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

Planning and Real Time Control of a Minimally Invasive Robotic Surgery System

This paper introduces the planning and control software of a teleoperating robotic system for minimally invasive surgery. It addresses the problem of how to organize a complex system with 41 degrees of freedom including robot setup planning, force feedback control and nullspace handling with three robotic arms. The planning software is separated into sequentially executed planning and registration procedures. An optimal setup is first planned in virtual reality and then adapted to variations in the operating room. The real time control system is composed of hierarchical layers. The design is flexible and expandable without losing performance. Structure, functionality and implementation of planning and control are described. The robotic system provides the surgeon with an intuitive hand-eye-coordination and force feedback in teleoperation for both hands

Force measurement capability for robotic assisted minimally invasive surgery systems

An automated laparoscopic instrument capable of non-invasive measurement of tip/tissue interaction forces for direct application in robotic assisted minimally invasive surgery systems_ is introduced in this paper. It has the capability to measure normal grasping forces as well as lateral interaction forces without any sensor mounted on the tip jaws. Further to non-invasive actuation of the tip, the proposed instrument is also able to change the grasping direction during surgical operation. Modular design of the instrument allows conversion between surgical modalities (e.g., grasping, cutting, and dissecting). The main focus of this paper is on evaluation of the grasping force capability of the proposed instrument. The mathematical formulation of fenestrated insert is presented and its non-linear behaviour is studied. In order to measure the stiffness of soft tissues, a device was developed that is also described in this paper. Tissue characterisation experiments were conducted and results are presented and analysed here. The experimental results verify the capability of the proposed instrument in accurately measuring grasping forces and in characterising artificial tissue samples of varying stiffness.<br /

Surgical Applications of Compliant Mechanisms:A Review

Current surgical devices are mostly rigid and are made of stiff materials, even though their predominant use is on soft and wet tissues. With the emergence of compliant mechanisms (CMs), surgical tools can be designed to be flexible and made using soft materials. CMs offer many advantages such as monolithic fabrication, high precision, no wear, no friction, and no need for lubrication. It is therefore beneficial to consolidate the developments in this field and point to challenges ahead. With this objective, in this article, we review the application of CMs to surgical interventions. The scope of the review covers five aspects that are important in the development of surgical devices: (i) conceptual design and synthesis, (ii) analysis, (iii) materials, (iv) maim facturing, and (v) actuation. Furthermore, the surgical applications of CMs are assessed by classification into five major groups, namely, (i) grasping and cutting, (ii) reachability and steerability, (iii) transmission, (iv) sensing, and (v) implants and deployable devices. The scope and prospects of surgical devices using CMs are also discussed

Optical Fibre-based Force Sensing Needle Driver for Minimally Invasive Surgery

Minimally invasive surgery has been limited from its inception by insufficient haptic feedback to surgeons. The loss of haptic information threatens patients safety and results in longer operation times. To address this problem, various force sensing systems have been developed to provide information about tool–tissue interaction forces. However, the provided results for axial and grasping forces have been inaccurate in most of these studies due to considerable amount of error and uncertainty in their force acquisition method. Furthermore, sterilizability of the sensorized instruments plays a pivotal role in accurate measurement of forces inside a patient\u27s body. Therefore, the objective of this thesis was to develop a sterilizable needle-driver type grasper using fibre Bragg gratings. In order to measure more accurate and reliable tool–tissue interaction forces, optical force sensors were integrated in the grasper jaw to measure axial and grasping forces directly at their exertion point on the tool tip. Two sets of sensor prototypes were developed to prove the feasibility of proposed concept. Implementation of this concept into a needle-driver instrument resulted in the final proposed model of the sensorized laparoscopic instrument. Fibre Bragg gratings were used for measuring forces due to their many advantages for this application such as small size, sterilizability and high sensitivity. Visual force feedback was provided for users based on the acquired real-time force data. Improvement and consideration points related to the current work were identified and potential areas to continue this project in the future are discussed

Haptics-Enabled Forceps with Multi-Modal Force Sensing: Towards Task-Autonomous Surgery

Many robotic surgical systems have been developed with micro-sized biopsy forceps for tissue manipulation. However, these systems often lack force sensing at the tool side. This paper presents a vision-based force sensing method for micro-sized biopsy forceps. A miniature sensing module adaptive to common biopsy forceps is proposed, consisting of a flexure, a camera, and a customised target. The deformation of the flexure is obtained by the camera estimating the pose variation of the top-mounted target. Then, the external force applied to the sensing module is calculated using the flexure's displacement and stiffness matrix. Integrating the sensing module into the biopsy forceps, in conjunction with a single-axial force sensor at the proximal end, we equip the forceps with haptic sensing capabilities. Mathematical equations are derived to estimate the multi-modal force sensing of the haptics-enabled forceps, including pushing/pulling forces (Mode-I) and grasping forces (Mode-II). A series of experiments on phantoms and ex vivo tissues are conducted to verify the feasibility of the proposed design and method. Results indicate that the haptics-enabled forceps can achieve multi-modal force estimation effectively and potentially realize autonomous robotic tissue grasping procedures with controlled forces.Comment: 11 pages, 9 figures, submitted to T-MEC

Robocatch: Design and Making of a Hand-Held Spillage-Free Specimen Retrieval Robot for Laparoscopic Surgery

Specimen retrieval is an important step in laparoscopy, a minimally invasive surgical procedure performed to diagnose and treat a myriad of medical pathologies in fields ranging from gynecology to oncology. Specimen retrieval bags (SRBs) are used to facilitate this task, while minimizing contamination of neighboring tissues and port-sites in the abdominal cavity. This manual surgical procedure requires usage of multiple ports, creating a traffic of simultaneous operations of multiple instruments in a limited shared workspace. The skill-demanding nature of this procedure makes it time-consuming, leading to surgeons’ fatigue and operational inefficiency. This thesis presents the design and making of RoboCatch, a novel hand-held robot that aids a surgeon in performing spillage-free retrieval of operative specimens in laparoscopic surgery. The proposed design significantly modifies and extends conventional instruments that are currently used by surgeons for the retrieval task: The core instrumentation of RoboCatch comprises a webbed three-fingered grasper and atraumatic forceps that are concentrically situated in a folded configuration inside a trocar. The specimen retrieval task is achieved in six stages: 1) The trocar is introduced into the surgical site through an instrument port, 2) the three webbed fingers slide out of the tube and simultaneously unfold in an umbrella like-fashion, 3) the forceps slide toward, and grasp, the excised specimen, 4) the forceps retract the grasped specimen into the center of the surrounding grasper, 5) the grasper closes to achieve a secured containment of the specimen, and 6) the grasper, along with the contained specimen, is manually removed from the abdominal cavity. The resulting reduction in the number of active ports reduces obstruction of the port-site and increases the procedure’s efficiency. The design process was initiated by acquiring crucial parameters from surgeons and creating a design table, which informed the CAD modeling of the robot structure and selection of actuation units and fabrication material. The robot prototype was first examined in CAD simulation and then fabricated using an Objet30 Prime 3D printer. Physical validation experiments were conducted to verify the functionality of different mechanisms of the robot. Further, specimen retrieval experiments were conducted with porcine meat samples to test the feasibility of the proposed design. Experimental results revealed that the robot was capable of retrieving masses of specimen ranging from 1 gram to 50 grams. The making of RoboCatch represents a significant step toward advancing the frontiers of hand-held robots for performing specimen retrieval tasks in minimally invasive surgery

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

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