Magnetic Surgical Instruments for Robotic Abdominal Surgery.

This review looks at the implementation of magnetic-based approaches in surgical instruments for abdominal surgeries. As abdominal surgical techniques advance toward minimizing surgical trauma, surgical instruments are enhanced to support such an objective through the exploration of magnetic-based systems. With this design approach, surgical devices are given the capabilities to be fully inserted intraabdominally to achieve access to all abdominal quadrants, without the conventional rigid link connection with the external unit. The variety of intraabdominal surgical devices are anchored, guided, and actuated by external units, with power and torque transmitted across the abdominal wall through magnetic linkage. This addresses many constraints encountered by conventional laparoscopic tools, such as loss of triangulation, fulcrum effect, and loss/lack of dexterity for surgical tasks. Design requirements of clinical considerations to aid the successful development of magnetic surgical instruments, are also discussed

A development of assistant surgical robot system based on surgical-operation-by-wire and hands-on-throttle-and-stick

BACKGROUND: Robot-assisted laparoscopic surgery offers several advantages compared with open surgery and conventional minimally invasive surgery. However, one issue that needs to be resolved is a collision between the robot arm and the assistant instrument. This is mostly caused by miscommunication between the surgeon and the assistant. To resolve this limitation, an assistant surgical robot system that can be simultaneously manipulated via a wireless controller is proposed to allow the surgeon to control the assistant instrument. METHODS: The system comprises two novel master interfaces (NMIs), a surgical instrument with a gripper actuated by a micromotor, and 6-axis robot arm. Two NMIs are attached to master tool manipulators of da Vinci research kit (dVRK) to control the proposed system simultaneously with patient side manipulators of dVRK. The developments of the surgical instrument and NMI are based on surgical-operation-by-wire concept and hands-on-throttle-and-stick concept from the earlier research, respectively. Tests for checking the accuracy, latency, and power consumption of the NMI are performed. The gripping force, reaction time, and durability are assessed to validate the surgical instrument. The workspace is calculated for estimating the clinical applicability. A simple peg task using the fundamentals of laparoscopic surgery board and an in vitro test are executed with three novice volunteers. RESULTS: The NMI was operated for 185 min and reflected the surgeon’s decision successfully with a mean latency of 132 ms. The gripping force of the surgical instrument was comparable to that of conventional systems and was consistent even after 1000 times of gripping motion. The reaction time was 0.4 s. The workspace was calculated to be 8397.4 cm(3). Recruited volunteers were able to execute the simple peg task within the cut-off time and successfully performed the in vitro test without any collision. CONCLUSIONS: Various experiments were conducted and it is verified that the proposed assistant surgical robot system enables collision-free and simultaneous operation of the dVRK’s robot arm and the proposed assistant robot arm. The workspace is appropriate for the performance of various kinds of surgeries. Therefore, the proposed system is expected to provide higher safety and effectiveness for the current surgical robot system

Snake-Like Robots for Minimally Invasive, Single Port, and Intraluminal Surgeries

The surgical paradigm of Minimally Invasive Surgery (MIS) has been a key driver to the adoption of robotic surgical assistance. Progress in the last three decades has led to a gradual transition from manual laparoscopic surgery with rigid instruments to robot-assisted surgery. In the last decade, the increasing demand for new surgical paradigms to enable access into the anatomy without skin incision (intraluminal surgery) or with a single skin incision (Single Port Access surgery - SPA) has led researchers to investigate snake-like flexible surgical devices. In this chapter, we first present an overview of the background, motivation, and taxonomy of MIS and its newer derivatives. Challenges of MIS and its newer derivatives (SPA and intraluminal surgery) are outlined along with the architectures of new snake-like robots meeting these challenges. We also examine the commercial and research surgical platforms developed over the years, to address the specific functional requirements and constraints imposed by operations in confined spaces. The chapter concludes with an evaluation of open problems in surgical robotics for intraluminal and SPA, and a look at future trends in surgical robot design that could potentially address these unmet needs.Comment: 41 pages, 18 figures. Preprint of article published in the Encyclopedia of Medical Robotics 2018, World Scientific Publishing Company www.worldscientific.com/doi/abs/10.1142/9789813232266_000

