Towards retrieving force feedback in robotic-assisted surgery: a supervised neuro-recurrent-vision approach

Robotic-assisted minimally invasive surgeries have gained a lot of popularity over conventional procedures as they offer many benefits to both surgeons and patients. Nonetheless, they still suffer from some limitations that affect their outcome. One of them is the lack of force feedback which restricts the surgeon's sense of touch and might reduce precision during a procedure. To overcome this limitation, we propose a novel force estimation approach that combines a vision based solution with supervised learning to estimate the applied force and provide the surgeon with a suitable representation of it. The proposed solution starts with extracting the geometry of motion of the heart's surface by minimizing an energy functional to recover its 3D deformable structure. A deep network, based on a LSTM-RNN architecture, is then used to learn the relationship between the extracted visual-geometric information and the applied force, and to find accurate mapping between the two. Our proposed force estimation solution avoids the drawbacks usually associated with force sensing devices, such as biocompatibility and integration issues. We evaluate our approach on phantom and realistic tissues in which we report an average root-mean square error of 0.02 N.Peer ReviewedPostprint (author's final draft

Control techniques for mechatronic assisted surgery

The treatment response for traumatic head injured patients can be improved by using an autonomous robotic system to perform basic, time-critical emergency neurosurgery, reducing costs and saving lives. In this thesis, a concept for a neurosurgical robotic system is proposed to perform three specific emergency neurosurgical procedures; they are the placement of an intracranial pressure monitor, external ventricular drainage, and the evacuation of chronic subdural haematoma. The control methods for this system are investigated following a curiosity led approach. Individual problems are interpreted in the widest sense and solutions posed that are general in nature. Three main contributions result from this approach: 1) a clinical evidence based review of surgical robotics and a methodology to assist in their evaluation, 2) a new controller for soft-grasping of objects, and 3) new propositions and theorems for chatter suppression sliding mode controllers. These contributions directly assist in the design of the control system of the neurosurgical robot and, more broadly, impact other areas outside the narrow con nes of the target application. A methodology for applied research in surgical robotics is proposed. The methodology sets out a hierarchy of criteria consisting of three tiers, with the most important being the bottom tier and the least being the top tier. It is argued that a robotic system must adhere to these criteria in order to achieve acceptability. Recent commercial systems are reviewed against these criteria, and are found to conform up to at least the bottom and intermediate tiers. However, the lack of conformity to the criteria in the top tier, combined with the inability to conclusively prove increased clinical benefit, particularly symptomatic benefit, is shown to be hampering the potential of surgical robotics in gaining wide establishment. A control scheme for soft-grasping objects is presented. Grasping a soft or fragile object requires the use of minimum contact force to prevent damage or deformation. Without precise knowledge of object parameters, real-time feedback control must be used to regulate the contact force and prevent slip. Moreover, the controller must be designed to have good performance characteristics to rapidly modulate the fingertip contact force in response to a slip event. A fuzzy sliding mode controller combined with a disturbance observer is proposed for contact force control and slip prevention. The robustness of the controller is evaluated through both simulation and experiment. The control scheme was found to be effective and robust to parameter uncertainty. When tested on a real system, however, chattering phenomena, well known to sliding mode research, was induced by the unmodelled suboptimal components of the system (filtering, backlash, and time delays). This reduced the controller performance. The problem of chattering and potential solutions are explored. Real systems using sliding mode controllers, such as the control scheme for soft-grasping, have a tendency to chatter at high frequencies. This is caused by the sliding mode controller interacting with un-modelled parasitic dynamics at the actuator-input and sensor-output of the plant. As a result, new chatter-suppression sliding mode controllers have been developed, which introduce new parameters into the system. However, the effect any particular choice of parameters has on system performance is unclear, and this can make tuning the parameters to meet a set of performance criteria di cult. In this thesis, common chatter-suppression sliding mode control strategies are surveyed and simple design and estimation methods are proposed. The estimation methods predict convergence, chattering amplitude, settling time, and maximum output bounds (overshoot) using harmonic linearizations and invariant ellipsoid sets

