Medical robots with potential applications in participatory and opportunistic remote sensing: A review

Among numerous applications of medical robotics, this paper concentrates on the design, optimal use and maintenance of the related technologies in the context of healthcare, rehabilitation and assistive robotics, and provides a comprehensive review of the latest advancements in the foregoing field of science and technology, while extensively dealing with the possible applications of participatory and opportunistic mobile sensing in the aforementioned domains. The main motivation for the latter choice is the variety of such applications in the settings having partial contributions to functionalities such as artery, radiosurgery, neurosurgery and vascular intervention. From a broad perspective, the aforementioned applications can be realized via various strategies and devices benefiting from detachable drives, intelligent robots, human-centric sensing and computing, miniature and micro-robots. Throughout the paper tens of subjects, including sensor-fusion, kinematic, dynamic and 3D tissue models are discussed based on the existing literature on the state-of-the-art technologies. In addition, from a managerial perspective, topics such as safety monitoring, security, privacy and evolutionary optimization of the operational efficiency are reviewed

Sliding mode control for a surgical teleoperation system via a disturbance observer

To obtain accurate trajectory tracking with robustness and faithful force feedback in a practical application, a sliding mode controller (SMC) combined with a compensation controller based on a nonlinear disturbance observer (DOB) is proposed. The DOB estimates the disturbances arising mainly from the uncertain dynamic model of a surgical manipulator, frictional forces and external interaction forces, and compensates for these disturbances in the control law. Accordingly, it alleviates the chattering problem caused by t

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

An Underactuated Flexible Instrument for Single Incision Laparoscopic Surgery

More and more patients and surgeons have switched from open surgery to minimally invasive surgery over these years. This exciting advancement has brought massive benefits to patients. Researchers and institutions have proposed robot assisted surgery which combines the advantage of developed robot system and human experience. This thesis reviews state of the art in this area and analyze some advanced surgical instrument for single incision laparoscopic instrument, then propose a design of robotic instrument for single incision laparoscopic surgery which can be integrated with collaborative robot manipulator to construct a surgical robot system.Single-incision laparoscopic surgery (SILS) has its own features and advantages compare to other minimally invasive surgery techniques which also lead to special design requirements for SILS instruments, among which increased flexibility compare to multi-incision surgery instruments is an important part. So we want to design a robotic surgical instrument that has increased flexibility compare to traditional instruments for other MIS techniques. As a laparoscopic robotic instrument compactness and light weight are also our considerations.Single incision laparoscopic surgery (SILS) inserts multiple instruments and laparoscopes through a single trocar which reduces trauma. But this improvement for patients caused difficulty in operation because of instruments triangulation, laparoscope field-of-view, etc. That brings up our challenges in designing a robotic instruments. Designing a highly flexible robotic instrument that provides sufficient workspace and good triangulation in order to relieve the difficulties introduced by narrow instrument trocars.We want to implement a highly recognized surgical instrument with a designed robotic instrument actuation pack. These two parts compose a robotic surgical instrument for single incision laparoscopic surgery. And we want to analyze the performance and viability of our design approach for SILS application

