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

Autofluorescence lifetime augmented reality as a means for real-time robotic surgery guidance in human patients.

Due to loss of tactile feedback the assessment of tumor margins during robotic surgery is based only on visual inspection, which is neither significantly sensitive nor specific. Here we demonstrate time-resolved fluorescence spectroscopy (TRFS) as a novel technique to complement the visual inspection of oral cancers during transoral robotic surgery (TORS) in real-time and without the need for exogenous contrast agents. TRFS enables identification of cancerous tissue by its distinct autofluorescence signature that is associated with the alteration of tissue structure and biochemical profile. A prototype TRFS instrument was integrated synergistically with the da Vinci Surgical robot and the combined system was validated in swine and human patients. Label-free and real-time assessment and visualization of tissue biochemical features during robotic surgery procedure, as demonstrated here, not only has the potential to improve the intraoperative decision making during TORS but also other robotic procedures without modification of conventional clinical protocols

Optical coherence tomography-based consensus definition for lamellar macular hole.

BackgroundA consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed.MethodsThe panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions.ResultsThe panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle's fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness.ConclusionsThe use of the proposed definitions may provide uniform language for clinicians and future research

State of the art of robotic surgery related to vision: Brain and eye applications of newly available devices

Raffaele Nuzzi, Luca Brusasco Department of Surgical Sciences, Eye Clinic, University of Torino, Turin, Italy Background: Robot-assisted surgery has revolutionized many surgical subspecialties, mainly where procedures have to be performed in confined, difficult to visualize spaces. Despite advances in general surgery and neurosurgery, in vivo application of robotics to ocular surgery is still in its infancy, owing to the particular complexities of microsurgery. The use of robotic assistance and feedback guidance on surgical maneuvers could improve the technical performance of expert surgeons during the initial phase of the learning curve. Evidence acquisition: We analyzed the advantages and disadvantages of surgical robots, as well as the present applications and future outlook of robotics in neurosurgery in brain areas related to vision and ophthalmology. Discussion: Limitations to robotic assistance remain, that need to be overcome before it can be more widely applied in ocular surgery. Conclusion: There is heightened interest in studies documenting computerized systems that filter out hand tremor and optimize speed of movement, control of force, and direction and range of movement. Further research is still needed to validate robot-assisted procedures. Keywords: robotic surgery related to vision, robots, ophthalmological applications of robotics, eye and brain robots, eye robot

Development of an intelligent object for grasp and manipulation research

Kõiva R, Haschke R, Ritter H. Development of an intelligent object for grasp and manipulation research. Presented at the ICAR 2011, Tallinn, Estonia.In this paper we introduce a novel device, called iObject, which is equipped with tactile and motion tracking sensors that allow for the evaluation of human and robot grasping and manipulation actions. Contact location and contact force, object acceleration in space (6D) and orientation relative to the earth (3D magnetometer) are measured and transmitted wirelessly over a Bluetooth connection. By allowing human-human, human-robot and robot-robot comparisons to be made, iObject is a versatile tool for studying manual interaction. To demonstrate the efficiency and flexibility of iObject for the study of bimanual interactions, we report on a physiological experiment and evaluate the main parameters of the considered dual-handed manipulation task

Scalability study for robotic hand platform

The goal of this thesis project was to determine the lower limit of scale for the RIT robotic grasping hand. This was accomplished using a combination of computer simulation and experimental studies. A force analysis was conducted to determine the size of air muscles required to achieve appropriate contact forces at a smaller scale. Input variables, such as the actuation force and tendon return force, were determined experimentally. A dynamic computer model of the hand system was then created using Recurdyn. This was used to predict the contact (grasping) force of the fingers at full-scale, half-scale, and quarter-scale. Correlation between the computer model and physical testing was achieved for both a life-size and half-scale finger assembly. To further demonstrate the scalability of the hand design, both half and quarter-scale robotic hand rapid prototype assemblies were built using 3D printing techniques. This thesis work identified the point where further miniaturization would require a change in the manufacturing process to micro-fabrication. Several techniques were compared as potential methods for making a production intent quarter-scale robotic hand. Investment casting, Swiss machining, and Selective Laser Sintering were the manufacturing techniques considered. A quarter-scale robotic hand tested the limits of each technology. Below this scale, micro-machining would be required. The break point for the current actuation method, air muscles, was also explored. Below the quarter-scale, an alternative actuation method would also be required. Electroactive Polymers were discussed as an option for the micro-scale. In summary, a dynamic model of the RIT robotic grasping hand was created and validated as scalable at full and half-scales. The model was then used to predict finger contact forces at the quarter-scale. The quarter-scale was identified as the break point in terms of the current RIT robotic grasping hand based on both manufacturing and actuation. A novel, prototype quarter-scale robotic hand assembly was successfully built by an additive manufacturing process, a high resolution 3D printer. However, further miniaturization would require alternate manufacturing techniques and actuation mechanisms

Feasibility study of a hand guided robotic drill for cochleostomy

The concept of a hand guided robotic drill has been inspired by an automated, arm supported robotic drill recently applied in clinical practice to produce cochleostomies without penetrating the endosteum ready for inserting cochlear electrodes. The smart tactile sensing scheme within the drill enables precise control of the state of interaction between tissues and tools in real-time. This paper reports development studies of the hand guided robotic drill where the same consistent outcomes, augmentation of surgeon control and skill, and similar reduction of induced disturbances on the hearing organ are achieved. The device operates with differing presentation of tissues resulting from variation in anatomy and demonstrates the ability to control or avoid penetration of tissue layers as required and to respond to intended rather than involuntary motion of the surgeon operator. The advantage of hand guided over an arm supported system is that it offers flexibility in adjusting the drilling trajectory. This can be important to initiate cutting on a hard convex tissue surface without slipping and then to proceed on the desired trajectory after cutting has commenced. The results for trials on phantoms show that drill unit compliance is an important factor in the design