Vision-Based Autonomous Control in Robotic Surgery

Robotic Surgery has completely changed surgical procedures. Enhanced dexterity, ergonomics, motion scaling, and tremor filtering, are well-known advantages introduced with respect to classical laparoscopy. In the past decade, robotic plays a fundamental role in Minimally Invasive Surgery (MIS) in which the da Vinci robotic system (Intuitive Surgical Inc., Sunnyvale, CA) is the most widely used system for robot-assisted laparoscopic procedures. Robots also have great potentiality in Microsurgical applications, where human limits are crucial and surgical sub-millimetric gestures could have enormous benefits with motion scaling and tremor compensation. However, surgical robots still lack advanced assistive control methods that could notably support surgeon's activity and perform surgical tasks in autonomy for a high quality of intervention. In this scenario, images are the main feedback the surgeon can use to correctly operate in the surgical site. Therefore, in view of the increasing autonomy in surgical robotics, vision-based techniques play an important role and can arise by extending computer vision algorithms to surgical scenarios. Moreover, many surgical tasks could benefit from the application of advanced control techniques, allowing the surgeon to work under less stressful conditions and performing the surgical procedures with more accuracy and safety. The thesis starts from these topics, providing surgical robots the ability to perform complex tasks helping the surgeon to skillfully manipulate the robotic system to accomplish the above requirements. An increase in safety and a reduction in mental workload is achieved through the introduction of active constraints, that can prevent the surgical tool from crossing a forbidden region and similarly generate constrained motion to guide the surgeon on a specific path, or to accomplish robotic autonomous tasks. This leads to the development of a vision-based method for robot-aided dissection procedure allowing the control algorithm to autonomously adapt to environmental changes during the surgical intervention using stereo images elaboration. Computer vision is exploited to define a surgical tools collision avoidance method that uses Forbidden Region Virtual Fixtures by rendering a repulsive force to the surgeon. Advanced control techniques based on an optimization approach are developed, allowing multiple tasks execution with task definition encoded through Control Barrier Functions (CBFs) and enhancing haptic-guided teleoperation system during suturing procedures. The proposed methods are tested on a different robotic platform involving da Vinci Research Kit robot (dVRK) and a new microsurgical robotic platform. Finally, the integration of new sensors and instruments in surgical robots are considered, including a multi-functional tool for dexterous tissues manipulation and different visual sensing technologies

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

A minimally invasive surgical system for 3D ultrasound guided robotic retrieval of foreign bodies from a beating heart

The result of various medical conditions and trauma, foreign bodies in the heart pose a serious health risk as they may interfere with cardiovascular function. Particles such as thrombi, bullet fragments, and shrapnel can become trapped in a person's heart after migrating through the venous system, or by direct penetration. The severity of disruption can range from benign to fatal, with associated symptoms including anxiety, fever, cardiac tamponade, hemorrhage, infection, embolism, arrhythmia, and valve dysfunction. Injuries of this nature are common in both civilian and military populations. For symptomatic cases, conventional treatment is removal of the foreign body through open surgery via a median sternotomy, the use of cardiopulmonary bypass, and a wide incision in the heart muscle; these methods incur pronounced perioperative risks and long recovery periods. In order to improve upon the standard of care, we propose an image guided robotic system and a corresponding minimally invasive surgical approach. The system employs a dexterous robotic capture device that can maneuver inside the heart through a small incision. Visualization and guidance within the otherwise occluded internal regions are provided by 3D transesophageal echocardiography (TEE), an emerging form of intraoperative medical imaging used in interventions such as mitral valve repair and device implantation. A robotic approach, as opposed to a manual procedure using rigid instruments, is motivated by the various challenges inherent in minimally invasive surgery, which arise from attempts to perform skilled surgical tasks through small incisions without direct vision. Challenges include reduced dexterity, constrained workspace, limited visualization, and difficult hand-eye coordination, which ultimately lead to poor manipulability. A dexterous robotic end effector with real-time image guidance can help overcome these challenges and potentially improve surgical performance. However promising, such a system and approach require that several technical hurdles be resolved. The foreign body must be automatically tracked as it travels about the dynamic environment of the heart. The erratically moving particle must then be captured using a dexterous robot that moves much more slowly in comparison. Furthermore, retrieval must be performed under 3D ultrasound guidance, amidst the uncertainties presented by both the turbulent flow and by the imaging modality itself. In addressing such barriers, this thesis explores the development of a prototype system capable of retrieving a foreign body from a beating heart, culminating in a set of demonstrative in vitro experiments

