A Cognitive Robot Control Architecture for Autonomous Execution of Surgical Tasks

The research on medical robotics is starting to address the autonomous execution of surgical tasks, without effective intervention of humans apart from supervision and task configuration. This paper addresses the complete automation of a surgical robot by combining advanced sensing, cognition and control capabilities, developed according to rigorous assessment of surgical require- ments, formal specification of robotic system behavior and software design and implementation based on solid tools and frame- works. In particular, the paper focuses on the cognitive control architecture and its development process, based on formal modeling and verification methods as best practices to ensure safe and reliable behavior. Full implementation of the proposed architecture has been tested on an experimental setup including a novel robot specifically designed for surgical applications, but adaptable to different selected tasks (i.e. needle insertion, wound suturing)

Advanced Augmented Reality Telestration Techniques With Applications In Laparoscopic And Robotic Surgery

The art of teaching laparoscopic or robotic surgery currently has a primary reliance on an expert surgeon tutoring a student during a live surgery. During these operations, surgeons are viewing the inside of the body through a manipulatable camera. Due to the viewpoint translation and narrow field of view, these techniques have a substantial learning curve in order to gain the mastery necessary to operate safely. In addition to moving and rotating the camera, the surgeon must also manipulate tools inserted into the body. These tools are only visible on camera, and pass through a pivot point on the body that, in non-robotic cases, reverses their directions of motion when compared to the surgeon\u27s hands. These difficulties spurred on this dissertation. The main hypothesis of this research is that advanced augmented reality techniques can improve telementoring for use between expert surgeons and surgical students. In addition, it can provide a better method of communication between surgeon and camera operator. This research has two specific aims: (1) Create a head-mounted direction of focus indicator to provide non-verbal assistance for camera operation. A system was created to track where the surgeon is looking and provides augmented reality cues to the camera operator explaining the camera desires of the surgeon. (2) Create a hardware / software environment for the tracking of a camera and an object, allowing for the display of registered pre-operative imaging that can be manipulated during the procedure. A set of augmented reality cues describing the translation, zoom, and roll of a laparoscopic camera were developed for Aim 1. An experiment was run to determine whether using augmented reality cues or verbal cues was faster and more efficient at acquiring targets on camera at a specific location, zoom level, and roll angle. The study found that in all instances, the augmented reality cues resulted in faster completion of the task with better economy of movement than with the verbal cues. A large number of environmentally registered augmented reality telestration and visualization features were added to a hardware / software platform for Aim 2. The implemented manipulation of pre-operative imaging and the ability to provide different types of registered annotation in the working environment has provided numerous examples of improved utility in telementoring systems. The results of this work provide potential improvements to the utilization of pre-operative imaging in the operating room, to the effectiveness of telementoring as a surgical teaching tool, and to the effective communication between the surgeon and the camera operator in laparoscopic surgery

Redesigning the human-robot interface : intuitive teleoperation of anthropomorphic robots

textA novel interface for robotic teleoperation was developed to enable accurate and highly efficient teleoperation of the Industrial Reconfigurable Anthropomorphic Dual-arm (IRAD) system and other robotic systems. In order to achieve a revolutionary increase in operator productivity, the bilateral/master-slave approach must give way to shared autonomy and unilateral control; autonomy must be employed where possible, and appropriate sensory feedback only where autonomy is impossible; and today’s low-information/high feedback model must be replaced by one that emphasizes feedforward precision and minimal corrective feedback. This is emphasized for task spaces outside of the traditional anthropomorphic scale such as mobile manipulation (i.e. large task spaces) and high precision tasks (i.e. very small task spaces). The system is demonstrated using an anthropomorphically dimensioned industrial manipulator working in task spaces from one meter to less than one millimeter, in both simulation and hardware. This thesis discusses the design requirements and philosophy of this interface, provides a summary of prototype teleoperation hardware, simulation environment, test-bed hardware, and experimental results.Mechanical Engineerin

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

Cognitive and physical effort of surgeons using master/slave surgical systems for minimally invasive surgery

