A Cognitive Robot Control Architecture for Autonomous Execution of Surgical Tasks

The research on medical robotics is starting to address the autonomous execution of surgical tasks, without effective intervention of humans apart from supervision and task configuration. This paper addresses the complete automation of a surgical robot by combining advanced sensing, cognition and control capabilities, developed according to rigorous assessment of surgical require- ments, formal specification of robotic system behavior and software design and implementation based on solid tools and frame- works. In particular, the paper focuses on the cognitive control architecture and its development process, based on formal modeling and verification methods as best practices to ensure safe and reliable behavior. Full implementation of the proposed architecture has been tested on an experimental setup including a novel robot specifically designed for surgical applications, but adaptable to different selected tasks (i.e. needle insertion, wound suturing)

Task Analysis, Modeling, And Automatic Identification Of Elemental Tasks In Robot-Assisted Laparoscopic Surgery

Robotic microsurgery provides many advantages for surgical operations, including tremor filtration, an increase in dexterity, and smaller incisions. There is a growing need for a task analyses on robotic laparoscopic operations to understand better the tasks involved in robotic microsurgery cases. A few research groups have conducted task observations to help systems automatically identify surgeon skill based on task execution. Their gesture analyses, however, lacked depth and their class libraries were composed of ambiguous groupings of gestures that did not share contextual similarities. A Hierarchical Task Analysis was performed on a four-throw suturing task using a robotic microsurgical platform. Three skill levels were studied: attending surgeons, residents, and naïve participants. From this task analysis, a subtask library was created. The Hierarchical Task Analysis subtask library, a computer system was created that accurately identified surgeon subtasks based on surgeon hand gestures. An automatic classifier was trained on the subtasks identified during the Hierarchical Task Analysis of a four-throw suturing task and the motion signature recorded during task performance. Using principal component analysis and a J48 decision tree classifier, an average individual classification accuracy of 94.56% was achieved. This research lays the foundation for accurate and meaningful autonomous computer assistance in a surgical arena by creating a gesture library from a detailed Hierarchical Task Analysis. The results of this research will improve the surgeon-robot interface and enhance surgery performance. The classes used will eliminate human machine miscommunication by using an understandable and structured class library based on a Hierarchical Task Analysis. By enabling a robot to understand surgeon actions, intelligent contextual-based assistance could be provide to the surgeon by the robot. Limitations of this research included the small participant sample size used for this research which resulted in high subtask execution variability. Future work will include a larger participant population to address this limitation. Additionally, a Hidden Markov Model will be incorporated into the classification process to help increase the classification accuracy. Finally, a closer investigation of vestigial techniques will be conducted to study the effect of past learned laparoscopic techniques, which are no longer necessary in the robotic-assisted laparoscopic surgery arena

Smart Camera Robotic Assistant for Laparoscopic Surgery

The cognitive architecture also includes learning mechanisms to adapt the behavior of the robot to the different ways of working of surgeons, and to improve the robot behavior through experience, in a similar way as a human assistant would do. The theoretical concepts of this dissertation have been validated both through in-vitro experimentation in the labs of medical robotics of the University of Malaga and through in-vivo experimentation with pigs in the IACE Center (Instituto Andaluz de Cirugía Experimental), performed by expert surgeons.In the last decades, laparoscopic surgery has become a daily practice in operating rooms worldwide, which evolution is tending towards less invasive techniques. In this scenario, robotics has found a wide field of application, from slave robotic systems that replicate the movements of the surgeon to autonomous robots able to assist the surgeon in certain maneuvers or to perform autonomous surgical tasks. However, these systems require the direct supervision of the surgeon, and its capacity of making decisions and adapting to dynamic environments is very limited. This PhD dissertation presents the design and implementation of a smart camera robotic assistant to collaborate with the surgeon in a real surgical environment. First, it presents the design of a novel camera robotic assistant able to augment the capacities of current vision systems. This robotic assistant is based on an intra-abdominal camera robot, which is completely inserted into the patient’s abdomen and it can be freely moved along the abdominal cavity by means of magnetic interaction with an external magnet. To provide the camera with the autonomy of motion, the external magnet is coupled to the end effector of a robotic arm, which controls the shift of the camera robot along the abdominal wall. This way, the robotic assistant proposed in this dissertation has six degrees of freedom, which allow providing a wider field of view compared to the traditional vision systems, and also to have different perspectives of the operating area. On the other hand, the intelligence of the system is based on a cognitive architecture specially designed for autonomous collaboration with the surgeon in real surgical environments. The proposed architecture simulates the behavior of a human assistant, with a natural and intuitive human-robot interface for the communication between the robot and the surgeon

