Identifying barriers in telesurgery by studying current team practices in robot-assisted surgery

This paper investigates challenges in current practices in robot-assisted surgery. In addition, by using the method of proxy technology assessment, we provide insights into the current barriers to wider application of robot-assisted telesurgery, where the surgeon and console are physically remote from the patient and operating team. Research in this field has focused on the financial and technological constraints that limit such application; less has been done to clarify the complex dynamics of an operating team that traditionally works in close symbiosis. Results suggest that there are implications for working practices in transitioning from traditional robot-assisted surgery to remote robotic surgery that need to be addressed, such as possible communication problems which might have a negative impact on patient outcomes

Chapter 8: Executive Summary

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63118/1/15305620252933437.pd

ROBOTIC TELESURGERY: AN INVESTIGATION OF UTILITY, HUMAN ADAPTATION, AND PERFORMANCE

Robotic surgery is a powerful, new method for performing minimally invasive surgery (MIS). The method allows complex procedures through incisions which are 10 mm or less. Robotic surgery has grown rapidly because small MIS incisions result in rapid patient recovery compared to conventional methods. Although surgical robots have the potential of long distance control, insufficient data is available to determine whether long distance robotic surgery, or telesurgery, is practical. Telesurgery could provide multiple benefits, including dissemination of expertise, widespread patient care, cost savings, and improved community care. We describe a series of experiments to investigate telesurgery using a one of a kind telesurgery platform and ground- and satellite-based Internet networks. The networks provided the redundancy and quality of service that would be required for human surgery. Tolerances for performing surgical tasks over a long distance were unknown. We show that operators using the platform can complete dry lab manoeuvres with communication latencies up to 500 ms, with no appreciable increase in error rates. Such latency would be equivalent to a North American transcontinental distance, implying a wide range of telesurgical capability. The characteristics of ground- and satellite-based Internet networks for telesurgery were unavailable. We demonstrate that emulated surgery in animals can be effectively performed using either ground or satellite. The networks can reliably support surgery, and satellite-based surgery can be performed even though latency exceeds 500 ms. Further, satellite bandwidth should be above 5 Mb/s for telesurgery applications. Satellite networks could be used either for back up or primarily where a community does not have ground-based equipment. iii Methods of training operators for telesurgery had not been explored. We demonstrate two methods of training for telesurgery. Operators doing dry lab surgical manoeuvres performed equally well either with sequentially increasing latency or with full latency only, suggesting that both methods of training may be effective. Telesurgery can become a practical method of treatment. Within a few years, more widespread platforms and telecommunications may exist to launch everyday telesurgery procedures

Learning to Assist Bimanual Teleoperation using Interval Type-2 Polynomial Fuzzy Inference

Assisting humans in collaborative tasks is a promising application for robots, however effective assistance remains challenging. In this paper, we propose a method for providing intuitive robotic assistance based on learning from human natural limb coordination. To encode coupling between multiple-limb motions, we use a novel interval type-2 (IT2) polynomial fuzzy inference for modeling trajectory adaptation. The associated polynomial coefficients are estimated using a modified recursive least-square with a dynamic forgetting factor. We propose to employ a Gaussian process to produce robust human motion predictions, and thus address the uncertainty and measurement noise of the system caused by interactive environments. Experimental results on two types of interaction tasks demonstrate the effectiveness of this approach, which achieves high accuracy in predicting assistive limb motion and enables humans to perform bimanual tasks using only one limb

From Concept to Market: Surgical Robot Development

Surgical robotics and supporting technologies have really become a prime example of modern applied information technology infiltrating our everyday lives. The development of these systems spans across four decades, and only the last few years brought the market value and saw the rising customer base imagined already by the early developers. This chapter guides through the historical development of the most important systems, and provide references and lessons learnt for current engineers facing similar challenges. A special emphasis is put on system validation, assessment and clearance, as the most commonly cited barrier hindering the wider deployment of a system

