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

A novel hybrid 3D endoscope zooming and repositioning system : design and feasibility study

Background: Manipulation of the endoscope during minimally invasive surgery is a major source of inconvenience and discomfort. This report elucidates the architecture of a novel one-hand controlled endoscope positioning device and presents a practicability evaluation. Methods and materials: Setup time and total surgery time, number and duration of the manipulations, side effects of three-dimensional (3D) imaging, and ergonomic complaints were assessed by three surgeons during cadaveric and in vivo porcine trials. Results: Setup was accomplished in an average (SD) of 230 (120) seconds. The manipulation time was 3.87 (1.77) seconds for angular movements and 0.83 (0.24) seconds for zooming, with an average (SD) of 30.5 (16.3) manipulations per procedure. No side effects of 3D imaging or ergonomic complaints were reported. Conclusions: The integration of an active zoom into a passive endoscope holder delivers a convenient synergy between a human and a machine-controlled holding device. It is shown to be safe, simple, and intuitive to use and allows unrestrained autonomic control of the endoscope by the surgeon

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

Automated pick-up of suturing needles for robotic surgical assistance

Robot-assisted laparoscopic prostatectomy (RALP) is a treatment for prostate cancer that involves complete or nerve sparing removal prostate tissue that contains cancer. After removal the bladder neck is successively sutured directly with the urethra. The procedure is called urethrovesical anastomosis and is one of the most dexterity demanding tasks during RALP. Two suturing instruments and a pair of needles are used in combination to perform a running stitch during urethrovesical anastomosis. While robotic instruments provide enhanced dexterity to perform the anastomosis, it is still highly challenging and difficult to learn. In this paper, we presents a vision-guided needle grasping method for automatically grasping the needle that has been inserted into the patient prior to anastomosis. We aim to automatically grasp the suturing needle in a position that avoids hand-offs and immediately enables the start of suturing. The full grasping process can be broken down into: a needle detection algorithm; an approach phase where the surgical tool moves closer to the needle based on visual feedback; and a grasping phase through path planning based on observed surgical practice. Our experimental results show examples of successful autonomous grasping that has the potential to simplify and decrease the operational time in RALP by assisting a small component of urethrovesical anastomosis

Concept of Virtual Incision for Minimally Invasive Surgery

Minimally invasive surgery has been introduced to various surgical fields for its benefits such as smaller scars and less pain as compared to open surgery. Highly skilled surgical techniques are required for surgeons to conduct minimally invasive surgery with fewer ports, whereas minimally invasive surgery has a number of advantages for patients. Single-incision laparoscopic surgery (SILS), in which surgical instruments and a laparoscope are inserted through a single port, has better cosmetic results than conventional multi-incision surgery; moreover, the scar is invisible when the port is opened in navel. However, instrument collisions and visual defects often occur due to the limited space of the single opening. We propose a new surgical approach entitled “virtual incision” that enables surgeons to increase the number of openings virtually. Using our approach, we have developed two types of master-slave surgical robot systems for SILS—remote-operated and local-operated systems—which have operability close to that of multiple-incision surgery. Through evaluation of these systems, we demonstrated that the visual field and operability during virtual incision surgery are similar to those of conventional multi-incision surgery. Our surgical approach can be applied to not only single-incision surgery but also multi-incision surgery, and is very likely to improve operability

Medical image computing and computer-aided medical interventions applied to soft tissues. Work in progress in urology

Until recently, Computer-Aided Medical Interventions (CAMI) and Medical Robotics have focused on rigid and non deformable anatomical structures. Nowadays, special attention is paid to soft tissues, raising complex issues due to their mobility and deformation. Mini-invasive digestive surgery was probably one of the first fields where soft tissues were handled through the development of simulators, tracking of anatomical structures and specific assistance robots. However, other clinical domains, for instance urology, are concerned. Indeed, laparoscopic surgery, new tumour destruction techniques (e.g. HIFU, radiofrequency, or cryoablation), increasingly early detection of cancer, and use of interventional and diagnostic imaging modalities, recently opened new challenges to the urologist and scientists involved in CAMI. This resulted in the last five years in a very significant increase of research and developments of computer-aided urology systems. In this paper, we propose a description of the main problems related to computer-aided diagnostic and therapy of soft tissues and give a survey of the different types of assistance offered to the urologist: robotization, image fusion, surgical navigation. Both research projects and operational industrial systems are discussed

Mobile locally operated detachable end-effector manipulator for endoscopic surgery

Purpose\n Local surgery is safer than remote surgery because emergencies can be more easily addressed. Although many locally operated surgical robots and devices have been developed, none can safely grasp organs and provide traction. A new manipulator with a detachable commercial forceps was developed that can act as a third arm for a surgeon situated in a sterile area near the patient. This mechanism can be disassembled into compact parts that enable mobile use.Methods\n A mobile locally operated detachable end-effector manipulator (LODEM) was developed and tested. This device uses crank-slider and cable-rod mechanisms to achieve 5 degrees of freedom and an acting force of more than 5 N. The total mass is less than 15 kg. The positional accuracy and speed of the prototype device were evaluated while performing simulated in vivo surgery.Results\n The accuracy of the mobile LODEM was 0.4 mm, sufficient for handling organs. The manipulator could be assembled and disassembled in 8 min, making it highly mobile. The manipulator could successfully handle the target organs with the required level of dexterity during an in vivo laparoscopic surgical procedure.Conclusions\n A mobile LODEM was designed that allows minimally invasive robotically assisted endoscopic surgery by a surgeon working near the patient. This device is highly promising for robotic surgery applications.ArticleINTERNATIONAL JOURNAL OF COMPUTER ASSISTED RADIOLOGY AND SURGERY. 10(2):161-169 (2015)journal articl