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

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 320)

This bibliography lists 125 reports, articles and other documents introduced into the NASA Scientific and Technical Information System during January, 1989. Subject coverage includes: aerospace medicine and psychology, life support systems and controlled environments, safety equipment, exobiology and extraterrestrial life, and flight crew behavior and performance

Complementary Situational Awareness for an Intelligent Telerobotic Surgical Assistant System

Robotic surgical systems have contributed greatly to the advancement of Minimally Invasive Surgeries (MIS). More specifically, telesurgical robots have provided enhanced dexterity to surgeons performing MIS procedures. However, current robotic teleoperated systems have only limited situational awareness of the patient anatomy and surgical environment that would typically be available to a surgeon in an open surgery. Although the endoscopic view enhances the visualization of the anatomy, perceptual understanding of the environment and anatomy is still lacking due to the absence of sensory feedback. In this work, these limitations are addressed by developing a computational framework to provide Complementary Situational Awareness (CSA) in a surgical assistant. This framework aims at improving the human-robot relationship by providing elaborate guidance and sensory feedback capabilities for the surgeon in complex MIS procedures. Unlike traditional teleoperation, this framework enables the user to telemanipulate the situational model in a virtual environment and uses that information to command the slave robot with appropriate admittance gains and environmental constraints. Simultaneously, the situational model is updated based on interaction of the slave robot with the task space environment. However, developing such a system to provide real-time situational awareness requires that many technical challenges be met. To estimate intraoperative organ information continuous palpation primitives are required. Intraoperative surface information needs to be estimated in real-time while the organ is being palpated/scanned. The model of the task environment needs to be updated in near real-time using the estimated organ geometry so that the force-feedback applied on the surgeon's hand would correspond to the actual location of the model. This work presents a real-time framework that meets these requirements/challenges to provide situational awareness of the environment in the task space. Further, visual feedback is also provided for the surgeon/developer to view the near video frame rate updates of the task model. All these functions are executed in parallel and need to have a synchronized data exchange. The system is very portable and can be incorporated to any existing telerobotic platforms with minimal overhead

Exploring Robot Teleoperation in Virtual Reality

This thesis presents research on VR-based robot teleoperation with a focus on remote environment visualisation in virtual reality, the effects of remote environment reconstruction scale in virtual reality on the human-operator's ability to control the robot and human-operator's visual attention patterns when teleoperating a robot from virtual reality. A VR-based robot teleoperation framework was developed, it is compatible with various robotic systems and cameras, allowing for teleoperation and supervised control with any ROS-compatible robot and visualisation of the environment through any ROS-compatible RGB and RGBD cameras. The framework includes mapping, segmentation, tactile exploration, and non-physically demanding VR interface navigation and controls through any Unity-compatible VR headset and controllers or haptic devices. Point clouds are a common way to visualise remote environments in 3D, but they often have distortions and occlusions, making it difficult to accurately represent objects' textures. This can lead to poor decision-making during teleoperation if objects are inaccurately represented in the VR reconstruction. A study using an end-effector-mounted RGBD camera with OctoMap mapping of the remote environment was conducted to explore the remote environment with fewer point cloud distortions and occlusions while using a relatively small bandwidth. Additionally, a tactile exploration study proposed a novel method for visually presenting information about objects' materials in the VR interface, to improve the operator's decision-making and address the challenges of point cloud visualisation. Two studies have been conducted to understand the effect of virtual world dynamic scaling on teleoperation flow. The first study investigated the use of rate mode control with constant and variable mapping of the operator's joystick position to the speed (rate) of the robot's end-effector, depending on the virtual world scale. The results showed that variable mapping allowed participants to teleoperate the robot more effectively but at the cost of increased perceived workload. The second study compared how operators used a virtual world scale in supervised control, comparing the virtual world scale of participants at the beginning and end of a 3-day experiment. The results showed that as operators got better at the task they as a group used a different virtual world scale, and participants' prior video gaming experience also affected the virtual world scale chosen by operators. Similarly, the human-operator's visual attention study has investigated how their visual attention changes as they become better at teleoperating a robot using the framework. The results revealed the most important objects in the VR reconstructed remote environment as indicated by operators' visual attention patterns as well as their visual priorities shifts as they got better at teleoperating the robot. The study also demonstrated that operators’ prior video gaming experience affects their ability to teleoperate the robot and their visual attention behaviours

Expert-in-the-Loop Multilateral Telerobotics for Haptics-Enabled Motor Function and Skills Development

