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

Design of a wearable fingertip haptic device for remote palpation: Characterisation and interface with a virtual environment

© 2018 Tzemanaki, Al, Melhuish and Dogramadzi. This paper presents the development of a wearable Fingertip Haptic Device (FHD) that can provide cutaneous feedback via a Variable Compliance Platform (VCP). The FHD includes an inertial measurement unit, which tracks the motion of the user's finger while its haptic functionality relies on two parameters: pressure in the VCP and its linear displacement towards the fingertip. The combination of these two features results in various conditions of the FHD, which emulate the remote object or surface stiffness properties. Such a device can be used in tele-operation, including virtual reality applications, where rendering the level of stiffness of different physical or virtual materials could provide a more realistic haptic perception to the user. The FHD stiffness representation is characterised in terms of resulting pressure and force applied to the fingertip created through the relationship of the two functional parameters - pressure and displacement of the VCP. The FHD was tested in a series of user studies to assess its potential to create a user perception of the object's variable stiffness. The viability of the FHD as a haptic device has been further confirmed by interfacing the users with a virtual environment. The developed virtual environment task required the users to follow a virtual path, identify objects of different hardness on the path and navigate away from "no-go" zones. The task was performed with and without the use of the variable compliance on the FHD. The results showed improved performance with the presence of the variable compliance provided by the FHD in all assessed categories and particularly in the ability to identify correctly between objects of different hardness

Sensory substitution for force feedback recovery: A perception experimental study

Robotic-assisted surgeries are commonly used today as a more efficient alternative to traditional surgical options. Both surgeons and patients benefit from those systems, as they offer many advantages, including less trauma and blood loss, fewer complications, and better ergonomics. However, a remaining limitation of currently available surgical systems is the lack of force feedback due to the teleoperation setting, which prevents direct interaction with the patient. Once the force information is obtained by either a sensing device or indirectly through vision-based force estimation, a concern arises on how to transmit this information to the surgeon. An attractive alternative is sensory substitution, which allows transcoding information from one sensory modality to present it in a different sensory modality. In the current work, we used visual feedback to convey interaction forces to the surgeon. Our overarching goal was to address the following question: How should interaction forces be displayed to support efficient comprehension by the surgeon without interfering with the surgeon’s perception and workflow during surgery? Until now, the use the visual modality for force feedback has not been carefully evaluated. For this reason, we conducted an experimental study with two aims: (1) to demonstrate the potential benefits of using this modality and (2) to understand the surgeons’ perceptual preferences. The results derived from our study of 28 surgeons revealed a strong positive acceptance of the users (96%) using this modality. Moreover, we found that for surgeons to easily interpret the information, their mental model must be considered, meaning that the design of the visualizations should fit the perceptual and cognitive abilities of the end user. To our knowledge, this is the first time that these principles have been analyzed for exploring sensory substitution in medical robotics. Finally, we provide user-centered recommendations for the design of visual displays for robotic surgical systems.Peer ReviewedPostprint (author's final draft

Haptics in Robot-Assisted Surgery: Challenges and Benefits

Robotic surgery is transforming the current surgical practice, not only by improving the conventional surgical methods but also by introducing innovative robot-enhanced approaches that broaden the capabilities of clinicians. Being mainly of man-machine collaborative type, surgical robots are seen as media that transfer pre- and intra-operative information to the operator and reproduce his/her motion, with appropriate filtering, scaling, or limitation, to physically interact with the patient. The field, however, is far from maturity and, more critically, is still a subject of controversy in medical communities. Limited or absent haptic feedback is reputed to be among reasons that impede further spread of surgical robots. In this paper objectives and challenges of deploying haptic technologies in surgical robotics is discussed and a systematic review is performed on works that have studied the effects of providing haptic information to the users in major branches of robotic surgery. It has been tried to encompass both classical works and the state of the art approaches, aiming at delivering a comprehensive and balanced survey both for researchers starting their work in this field and for the experts

Robotic Ultrasound Imaging: State-of-the-Art and Future Perspectives

Ultrasound (US) is one of the most widely used modalities for clinical intervention and diagnosis due to the merits of providing non-invasive, radiation-free, and real-time images. However, free-hand US examinations are highly operator-dependent. Robotic US System (RUSS) aims at overcoming this shortcoming by offering reproducibility, while also aiming at improving dexterity, and intelligent anatomy and disease-aware imaging. In addition to enhancing diagnostic outcomes, RUSS also holds the potential to provide medical interventions for populations suffering from the shortage of experienced sonographers. In this paper, we categorize RUSS as teleoperated or autonomous. Regarding teleoperated RUSS, we summarize their technical developments, and clinical evaluations, respectively. This survey then focuses on the review of recent work on autonomous robotic US imaging. We demonstrate that machine learning and artificial intelligence present the key techniques, which enable intelligent patient and process-specific, motion and deformation-aware robotic image acquisition. We also show that the research on artificial intelligence for autonomous RUSS has directed the research community toward understanding and modeling expert sonographers' semantic reasoning and action. Here, we call this process, the recovery of the "language of sonography". This side result of research on autonomous robotic US acquisitions could be considered as valuable and essential as the progress made in the robotic US examination itself. This article will provide both engineers and clinicians with a comprehensive understanding of RUSS by surveying underlying techniques.Comment: Accepted by Medical Image Analysi

Measuring the impact of haptic feedback in collaborative robotic scenarios

[EN] In recent years, the interaction of a human operator with teleoperated robotic systems has been much improved. One of the factors influencing this improvement is the addition of force feedback to complement the visual feedback provided by traditional graphical user interfaces. However, the users of these systems performing tasks in isolated and safe environments are often inexperienced and occasional users. In addition, there is no common framework to assess the usability of these systems, due to the heterogeneity of applications and tasks, and therefore, there is a need for new usability assessment methods that are not domain specific. This study addresses this issue by proposing a measure of usability that includes five variables: user efficiency, user effectiveness, mental workload, perceived usefulness, and perceived ease of use. The empirical analysis shows that the integration of haptic feedback improves the usability of these systems for non-expert users, even though the differences are not statistically significant; further, the results suggest that mental workload is higher when haptic feedback is added. The analysis also reveals significant differences between participants depending on gender.SIPublicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCL

Recent Advances in Robot-Assisted Surgery: Soft Tissue Contact Identification

Robot-Assisted Minimally Invasive Surgery (RAMIS) is becoming standard-of-care in western medicine. RAMIS offers better patient outcome compared to traditional open surgery, however, the surgeons’ ability to identify the tissues with the sense of touch is missing from most robotic systems. Regarding haptic feedback, the most promising diagnostic technique is probably palpation; a physical contact examination method through which information can be gathered about the underlying structures by gently pressing with the fingers. In open surgery, palpation is widely used to identify blood vessels, tendons or even tumors; and the knowledge on the exact location of such elements is often crucial with respect to the outcome of the intervention. This paper presents a review of the actual research directions in the field of palpation in RAMIS