Tese de mestrado integrado, Engenharia Biomédica e Biofísica (Engenharia Clínica e Instrumentação Médica) Universidade de Lisboa, Faculdade de Ciências, 2020The integration of technology in health care has been increasing over the years, allowing more and better diagnoses and treatments in various areas of health. One of these areas is the surgery area, with da Vinci system being one of the most successful and most commercialized. Despite all the advantages, there are some disadvantages such as a limited number of degrees of freedom, the possibility of collision between the different robotic arms, among others. Therefore, the SMARTsurg (Smart Wearble Robotic Teleoperated Surgery) project was developed for the purpose of correcting these problems, proposing a wearable robotic system for minimally invasive surgeries, offering surgeons more natural movements. However, to verify that this is a necessary improvement, it is necessary to understand how these changes affects the performance and condition of surgeons. Thus, the aim of this dissertation is to compare the muscular and mental effort of surgeons when performing tasks using the da Vinci system and the SMARTsurg system. Biological signals such as electromyography (EMG) and electroencephalography (EEG) were studied to verify how these signals changed using each of the systems. Using these biosignals it was possible to evaluate muscle and mental fatigue in the participants of this study. The experimental trials with the da Vinci system took place at Southmead Hospital Bristol, where the fatigue of clinicians was tested, performing a series of surgical training tasks in the simulator embedded in the da Vinci systems. For the SMARTsurg system, the trials took place at the Bristol Robotics Lab, having been tested volunteers from the lab without any experience in robotic surgical systems and one of the subjects who participated in the trial in the hospital. Also here, subjects were asked to perform small surgical training tasks, similar to those of the da Vinci system. The analysis of the results showed that it was only possible to verify muscle fatigue in participants using the da Vinci system, and it was not possible to determine any type of mental fatigue using any of the systems. Nevertheless, it will be necessary to do more experiments to verify a broader trend in the data, and it was possible to determine with this dissertation the validity of the use of two wireless devices available in the market to infer conclusions about human physiological changes

Robot Assisted Object Manipulation for Minimally Invasive Surgery

Robotic systems have an increasingly important role in facilitating minimally invasive surgical treatments. In robot-assisted minimally invasive surgery, surgeons remotely control instruments from a console to perform operations inside the patient. However, despite the advanced technological status of surgical robots, fully autonomous systems, with decision-making capabilities, are not yet available. In 2017, a structure to classify the research efforts toward autonomy achievable with surgical robots was proposed by Yang et al. Six different levels were identified: no autonomy, robot assistance, task autonomy, conditional autonomy, high autonomy, and full autonomy. All the commercially available platforms in robot-assisted surgery is still in level 0 (no autonomy). Despite increasing the level of autonomy remains an open challenge, its adoption could potentially introduce multiple benefits, such as decreasing surgeons’ workload and fatigue and pursuing a consistent quality of procedures. Ultimately, allowing the surgeons to interpret the ample and intelligent information from the system will enhance the surgical outcome and positively reflect both on patients and society. Three main aspects are required to introduce automation into surgery: the surgical robot must move with high precision, have motion planning capabilities and understand the surgical scene. Besides these main factors, depending on the type of surgery, there could be other aspects that might play a fundamental role, to name some compliance, stiffness, etc. This thesis addresses three technological challenges encountered when trying to achieve the aforementioned goals, in the specific case of robot-object interaction. First, how to overcome the inaccuracy of cable-driven systems when executing fine and precise movements. Second, planning different tasks in dynamically changing environments. Lastly, how the understanding of a surgical scene can be used to solve more than one manipulation task. To address the first challenge, a control scheme relying on accurate calibration is implemented to execute the pick-up of a surgical needle. Regarding the planning of surgical tasks, two approaches are explored: one is learning from demonstration to pick and place a surgical object, and the second is using a gradient-based approach to trigger a smoother object repositioning phase during intraoperative procedures. Finally, to improve scene understanding, this thesis focuses on developing a simulation environment where multiple tasks can be learned based on the surgical scene and then transferred to the real robot. Experiments proved that automation of the pick and place task of different surgical objects is possible. The robot was successfully able to autonomously pick up a suturing needle, position a surgical device for intraoperative ultrasound scanning and manipulate soft tissue for intraoperative organ retraction. Despite automation of surgical subtasks has been demonstrated in this work, several challenges remain open, such as the capabilities of the generated algorithm to generalise over different environment conditions and different patients