Among medical robotics applications are Robotics-Assisted Mirror Rehabilitation Therapy (RAMRT) and Minimally-Invasive Surgical Training (RAMIST) that extensively rely on motor function development. Haptics-enabled expert-in-the-loop motor function development for such applications is made possible through multilateral telerobotic frameworks. While several studies have validated the benefits of haptic interaction with an expert in motor learning, contradictory results have also been reported. This emphasizes the need for further in-depth studies on the nature of human motor learning through haptic guidance and interaction. The objective of this study was to design and evaluate expert-in-the-loop multilateral telerobotic frameworks with stable and human-safe control loops that enable adaptive “hand-over-hand” haptic guidance for RAMRT and RAMIST. The first prerequisite for such frameworks is active involvement of the patient or trainee, which requires the closed-loop system to remain stable in the presence of an adaptable time-varying dominance factor. To this end, a wave-variable controller is proposed in this study for conventional trilateral teleoperation systems such that system stability is guaranteed in the presence of a time-varying dominance factor and communication delay. Similar to other wave-variable approaches, the controller is initially developed for the Velocity-force Domain (VD) based on the well-known passivity assumption on the human arm in VD. The controller can be applied straightforwardly to the Position-force Domain (PD), eliminating position-error accumulation and position drift, provided that passivity of the human arm in PD is addressed. However, the latter has been ignored in the literature. Therefore, in this study, passivity of the human arm in PD is investigated using mathematical analysis, experimentation as well as user studies involving 12 participants and 48 trials. The results, in conjunction with the proposed wave-variables, can be used to guarantee closed-loop PD stability of the supervised trilateral teleoperation system in its classical format. The classic dual-user teleoperation architecture does not, however, fully satisfy the requirements for properly imparting motor function (skills) in RAMRT (RAMIST). Consequently, the next part of this study focuses on designing novel supervised trilateral frameworks for providing motor learning in RAMRT and RAMIST, each customized according to the requirements of the application. The framework proposed for RAMRT includes the following features: a) therapist-in-the-loop mirror therapy; b) haptic feedback to the therapist from the patient side; c) assist-as-needed therapy realized through an adaptive Guidance Virtual Fixture (GVF); and d) real-time task-independent and patient-specific motor-function assessment. Closed-loop stability of the proposed framework is investigated using a combination of the Circle Criterion and the Small-Gain Theorem. The stability analysis addresses the instabilities caused by: a) communication delays between the therapist and the patient, facilitating haptics-enabled tele- or in-home rehabilitation; and b) the integration of the time-varying nonlinear GVF element into the delayed system. The platform is experimentally evaluated on a trilateral rehabilitation setup consisting of two Quanser rehabilitation robots and one Quanser HD2 robot. The framework proposed for RAMIST includes the following features: a) haptics-enabled expert-in-the-loop surgical training; b) adaptive expertise-oriented training, realized through a Fuzzy Interface System, which actively engages the trainees while providing them with appropriate skills-oriented levels of training; and c) task-independent skills assessment. Closed-loop stability of the architecture is analyzed using the Circle Criterion in the presence and absence of haptic feedback of tool-tissue interactions. In addition to the time-varying elements of the system, the stability analysis approach also addresses communication delays, facilitating tele-surgical training. The platform is implemented on a dual-console surgical setup consisting of the classic da Vinci surgical system (Intuitive Surgical, Inc., Sunnyvale, CA), integrated with the da Vinci Research Kit (dVRK) motor controllers, and the dV-Trainer master console (Mimic Technology Inc., Seattle, WA). In order to save on the expert\u27s (therapist\u27s) time, dual-console architectures can also be expanded to accommodate simultaneous training (rehabilitation) for multiple trainees (patients). As the first step in doing this, the last part of this thesis focuses on the development of a multi-master/single-slave telerobotic framework, along with controller design and closed-loop stability analysis in the presence of communication delays. Various parts of this study are supported with a number of experimental implementations and evaluations. The outcomes of this research include multilateral telerobotic testbeds for further studies on the nature of human motor learning and retention through haptic guidance and interaction. They also enable investigation of the impact of communication time delays on supervised haptics-enabled motor function improvement through tele-rehabilitation and mentoring

Model Driven Robotic Assistance for Human-Robot Collaboration

While robots routinely perform complex assembly tasks in highly structured factory environments, it is challenging to apply completely autonomous robotic systems in less structured manipulation tasks, such as surgery and machine assembly/repair, due to the limitations of machine intelligence, sensor data interpretation and environment modeling. A practical, yet effective approach to accomplish these tasks is through human-robot collaboration, in which the human operator and the robot form a partnership and complement each other in performing a complex task. We recognize that humans excel at determining task goals and recognizing constraints, if given sufficient feedback about the interaction between the tool (e.g., end-effector of the robot) and the environment. Robots are precise, unaffected by fatigue and able to work in environments not suitable for humans. We hypothesize that by providing the operator with adequate information about the task, through visual and force (haptic) feedback, the operator can: (1) define the task model, in terms of task goals and virtual fixture constraints through an interactive, or immersive augmented reality interface, and (2) have the robot actively assist the operator to enhance the execution time, quality and precision of the tasks. We validate our approaches through the implementations of both cooperative (i.e., hands-on) control and telerobotic systems, for image-guided robotic neurosurgery and telerobotic manipulation tasks for satellite servicing under significant time delay

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