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

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

A Review of Pneumatic Actuators Used for the Design of Medical Simulators and Medical Tools

International audienc

Realistic tool-tissue interaction models for surgical simulation and planning

Surgical simulators present a safe and potentially effective method for surgical training, and can also be used in pre- and intra-operative surgical planning. Realistic modeling of medical interventions involving tool-tissue interactions has been considered to be a key requirement in the development of high-fidelity simulators and planners. The soft-tissue constitutive laws, organ geometry and boundary conditions imposed by the connective tissues surrounding the organ, and the shape of the surgical tool interacting with the organ are some of the factors that govern the accuracy of medical intervention planning.\ud \ud This thesis is divided into three parts. First, we compare the accuracy of linear and nonlinear constitutive laws for tissue. An important consequence of nonlinear models is the Poynting effect, in which shearing of tissue results in normal force; this effect is not seen in a linear elastic model. The magnitude of the normal force for myocardial tissue is shown to be larger than the human contact force discrimination threshold. Further, in order to investigate and quantify the role of the Poynting effect on material discrimination, we perform a multidimensional scaling study. Second, we consider the effects of organ geometry and boundary constraints in needle path planning. Using medical images and tissue mechanical properties, we develop a model of the prostate and surrounding organs. We show that, for needle procedures such as biopsy or brachytherapy, organ geometry and boundary constraints have more impact on target motion than tissue material parameters. Finally, we investigate the effects surgical tool shape on the accuracy of medical intervention planning. We consider the specific case of robotic needle steering, in which asymmetry of a bevel-tip needle results in the needle naturally bending when it is inserted into soft tissue. We present an analytical and finite element (FE) model for the loads developed at the bevel tip during needle-tissue interaction. The analytical model explains trends observed in the experiments. We incorporated physical parameters (rupture toughness and nonlinear material elasticity) into the FE model that included both contact and cohesive zone models to simulate tissue cleavage. The model shows that the tip forces are sensitive to the rupture toughness. In order to model the mechanics of deflection of the needle, we use an energy-based formulation that incorporates tissue-specific parameters such as rupture toughness, nonlinear material elasticity, and interaction stiffness, and needle geometric and material properties. Simulation results follow similar trends (deflection and radius of curvature) to those observed in macroscopic experimental studies of a robot-driven needle interacting with gels

Teleoperation of MRI-Compatible Robots with Hybrid Actuation and Haptic Feedback

Image guided surgery (IGS), which has been developing fast recently, benefits significantly from the superior accuracy of robots and magnetic resonance imaging (MRI) which is a great soft tissue imaging modality. Teleoperation is especially desired in the MRI because of the highly constrained space inside the closed-bore MRI and the lack of haptic feedback with the fully autonomous robotic systems. It also very well maintains the human in the loop that significantly enhances safety. This dissertation describes the development of teleoperation approaches and implementation on an example system for MRI with details of different key components. The dissertation firstly describes the general teleoperation architecture with modular software and hardware components. The MRI-compatible robot controller, driving technology as well as the robot navigation and control software are introduced. As a crucial step to determine the robot location inside the MRI, two methods of registration and tracking are discussed. The first method utilizes the existing Z shaped fiducial frame design but with a newly developed multi-image registration method which has higher accuracy with a smaller fiducial frame. The second method is a new fiducial design with a cylindrical shaped frame which is especially suitable for registration and tracking for needles. Alongside, a single-image based algorithm is developed to not only reach higher accuracy but also run faster. In addition, performance enhanced fiducial frame is also studied by integrating self-resonant coils. A surgical master-slave teleoperation system for the application of percutaneous interventional procedures under continuous MRI guidance is presented. The slave robot is a piezoelectric-actuated needle insertion robot with fiber optic force sensor integrated. The master robot is a pneumatic-driven haptic device which not only controls the position of the slave robot, but also renders the force associated with needle placement interventions to the surgeon. Both of master and slave robots mechanical design, kinematics, force sensing and feedback technologies are discussed. Force and position tracking results of the master-slave robot are demonstrated to validate the tracking performance of the integrated system. MRI compatibility is evaluated extensively. Teleoperated needle steering is also demonstrated under live MR imaging. A control system of a clinical grade MRI-compatible parallel 4-DOF surgical manipulator for minimally invasive in-bore prostate percutaneous interventions through the patient’s perineum is discussed in the end. The proposed manipulator takes advantage of four sliders actuated by piezoelectric motors and incremental rotary encoders, which are compatible with the MRI environment. Two generations of optical limit switches are designed to provide better safety features for real clinical use. The performance of both generations of the limit switch is tested. MRI guided accuracy and MRI-compatibility of whole robotic system is also evaluated. Two clinical prostate biopsy cases have been conducted with this assistive robot

Study of Needle Insertion Parameters of Human Body Tissue for Surgical Operations

