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

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 fabric-based approach for wearable haptics

In recent years, wearable haptic systems (WHS) have gained increasing attention as a novel and exciting paradigm for human-robot interaction (HRI).These systems can be worn by users, carried around, and integrated in their everyday lives, thus enabling a more natural manner to deliver tactile cues.At the same time, the design of these types of devices presents new issues: the challenge is the correct identification of design guidelines, with the two-fold goal of minimizing system encumbrance and increasing the effectiveness and naturalness of stimulus delivery.Fabrics can represent a viable solution to tackle these issues.They are specifically thought “to be worn”, and could be the key ingredient to develop wearable haptic interfaces conceived for a more natural HRI.In this paper, the author will review some examples of fabric-based WHS that can be applied to different body locations, and elicit different haptic perceptions for different application fields.Perspective and future developments of this approach will be discussed

Kinesthetic Feedback for Robot-Assisted Minimally Invasive Surgery (Da Vinci) with Two Fingers Exoskeleton

Minimally Invasive Surgery and, in particular, Robotic Minimally Invasive Surgery may benefit from the integration of Haptic device: here we propose a preliminary study on a two-finger exoskeleton for kinesthetic feed-back of surgeon thumb and index finger while controlling a Da Vinci Robotic Device through its Master Tool Manipulator (MTM). Simulation of contact be-tween rigid and soft objects with the Patient Side Manipulator (PSM) are inte-grated with Force Feedback on the MTM coupled with the exoskeleton

Haptics-Enabled Teleoperation for Robotics-Assisted Minimally Invasive Surgery

The lack of force feedback (haptics) in robotic surgery can be considered to be a safety risk leading to accidental tissue damage and puncturing of blood vessels due to excessive forces being applied to tissue and vessels or causing inefficient control over the instruments because of insufficient applied force. This project focuses on providing a satisfactory solution for introducing haptic feedback in robotics-assisted minimally invasive surgical (RAMIS) systems. The research addresses several key issues associated with the incorporation of haptics in a master-slave (teleoperated) robotic environment for minimally invasive surgery (MIS). In this project, we designed a haptics-enabled dual-arm (two masters - two slaves) robotic MIS testbed to investigate and validate various single-arm as well as dual-arm teleoperation scenarios. The most important feature of this setup is the capability of providing haptic feedback in all 7 degrees of freedom (DOF) required for RAMIS (3 translations, 3 rotations and pinch motion of the laparoscopic tool). The setup also enables the evaluation of the effect of replacing haptic feedback by other sensory cues such as visual representation of haptic information (sensory substitution) and the hypothesis that surgical outcomes may be improved by substituting or augmenting haptic feedback by such sensory cues

A Sensorized Instrument for Minimally Invasive Surgery for the Measurement of Forces during Training and Surgery: Development and Applications

The reduced access conditions present in Minimally Invasive Surgery (MIS) affect the feel of interaction forces between the instruments and the tissue being treated. This loss of haptic information compromises the safety of the procedure and must be overcome through training. Haptics in MIS is the subject of extensive research, focused on establishing force feedback mechanisms and developing appropriate sensors. This latter task is complicated by the need to place the sensors as close as possible to the instrument tip, as the measurement of forces outside of the patient\u27s body does not represent the true tool--tissue interaction. Many force sensors have been proposed, but none are yet available for surgery. The objectives of this thesis were to develop a set of instruments capable of measuring tool--tissue force information in MIS, and to evaluate the usefulness of force information during surgery and for training and skills assessment. To address these objectives, a set of laparoscopic instruments was developed that can measure instrument position and tool--tissue interaction forces in multiple degrees of freedom. Different design iterations and the work performed towards the development of a sterilizable instrument are presented. Several experiments were performed using these instruments to establish the usefulness of force information in surgery and training. The results showed that the combination of force and position information can be used in the development of realistic tissue models or haptic interfaces specifically designed for MIS. This information is also valuable in order to create tactile maps to assist in the identification of areas of different stiffness. The real-time measurement of forces allows visual force feedback to be presented to the surgeon. When applied to training scenarios, the results show that experience level correlates better with force-based metrics than those currently used in training simulators. The proposed metrics can be automatically computed, are completely objective, and measure important aspects of performance. The primary contribution of this thesis is the design and development of highly versatile instruments capable of measuring force and position during surgery. A second contribution establishes the importance and usefulness of force data during skills assessment, training and surgery