Multi-robot cooperative platform : a task-oriented teleoperation paradigm

This thesis proposes the study and development of a teleoperation system based on multi-robot cooperation under the task oriented teleoperation paradigm: Multi-Robot Cooperative Paradigm, MRCP. In standard teleoperation, the operator uses the master devices to control the remote slave robot arms. These arms reproduce the desired movements and perform the task. With the developed work, the operator can virtually manipulate an object. MRCP automatically generates the arms orders to perform the task. The operator does not have to solve situations arising from possible restrictions that the slave arms may have. The research carried out is therefore aimed at improving the accuracy teleoperation tasks in complex environments, particularly in the field of robot assisted minimally invasive surgery. This field requires patient safety and the workspace entails many restrictions to teleoperation. MRCP can be defined as a platform composed of several robots that cooperate automatically to perform a teleoperated task, creating a robotic system with increased capacity (workspace volume, accessibility, dexterity ...). The cooperation is based on transferring the task between robots when necessary to enable a smooth task execution. The MRCP control evaluates the suitability of each robot to continue with the ongoing task and the optimal time to execute a task transfer between the current selected robot and the best candidate to continue with the task. From the operator¿s point of view, MRCP provides an interface that enables the teleoperation though the task-oriented paradigm: operator orders are translated into task actions instead of robot orders. This thesis is structured as follows: The first part is dedicated to review the current solutions in the teleoperation of complex tasks and compare them with those proposed in this research. The second part of the thesis presents and reviews in depth the different evaluation criteria to determine the suitability of each robot to continue with the execution of a task, considering the configuration of the robots and emphasizing the criterion of dexterity and manipulability. The study reviews the different required control algorithms to enable the task oriented telemanipulation. This proposed teleoperation paradigm is transparent to the operator. Then, the Thesis presents and analyses several experimental results using MRCP in the field of minimally invasive surgery. These experiments study the effectiveness of MRCP in various tasks requiring the cooperation of two hands. A type task is used: a suture using minimally invasive surgery technique. The analysis is done in terms of execution time, economy of movement, quality and patient safety (potential damage produced by undesired interaction between the tools and the vital tissues of the patient). The final part of the thesis proposes the implementation of different virtual aids and restrictions (guided teleoperation based on haptic visual and audio feedback, protection of restricted workspace regions, etc.) using the task oriented teleoperation paradigm. A framework is defined for implementing and applying a basic set of virtual aids and constraints within the framework of a virtual simulator for laparoscopic abdominal surgery. The set of experiments have allowed to validate the developed work. The study revealed the influence of virtual aids in the learning process of laparoscopic techniques. It has also demonstrated the improvement of learning curves, which paves the way for its implementation as a methodology for training new surgeons.Aquesta tesi doctoral proposa l'estudi i desenvolupament d'un sistema de teleoperació basat en la cooperació multi-robot sota el paradigma de la teleoperació orientada a tasca: Multi-Robot Cooperative Paradigm, MRCP. En la teleoperació clàssica, l'operador utilitza els telecomandaments perquè els braços robots reprodueixin els seus moviments i es realitzi la tasca desitjada. Amb el treball realitzat, l'operador pot manipular virtualment un objecte i és mitjançant el MRCP que s'adjudica a cada braç les ordres necessàries per realitzar la tasca, sense que l'operador hagi de resoldre les situacions derivades de possibles restriccions que puguin tenir els braços executors. La recerca desenvolupada està doncs orientada a millorar la teleoperació en tasques de precisió en entorns complexos i, en particular, en el camp de la cirurgia mínimament invasiva assistida per robots. Aquest camp imposa condicions de seguretat del pacient i l'espai de treball comporta moltes restriccions a la teleoperació. MRCP es pot definir com a una plataforma formada per diversos robots que cooperen de forma automàtica per dur a terme una tasca teleoperada, generant un sistema robòtic amb capacitats augmentades (volums de treball, accessibilitat, destresa,...). La cooperació es basa en transferir la tasca entre robots a partir de determinar quin és aquell que és més adequat per continuar amb la seva execució i el moment òptim per realitzar la transferència de la tasca entre el robot actiu i el millor candidat a continuar-la. Des del punt de vista de l'operari, MRCP ofereix una interfície de teleoperació que permet la realització de la teleoperació mitjançant el paradigma d'ordres orientades a la tasca: les ordres es tradueixen en accions sobre la tasca en comptes d'estar dirigides als robots. Aquesta tesi està estructurada de la següent manera: Primerament es fa una revisió de l'estat actual de les diverses solucions desenvolupades actualment en el camp de la teleoperació de tasques complexes, comparant-les amb les proposades en aquest treball de recerca. En el segon bloc de la tesi es presenten i s'analitzen a fons els diversos criteris per determinar la capacitat de cada robot per continuar l'execució d'una tasca, segons la configuració del conjunt de robots i fent especial èmfasi en el criteri de destresa i manipulabilitat. Seguint aquest estudi, es presenten els diferents processos de control emprats per tal d'assolir la telemanipulació orientada a tasca de forma transparent a l'operari. Seguidament es presenten diversos resultats experimentals aplicant MRCP al camp de la cirurgia mínimament invasiva. En aquests experiments s'estudia l'eficàcia de MRCP en diverses tasques que requereixen de la cooperació de dues mans. S'ha escollit una tasca tipus: sutura amb tècnica de cirurgia mínimament invasiva. L'anàlisi es fa en termes de temps d'execució, economia de moviment, qualitat i seguretat del pacient (potencials danys causats per la interacció no desitjada entre les eines i els teixits vitals del pacient). Finalment s'ha estudiat l'ús de diferents ajudes i restriccions virtuals (guiat de la teleoperació via retorn hàptic, visual o auditiu, protecció de regions de l'espai de treball, etc) dins el paradigma de teleoperació orientada a tasca. S'ha definint un marc d'aplicació base i implementant un conjunt de restriccions virtuals dins el marc d'un simulador de cirurgia laparoscòpia abdominal. El conjunt d'experiments realitzats han permès validar el treball realitzat. Aquest estudi ha permès determinar la influencia de les ajudes virtuals en el procés d'aprenentatge de les tècniques laparoscòpiques. S'ha evidenciat una millora en les corbes d'aprenentatge i obre el camí a la seva implantació com a metodologia d'entrenament de nous cirurgians.Postprint (published version

