Robotic simulators for tissue examination training with multimodal sensory feedback

Tissue examination by hand remains an essential technique in clinical practice. The effective application depends on skills in sensorimotor coordination, mainly involving haptic, visual, and auditory feedback. The skills clinicians have to learn can be as subtle as regulating finger pressure with breathing, choosing palpation action, monitoring involuntary facial and vocal expressions in response to palpation, and using pain expressions both as a source of information and as a constraint on physical examination. Patient simulators can provide a safe learning platform to novice physicians before trying real patients. This paper reviews state-of-the-art medical simulators for the training for the first time with a consideration of providing multimodal feedback to learn as many manual examination techniques as possible. The study summarizes current advances in tissue examination training devices simulating different medical conditions and providing different types of feedback modalities. Opportunities with the development of pain expression, tissue modeling, actuation, and sensing are also analyzed to support the future design of effective tissue examination simulators

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

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

A comprehensive review of haptic feedback in minimally invasive robotic liver surgery: Advancements and challenges

Background: Liver medical procedures are considered one of the most challenging because of the liver's complex geometry, heterogeneity, mechanical properties, and movement due to respiration. Haptic features integrated into needle insertion systems and other medical devices could support physicians but are uncommon. Additional training time and safety concerns make it difficult to implement in robot-assisted surgery. The main challenges of any haptic device in a teleoperated system are the stability and transparency levels required to develop a safe and efficient system that suits the physician's needs. Purpose: The objective of the review article is to investigate whether haptic-based teleoperation potentially improves the efficiency and safety of liver needle insertion procedures compared with insertion without haptic feedback. In addition, it looks into haptic technology that can be integrated into simulators to train novice physicians in liver procedures. Methods: This review presents the physician's needs during liver interventions and the consequent requirements of haptic features to help the physician. This paper provides an overview of the different aspects of a teleoperation system in various applications, especially in the medical field. It finally presents the state-of-the-art haptic technology in robot-assisted procedures for the liver. This includes 3D virtual models of the liver and force measurement techniques used in haptic rendering to estimate the real-time position of the surgical instrument relative to the liver. Results: Haptic feedback technology can be used to navigate the surgical tool through the desired trajectory to reach the target accurately and avoid critical regions. It also helps distinguish between various textures of liver tissue. Conclusion: Haptic feedback can complement the physician's experience to compensate for the lack of real-time imaging during Computed Tomography guided (CT-guided) liver procedures. Consequently, it helps the physician mitigate the destruction of healthy tissues and takes less time to reach the target.</p

An Abdominal Phantom with Tunable Stiffness Nodules and Force Sensing Capability for Palpation Training

Robotic phantoms enable advanced physical examination training before using human patients. In this paper, we present an abdominal phantom for palpation training with controllable stiffness liver nodules that can also sense palpation forces. The coupled sensing and actuation approach is achieved by pneumatic control of positive-granular jammed nodules for tunable stiffness. Soft sensing is done using the variation of internal pressure of the nodules under external forces. This paper makes original contributions to extend the linear region of the neo-Hookean characteristic of the mechanical behavior of the nodules by 140% compared to no-jamming conditions and to propose a method using the organ level controllable nodules as sensors to estimate palpation position and force with a root-means-quare error (RMSE) of 4% and 6.5%, respectively. Compared to conventional soft sensors, the method allows the phantom to sense with no interference to the simulated physiological conditions when providing quantified feedback to trainees, and to enable training following current bare-hand examination protocols without the need to wear data gloves to collect data.This work was supported in part by the Engineering and Physical Sciences Research Council (EPSRC) MOTION grant EP/N03211X/2 and EP/N03208X/1, and EPSRC RoboPatient grant EP/T00603X/

A Review of Pneumatic Actuators Used for the Design of Medical Simulators and Medical Tools

International audienc

Haptic assessment of tissue stiffness in locating and identifying gynaecological cancer in human tissue