Estimating and understanding motion : from diagnostic to robotic surgery

Estimating and understanding motion from an image sequence is a central topic in computer vision. The high interest in this topic is because we are living in a world where many events that occur in the environment are dynamic. This makes motion estimation and understanding a natural component and a key factor in a widespread of applications including object recognition , 3D shape reconstruction, autonomous navigation and medica! diagnosis. Particularly, we focus on the medical domain in which understanding the human body for clinical purposes requires retrieving the organs' complex motion patterns, which is in general a hard problem when using only image data. In this thesis, we cope with this problem by posing the question - How to achieve a realistic motion estimation to offer a better clinical understanding? We focus this thesis on answering this question by using a variational formulation as a basis to understand one of the most complex motions in the human's body, the heart motion, through three different applications: (i) cardiac motion estimation for diagnostic, (ii) force estimation and (iii) motion prediction, both for robotic surgery. Firstly, we focus on a central topic in cardiac imaging that is the estimation of the cardiac motion. The main aim is to offer objective and understandable measures to physicians for helping them in the diagnostic of cardiovascular diseases. We employ ultrafast ultrasound data and tools for imaging motion drawn from diverse areas such as low-rank analysis and variational deformation to perform a realistic cardiac motion estimation. The significance is that by taking low-rank data with carefully chosen penalization, synergies in this complex variational problem can be created. We demonstrate how our proposed solution deals with complex deformations through careful numerical experiments using realistic and simulated data. We then move from diagnostic to robotic surgeries where surgeons perform delicate procedures remotely through robotic manipulators without directly interacting with the patients. As a result, they lack force feedback, which is an important primary sense for increasing surgeon-patient transparency and avoiding injuries and high mental workload. To solve this problem, we follow the conservation principies of continuum mechanics in which it is clear that the change in shape of an elastic object is directly proportional to the force applied. Thus, we create a variational framework to acquire the deformation that the tissues undergo due to an applied force. Then, this information is used in a learning system to find the nonlinear relationship between the given data and the applied force. We carried out experiments with in-vivo and ex-vivo data and combined statistical, graphical and perceptual analyses to demonstrate the strength of our solution. Finally, we explore robotic cardiac surgery, which allows carrying out complex procedures including Off-Pump Coronary Artery Bypass Grafting (OPCABG). This procedure avoids the associated complications of using Cardiopulmonary Bypass (CPB) since the heart is not arrested while performing the surgery on a beating heart. Thus, surgeons have to deal with a dynamic target that compromisetheir dexterity and the surgery's precision. To compensate the heart motion, we propase a solution composed of three elements: an energy function to estimate the 3D heart motion, a specular highlight detection strategy and a prediction approach for increasing the robustness of the solution. We conduct evaluation of our solution using phantom and realistic datasets. We conclude the thesis by reporting our findings on these three applications and highlight the dependency between motion estimation and motion understanding at any dynamic event, particularly in clinical scenarios.L’estimació i comprensió del moviment dins d’una seqüència d’imatges és un tema central en la visió per ordinador, el que genera un gran interès perquè vivim en un entorn ple d’esdeveniments