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

Real-time Robot-assisted Ergonomics

This paper describes a novel approach in human robot interaction driven by ergonomics. With a clear focus on optimising ergonomics, the approach proposed here continuously observes a human user's posture and by invoking appropriate cooperative robot movements, the user's posture is, whenever required, brought back to an ergonomic optimum. Effectively, the new protocol optimises the human-robot relative position and orientation as a function of human ergonomics. An RGB-D camera is used to calculate and monitor human joint angles in real-time and to determine the current ergonomics state. A total of 6 main causes of low ergonomic states are identified, leading to 6 universal robot responses to allow the human to return to an optimal ergonomics state. The algorithmic framework identifies these 6 causes and controls the cooperating robot to always adapt the environment (e.g. change the pose of the workpiece) in a way that is ergonomically most comfortable for the interacting user. Hence, human-robot interaction is continuously re-evaluated optimizing ergonomics states. The approach is validated through an experimental study, based on established ergonomic methods and their adaptation for real-time application. The study confirms improved ergonomics using the new approach.Comment: 6 pages, accepted and to be presented at IEEE ICRA 201

Development of Modular and Adaptive Laboratory Set-Up for Neuroergonomic and Human-Robot Interaction Research

The industry increasingly insists on academic cooperation to solve the identified problems such as workers\u27 performance, wellbeing, job satisfaction, and injuries. It causes an unsafe and unpleasant working environment that directly impacts the quality of the product, workers\u27 productivity, and effectiveness. This study aimed to give a specialized solution for tests and explore possible solutions to the given problem in neuroergonomics and human-robot interaction. The designed modular and adaptive laboratory model of the industrial assembly workstation represents the laboratory infrastructure for conducting advanced research in the field of ergonomics, neuroergonomics, and human-robot interaction. It meets the operator\u27s anatomical, anthropometric, physiological, and biomechanical characteristics. Comparing standard, ergonomic, guided, and collaborative work will be possible based on workstation construction and integrated elements. These possibilities allow the industry to try, analyze, and get answers for an identified problem, the condition, habits, and behavior of operators in the workplace. The set-up includes a workstation with an industry work chair, a Poka-Yoke system, adequate lighting, an audio 5.0 system, containers with parts and tools, EEG devices (a cap and smartfones), an EMG device, touchscreen PC screen, and collaborative robot. The first phase of the neuroergonomic study was performed according to the most common industry tasks defined as manual, monotonous, and repetitive activities. Participants have a task to assemble the developed prototype model of an industrial product using prepared parts and elements, and instructed by the installed touchscreen PC. In the beginning, the participant gets all the necessary information about the experiment and gets 15 min of practice. After the introductory part, the EEG device is mounted and prepared for recording. The experiment starts with relaxing music for 5 min. The whole experiment lasts two sessions per 60 min each, with a 15 min break between the sessions. Based on the first experiments, it is possible to develop, construct, and conduct complex experiments for industrial purposes to improve the physical, cognitive, and organizational aspects and increase workers\u27 productivity, efficiency, and effectiveness. It has highlighted the possibility of applying modular and adaptive ergonomic research laboratory experimental set-up to transform standard workplaces into the workplaces of the future

A gaze-contingent framework for perceptually-enabled applications in healthcare

Patient safety and quality of care remain the focus of the smart operating room of the future. Some of the most influential factors with a detrimental effect are related to suboptimal communication among the staff, poor flow of information, staff workload and fatigue, ergonomics and sterility in the operating room. While technological developments constantly transform the operating room layout and the interaction between surgical staff and machinery, a vast array of opportunities arise for the design of systems and approaches, that can enhance patient safety and improve workflow and efficiency. The aim of this research is to develop a real-time gaze-contingent framework towards a "smart" operating suite, that will enhance operator's ergonomics by allowing perceptually-enabled, touchless and natural interaction with the environment. The main feature of the proposed framework is the ability to acquire and utilise the plethora of information provided by the human visual system to allow touchless interaction with medical devices in the operating room. In this thesis, a gaze-guided robotic scrub nurse, a gaze-controlled robotised flexible endoscope and a gaze-guided assistive robotic system are proposed. Firstly, the gaze-guided robotic scrub nurse is presented; surgical teams performed a simulated surgical task with the assistance of a robot scrub nurse, which complements the human scrub nurse in delivery of surgical instruments, following gaze selection by the surgeon. Then, the gaze-controlled robotised flexible endoscope is introduced; experienced endoscopists and novice users performed a simulated examination of the upper gastrointestinal tract using predominately their natural gaze. Finally, a gaze-guided assistive robotic system is presented, which aims to facilitate activities of daily living. The results of this work provide valuable insights into the feasibility of integrating the developed gaze-contingent framework into clinical practice without significant workflow disruptions.Open Acces

Context-aware learning for robot-assisted endovascular catheterization

Endovascular intervention has become a mainstream treatment of cardiovascular diseases. However, multiple challenges remain such as unwanted radiation exposures, limited two-dimensional image guidance, insufficient force perception and haptic cues. Fast evolving robot-assisted platforms improve the stability and accuracy of instrument manipulation. The master-slave system also removes radiation to the operator. However, the integration of robotic systems into the current surgical workflow is still debatable since repetitive, easy tasks have little value to be executed by the robotic teleoperation. Current systems offer very low autonomy, potential autonomous features could bring more benefits such as reduced cognitive workloads and human error, safer and more consistent instrument manipulation, ability to incorporate various medical imaging and sensing modalities. This research proposes frameworks for automated catheterisation with different machine learning-based algorithms, includes Learning-from-Demonstration, Reinforcement Learning, and Imitation Learning. Those frameworks focused on integrating context for tasks in the process of skill learning, hence achieving better adaptation to different situations and safer tool-tissue interactions. Furthermore, the autonomous feature was applied to next-generation, MR-safe robotic catheterisation platform. The results provide important insights into improving catheter navigation in the form of autonomous task planning, self-optimization with clinical relevant factors, and motivate the design of intelligent, intuitive, and collaborative robots under non-ionizing image modalities.Open Acces

Performance Analysis of Vibrotactile and Slide-and-Squeeze Haptic Feedback Devices for Limbs Postural Adjustment

Recurrent or sustained awkward body postures are among the most frequently cited risk factors to the development of work-related musculoskeletal disorders (MSDs). To prevent workers from adopting harmful configurations but also to guide them toward more ergonomic ones, wearable haptic devices may be the ideal solution. In this paper, a vibrotactile unit, called ErgoTac, and a slide-and-squeeze unit, called CUFF, were evaluated in a limbs postural correction setting. Their capability of providing single-joint (shoulder or knee) and multi-joint (shoulder and knee at once) guidance was compared in twelve healthy subjects, using quantitative task-related metrics and subjective quantitative evaluation. An integrated environment was also built to ease communication and data sharing between the involved sensor and feedback systems. Results show good acceptability and intuitiveness for both devices. ErgoTac appeared as the suitable feedback device for the shoulder, while the CUFF may be the effective solution for the knee. This comparative study, although preliminary, was propaedeutic to the potential integration of the two devices for effective whole-body postural corrections, with the aim to develop a feedback and assistive apparatus to increase workers' awareness about risky working conditions and therefore to prevent MSDs