Image guided robotic assistance for the diagnosis and treatment of tumor

The aim of this thesis is to demonstrate the feasibility and the potentiality of introduction of robotics and image guidance in the overall oncologic workflow, from the diagnosis to the treatment phase. The popularity of robotics in the operating room has grown in recent years. Currently the most popular systems is the da Vinci telemanipulator (Intuitive Surgical), it is based on a master-slave control, for minimally invasive surgery and it is used in several surgical fields such us urology, general, gynecology, cardiothoracic. An accurate study of this system, from a technological field of view, has been conducted addressing all drawbacks and advantages of this system. The da Vinci System creates an immersive operating environment for the surgeon by providing both high quality stereo visualization and a human-machine interface that directly connects the surgeon’s hands to the motion of the surgical tool tips inside the patient’s body. It has undoubted advantages for the surgeon work and for the patient health, at least for some interventions, while its very high costs leaves many doubts on its price benefit ratio. In the robotic surgery field many researchers are working on the optimization and miniaturization robots mechanic, while others are trying to obtain smart functionalities to realize robotic systems, that, “knowing” the patient anatomy from radiological images, can assists the surgeon in an active way. Regarding the second point, image guided systems can be useful to plan and to control medical robots motion and to provide the surgeon pre-operative and intra-operative images with augmented reality visualization to enhance his/her perceptual capacities and, as a consequence, to improve the quality of treatments. To demonstrate this thesis some prototypes has been designed, implemented and tested. The development of image guided medical devices, comprehensive of augmented reality, virtual navigation and robotic surgical features, requires to address several problems. The first ones are the choosing of the robotic platform and of the image source to employ. An industrial anthropomorphic arm has been used as testing platform. The idea of integrating industrial robot components in the clinical workflow has been supported by the da Vinci technical analysis. The algorithms and methods developed, regarding in particular robot calibration, based on literature theories and on an easily integration in the clinical scenario, can be adapted to each anthropomorphic arm. In this way this work can be integrated with light-weight robots, for industrial or clinical use, able to work in close contact to humans, which will become numerous in the early future. Regarding the medical image source, it has been decided to work with ultrasound imaging. Two-dimensional ultrasound imaging is widely used in clinical practice because is not dangerous for the patient, inexpensive, compact and it is a highly flexible imaging that allows users to study many anatomic structures. It is routinely used for diagnosis and as guidance in percutaneous treatments. However the use of 2D ultrasound imaging presents some disadvantages that require great ability of the user: it requires that the clinician mentally integrates many images to reconstruct a complete idea of the anatomy in 3D. Furthermore the freehand control of the probe make it difficult to individuate anatomic positions and orientations and probe repositioning to reach a particular location. To overcome these problems it has been developed an image guided system that fuse 2D US real time images with routinely CT or MRI 3D images, previously acquired from the patient, to enhance clinician orientation and probe guidance. The implemented algorithms for robot calibration and US image guidance has been used to realize two applications responding to specific clinical needs. The first one to speed up the execution of routinely and very recurrently procedures like percutaneous biopsy or ablation. The second one to improve a new completely non invasive type of treatment for solid tumors, the HIFU (High Intensity Focused Ultrasound). An ultrasound guided robotic system has been developed to assist the clinician to execute complicated biopsies, or percutaneous ablations, in particular for deep abdominal organs. It was developed an integrated system that provides the clinician two types of assistance: a mixed reality visualization allows accurate and easy planning of needle trajectory and target reaching verification; the robot arm equipped with a six-degree-of-freedom force sensor allows the precise positioning of the needle holder and allows the clinician to adjust, by means of a cooperative control, the planned trajectory to overcome needle deflection and target motion. The second application consists in an augmented reality navigation system for HIFU treatment. HIFU represents a completely non invasive method for treatment of solid tumors, hemostasis and other vascular features in human tissues. The technology for HIFU treatments is still evolving and the systems available on the market have some limitations and drawbacks. A disadvantage resulting from our experience with the machinery available in our hospital (JC200 therapeutic system Haifu (HIFU) by Tech Co., Ltd, Chongqing), which is similar to other analogous machines, is the long time required to perform the procedure due to the difficulty to find the target, using the remote motion of an ultrasound probe under the patient. This problem has been addressed developing an augmented reality navigation system to enhance US guidance during HIFU treatments allowing an easy target localization. The system was implemented using an additional free hand ultrasound probe coupled with a localizer and CT fused imaging. It offers a simple and an economic solution to an easy HIFU target localization. This thesis demonstrates the utility and usability of robots for diagnosis and treatment of the tumor, in particular the combination of automatic positioning and cooperative control allows the surgeon and the robot to work in synergy. Further the work demonstrates the feasibility and the potentiality of the use of a mixed reality navigation system to facilitate the target localization and consequently to reduce the times of sittings, to increase the number of possible diagnosis/treatments and to decrease the risk of potential errors. The proposed solutions for the integration of robotics and image guidance in the overall oncologic workflow, take into account current available technologies, traditional clinical procedures and cost minimization

Shared control for natural motion and safety in hands-on robotic surgery

Hands-on robotic surgery is where the surgeon controls the tool's motion by applying forces and torques to the robot holding the tool, allowing the robot-environment interaction to be felt though the tool itself. To further improve results, shared control strategies are used to combine the strengths of the surgeon with those of the robot. One such strategy is active constraints, which prevent motion into regions deemed unsafe or unnecessary. While research in active constraints on rigid anatomy has been well-established, limited work on dynamic active constraints (DACs) for deformable soft tissue has been performed, particularly on strategies which handle multiple sensing modalities. In addition, attaching the tool to the robot imposes the end effector dynamics onto the surgeon, reducing dexterity and increasing fatigue. Current control policies on these systems only compensate for gravity, ignoring other dynamic effects. This thesis presents several research contributions to shared control in hands-on robotic surgery, which create a more natural motion for the surgeon and expand the usage of DACs to point clouds. A novel null-space based optimization technique has been developed which minimizes the end effector friction, mass, and inertia of redundant robots, creating a more natural motion, one which is closer to the feeling of the tool unattached to the robot. By operating in the null-space, the surgeon is left in full control of the procedure. A novel DACs approach has also been developed, which operates on point clouds. This allows its application to various sensing technologies, such as 3D cameras or CT scans and, therefore, various surgeries. Experimental validation in point-to-point motion trials and a virtual reality ultrasound scenario demonstrate a reduction in work when maneuvering the tool and improvements in accuracy and speed when performing virtual ultrasound scans. Overall, the results suggest that these techniques could increase the ease of use for the surgeon and improve patient safety.Open Acces