Activity profiling for minimally invasive surgery

Imperial Users onl

A minimally invasive surgical system for 3D ultrasound guided robotic retrieval of foreign bodies from a beating heart

The result of various medical conditions and trauma, foreign bodies in the heart pose a serious health risk as they may interfere with cardiovascular function. Particles such as thrombi, bullet fragments, and shrapnel can become trapped in a person's heart after migrating through the venous system, or by direct penetration. The severity of disruption can range from benign to fatal, with associated symptoms including anxiety, fever, cardiac tamponade, hemorrhage, infection, embolism, arrhythmia, and valve dysfunction. Injuries of this nature are common in both civilian and military populations. For symptomatic cases, conventional treatment is removal of the foreign body through open surgery via a median sternotomy, the use of cardiopulmonary bypass, and a wide incision in the heart muscle; these methods incur pronounced perioperative risks and long recovery periods. In order to improve upon the standard of care, we propose an image guided robotic system and a corresponding minimally invasive surgical approach. The system employs a dexterous robotic capture device that can maneuver inside the heart through a small incision. Visualization and guidance within the otherwise occluded internal regions are provided by 3D transesophageal echocardiography (TEE), an emerging form of intraoperative medical imaging used in interventions such as mitral valve repair and device implantation. A robotic approach, as opposed to a manual procedure using rigid instruments, is motivated by the various challenges inherent in minimally invasive surgery, which arise from attempts to perform skilled surgical tasks through small incisions without direct vision. Challenges include reduced dexterity, constrained workspace, limited visualization, and difficult hand-eye coordination, which ultimately lead to poor manipulability. A dexterous robotic end effector with real-time image guidance can help overcome these challenges and potentially improve surgical performance. However promising, such a system and approach require that several technical hurdles be resolved. The foreign body must be automatically tracked as it travels about the dynamic environment of the heart. The erratically moving particle must then be captured using a dexterous robot that moves much more slowly in comparison. Furthermore, retrieval must be performed under 3D ultrasound guidance, amidst the uncertainties presented by both the turbulent flow and by the imaging modality itself. In addressing such barriers, this thesis explores the development of a prototype system capable of retrieving a foreign body from a beating heart, culminating in a set of demonstrative in vitro experiments

Robotic manipulators for single access surgery

This thesis explores the development of cooperative robotic manipulators for enhancing surgical precision and patient outcomes in single-access surgery and, specifically, Transanal Endoscopic Microsurgery (TEM). During these procedures, surgeons manipulate a heavy set of instruments via a mechanical clamp inserted in the patient’s body through a surgical port, resulting in imprecise movements, increased patient risks, and increased operating time. Therefore, an articulated robotic manipulator with passive joints is initially introduced, featuring built-in position and force sensors in each joint and electronic joint brakes for instant lock/release capability. The articulated manipulator concept is further improved with motorised joints, evolving into an active tool holder. The joints allow the incorporation of advanced robotic capabilities such as ultra-lightweight gravity compensation and hands-on kinematic reconfiguration, which can optimise the placement of the tool holder in the operating theatre. Due to the enhanced sensing capabilities, the application of the active robotic manipulator was further explored in conjunction with advanced image guidance approaches such as endomicroscopy. Recent advances in probe-based optical imaging such as confocal endomicroscopy is making inroads in clinical uses. However, the challenging manipulation of imaging probes hinders their practical adoption. Therefore, a combination of the fully cooperative robotic manipulator with a high-speed scanning endomicroscopy instrument is presented, simplifying the incorporation of optical biopsy techniques in routine surgical workflows. Finally, another embodiment of a cooperative robotic manipulator is presented as an input interface to control a highly-articulated robotic instrument for TEM. This master-slave interface alleviates the drawbacks of traditional master-slave devices, e.g., using clutching mechanics to compensate for the mismatch between slave and master workspaces, and the lack of intuitive manipulation feedback, e.g. joint limits, to the user. To address those drawbacks a joint-space robotic manipulator is proposed emulating the kinematic structure of the flexible robotic instrument under control.Open Acces