A Study on the Development of Surgical-Operation-By-Wire (SOBW) for Advanced Surgical Robot System

학위논문 (박사)-- 서울대학교 대학원 : 협동과정 바이오엔지니어링전공, 2015. 8. Sungwan Kim.기존의 개복 수술에 비해 최소 침습 수술은 많은 장점이 있다. 하지만 기존 복강경 도구를 이용한 최소 침습 수술의 한계를 극복하고자 로봇을 이용한 복강경 수술이 널리 시행되고 있다. 하지만 대표적인 복강경 수술 로봇인 다빈치 로봇의 경우 엔드이펙터의 집게가 다양한 자세에서 균일한 힘을 내지 못하는 것이 다른 연구진에 의해 밝혀졌다. 본 연구에서는 이를 가설로 두고 이를 구체적인 실험으로 규명하였으며, 문제의 원인이 금속 줄로 제어되는 엔드이펙터 때문임을 증명하였다. 이를 위해 엔드이펙터의 집는 힘, 자세에 따른 커넥터 각도, 전달 토크를 새로이 고안한 토크전달시스템으로 측정하였다. 측정 결과 의사의 균일한 의도에도 불구하고 27가지 자세에서 세가지 엔드이펙터가 모두 다른 힘을 내었으며 최소 1.84배에서 최대 3.37배의 차이가 나는 것을 확인하였다. 이러한 단점을 극복하고자 본 연구에서는 두 가지 측면에서 해결책을 제시하였다. 첫째로, 다빈치의 엔드이펙터 내부 메커니즘을 분석하여 엔드이펙터의 다양한 자세에서 균일한 힘을 내기 위한 보상 힘을 제시하는 모델을 개발하였다. 모델에서 계산되는 값과 실제 값을 비교하여 검증하였다. 토크전달시스템을 통해 얻은 파라미터로부터 10.69-16.25%의 오차 범위 내에서 예측 집는 힘을 계산하는 결과를 도출하였다. 본 모델을 이용하면 기존 다빈치 시스템의 구조적 문제를 소프트웨어적으로 극복하는데 도움을 줄 수 있다. 또한 의사는 엔드이펙터 집게에 작용하는 실제 힘에 대한 정보를 얻을 수 있으며, 마스터 인터페이스에 압력 센서 등이 구비되면 집는 힘을 원하는 대로 조정할 수도 있어서 수술 도중 발생할 수 있는 사고를 미연에 방지 할 수 있다. 둘째로, 다빈치 시스템의 구조적 문제를 근본적으로 해결하기 위하여 새로운 수술 로봇 엔드이펙터 시스템, Surgical-Operation-By-Wire (SOBW)를 개발하였다. 6축 로봇팔을 사용하여 새로운 엔드이펙터와 함께 수술에 쓰일 수 있는 추가의 자유도를 갖추었다. 제안된 수술 로봇 시스템은 항공우주공학기술에 널리 쓰이는 Hands-On-Throttle-And-Stick (HOTAS)을 활용하여 6축 힘/토크 센서가 추가된 iHOTAS 인터페이스를 통해 제어된다. 집게의 반응시간이 0.2초로 계산되었고, 본 시스템을 처음 접하는 참가자가 술기 테스트에서 평균 176초안에 수행하여 300초 컷오프 타임안에 수행할 수 있게 시스템이 잘 구성되었음을 확인하였다. 또한 시스템의 동작 범위는 11,157.0 cm3으로 계산되었다. 다양한 검증을 통해 제안된 수술 로봇 시스템이 실제 수술에 충분히 쓰일 수 있음을 확인하였다.Abstract i List of Tables iv List of Figures vi Contents x 1. Introduction 1 1.1. Robotic Laparoscopic Surgery 1 1.2. End-effectors and Master Interfaces in Robotic Laparoscopic Surgery 8 1.3. Objectives and Scope 12 1.3.1. Gripping Force Measurement for Various Postures and Mathematical Compensation Model 17 1.3.1.1. Torque Transfer System (TTS) 18 1.3.1.2. Calibration of the Sensors 21 1.3.1.3. Force Measurement with Respect to the EndoWrists Posture 23 1.3.2. Novel End-effector and Mater Interface 31 ? 2. Materials and Methods 34 2.1. EndoWrist Inner Mechanism Model 34 2.2. Development of the Laparoscopic Robot 37 2.2.1. Overview 40 2.2.2. External Arm 40 2.2.3. End-effector (KS-4) 42 2.2.3.1. Pneumatic Gripper System 48 2.2.4. Forward Kinematics of the System 53 3. Results 58 3.1.Prediction of the Compensation Force for EndoWrists 58 3.1.1. EndoWrists Gripping Force 58 3.1.2. Prediction Results and Validation 60 3.2. Pneumatic Type of End-effector (KS-4) and Novel Master Interfaces 63 3.2.1. End-effectors Gripping Force 63? 3.2.1.1. Gripping Force System Setup 63 3.2.1.2. Relationship between Compressors Pressure and Gripping Force 66 3.2.1.3. Reaction Time 68 3.2.1.4. Durability Test 71 3.2.2. Simple Peg Task 72 3.2.3. Workspace 76 3.2.4. System Specification 77 4. Discussion 80 5. Conclusion 89 References 90 Abstract in Korean 100Docto