A continuum robotic platform for endoscopic non-contact laser surgery: design, control, and preclinical evaluation

The application of laser technologies in surgical interventions has been accepted in the clinical domain due to their atraumatic properties. In addition to manual application of fibre-guided lasers with tissue contact, non-contact transoral laser microsurgery (TLM) of laryngeal tumours has been prevailed in ENT surgery. However, TLM requires many years of surgical training for tumour resection in order to preserve the function of adjacent organs and thus preserve the patient’s quality of life. The positioning of the microscopic laser applicator outside the patient can also impede a direct line-of-sight to the target area due to anatomical variability and limit the working space. Further clinical challenges include positioning the laser focus on the tissue surface, imaging, planning and performing laser ablation, and motion of the target area during surgery. This dissertation aims to address the limitations of TLM through robotic approaches and intraoperative assistance. Although a trend towards minimally invasive surgery is apparent, no highly integrated platform for endoscopic delivery of focused laser radiation is available to date. Likewise, there are no known devices that incorporate scene information from endoscopic imaging into ablation planning and execution. For focusing of the laser beam close to the target tissue, this work first presents miniaturised focusing optics that can be integrated into endoscopic systems. Experimental trials characterise the optical properties and the ablation performance. A robotic platform is realised for manipulation of the focusing optics. This is based on a variable-length continuum manipulator. The latter enables movements of the endoscopic end effector in five degrees of freedom with a mechatronic actuation unit. The kinematic modelling and control of the robot are integrated into a modular framework that is evaluated experimentally. The manipulation of focused laser radiation also requires precise adjustment of the focal position on the tissue. For this purpose, visual, haptic and visual-haptic assistance functions are presented. These support the operator during teleoperation to set an optimal working distance. Advantages of visual-haptic assistance are demonstrated in a user study. The system performance and usability of the overall robotic system are assessed in an additional user study. Analogous to a clinical scenario, the subjects follow predefined target patterns with a laser spot. The mean positioning accuracy of the spot is 0.5 mm. Finally, methods of image-guided robot control are introduced to automate laser ablation. Experiments confirm a positive effect of proposed automation concepts on non-contact laser surgery.Die Anwendung von Lasertechnologien in chirurgischen Interventionen hat sich aufgrund der atraumatischen Eigenschaften in der Klinik etabliert. Neben manueller Applikation von fasergeführten Lasern mit Gewebekontakt hat sich die kontaktfreie transorale Lasermikrochirurgie (TLM) von Tumoren des Larynx in der HNO-Chirurgie durchgesetzt. Die TLM erfordert zur Tumorresektion jedoch ein langjähriges chirurgisches Training, um die Funktion der angrenzenden Organe zu sichern und damit die Lebensqualität der Patienten zu erhalten. Die Positionierung des mikroskopis chen Laserapplikators außerhalb des Patienten kann zudem die direkte Sicht auf das Zielgebiet durch anatomische Variabilität erschweren und den Arbeitsraum einschränken. Weitere klinische Herausforderungen betreffen die Positionierung des Laserfokus auf der Gewebeoberfläche, die Bildgebung, die Planung und Ausführung der Laserablation sowie intraoperative Bewegungen des Zielgebietes. Die vorliegende Dissertation zielt darauf ab, die Limitierungen der TLM durch robotische Ansätze und intraoperative Assistenz zu adressieren. Obwohl ein Trend zur minimal invasiven Chirurgie besteht, sind bislang keine hochintegrierten Plattformen für die endoskopische Applikation fokussierter Laserstrahlung verfügbar. Ebenfalls sind keine Systeme bekannt, die Szeneninformationen aus der endoskopischen Bildgebung in die Ablationsplanung und -ausführung einbeziehen. Für eine situsnahe Fokussierung des Laserstrahls wird in dieser Arbeit zunächst eine miniaturisierte Fokussieroptik zur Integration in endoskopische Systeme vorgestellt. Experimentelle Versuche charakterisieren die optischen Eigenschaften und das Ablationsverhalten. Zur Manipulation der Fokussieroptik wird eine robotische Plattform realisiert. Diese basiert auf einem längenveränderlichen Kontinuumsmanipulator. Letzterer ermöglicht in Kombination mit einer mechatronischen Aktuierungseinheit Bewegungen des Endoskopkopfes in fünf Freiheitsgraden. Die kinematische Modellierung und Regelung des Systems werden in ein modulares Framework eingebunden und evaluiert. Die Manipulation fokussierter Laserstrahlung erfordert zudem eine präzise Anpassung der Fokuslage auf das Gewebe. Dafür werden visuelle, haptische und visuell haptische Assistenzfunktionen eingeführt. Diese unterstützen den Anwender bei Teleoperation zur Einstellung eines optimalen Arbeitsabstandes. In einer Anwenderstudie werden Vorteile der visuell-haptischen Assistenz nachgewiesen. Die Systemperformanz und Gebrauchstauglichkeit des robotischen Gesamtsystems werden in einer weiteren Anwenderstudie untersucht. Analog zu einem klinischen Einsatz verfolgen die Probanden mit einem Laserspot vorgegebene Sollpfade. Die mittlere Positioniergenauigkeit des Spots beträgt dabei 0,5 mm. Zur Automatisierung der Ablation werden abschließend Methoden der bildgestützten Regelung vorgestellt. Experimente bestätigen einen positiven Effekt der Automationskonzepte für die kontaktfreie Laserchirurgie