dinàmics. Per aquest motiu és considerat com un component natural i factor clau dins d’un ampli ventall d’aplicacions, el qual inclou el reconeixement d’objectes, la reconstrucció de formes tridimensionals, la navegació autònoma i el diagnòstic de malalties. En particular, ens situem en l’àmbit mèdic en el qual la comprensió del cos humà, amb finalitats clíniques, requereix l’obtenció de patrons complexos de moviment dels òrgans. Aquesta és, en general, una tasca difícil quan s’utilitzen només dades de tipus visual. En aquesta tesi afrontem el problema plantejant-nos la pregunta - Com es pot aconseguir una estimació realista del moviment amb l’objectiu d’oferir una millor comprensió clínica? La tesi se centra en la resposta mitjançant l’ús d’una formulació variacional com a base per entendre un dels moviments més complexos del cos humà, el del cor, a través de tres aplicacions: (i) estimació del moviment cardíac per al diagnòstic, (ii) estimació de forces i (iii) predicció del moviment, orientant-se les dues últimes en cirurgia robòtica. En primer lloc, ens centrem en un tema principal en la imatge cardíaca, que és l’estimació del moviment cardíac. L’objectiu principal és oferir als metges mesures objectives i comprensibles per ajudar-los en el diagnòstic de les malalties cardiovasculars. Fem servir dades d’ultrasons ultraràpids i eines per al moviment d’imatges procedents de diverses àrees, com ara l’anàlisi de baix rang i la deformació variacional, per fer una estimació realista del moviment cardíac. La importància rau en que, en prendre les dades de baix rang amb una penalització acurada, es poden crear sinergies en aquest problema variacional complex. Mitjançant acurats experiments numèrics, amb dades realístiques i simulades, hem demostrat com les nostres propostes solucionen deformacions complexes. Després passem del diagnòstic a la cirurgia robòtica, on els cirurgians realitzen procediments delicats remotament, a través de manipuladors robòtics, sense interactuar directament amb els pacients. Com a conseqüència, no tenen la percepció de la força com a resposta, que és un sentit primari important per augmentar la transparència entre el cirurgià i el pacient, per evitar lesions i per reduir la càrrega de treball mental. Resolem aquest problema seguint els principis de conservació de la mecànica del medi continu, en els quals està clar que el canvi en la forma d’un objecte elàstic és directament proporcional a la força aplicada. Per això hem creat un marc variacional que adquireix la deformació que pateixen els teixits per l’aplicació d’una força. Aquesta informació s’utilitza en un sistema d’aprenentatge, per trobar la relació no lineal entre les dades donades i la força aplicada. Hem dut a terme experiments amb dades in-vivo i ex-vivo i hem combinat l’anàlisi estadístic, gràfic i de percepció que demostren la robustesa de la nostra solució. Finalment, explorem la cirurgia cardíaca robòtica, la qual cosa permet realitzar procediments complexos, incloent la cirurgia coronària sense bomba (off-pump coronary artery bypass grafting o OPCAB). Aquest procediment evita les complicacions associades a l’ús de circulació extracorpòria (Cardiopulmonary Bypass o CPB), ja que el cor no s’atura mentre es realitza la cirurgia. Això comporta que els cirurgians han de tractar amb un objectiu dinàmic que compromet la seva destresa i la precisió de la cirurgia. Per compensar el moviment del cor, proposem una solució composta de tres elements: un funcional d’energia per estimar el moviment tridimensional del cor, una estratègia de detecció de les reflexions especulars i una aproximació basada en mètodes de predicció, per tal d’augmentar la robustesa de la solució. L’avaluació de la nostra solució s’ha dut a terme mitjançant conjunts de dades sintètiques i realistes. La tesi conclou informant dels nostres resultats en aquestes tres aplicacions i posant de relleu la dependència entre l’estimació i la comprensió del moviment en qualsevol esdeveniment dinàmic, especialment en escenaris clínics.Postprint (published version

