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

Autonomy in surgical robots and its meaningful human control

AbstractThis article focuses on ethical issues raised by increasing levels of autonomy for surgical robots. These ethical issues are explored mainly by reference to state-ofart case studies and imminent advances in Minimally Invasive Surgery (MIS) and Microsurgery. In both area, surgicalworkspace is limited and the required precision is high. For this reason, increasing levels of robotic autonomy can make a significant difference there, and ethically justified control sharing between humans and robots must be introduced. In particular, from a responsibility and accountability perspective suitable policies for theMeaningfulHuman Control (MHC) of increasingly autonomous surgical robots are proposed. It is highlighted how MHC should be modulated in accordance with various levels of autonomy for MIS and Microsurgery robots. Moreover, finer MHC distinctions are introduced to deal with contextual conditions concerning e.g. soft or rigid anatomical environments

Factors of Micromanipulation Accuracy and Learning

Micromanipulation refers to the manipulation under a microscope in order to perform delicate procedures. It is difficult for humans to manipulate objects accurately under a microscope due to tremor and imperfect perception, limiting performance. This project seeks to understand factors affecting accuracy in micromanipulation, and to propose strategies for learning improving accuracy. Psychomotor experiments were conducted using computer-controlled setups to determine how various feedback modalities and learning methods can influence micromanipulation performance. In a first experiment, static and motion accuracy of surgeons, medical students and non-medical students under different magniification levels and grip force settings were compared. A second experiment investigated whether the non-dominant hand placed close to the target can contribute to accurate pointing of the dominant hand. A third experiment tested a training strategy for micromanipulation using unstable dynamics to magnify motion error, a strategy shown to be decreasing deviation in large arm movements. Two virtual reality (VR) modules were then developed to train needle grasping and needle insertion tasks, two primitive tasks in a microsurgery suturing procedure. The modules provided the trainee with a visual display in stereoscopic view and information on their grip, tool position and angles. Using the VR module, a study examining effects of visual cues was conducted to train tool orientation. Results from these studies suggested that it is possible to learn and improve accuracy in micromanipulation using appropriate sensorimotor feedback and training

Vision-Based Autonomous Control in Robotic Surgery

Robotic Surgery has completely changed surgical procedures. Enhanced dexterity, ergonomics, motion scaling, and tremor filtering, are well-known advantages introduced with respect to classical laparoscopy. In the past decade, robotic plays a fundamental role in Minimally Invasive Surgery (MIS) in which the da Vinci robotic system (Intuitive Surgical Inc., Sunnyvale, CA) is the most widely used system for robot-assisted laparoscopic procedures. Robots also have great potentiality in Microsurgical applications, where human limits are crucial and surgical sub-millimetric gestures could have enormous benefits with motion scaling and tremor compensation. However, surgical robots still lack advanced assistive control methods that could notably support surgeon's activity and perform surgical tasks in autonomy for a high quality of intervention. In this scenario, images are the main feedback the surgeon can use to correctly operate in the surgical site. Therefore, in view of the increasing autonomy in surgical robotics, vision-based techniques play an important role and can arise by extending computer vision algorithms to surgical scenarios. Moreover, many surgical tasks could benefit from the application of advanced control techniques, allowing the surgeon to work under less stressful conditions and performing the surgical procedures with more accuracy and safety. The thesis starts from these topics, providing surgical robots the ability to perform complex tasks helping the surgeon to skillfully manipulate the robotic system to accomplish the above requirements. An increase in safety and a reduction in mental workload is achieved through the introduction of active constraints, that can prevent the surgical tool from crossing a forbidden region and similarly generate constrained motion to guide the surgeon on a specific path, or to accomplish robotic autonomous tasks. This leads to the development of a vision-based method for robot-aided dissection procedure allowing the control algorithm to autonomously adapt to environmental changes during the surgical intervention using stereo images elaboration. Computer vision is exploited to define a surgical tools collision avoidance method that uses Forbidden Region Virtual Fixtures by rendering a repulsive force to the surgeon. Advanced control techniques based on an optimization approach are developed, allowing multiple tasks execution with task definition encoded through Control Barrier Functions (CBFs) and enhancing haptic-guided teleoperation system during suturing procedures. The proposed methods are tested on a different robotic platform involving da Vinci Research Kit robot (dVRK) and a new microsurgical robotic platform. Finally, the integration of new sensors and instruments in surgical robots are considered, including a multi-functional tool for dexterous tissues manipulation and different visual sensing technologies

Design and control of a parallel linkage wrist for robotic microsurgery

This paper presents the design and control of a teleoperated robotic system for dexterous micromanipulation tasks at the meso-scale, specifically open microsurgery. Robotic open microsurgery is an unexplored yet potentially a high impact area of surgical robotics. Microsurgical operations, such as microanastomosis of blood vessels and reattachment of nerve fibers, require high levels of manual dexterity and accuracy that surpass human capabilities. A 3-DoF robotic wrist is designed and built based on a spherical five-bar mechanism. The wrist is attached to a 3-axis commercial off-the-shelf linear stage, achieving a fully dexterous system. Design requirements are determined using motion data collected during a simulated microanastomosis operation. The wrist design is optimized to maximize workspace and manipulability. The system is teleoperated using a haptic device, and has the required bandwidth to replicate microsurgical motions. The system was successfully used in a micromanipulation task to stack 1 mm-diameter metal spheres. The micromanipulation system presented here may improve surgical outcomes during open microsurgery by offering better accuracy and dexterity to surgeons.Engineering and Applied Science

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