Gynaecological surgeons are not able to gather adequate tissue feedback during minimal access surgery for cancer treatment. This can result in failure to locate tumour boundaries and to ensure these are completely resected within tumour-free resection margins. Surgeons achieve significantly better surgical and oncological outcomes if they can identify the precise location of a gynaecological tumour. Indeed, the true nature of tumour, whether benign or cancerous, is often not known prior to surgery. If more details were available in relation to the characteristics that differentiate gynaecological cancer in tumours, this would enable more accurate diagnosis and help in the planning of surgery. HYPOTHESIS: Haptic technology has the potential to enhance the surgeon’s degree of perception during minimal access surgery. Alteration in tissue stiffness in gynaecological tumours, thought to be associated with the accelerated multiplication of cancer cells, should allow their location to be identified and help in determining the likelihood of malignancy. METHOD: Setting: (i) Guy's &amp; St Thomas' Hospital (ii) Dept of Informatics (King's College London).Permission from the National Research Ethics Committee and Research &amp; Development (R&amp;D) approval were sought from the National Health Service. The Phantom Omni, capable of 3D motion tracking, attached to a nano-17 force sensor, was used to capture real-time position data and force data. Uniaxial indentation palpation behaviour was used. The indentation depth was calculated using the displacement of the probe from the surface to the deepest point for each contact. The tissue stiffness (TS) was then calculated.The haptic probe was tested first on silicone models with embedded nodules mimicking tumour(s). This was followed by assessing TS ex-vivo using a haptic probe on fresh human gynaecological organs that had been removed in surgery. Tissue stiffness maps were generated in real time using the haptic device by converting stiffness values into RGB values. Surgeons also manually palpated and recorded the site of the tumour. Histology was used as the gold standard for location and cancer diagnosis. Manual palpation and haptic data were compared for accuracy on tumour location. The tissue stiffness calculated by the haptic probe was compared in cancer and control specimens. Several data analysis techniques were applied to derive results.CONTRIBUTIONS: Haptic indentation probe was tested for the first time on fresh human gynaecological organs to locate cancer in a clinical setting. We are the first one to evaluate the accuracy of cancer diagnosis in human gynaecological organs with a force sensing haptic indentation probe measuring tissue stiffness

Virtual Reality and Simulation for Progressive Treatments in Urology

In urology technologies and surgical practices are constantly evolving and virtual reality (VR) simulation has become a significant supplement to existing urology methods in the training curricula of urologists. However, new developments in urology also require training and simulation for a wider application. In order to achieve this VR and simulation could play a central role. The purpose of this article is a review of the principal applications for VR and simulation in the field of urology education and to demonstrate the potential for the propagation of new progressive treatments. Two different cases are presented as examples: exposure therapy for paruresis and virtual cystoscopy for diagnosis and surgery of bladder cancer. The article uses research and publications listed in openly accessible directories and is organized into 3 sections: The first section covers features of VR and simulation technologies. The second one presents confirmed applications of current technologies in urology education and showcases example future applications in the domain of bladder treatment and surgery. The final section discusses the potential of the technology to improve health care quality

Accelerating Surgical Robotics Research: A Review of 10 Years With the da Vinci Research Kit

Robotic-assisted surgery is now well-established in clinical practice and has become the gold standard clinical treatment option for several clinical indications. The field of robotic-assisted surgery is expected to grow substantially in the next decade with a range of new robotic devices emerging to address unmet clinical needs across different specialities. A vibrant surgical robotics research community is pivotal for conceptualizing such new systems as well as for developing and training the engineers and scientists to translate them into practice. The da Vinci Research Kit (dVRK), an academic and industry collaborative effort to re-purpose decommissioned da Vinci surgical systems (Intuitive Surgical Inc, CA, USA) as a research platform for surgical robotics research, has been a key initiative for addressing a barrier to entry for new research groups in surgical robotics. In this paper, we present an extensive review of the publications that have been facilitated by the dVRK over the past decade. We classify research efforts into different categories and outline some of the major challenges and needs for the robotics community to maintain this initiative and build upon it

Conditioned haptic perception for 3D localization of nodules in soft tissue palpation with a variable stiffness probe

This paper provides a solution for fast haptic information gain during soft tissue palpation using a Variable Lever Mechanism (VLM) probe. More specifically, we investigate the impact of stiffness variation of the probe to condition likelihood functions of the kinesthetic force and tactile sensors measurements during a palpation task for two sweeping directions. Using knowledge obtained from past probing trials or Finite Element (FE) simulations, we implemented this likelihood conditioning in an autonomous palpation control strategy. Based on a recursive Bayesian inferencing framework, this new control strategy adapts the sweeping direction and the stiffness of the probe to detect abnormal stiff inclusions in soft tissues. This original control strategy for compliant palpation probes shows a sub-millimeter accuracy for the 3D localization of the nodules in a soft tissue phantom as well as a 100% reliability detecting the existence of nodules in a soft phantom