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

Activity profiling for minimally invasive surgery

Imperial Users onl

Impact of Ear Occlusion on In-Ear Sounds Generated by Intra-oral Behaviors

We conducted a case study with one volunteer and a recording setup to detect sounds induced by the actions: jaw clenching, tooth grinding, reading, eating, and drinking. The setup consisted of two in-ear microphones, where the left ear was semi-occluded with a commercially available earpiece and the right ear was occluded with a mouldable silicon ear piece. Investigations in the time and frequency domains demonstrated that for behaviors such as eating, tooth grinding, and reading, sounds could be recorded with both sensors. For jaw clenching, however, occluding the ear with a mouldable piece was necessary to enable its detection. This can be attributed to the fact that the mouldable ear piece sealed the ear canal and isolated it from the environment, resulting in a detectable change in pressure. In conclusion, our work suggests that detecting behaviors such as eating, grinding, reading with a semi-occluded ear is possible, whereas, behaviors such as clenching require the complete occlusion of the ear if the activity should be easily detectable. Nevertheless, the latter approach may limit real-world applicability because it hinders the hearing capabilities.</p

Expert-in-the-Loop Multilateral Telerobotics for Haptics-Enabled Motor Function and Skills Development

Among medical robotics applications are Robotics-Assisted Mirror Rehabilitation Therapy (RAMRT) and Minimally-Invasive Surgical Training (RAMIST) that extensively rely on motor function development. Haptics-enabled expert-in-the-loop motor function development for such applications is made possible through multilateral telerobotic frameworks. While several studies have validated the benefits of haptic interaction with an expert in motor learning, contradictory results have also been reported. This emphasizes the need for further in-depth studies on the nature of human motor learning through haptic guidance and interaction. The objective of this study was to design and evaluate expert-in-the-loop multilateral telerobotic frameworks with stable and human-safe control loops that enable adaptive “hand-over-hand” haptic guidance for RAMRT and RAMIST. The first prerequisite for such frameworks is active involvement of the patient or trainee, which requires the closed-loop system to remain stable in the presence of an adaptable time-varying dominance factor. To this end, a wave-variable controller is proposed in this study for conventional trilateral teleoperation systems such that system stability is guaranteed in the presence of a time-varying dominance factor and communication delay. Similar to other wave-variable approaches, the controller is initially developed for the Velocity-force Domain (VD) based on the well-known passivity assumption on the human arm in VD. The controller can be applied straightforwardly to the Position-force Domain (PD), eliminating position-error accumulation and position drift, provided that passivity of the human arm in PD is addressed. However, the latter has been ignored in the literature. Therefore, in this study, passivity of the human arm in PD is investigated using mathematical analysis, experimentation as well as user studies involving 12 participants and 48 trials. The results, in conjunction with the proposed wave-variables, can be used to guarantee closed-loop PD stability of the supervised trilateral teleoperation system in its classical format. The classic dual-user teleoperation architecture does not, however, fully satisfy the requirements for properly imparting motor function (skills) in RAMRT (RAMIST). Consequently, the next part of this study focuses on designing novel supervised trilateral frameworks for providing motor learning in RAMRT and RAMIST, each customized according to the requirements of the application. The framework proposed for RAMRT includes the following features: a) therapist-in-the-loop mirror therapy; b) haptic feedback to the therapist from the patient side; c) assist-as-needed therapy realized through an adaptive Guidance Virtual Fixture (GVF); and d) real-time task-independent and patient-specific motor-function assessment. Closed-loop stability of the proposed framework is investigated using a combination of the Circle Criterion and the Small-Gain Theorem. The stability analysis addresses the instabilities caused by: a) communication delays between the therapist and the patient, facilitating haptics-enabled tele- or in-home rehabilitation; and b) the integration of the time-varying nonlinear GVF element into the delayed system. The platform is experimentally evaluated on a trilateral rehabilitation setup consisting of two Quanser rehabilitation robots and one Quanser HD2 robot. The framework proposed for RAMIST includes the following features: a) haptics-enabled expert-in-the-loop surgical training; b) adaptive expertise-oriented training, realized through a Fuzzy Interface System, which actively engages the trainees while providing them with appropriate skills-oriented levels of training; and c) task-independent skills assessment. Closed-loop stability of the architecture is analyzed using the Circle Criterion in the presence and absence of haptic feedback of tool-tissue interactions. In addition to the time-varying elements of the system, the stability analysis approach also addresses communication delays, facilitating tele-surgical training. The platform is implemented on a dual-console surgical setup consisting of the classic da Vinci surgical system (Intuitive Surgical, Inc., Sunnyvale, CA), integrated with the da Vinci Research Kit (dVRK) motor controllers, and the dV-Trainer master console (Mimic Technology Inc., Seattle, WA). In order to save on the expert\u27s (therapist\u27s) time, dual-console architectures can also be expanded to accommodate simultaneous training (rehabilitation) for multiple trainees (patients). As the first step in doing this, the last part of this thesis focuses on the development of a multi-master/single-slave telerobotic framework, along with controller design and closed-loop stability analysis in the presence of communication delays. Various parts of this study are supported with a number of experimental implementations and evaluations. The outcomes of this research include multilateral telerobotic testbeds for further studies on the nature of human motor learning and retention through haptic guidance and interaction. They also enable investigation of the impact of communication time delays on supervised haptics-enabled motor function improvement through tele-rehabilitation and mentoring

Advanced Strategies for Robot Manipulators

Amongst the robotic systems, robot manipulators have proven themselves to be of increasing importance and are widely adopted to substitute for human in repetitive and/or hazardous tasks. Modern manipulators are designed complicatedly and need to do more precise, crucial and critical tasks. So, the simple traditional control methods cannot be efficient, and advanced control strategies with considering special constraints are needed to establish. In spite of the fact that groundbreaking researches have been carried out in this realm until now, there are still many novel aspects which have to be explored