Automation of tissue piercing using circular needles and vision guidance for computer aided laparoscopic surgery

Abstract—Despite the fact that minimally invasive robotic surgery provides many advantages for patients, such as reduced tissue trauma and shorter hospitalization, complex tasks (e.g. tissue piercing or knot-tying) are still time-consuming, error-prone and lead to quicker fatigue of the surgeon. Automating these recurrent tasks could greatly reduce total surgery time for patients and disburden the surgeon while he can focus on higher level challenges. This work tackles the problem of autonomous tissue piercing in robot-assisted laparoscopic surgery with a circular needle and general purpose surgical instruments. To command the instruments to an incision point, the surgeon utilizes a laser pointer to indicate the stitching area. A precise positioning of the needle is obtained by means of a switching visual servoing approach and the subsequent stitch is performed in a circular motion. Index Terms—robot surgery, minimally invasive surgery, tissue piercing, visual servoing I

Haptic communication to support biopsy procedures learning in virtual environments

International audienceIn interventional radiology, physicians require high haptic sensitivity and fine motor skills development because of the limited real-time visual feedback of the surgical site. The transfer of this type of surgical skill to novices is a challenging issue. This paper presents a study on the design of a biopsy procedure learning system. Our methodology, based on a task-centered design approach, aims to bring out new design rules for virtual learning environments. A new collaborative haptic training paradigm is introduced to support human-haptic interaction in a virtual environment. The interaction paradigm supports haptic communication between two distant users to teach a surgical skill. In order to evaluate this paradigm, a user experiment was conducted. Sixty volunteer medical students participated in the study to assess the influence of the teaching method on their performance in a biopsy procedure task. The results show that to transfer the skills, the combination of haptic communication with verbal and visual communications improves the novices' performance compared to conventional teaching methods. Furthermore, the results show that, depending on the teaching method, participants developed different needle insertion profiles. We conclude that our interaction paradigm facilitates expert-novice haptic communication and improves skills transfer; and new skills acquisition depends on the availability of different communication channels between experts and novices. Our findings indicate that the traditional fellowship methods in surgery should evolve to an off-patient collaborative environment that will continue to support visual and verbal communication, but also haptic communication, in order to achieve a better and more complete skills training

Haptic communication to support biopsy procedures learning in virtual environments

International audienceIn interventional radiology, physicians require high haptic sensitivity and fine motor skills development because of the limited real-time visual feedback of the surgical site. The transfer of this type of surgical skill to novices is a challenging issue. This paper presents a study on the design of a biopsy procedure learning system. Our methodology, based on a task-centered design approach, aims to bring out new design rules for virtual learning environments. A new collaborative haptic training paradigm is introduced to support human-haptic interaction in a virtual environment. The interaction paradigm supports haptic communication between two distant users to teach a surgical skill. In order to evaluate this paradigm, a user experiment was conducted. Sixty volunteer medical students participated in the study to assess the influence of the teaching method on their performance in a biopsy procedure task. The results show that to transfer the skills, the combination of haptic communication with verbal and visual communications improves the novices' performance compared to conventional teaching methods. Furthermore, the results show that, depending on the teaching method, participants developed different needle insertion profiles. We conclude that our interaction paradigm facilitates expert-novice haptic communication and improves skills transfer; and new skills acquisition depends on the availability of different communication channels between experts and novices. Our findings indicate that the traditional fellowship methods in surgery should evolve to an off-patient collaborative environment that will continue to support visual and verbal communication, but also haptic communication, in order to achieve a better and more complete skills training

Skill-based human-robot cooperation in tele-operated path tracking

This work proposes a shared-control tele-operation framework that adapts its cooperative properties to the estimated skill level of the operator. It is hypothesized that different aspects of an operatorâ\u80\u99s performance in executing a tele-operated path tracking task can be assessed through conventional machine learning methods using motion-based and task-related features. To identify performance measures that capture motor skills linked to the studied task, an experiment is conducted where users new to tele-operation, practice towards motor skill proficiency in 7 training sessions. A set of classifiers are then learned from the acquired data and selected features, which can generate a skill profile that comprises estimations of userâ\u80\u99s various competences. Skill profiles are exploited to modify the behavior of the assistive robotic system accordingly with the objective of enhancing user experience by preventing unnecessary restriction for skilled users. A second experiment is implemented in which novice and expert users execute the path tracking on different pathways while being assisted by the robot according to their estimated skill profiles. Results validate the skill estimation method and hint at feasibility of shared-control customization in tele-operated path tracking