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

Ilaptic Feedback Device for Needle Insertion

Tele-surgery is one of the emerging fields which combine engineering and medical sciences. Application of tole-surgery can be found in remote communities, war-zones and disasterstricken areas. One of the most complex and tedious issue in tele-surgery is needle insertion. The surgeon relies on haptic feedback during needle insertion. The force exerted on needle during insertion is measured and reproduced at surgeon's end is known as haptic feedback. The realistic force reproduction requires haptic feedback device which should be dynamically identical to needle. The haptic feedback device enables the surgeon to sense the needle insertion remotely. The basic objective of this thesis is to design a device used for needle insertions in soft tissue. The force information from needle insertions is measured by a sensor. The force feedback produced by the device can be used in robot-assisted needle insertion. A device is designed for reality-based data that results in more accurate representation of a needle insertion haptic feedback scenario. The device is modeled dynamically and it is clear from the model that the reactive force is reproduced by the friction forces which is controlled by the motors. The system is sensitive to mass of rollers, mass of the stick and friction between the stick and rollers. The needle insertion force is modeled in three parts; force due to capsule stiffness, friction, and cutting. The force due to capsule stiffness is modeled terms of three components namely diameter of needle, elasticity of tissue and deformation of tissue. The data from model is compared with real time force data. The haptic feedback device input and output forces are compared and the highest correlation factor is 82%. The sensitivity analysis of the device is performed. The capsule stiffness force for 0.9 millimeter diameter needle is 0.98 Newton, the stiffness force for 0.8 millimeter is 0.91 Newton and stiffness force for 0.6 millimeter diameter is 0.41 Newton. The capsule stiffness force for 0.6 millimeter needle is not following the capsule stiffness model. The insertion force data was collected on chicken skin and meat. The device designed in this work is having one degree of freedom; it only produces force feedback for vertical needle insertion. This design is not able to produce the force feedback for angular needle insertion. Graphical User Interface is designed for the visual haptic feedback. The data acquisition is done with the help of a PC sound card. Future work should include the design of a multidegree of freedom haptic feedback device and to advance the GUI for audio feedback that may be extended to accommodate the design of a simulator

Haptic teleoperation of mobile manipulator systems using virtual fixtures.

In order to make the task of controlling Mobile-Manipulator Systems (MMS) simpler, a novel command strategy that uses a single joystick is presented to replace the existing paradigm of using multiple joysticks. To improve efficiency and accuracy, virtual fixtures were implemented with the use of a haptic joystick. Instead of modeling the MMS as a single unit with three redundant degrees-of-freedom (DOF), the operator controls either the manipulator or the mobile base, with the command strategy choosing which one to move. The novel command strategy uses three modes of operation to automatically switch control between the manipulator and base. The three modes of operation are called near-target manipulation mode, off-target manipulation mode, and transportation mode. The system enters near-target manipulation mode only when close to a target of interest, and allows the operator to control the manipulator using velocity control. When the operator attempts to move the manipulator out of its workspace limits, the system temporarily enters transportation mode. When the operator moves the manipulator in a direction towards the manipulator???s workspace the system returns to near-target manipulation mode. In off-target manipulation mode, when the operator moves the manipulator to its workspace limits, the system retracts the arm near to the centre of its workspace to enter and remain in transportation mode. While in transportation mode the operator controls the base using velocity control. Two types of virtual fixtures are used, repulsive virtual fixtures and forbidden region virtual fixtures. Repulsive virtual fixtures are present in the form of six virtual walls forming a cube at the manipulator???s workspace limits. When the operator approaches a virtual wall, a repulsive force is felt pushing the operator???s hand away from the workspace limits. The forbidden region virtual fixtures prevent the operator from driving into obstacles by disregarding motion commands that would result in a collision. The command strategy was implemented on the Omnibot MMS and test results show that it was successful in improving simplicity, accuracy, and efficiency when teleoperating a MMS