Event-based device-behavior switching in surgical human-robot interaction

In present days, the number of application in which robots and users share the same workspace is increasing, as long as the need of cooperation between them. To achieve a smooth cooperation, in particular in surgical applications, the robot needs to timely change its behavior to adapt to the needs of the user. In this work, a simplified scenario for neurosurgery was defined in which the user interacts with the robot through a Graphical User Interface (GUI) and by touching the robot links and, based to those events and on the current status, different control modes are enabled in the high level controller we developed, such as autonomous, cooperative and teleoperation. Experiments were performed to measure the performances and safety of the developed high level controller in handling the transitions between two states by checking the continuity of data from the robot and from an external measurement system. Results proved that the trajectories of the end effector and links during the switching phase are continuous and thus the modular high level controller developed switches control safely without undesired deviation from desired course

Toward a Discourse Community for Telemedicine: A Domain Analytic View of Published Scholarship

In the past 20 years, the use of telemedicine has increased, with telemedicine programs increasingly being conducted through the Internet and ISDN technologies. The purpose of this dissertation is to examine the discourse community of telemedicine. This study examined the published literature on telemedicine as it pertains to quality of care, defined as correct diagnosis and treatment (Bynum and Irwin 2011). Content analysis and bibliometrics were conducted on the scholarly discourse, and the most prominent authors and journals were documented to paint and depict the epistemological map of the discourse community of telemedicine. A taxonomy based on grounded research of scholarly literature was developed and validated against other existing taxonomies. Telemedicine has been found to increase the quality and access of health care and decrease health care costs (Heinzelmann, Williams, Lugn and Kvedar 2005 and Wootton and Craig 1999). Patients in rural areas where there is no specialist or patients who find it difficult to get to a doctor’s office benefit from telemedicine. Little research thus far has examined scholarly journals in order to aggregate and analyze the prevalent issues in the discourse community of telemedicine. The purpose of this dissertation is to empiricallydocument the prominent topics and issues in telemedicine by examining the related published scholarly discourse of telemedicine during a snapshot in time. This study contributes to the field of telemedicine by offering a comprehensive taxonomy of the leading authors and journals in telemedicine, and informs clinicians, librarians and other stakeholders, including those who may want to implement telemedicine in their institution, about issues telemedicine

Origins of Surgical Robotics: From Space to the Operating Room

The rapid development of telerobotic systems led to novel applications beyond the nuclear and industrial domains. Medical telerobotics enabled surgeons to perform medical operations from remote places, far from their patient. Telesurgery systems allow great flexibility, improved performance in general, and support the creation of ideal surgical conditions. The first attempts to develop telesurgical systems borrowed the idea from space research, where the need of novel robots emerged for invasive treatment, even under extremesituations, such as weightlessness. Telesurgical instruments on Earth appeared following the same concept, aiming first for military, then onward for civilian applications. Today, more than 1.5 million patients are receiving telerobotic treatment annually, worldwide. As the surgical robotics domain grew from the initial concepts, it developed along three major concepts: telesurgery, cooperatively controlled robots and automated (image-guided) applications. These domains continue to develop into application specific systems with the goal of reaching the specificity and versatility of conventional surgical instruments

Teleoperation of a service robot using a mobile device

Teleoperation is a concept born with the rapid evolution of technology, with an intuitive meaning "operate at a distance." The first teleoperation system was created in the mid 1950s, which were handled chemicals. Remote controlled systems are present nowadays in various types of applications. This dissertation presents the development of a mobile application to perform the teleoperation of a mobile service robot. The application integrates a distributed surveillance (the result of a research project QREN) and led to the development of a communication interface between the robot (the result of another QREN project) and the vigilance system. It was necessary to specify a communication protocol between the two systems, which was implemented over a communication framework 0MQ (Zero Message Queue). For the testing, three prototype applications were developed before to perform the test on the robot