The thesis introduces the study on needle insertion during the laboratory experiment. The percutaneous needle insertion is performed several times in day to day life. Manually placement of needle in the tissue may cause damage inside the body sothe thesis presents the existing methodology of needle insertion and researched methodology in our laboratory. It shows the proper way of needle placement and which parameters are necessary to keep in mind when perform the needle insertion. It deals with the proper way of needle insertion, minimise the deflection of needle inside the tissue and gives an idea of reduction in deformation of tissue. The test procedures and experimental setup provide an understanding on the mechanics of needle placement and the design improvement of insertion instruments.The experimental analysis optimize the results of operative parameters of needle when it insert in the tissue like needle translation motion during the insertion, needle rotational motion during insertion, angle of needle insertion and force acting on the needle when it inserted in the tissue. The optimize results provide a brief knowledge for the surgeons about the needle behaviour during the insertion in soft tissue so surgeons are pre imagined the situations by which they would going through during the operation. The model enhances the quality of insertion by presenting the optimize model for parameters of needle insertion. In most of the insertion operations accuracy and precision is important parameters which must be kept in mind by the surgeons when they performed the insertion of needle inside the tissue so this is study is relevant for them to get the accuracy and precision in work. The aim of this research is to present standard methodology for needle insertion which can be possible by experimental analysis of needle insertion in laborator

Robot Autonomy for Surgery

Autonomous surgery involves having surgical tasks performed by a robot operating under its own will, with partial or no human involvement. There are several important advantages of automation in surgery, which include increasing precision of care due to sub-millimeter robot control, real-time utilization of biosignals for interventional care, improvements to surgical efficiency and execution, and computer-aided guidance under various medical imaging and sensing modalities. While these methods may displace some tasks of surgical teams and individual surgeons, they also present new capabilities in interventions that are too difficult or go beyond the skills of a human. In this chapter, we provide an overview of robot autonomy in commercial use and in research, and present some of the challenges faced in developing autonomous surgical robots

Flexible robotic device for spinal surgery

Surgical robots have proliferated in recent years, with well-established benefits including: reduced patient trauma, shortened hospitalisation, and improved diagnostic accuracy and therapeutic outcome. Despite these benefits, many challenges in their development remain, including improved instrument control and ergonomics caused by rigid instrumentation and its associated fulcrum effect. Consequently, it is still extremely challenging to utilise such devices in cases that involve complex anatomical pathways such as the spinal column. The focus of this thesis is the development of a flexible robotic surgical cutting device capable of manoeuvring around the spinal column. The target application of the flexible surgical tool is the removal of cancerous tumours surrounding the spinal column, which cannot be excised completely using the straight surgical tools in use today; anterior and posterior sections of the spine must be accessible for complete tissue removal. A parallel robot platform with six degrees of freedom (6 DoFs) has been designed and fabricated to direct a flexible cutting tool to produce the necessary range of movements to reach anterior and posterior sections of the spinal column. A flexible water jet cutting system and a flexible mechanical drill, which may be assembled interchangeably with the flexible probe, have been developed and successfully tested experimentally. A model predicting the depth of cut by the water jet was developed and experimentally validated. A flexion probe that is able to guide the surgical cutting device around the spinal column has been fabricated and tested with human lumber model. Modelling and simulations show the capacity for the flexible surgical system to enable entering the posterior side of the human lumber model and bend around the vertebral body to reach the anterior side of the spinal column. A computer simulation with a full Graphical User Interface (GUI) was created and used to validate the system of inverse kinematic equations for the robot platform. The constraint controller and the inverse kinematics relations are both incorporated into the overall positional control structure of the robot, and have successfully established a haptic feedback controller for the 6 DoFs surgical probe, and effectively tested in vitro on spinal mock surgery. The flexible surgical system approached the surgery from the posterior side of the human lumber model and bend around the vertebral body to reach the anterior side of the spinal column. The flexible surgical robot removed 82% of mock cancerous tissue compared to 16% of tissue removed by the rigid tool.Open Acces

Robotic simulators for tissue examination training with multimodal sensory feedback

Tissue examination by hand remains an essential technique in clinical practice. The effective application depends on skills in sensorimotor coordination, mainly involving haptic, visual, and auditory feedback. The skills clinicians have to learn can be as subtle as regulating finger pressure with breathing, choosing palpation action, monitoring involuntary facial and vocal expressions in response to palpation, and using pain expressions both as a source of information and as a constraint on physical examination. Patient simulators can provide a safe learning platform to novice physicians before trying real patients. This paper reviews state-of-the-art medical simulators for the training for the first time with a consideration of providing multimodal feedback to learn as many manual examination techniques as possible. The study summarizes current advances in tissue examination training devices simulating different medical conditions and providing different types of feedback modalities. Opportunities with the development of pain expression, tissue modeling, actuation, and sensing are also analyzed to support the future design of effective tissue examination simulators