Design of a Hand Held Minimally Invasive Lung Tumour Localization Device

Lung cancer is the leading type of cancer that causes death. If diagnosed, the treatment of choice is surgical resection of the tumour. Traditionally, a surgeon feels for the presence of a tumour in open thoracic surgery. However, a minimally invasive approach is desired. A major problem presented by the minimally invasive approach is the localization of the tumour. This project describes the design, analysis, and experimental validation of a novel minimally invasive instrument for lung tumour localization. The instrument end effector is a two degree of freedom lung tissue palpator. It allows for optimal tissue palpation to increase useful sensor feedback by ensuring sensor contact, and prevents tissue damage by uniformly distributing pressure on the tissue with an upper bound force. Finite element analysis was used extensively to guide the design process. The mechanism is actuated using high strength tungsten cables attached to controlled motors. Heat treatment experiments were undertaken with stainless steel alloy 440C for use in the design, achieving a device factor of safety of 4. This factor of safety is based on a 20 N force on the end effector — the approximate weight of a human lung. The design was prototyped and validation experiments were carried out to assess its articulation and its load carrying capacity. Up to 10 N of force was applied to the prototype. Issues to resolve in the current design include cable extension effects and the existence of joint inflection. The end effector was also designed to allow the inclusion of ultrasound, tactile, and kinaesthetic sensors. It is hypothesized that a plurality of sensors will increase the likelihood of positive tumour localization. These sensors, combined with the presented mechanical design, form the basis for research in robotics-assisted palpation. A proof of concept control system is presented for automated palpation

A Novel Haptic Simulator for Evaluating and Training Salient Force-Based Skills for Laparoscopic Surgery

Laparoscopic surgery has evolved from an \u27alternative\u27 surgical technique to currently being considered as a mainstream surgical technique. However, learning this complex technique holds unique challenges to novice surgeons due to their \u27distance\u27 from the surgical site. One of the main challenges in acquiring laparoscopic skills is the acquisition of force-based or haptic skills. The neglect of popular training methods (e.g., the Fundamentals of Laparoscopic Surgery, i.e. FLS, curriculum) in addressing this aspect of skills training has led many medical skills professionals to research new, efficient methods for haptic skills training. The overarching goal of this research was to demonstrate that a set of simple, simulator-based haptic exercises can be developed and used to train users for skilled application of forces with surgical tools. A set of salient or core haptic skills that underlie proficient laparoscopic surgery were identified, based on published time-motion studies. Low-cost, computer-based haptic training simulators were prototyped to simulate each of the identified salient haptic skills. All simulators were tested for construct validity by comparing surgeons\u27 performance on the simulators with the performance of novices with no previous laparoscopic experience. An integrated, \u27core haptic skills\u27 simulator capable of rendering the three validated haptic skills was built. To examine the efficacy of this novel salient haptic skills training simulator, novice participants were tested for training improvements in a detailed study. Results from the study demonstrated that simulator training enabled users to significantly improve force application for all three haptic tasks. Research outcomes from this project could greatly influence surgical skills simulator design, resulting in more efficient training

Perception of Compliance in Laparoscopic Surgery

Laparoscopic surgery provides major benefits to patients in terms of decreased pain and post-operative hospital stays, but also increases their risks of intra-operative injuries because of the reduction in feedback in the tactile and visual channels compared to open surgery. Although the limitations of laparoscopy have been studied, the specific role of force feedback in laparoscopic surgery performance is not well understood. The purpose of this thesis is to determine the effect of force feedback on the ability to accurately discriminate tissue compliance by comparing subjective tissue softness assessment, force output, and subjective force assessment, in conventional and laparoscopic setups. The experimental trials involved eleven participants providing evaluations for a range of compliant samples, and analyzed their force output as well as their subjective evaluation of force output. The results of this investigation show that the accuracy of compliance discrimination is worse when using indirect probing compared to direct probing, and that the force used in direct probing is lower than the indirect scenario. Further, the subjective assessment of force output in direct probing is not significantly different compared to indirect probing. Further research involving more replication, expert of laparoscopy, and a focus on grip force are recommended to better understand our awareness of the subjective force output