Modeling, Sensorization and Control of Concentric-Tube Robots

Since the concept of the Concentric-Tube Robot (CTR) was proposed in 2006, CTRs have been a popular research topic in the field of surgical robotics. The unique mechanical design of this robot allows it to navigate through narrow channels in the human anatomy and operate in highly constrained environments. It is therefore likely to become the next generation of surgical robots to overcome the challenges that cannot be addressed by current technologies. In CSTAR, we have had ongoing work over the past several years aimed at developing novel techniques and technologies for CTRs. This thesis describes the contributions made in this context, focusing primarily on topics such as modeling, sensorization, and control of CTRs. Prior to this work, one of the main challenges in CTRs was to develop a kinematic model that achieves a balance between the numerical accuracy and computational efficiency for surgical applications. In this thesis, a fast kinematic model of CTRs is proposed, which can be solved at a comparatively fast rate (0.2 ms) with minimal loss of accuracy (0.1 mm) for a 3-tube CTR. A Jacobian matrix is derived based on this model, leading to the development of a real-time trajectory tracking controller for CTRs. For tissue-robot interactions, a force-rejection controller is proposed for position control of CTRs under time-varying force disturbances. In contrast to rigid-link robots, instability of position control could be caused by non-unique solutions to the forward kinematics of CTRs. This phenomenon is modeled and analyzed, resulting in design criteria that can ensure kinematic stability of a CTR in its entire workspace. Force sensing is another major difficulty for CTRs. To address this issue, commercial force/torque sensors (Nano43, ATI Industrial Automation, United States) are integrated into one of our CTR prototypes. These force/torque sensors are replaced by Fiber-Bragg Grating (FBG) sensors that are helically-wrapped and embedded in CTRs. A strain-force calculation algorithm is proposed, to convert the reflected wavelength of FBGs into force measurements with 0.1 N force resolution at 100 Hz sampling rate. In addition, this thesis reports on our innovations in prototyping drive units for CTRs. Three designs of CTR prototypes are proposed, the latest one being significantly more compact and cost efficient in comparison with most designs in the literature. All of these contributions have brought this technology a few steps closer to being used in operating rooms. Some of the techniques and technologies mentioned above are not merely limited to CTRs, but are also suitable for problems arising in other types of surgical robots, for example, for sensorizing da Vinci surgical instruments for force sensing (see Appendix A)

Visual Tracking in Robotic Minimally Invasive Surgery

Intra-operative imaging and robotics are some of the technologies driving forward better and more effective minimally invasive surgical procedures. To advance surgical practice and capabilities further, one of the key requirements for computationally enhanced interventions is to know how instruments and tissues move during the operation. While endoscopic video captures motion, the complex appearance dynamic effects of surgical scenes are challenging for computer vision algorithms to handle with robustness. Tackling both tissue and instrument motion estimation, this thesis proposes a combined non-rigid surface deformation estimation method to track tissue surfaces robustly and in conditions with poor illumination. For instrument tracking, a keypoint based 2D tracker that relies on the Generalized Hough Transform is developed to initialize a 3D tracker in order to robustly track surgical instruments through long sequences that contain complex motions. To handle appearance changes and occlusion a patch-based adaptive weighting with segmentation and scale tracking framework is developed. It takes a tracking-by-detection approach and a segmentation model is used to assigns weights to template patches in order to suppress back- ground information. The performance of the method is thoroughly evaluated showing that without any offline-training, the tracker works well even in complex environments. Finally, the thesis proposes a novel 2D articulated instrument pose estimation framework, which includes detection-regression fully convolutional network and a multiple instrument parsing component. The framework achieves compelling performance and illustrates interesting properties includ- ing transfer between different instrument types and between ex vivo and in vivo data. In summary, the thesis advances the state-of-the art in visual tracking for surgical applications for both tissue and instrument motion estimation. It contributes to developing the technological capability of full surgical scene understanding from endoscopic video