Robot Autonomy for Surgery

Autonomous surgery involves having surgical tasks performed by a robot operating under its own will, with partial or no human involvement. There are several important advantages of automation in surgery, which include increasing precision of care due to sub-millimeter robot control, real-time utilization of biosignals for interventional care, improvements to surgical efficiency and execution, and computer-aided guidance under various medical imaging and sensing modalities. While these methods may displace some tasks of surgical teams and individual surgeons, they also present new capabilities in interventions that are too difficult or go beyond the skills of a human. In this chapter, we provide an overview of robot autonomy in commercial use and in research, and present some of the challenges faced in developing autonomous surgical robots

Virtual Fixture Assistance for Suturing in Robot-Aided Pediatric Endoscopic Surgery

The limited workspace in pediatric endoscopic surgery makes surgical suturing one of the most difficult tasks. During suturing, surgeons have to prevent collisions between tools and also collisions with the surrounding tissues. Surgical robots have been shown to be effective in adult laparoscopy, but assistance for suturing in constrained workspaces has not been yet fully explored. In this letter, we propose guidance virtual fixtures to enhance the performance and the safety of suturing while generating the required task constraints using constrained optimization and Cartesian force feedback. We propose two guidance methods: looping virtual fixtures and a trajectory guidance cylinder, that are based on dynamic geometric elements. In simulations and experiments with a physical robot, we show that the proposed methods achieve a more precise and safer looping in robot-assisted pediatric endoscopy.Comment: Accepted on RA-L/ICRA 2020, 8 Pages. Fixed a few typo

Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-opera- tive morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilites by observ- ing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted in- struments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This paper reviews the state-of-the-art methods for optical intra-operative 3D reconstruction in laparoscopic surgery and discusses the technical challenges and future perspectives towards clinical translation. With the recent paradigm shift of surgical practice towards MIS and new developments in 3D opti- cal imaging, this is a timely discussion about technologies that could facilitate complex CAS procedures in dynamic and deformable anatomical regions

Real-time hybrid cutting with dynamic fluid visualization for virtual surgery

It is widely accepted that a reform in medical teaching must be made to meet today's high volume training requirements. Virtual simulation offers a potential method of providing such trainings and some current medical training simulations integrate haptic and visual feedback to enhance procedure learning. The purpose of this project is to explore the capability of Virtual Reality (VR) technology to develop a training simulator for surgical cutting and bleeding in a general surgery

Robots and tools for remodeling bone

The field of robotic surgery has progressed from small teams of researchers repurposing industrial robots, to a competitive and highly innovative subsection of the medical device industry. Surgical robots allow surgeons to perform tasks with greater ease, accuracy, or safety, and fall under one of four levels of autonomy; active, semi-active, passive, and remote manipulator. The increased accuracy afforded by surgical robots has allowed for cementless hip arthroplasty, improved postoperative alignment following knee arthroplasty, and reduced duration of intraoperative fluoroscopy among other benefits. Cutting of bone has historically used tools such as hand saws and drills, with other elaborate cutting tools now used routinely to remodel bone. Improvements in cutting accuracy and additional options for safety and monitoring during surgery give robotic surgeries some advantages over conventional techniques. This article aims to provide an overview of current robots and tools with a common target tissue of bone, proposes a new process for defining the level of autonomy for a surgical robot, and examines future directions in robotic surgery

Research on real-time physics-based deformation for haptic-enabled medical simulation

This study developed a multiple effective visuo-haptic surgical engine to handle a variety of surgical manipulations in real-time. Soft tissue models are based on biomechanical experiment and continuum mechanics for greater accuracy. Such models will increase the realism of future training systems and the VR/AR/MR implementations for the operating room