복강경 수술 로봇 시스템의 활용도 향상을 위한 추가적인 마스터 인터페이스 개발과 이를 이용한 응용 시스템 개발 연구

학위논문 (박사)-- 서울대학교 대학원 공과대학 협동과정 바이오엔지니어링전공, 2017. 8. Sungwan Kim.Robot-assisted laparoscopic surgery offers several advantages compared to open surgery and conventional minimally invasive surgery. However, important issues which need to be resolved are the complexity of current operation room environment for laparoscopic robotic surgery and demand for a larger operation room. To overcome these issues, additional interfaces based on Hands-On-Throttle-And-Stick (HOTAS) concept which can be simply attached and integrated with master interface of da Vinci surgical robot system were proposed. HOTAS controller is widely used for flight control in the aerospace field which can manipulate hundreds of functions and provide feedback to the pilot on flight conditions. The implementation of HOTAS controller significantly reduced the complexity of flights and reduced the number of pilots required in a cockpit from two to one. In this study, to provide above benefits to the operation room for robotic laparoscopic surgery, two types of additional interfaces are proposed. Proposed additional interfaces can be easily manipulated by the surgeons index finger, which is currently operated only by finger clutch buttons, and therefore enable the surgeon to use multiple functions. Initially, a novel master interface (NMI) was developed. The NMI mainly consists of a 9-way switch and a microprocessor with a wireless communication module. Thus, the NMI can be also regarded as a 9-way compact HOTAS. The performance test, latency, and power consumption of the developed NMI were verified by repeated experiments. Then, an improved novel master interface (iNMI) was developed to provide more intuitive and convenient manipulation. The iNMI was developed based on a capacitive touch sensor array and a wireless microprocessor to intuitively reflect the surgeons decision. Multiple experiments were performed to evaluate the iNMI performance in terms of performance test, latency, and power consumption. In addition, two application systems based on Surgical-Operation-By-Wire (SOBW) concept are proposed in this research to enhance the function of laparoscopic surgical robot system based on clinical needs that are stated below. The size of the additional interface is small enough to be easily installed to the master tool manipulators (MTMs) of da Vinci research kit (dVRK), which was used as an operation robot arm system, to maximize convenience to the surgeon when using the additional interfaces to simultaneously manipulate the application systems with the MTMs. Firstly, a robotic assistant that can be simultaneously manipulated via a wireless controller is proposed to allow the surgeon to control the assistant instrument. This approach not only decreases surgeon fatigue by eliminating communication process with assistants, but also resolves collision between the operation robot arms and the assistant instruments that can be caused by an inexperienced assistant or miscommunication and misaligned intent between the surgeon and the assistant. The system comprises two additional interfaces, a surgical instrument with a gripper actuated by a micromotor and a 6-axis robot arm. The gripping force of the surgical instrument was comparable to that of conventional systems and was consistent even after 1,000 times of gripping motion. The workspace was calculated to be 8,397.4 cm3. Recruited volunteers were able to execute the simple peg task within the cut-off time and successfully performed the in vitro test. Secondly, a wirelessly controllable stereo endoscope system which enables simultaneous control with the operating robot arm system is proposed. This is able to remove any discontinuous surgical flow that occurs when the control is swapped between the endoscope system and the operating robot arm system, and therefore prevent problems such as increased operation time, collision among surgical instruments, and injury to patients. The proposed system consists of two additional interfaces, a four-degrees of freedom (4-DOFs) endoscope control system (ECS) and a simple three-dimensional (3D) endoscope. The 4-DOFs ECS consists of four servo motors and employs a two-parallel link structure to provide translational and fulcrum point motions to the simple 3D endoscope. The workspace was calculated to be 20,378.3 cm3, which exceeds the reference workspace. The novice volunteers were able to successfully execute the modified peg transfer task. Throughout the various verifications, it has been confirmed that the proposed interfaces could make the surgical robot system more efficiently by overcoming its several limitations.1. Introduction 1 1.1. Robotic Laparoscopic Surgery 1 1.2. Objectives and Scope 8 1.2.1. Additional Master Interfaces 14 1.2.2. Application Systems 15 2. Materials and Methods 20 2.1. Additional Master Interfaces 20 2.1.1. Novel Master Interface: 9-way Compact Hands-On-Throttle-And-Stick 20 2.1.2. improved Novel Master Interface: Capacitive Touch Type Compact Hands-On-Throttle-And-Stick 26 2.2. Application Systems 34 2.2.1. Robotic Assistant 34 2.2.2. Stereo Endoscope System 49 3. Results 57 3.1. Novel Master Interface with Application Systems 57 3.1.1. Novel Master Interface 57 3.1.2. Robotic Assistant 59 3.1.3. Novel Master Interface with Robotic Assistant 67 3.1.4. Stereo Endoscope System 76 3.1.5. Novel Master Interface with Stereo Endoscope System 82 3.2. improved Novel Master Interface with Application Systems 87 3.2.1. improved Novel Master Interface 87 3.2.2. improved Novel Master Interface with Stereo Endoscope System 90 4. Discussion 91 5. Conclusion 102 References 105 Abstract in Korean 117Docto