Intuitive, iterative and assisted virtual guides programming for human-robot comanipulation

Pendant très longtemps, l'automatisation a été assujettie à l'usage de robots industriels traditionnels placés dans des cages et programmés pour répéter des tâches plus ou moins complexes au maximum de leur vitesse et de leur précision. Cette automatisation, dite rigide, possède deux inconvénients majeurs : elle est chronophage dû aux contraintes contextuelles applicatives et proscrit la présence humaine. Il existe désormais une nouvelle génération de robots avec des systèmes moins encombrants, peu coûteux et plus flexibles. De par leur structure et leurs modes de fonctionnement ils sont intrinsèquement sûrs ce qui leurs permettent de travailler main dans la main avec les humains. Dans ces nouveaux espaces de travail collaboratifs, l'homme peut être inclus dans la boucle comme un agent décisionnel actif. En tant qu'instructeur ou collaborateur il peut influencer le processus décisionnel du robot : on parle de robots collaboratifs (ou cobots). Dans ce nouveau contexte, nous faisons usage de guides virtuels. Ils permettent aux cobots de soulager les efforts physiques et la charge cognitive des opérateurs. Cependant, la définition d'un guide virtuel nécessite souvent une expertise et une modélisation précise de la tâche. Cela restreint leur utilité aux scénarios à contraintes fixes. Pour palier ce problème et améliorer la flexibilité de la programmation du guide virtuel, cette thèse présente une nouvelle approche par démonstration : nous faisons usage de l'apprentissage kinesthésique de façon itérative et construisons le guide virtuel avec une spline 6D. Grâce à cette approche, l'opérateur peut modifier itérativement les guides tout en gardant leur assistance. Cela permet de rendre le processus plus intuitif et naturel ainsi que de réduire la pénibilité. La modification locale d'un guide virtuel en trajectoire est possible par interaction physique avec le robot. L'utilisateur peut déplacer un point clé cartésien ou modifier une portion entière du guide avec une nouvelle démonstration partielle. Nous avons également étendu notre approche aux guides virtuels 6D, où les splines en déplacement sont définies via une interpolation Akima (pour la translation) et une 'interpolation quadratique des quaternions (pour l'orientation). L'opérateur peut initialement définir un guide virtuel en trajectoire, puis utiliser l'assistance en translation pour ne se concentrer que sur la démonstration de l'orientation. Nous avons appliqué notre approche dans deux scénarios industriels utilisant un cobot. Nous avons ainsi démontré l'intérêt de notre méthode qui améliore le confort de l'opérateur lors de la comanipulation.For a very long time, automation was driven by the use of traditional industrial robots placed in cages, programmed to repeat more or less complex tasks at their highest speed and with maximum accuracy. This robot-oriented solution is heavily dependent on hard automation which requires pre-specified fixtures and time consuming programming, hindering robots from becoming flexible and versatile tools. These robots have evolved towards a new generation of small, inexpensive, inherently safe and flexible systems that work hand in hand with humans. In these new collaborative workspaces the human can be included in the loop as an active agent. As a teacher and as a co-worker he can influence the decision-making process of the robot. In this context, virtual guides are an important tool used to assist the human worker by reducing physical effort and cognitive overload during tasks accomplishment. However, the construction of virtual guides often requires expert knowledge and modeling of the task. These limitations restrict the usefulness of virtual guides to scenarios with unchanging constraints. To overcome these challenges and enhance the flexibility of virtual guides programming, this thesis presents a novel approach that allows the worker to create virtual guides by demonstration through an iterative method based on kinesthetic teaching and displacement splines. Thanks to this approach, the worker is able to iteratively modify the guides while being assisted by them, making the process more intuitive and natural while reducing its painfulness. Our approach allows local refinement of virtual guiding trajectories through physical interaction with the robots. We can modify a specific cartesian keypoint of the guide or re- demonstrate a portion. We also extended our approach to 6D virtual guides, where displacement splines are defined via Akima interpolation (for translation) and quadratic interpolation of quaternions (for orientation). The worker can initially define a virtual guiding trajectory and then use the assistance in translation to only concentrate on defining the orientation along the path. We demonstrated that these innovations provide a novel and intuitive solution to increase the human's comfort during human-robot comanipulation in two industrial scenarios with a collaborative robot (cobot)

