18 GA brachytherapy needle was vibrated and inserted into an ex-vivo soft tissue sample using a pair of amplified piezoelectric actuators. Analysis demonstrates that the translational friction can be reduced by introducing a vibratory low-amplitude motion onto a regular insertion profile, which is usually performed at a constant rate. A robotics-assisted articulating ultrasonic surgical scalpel for minimally invasive soft tissue cutting and coagulation is designed and developed. For this purpose, the optimal design of a Langevin transducer with stepped horn profile is presented for internal-body applications. The modeling, optimization and design of the ultrasonic scalpel are performed through equivalent circuit theory and verified by finite element analysis. Moreover, a novel surgical wrist, compatible with the da Vinci® surgical system, with decoupled two degrees-of-freedom (DOFs) is developed that eliminates the strain of pulling cables and electrical wires. The developed instrument is then driven using the dVRK (da Vinci® research kit) and the Classic da Vinci® surgical system

Modeling and Control of Steerable Ablation Catheters

Catheters are long, flexible tubes that are extensively used in vascular and cardiac interventions, e.g., cardiac ablation, coronary angiography and mitral valve annuloplasty. Catheter-based cardiac ablation is a well-accepted treatment for atrial fibrillation, a common type of cardiac arrhythmia. During this procedure, a steerable ablation catheter is guided through the vasculature to the left atrium to correct the signal pathways inside the heart and restore normal heart rhythm. The outcome of the ablation procedure depends mainly on the correct positioning of the catheter tip at the target location inside the heart and also on maintaining a consistent contact between the catheter tip and cardiac tissue. In the presence of cardiac and respiratory motions, achieving these goals during the ablation procedure is very challenging without proper 3D visualization, dexterous control of the flexible catheter and an estimate of the catheter tip/tissue contact force. This research project provides the required basis for developing a robotics-assisted catheter manipulation system with contact force control for use in cardiac ablation procedures. The behavior of the catheter is studied in free space as well in contact with the environment to develop mathematical models of the catheter tip that are well suited for developing control systems. The validity of the proposed modeling approaches and the performance of the suggested control techniques are evaluated experimentally. As the first step, the static force-deflection relationship for ablation catheters is described with a large-deflection beam model and an optimized pseudo-rigid-body 3R model. The proposed static model is then used in developing a control system for controlling the contact force when the catheter tip is interacting with a static environment. Our studies also showed that it is possible to estimate the tip/tissue contact force by analyzing the shape of the catheter without installing a force sensor on the catheter. During cardiac ablation, the catheter tip is in contact with a relatively fast moving environment (cardiac tissue). Robotic manipulation of the catheter has the potential to improve the quality of contact between the catheter tip and cardiac tissue. To this end, the frequency response of the catheter is investigated and a control technique is proposed to compensate for the cardiac motion and to maintain a constant tip/tissue contact force. Our study on developing a motion compensated robotics-assisted catheter manipulation system suggests that redesigning the actuation mechanism of current ablation catheters would provide a major improvement in using these catheters in robotics-assisted cardiac ablation procedures

Lumen shape reconstruction using a soft robotic balloon catheter and electrical impedance tomography

Incorrectly sized balloon catheters can lead to increased post-surgical complications, yet even with preoperative imaging, correct selection remains a challenge. With limited feedback during surgery, it is difficult to verify correct deployment. We propose the use of integrated impedance measurements and Electrical Impedance Tomography (EIT) imaging to assess the deformation of the balloon and determine the size and shape of the surrounding lumen. Previous work using single impedance measurements, or pressure data and analytical models, whilst demonstrating high sizing accuracy, have assumed a circular cross section. Here we extend these methods by adding a multitude of electrodes to detect elliptical and occluded lumen and obtain EIT images to localise deformations. Using a 14 Fr (5.3 mm) catheter as an example, numerical simulations were performed to find the optimal electrode configuration of two rings of 8 electrodes spaced 10 mm apart. The simulations predicted that the maximum detectable aspect ratio decreased from 0.9 for a 14mm balloon to 0.5 at 30mm. The sizing and ellipticity detection results were verified experimentally. A prototype robotic balloon catheter was constructed to automatically inflate a compliant balloon while simultaneously recording EIT and pressure data. Data were collected in experiments replicating stenotic vessels with an elliptical and asymmetrical profile, and the widening of a lumen during angioplasty. After calibration, the system was able to correctly localise the occlusion and detect aspect ratios of 0.75. EIT images further localised the occlusion and visualised the dilation of the lumen during balloon inflation