Cable-driven parallel mechanisms for minimally invasive robotic surgery

Minimally invasive surgery (MIS) has revolutionised surgery by providing faster recovery times, less post-operative complications, improved cosmesis and reduced pain for the patient. Surgical robotics are used to further decrease the invasiveness of procedures, by using yet smaller and fewer incisions or using natural orifices as entry point. However, many robotic systems still suffer from technical challenges such as sufficient instrument dexterity and payloads, leading to limited adoption in clinical practice. Cable-driven parallel mechanisms (CDPMs) have unique properties, which can be used to overcome existing challenges in surgical robotics. These beneficial properties include high end-effector payloads, efficient force transmission and a large configurable instrument workspace. However, the use of CDPMs in MIS is largely unexplored. This research presents the first structured exploration of CDPMs for MIS and demonstrates the potential of this type of mechanism through the development of multiple prototypes: the ESD CYCLOPS, CDAQS, SIMPLE, neuroCYCLOPS and microCYCLOPS. One key challenge for MIS is the access method used to introduce CDPMs into the body. Three different access methods are presented by the prototypes. By focusing on the minimally invasive access method in which CDPMs are introduced into the body, the thesis provides a framework, which can be used by researchers, engineers and clinicians to identify future opportunities of CDPMs in MIS. Additionally, through user studies and pre-clinical studies, these prototypes demonstrate that this type of mechanism has several key advantages for surgical applications in which haptic feedback, safe automation or a high payload are required. These advantages, combined with the different access methods, demonstrate that CDPMs can have a key role in the advancement of MIS technology.Open Acces