OPTICAL-BASED TACTILE SENSORS FOR MINIMALLY INVASIVE SURGERIES: DESIGN, MODELING, FABRICATION AND VALIDATION

Loss of tactile perception is the most challenging limitation of state-of-the-art technology for minimally invasive surgery. In conventional open surgery, surgeons rely on their tactile sensation to perceive the tissue type, anatomical landmarks, and instrument-tissue interaction in the patient’s body. To compensate for the loss of tactile feedback in minimally invasive surgery, researchers have proposed various tactile sensors based on electrical and optical sensing principles. Optical-based sensors have shown the most compatibility with the functional and physical requirements of minimally invasive surgery applications. However, the proposed tactile sensors in the literature are typically bulky, expensive, cumbersome to integrate with surgical instruments and show nonlinearity in interaction with biological tissues. In this doctoral study, different optical tactile sensing principles were proposed, modeled, validated and various tactile sensors were fabricated, and experimentally studied to address the limitations of the state-of-the-art. The present thesis first provides a critical review of the proposed tactile sensors in the literature with a comparison of their advantages and limitations for surgical applications. Afterward, it compiles the results of the design, modeling, and validation of a hybrid optical-piezoresistive sensor, a distributed Bragg reflecting sensor, and two sensors based on the variable bending radius light intensity modulation principle. The performance of each sensor was verified experimentally for the required criteria of accuracy, resolution, range, repeatability, and hysteresis. Also, a novel image-based intensity estimation technique was proposed and its applicability for being used in surgical applications was verified experimentally. In the end, concluding remarks and recommendations for future studies are provided

Computer-Assisted Electroanatomical Guidance for Cardiac Electrophysiology Procedures

Cardiac arrhythmias are serious life-threatening episodes affecting both the aging population and younger patients with pre-existing heart conditions. One of the most effective therapeutic procedures is the minimally-invasive catheter-driven endovascular electrophysiology study, whereby electrical potentials and activation patterns in the affected cardiac chambers are measured and subsequent ablation of arrhythmogenic tissue is performed. Despite emerging technologies such as electroanatomical mapping and remote intraoperative navigation systems for improved catheter manipulation and stability, successful ablation of arrhythmias is still highly-dependent on the operator’s skills and experience. This thesis proposes a framework towards standardisation in the electroanatomical mapping and ablation planning by merging knowledge transfer from previous cases and patient-specific data. In particular, contributions towards four different procedural aspects were made: optimal electroanatomical mapping, arrhythmia path computation, catheter tip stability analysis, and ablation simulation and optimisation. In order to improve the intraoperative electroanatomical map, anatomical areas of high mapping interest were proposed, as learned from previous electrophysiology studies. Subsequently, the arrhythmic wave propagation on the endocardial surface and potential ablation points were computed. The ablation planning is further enhanced, firstly by the analysis of the catheter tip stability and the probability of slippage at sparse locations on the endocardium and, secondly, by the simulation of the ablation result from the computation of convolutional matrices which model mathematically the ablation process. The methods proposed by this thesis were validated on data from patients with complex congenital heart disease, who present unusual cardiac anatomy and consequently atypical arrhythmias. The proposed methods also build a generic framework for computer guidance of electrophysiology, with results showing complementary information that can be easily integrated into the clinical workflow.Open Acces