Activity profiling for minimally invasive surgery

Imperial Users onl

Planning for steerable needles in neurosurgery

The increasing adoption of robotic-assisted surgery has opened up the possibility to control innovative dexterous tools to improve patient outcomes in a minimally invasive way. Steerable needles belong to this category, and their potential has been recognised in various surgical fields, including neurosurgery. However, planning for steerable catheters' insertions might appear counterintuitive even for expert clinicians. Strategies and tools to aid the surgeon in selecting a feasible trajectory to follow and methods to assist them intra-operatively during the insertion process are currently of great interest as they could accelerate steerable needles' translation from research to practical use. However, existing computer-assisted planning (CAP) algorithms are often limited in their ability to meet both operational and kinematic constraints in the context of precise neurosurgery, due to its demanding surgical conditions and highly complex environment. The research contributions in this thesis relate to understanding the existing gap in planning curved insertions for steerable needles and implementing intelligent CAP techniques to use in the context of neurosurgery. Among this thesis contributions showcase (i) the development of a pre-operative CAP for precise neurosurgery applications able to generate optimised paths at a safe distance from brain sensitive structures while meeting steerable needles kinematic constraints; (ii) the development of an intra-operative CAP able to adjust the current insertion path with high stability while compensating for online tissue deformation; (iii) the integration of both methods into a commercial user front-end interface (NeuroInspire, Renishaw plc.) tested during a series of user-controlled needle steering animal trials, demonstrating successful targeting performances. (iv) investigating the use of steerable needles in the context of laser interstitial thermal therapy (LiTT) for maesial temporal lobe epilepsy patients and proposing the first LiTT CAP for steerable needles within this context. The thesis concludes with a discussion of these contributions and suggestions for future work.Open Acces

Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-opera- tive morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilites by observ- ing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted in- struments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This paper reviews the state-of-the-art methods for optical intra-operative 3D reconstruction in laparoscopic surgery and discusses the technical challenges and future perspectives towards clinical translation. With the recent paradigm shift of surgical practice towards MIS and new developments in 3D opti- cal imaging, this is a timely discussion about technologies that could facilitate complex CAS procedures in dynamic and deformable anatomical regions

A Sensorized Instrument for Minimally Invasive Surgery for the Measurement of Forces during Training and Surgery: Development and Applications

The reduced access conditions present in Minimally Invasive Surgery (MIS) affect the feel of interaction forces between the instruments and the tissue being treated. This loss of haptic information compromises the safety of the procedure and must be overcome through training. Haptics in MIS is the subject of extensive research, focused on establishing force feedback mechanisms and developing appropriate sensors. This latter task is complicated by the need to place the sensors as close as possible to the instrument tip, as the measurement of forces outside of the patient\u27s body does not represent the true tool--tissue interaction. Many force sensors have been proposed, but none are yet available for surgery. The objectives of this thesis were to develop a set of instruments capable of measuring tool--tissue force information in MIS, and to evaluate the usefulness of force information during surgery and for training and skills assessment. To address these objectives, a set of laparoscopic instruments was developed that can measure instrument position and tool--tissue interaction forces in multiple degrees of freedom. Different design iterations and the work performed towards the development of a sterilizable instrument are presented. Several experiments were performed using these instruments to establish the usefulness of force information in surgery and training. The results showed that the combination of force and position information can be used in the development of realistic tissue models or haptic interfaces specifically designed for MIS. This information is also valuable in order to create tactile maps to assist in the identification of areas of different stiffness. The real-time measurement of forces allows visual force feedback to be presented to the surgeon. When applied to training scenarios, the results show that experience level correlates better with force-based metrics than those currently used in training simulators. The proposed metrics can be automatically computed, are completely objective, and measure important aspects of performance. The primary contribution of this thesis is the design and development of highly versatile instruments capable of measuring force and position during surgery. A second contribution establishes the importance and usefulness of force data during skills assessment, training and surgery