Smart Navigation in Surgical Robotics

La cirugía mínimamente invasiva, y concretamente la cirugía laparoscópica, ha supuesto un gran cambio en la forma de realizar intervenciones quirúrgicas en el abdomen. Actualmente, la cirugía laparoscópica ha evolucionado hacia otras técnicas aún menos invasivas, como es la cirugía de un solo puerto, en inglés Single Port Access Surgery. Esta técnica consiste en realizar una única incisión, por la que son introducidos los instrumentos y la cámara laparoscópica a través de un único trocar multipuerto. La principal ventaja de esta técnica es una reducción de la estancia hospitalaria por parte del paciente, y los resultados estéticos, ya que el trocar se suele introducir por el ombligo, quedando la cicatriz oculta en él. Sin embargo, el hecho de que los instrumentos estén introducidos a través del mismo trocar hace la intervención más complicada para el cirujano, que necesita unas habilidades específicas para este tipo de intervenciones. Esta tesis trata el problema de la navegación de instrumentos quirúrgicos mediante plataformas robóticas teleoperadas en cirugía de un solo puerto. En concreto, se propone un método de navegación que dispone de un centro de rotación remoto virtual, el cuál coincide con el punto de inserción de los instrumentos (punto de fulcro). Para estimar este punto se han empleado las fuerzas ejercidas por el abdomen en los instrumentos quirúrgicos, las cuales han sido medidas por sensores de esfuerzos colocados en la base de los instrumentos. Debido a que estos instrumentos también interaccionan con tejido blando dentro del abdomen, lo cual distorsionaría la estimación del punto de inserción, es necesario un método que permita detectar esta circunstancia. Para solucionar esto, se ha empleado un detector de interacción con tejido basado en modelos ocultos de Markov el cuál se ha entrenado para detectar cuatro gestos genéricos. Por otro lado, en esta tesis se plantea el uso de guiado háptico para mejorar la experiencia del cirujano cuando utiliza plataformas robóticas teleoperadas. En concreto, se propone la técnica de aprendizaje por demostración (Learning from Demonstration) para generar fuerzas que puedan guiar al cirujano durante la resolución de tareas específicas. El método de navegación propuesto se ha implantado en la plataforma quirúrgica CISOBOT, desarrollada por la Universidad de Málaga. Los resultados experimentales obtenidos validan tanto el método de navegación propuesto, como el detector de interacción con tejido blando. Por otro lado, se ha realizado un estudio preliminar del sistema de guiado háptico. En concreto, se ha empleado una tarea genérica, la inserción de una clavija, para realizar los experimentos necesarios que permitan demostrar que el método propuesto es válido para resolver esta tarea y otras similares

Anthropomorphic surgical system for soft tissue robot-assisted surgery

Over the past century, abdominal surgery has seen a rapid transition from open procedures to less invasive methods such as laparoscopy and robot-assisted minimally invasive surgery (R-A MIS). These procedures have significantly decreased blood loss, postoperative morbidity and length of hospital stay in comparison with open surgery. R-A MIS has offered refined accuracy and more ergonomic instruments for surgeons, further minimising trauma to the patient.This thesis aims to investigate, design and prototype a novel system for R-A MIS that will provide more natural and intuitive manipulation of soft tissues and, at the same time, increase the surgeon's dexterity. The thesis reviews related work on surgical systems and discusses the requirements for designing surgical instrumentation. From the background research conducted in this thesis, it is clear that training surgeons in MIS procedures is becoming increasingly long and arduous. Furthermore, most available systems adopt a design similar to conventional laparoscopic instruments or focus on different techniques with debatable benefits. The system proposed in this thesis not only aims to reduce the training time for surgeons but also to improve the ergonomics of the procedure.In order to achieve this, a survey was conducted among surgeons, regarding their opinions on surgical training, surgical systems, how satisfied they are with them and how easy they are to use. A concept for MIS robotic instrumentation was then developed and a series of focus group meetings with surgeons were run to discuss it. The proposed system, named microAngelo, is an anthropomorphic master-slave system that comprises a three-digit miniature hand that can be controlled using the master, a three-digit sensory exoskeleton. While multi-fingered robotic hands have been developed for decades, none have been used for surgical operations. As the system has a human centred design, its relation to the human hand is discussed. Prototypes of both the master and the slave have been developed and their design and mechanisms is demonstrated. The accuracy and repeatability of the master as well as the accuracy and force capabilities of the slave are tested and discussed

Force-detecting gripper and force feedback system for neurosurgery applications

Purpose For the application of less invasive robotic neurosurgery to the resection of deep-seated tumors, a prototype system of a force-detecting gripper with a flexible micromanipulator and force feedback to the operating unit will be developed. Methods Gripping force applied on the gripper is detected by strain gauges attached to the gripper clip. The signal is transmitted to the amplifier by wires running through the inner tube of the manipulator. Proportional force is applied on the finger lever of the operating unit by the surgeon using a bilateral control program. A pulling force experienced by the gripper is also detected at the gripper clip. The signal for the pulling force is transmitted in a manner identical to that mentioned previously, and the proportional torque is applied on the touching roller of the finger lever of the operating unit. The surgeon can feel the gripping force as the resistance of the operating force of the finger and can feel the pulling force as the friction at the finger surface. Results A basic operation test showed that both the gripping force and pulling force were clearly detected in the gripping of soft material and that the operator could feel the gripping force and pulling force at the finger lever of the operating unit. Conclusions A prototype of the force feedback in the microgripping manipulator system has been developed. The system will be useful for removing deep-seated brain tumors in future master-slave-type robotic neurosurgery. © 2013 CARS

A Contact Force Sensor based on S-shaped Beams and Optoelectronic Sensors for Flexible Manipulators for Minimally Invasive Surgery (MIS)

Flexible, highly articulated robotic tools can greatly facilitate procedures in which the operator needs to access small openings and confined spaces. Particularly, in the context of robotic-assisted minimally invasive surgery (RMIS), the application of such manipulation tools can be significantly beneficial in preventing unnecessary interactions with sensitive body organs by which reducing patient’s recovery time when compared with conventional methods. However, these systems usually lack tactile feedback and are not able to perceive and quantify the interactions between themselves and soft body organs. This deficiency may result in damaging the organs due to unwanted excessive force applied. To this end, we introduce a contact force sensor based on three 'dyadic-S-shaped' beams and three optoelectronic sensors. The modular design of a flexible manipulation system described as part of this paper allows ready integration of a series of the proposed sensors within its structure. The sensor uses our novel sensing principle for measuring contact forces. The strategic employment of custom sensor structure and the optoelectronic components fulfill our design objectives which has been focused on the creation of a modular, low-cost, low-noise (electrically) with large voltage variation, without the need for an amplifier, through a simple fabrication process for MIS. Our experimental results, following a very simple calibration processes show the average errors of Fx (+19.37%±0.82, -18.32%±2.06) and Fy (+18.56%±1.69, -17.00%±1.32), and the average RMS errors of Fx (0.12N±0.0067) and Fy (0.11N±0.0032) in the measurement of force values within the range of -4 to 4 N

The design and fabrication of a meso scale minimally invasive surgical robot

Minimally invasive robotic Single Port Laparoscopic Surgery (SPLS) is of high importance, due to its ability to reduce operation times, recovery times, postoperative infection rates and improve cosmesis while providing surgeons with greater dexterity and precision than traditional SPLS techniques. Previous approaches to robotic SPLS rely on modifications to devices meant for multi-port procedures. These approaches suffer from larger port sizes and triangulation problems. Here, we propose a scheme for SPLS involving 6 degree-of-freedom robot manipulators and lumen design that translates the dexterity and triangulation capabilities of the human arm to the internal operating field using an insertion scheme where four 9 mm tools can be passed through a single 18 mm lumen

Laser microsurgery in the GFP era : a cell biologist's perspective

Author Posting. © The Author(s), 2007. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Methods in Cell Biology 82 (2007): 237, 239-266, doi:10.1016/S0091-679X(06)82007-8.Modern biology is based largely on a reductionistic ‘dissection’ approach – most cell biologists try to determine how complex biological systems work by removing their individual parts and studying the effects of this removal on the system. A variety of enzymatic and mechanical methods have been developed to dissect large cell assemblies like tissues and organs. Further, individual proteins can be inactivated or removed within a cell by genetic manipulations (e.g., RNAi or gene knockouts). However, there is a growing demand for tools that allow intracellular manipulations at the level of individual organelles. Laser microsurgery is ideally suited for this purpose and the popularity of this approach is on the rise among cell biologists. In this chapter we review some of the applications for laser microsurgery at the subcellular level, and describe practical requirements for laser microsurgery instrumentation demanded in the field. We also outline a relatively inexpensive but versatile laser microsurgery workstation that is being used in our lab. Our major thesis is that the limitations of the technology are no longer at the level of the laser, microscope or software, but instead only in defining creative questions and in visualizing the target to be destroyed.Our work is sponsored by grants from the NIH (GM59363 to AK and GM40198 to CLR) and HFSP (RGP0064 to AK). Construction of the laser microsurgery workstation was supported in par by Summer Research Fellowship from Nikon/Marine Biological Laboratory (2003 to AK)