A comprehensive review of haptic feedback in minimally invasive robotic liver surgery: Advancements and challenges

Background: Liver medical procedures are considered one of the most challenging because of the liver's complex geometry, heterogeneity, mechanical properties, and movement due to respiration. Haptic features integrated into needle insertion systems and other medical devices could support physicians but are uncommon. Additional training time and safety concerns make it difficult to implement in robot-assisted surgery. The main challenges of any haptic device in a teleoperated system are the stability and transparency levels required to develop a safe and efficient system that suits the physician's needs. Purpose: The objective of the review article is to investigate whether haptic-based teleoperation potentially improves the efficiency and safety of liver needle insertion procedures compared with insertion without haptic feedback. In addition, it looks into haptic technology that can be integrated into simulators to train novice physicians in liver procedures. Methods: This review presents the physician's needs during liver interventions and the consequent requirements of haptic features to help the physician. This paper provides an overview of the different aspects of a teleoperation system in various applications, especially in the medical field. It finally presents the state-of-the-art haptic technology in robot-assisted procedures for the liver. This includes 3D virtual models of the liver and force measurement techniques used in haptic rendering to estimate the real-time position of the surgical instrument relative to the liver. Results: Haptic feedback technology can be used to navigate the surgical tool through the desired trajectory to reach the target accurately and avoid critical regions. It also helps distinguish between various textures of liver tissue. Conclusion: Haptic feedback can complement the physician's experience to compensate for the lack of real-time imaging during Computed Tomography guided (CT-guided) liver procedures. Consequently, it helps the physician mitigate the destruction of healthy tissues and takes less time to reach the target.</p

Cutaneous Force Feedback as a Sensory Subtraction Technique in Haptics

A novel sensory substitution technique is presented. Kinesthetic and cutaneous force feedback are substituted by cutaneous feedback (CF) only, provided by two wearable devices able to apply forces to the index finger and the thumb, while holding a handle during a teleoperation task. The force pattern, fed back to the user while using the cutaneous devices, is similar, in terms of intensity and area of application, to the cutaneous force pattern applied to the finger pad while interacting with a haptic device providing both cutaneous and kinesthetic force feedback. The pattern generated using the cutaneous devices can be thought as a subtraction between the complete haptic feedback (HF) and the kinesthetic part of it. For this reason, we refer to this approach as sensory subtraction instead of sensory substitution. A needle insertion scenario is considered to validate the approach. The haptic device is connected to a virtual environment simulating a needle insertion task. Experiments show that the perception of inserting a needle using the cutaneous-only force feedback is nearly indistinguishable from the one felt by the user while using both cutaneous and kinesthetic feedback. As most of the sensory substitution approaches, the proposed sensory subtraction technique also has the advantage of not suffering from stability issues of teleoperation systems due, for instance, to communication delays. Moreover, experiments show that the sensory subtraction technique outperforms sensory substitution with more conventional visual feedback (VF)

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

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

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

A Review of Pneumatic Actuators Used for the Design of Medical Simulators and Medical Tools

International audienc

Design, Development, and Evaluation of a Teleoperated Master-Slave Surgical System for Breast Biopsy under Continuous MRI Guidance

The goal of this project is to design and develop a teleoperated master-slave surgical system that can potentially assist the physician in performing breast biopsy with a magnetic resonance imaging (MRI) compatible robotic system. MRI provides superior soft-tissue contrast compared to other imaging modalities such as computed tomography or ultrasound and is used for both diagnostic and therapeutic procedures. The strong magnetic field and the limited space inside the MRI bore, however, restrict direct means of breast biopsy while performing real-time imaging. Therefore, current breast biopsy procedures employ a blind targeting approach based on magnetic resonance (MR) images obtained a priori. Due to possible patient involuntary motion or inaccurate insertion through the registration grid, such approach could lead to tool tip positioning errors thereby affecting diagnostic accuracy and leading to a long and painful process, if repeated procedures are required. Hence, it is desired to develop the aforementioned teleoperation system to take advantages of real-time MR imaging and avoid multiple biopsy needle insertions, improving the procedure accuracy as well as reducing the sampling errors. The design, implementation, and evaluation of the teleoperation system is presented in this dissertation. A MRI-compatible slave robot is implemented, which consists of a 1 degree of freedom (DOF) needle driver, a 3-DOF parallel mechanism, and a 2-DOF X-Y stage. This slave robot is actuated with pneumatic cylinders through long transmission lines except the 1-DOF needle driver is actuated with a piezo motor. Pneumatic actuation through long transmission lines is then investigated using proportional pressure valves and controllers based on sliding mode control are presented. A dedicated master robot is also developed, and the kinematic map between the master and the slave robot is established. The two robots are integrated into a teleoperation system and a graphical user interface is developed to provide visual feedback to the physician. MRI experiment shows that the slave robot is MRI-compatible, and the ex vivo test shows over 85%success rate in targeting with the MRI-compatible robotic system. The success in performing in vivo animal experiments further confirm the potential of further developing the proposed robotic system for clinical applications

Robot Autonomy for Surgery

Autonomous surgery involves having surgical tasks performed by a robot operating under its own will, with partial or no human involvement. There are several important advantages of automation in surgery, which include increasing precision of care due to sub-millimeter robot control, real-time utilization of biosignals for interventional care, improvements to surgical efficiency and execution, and computer-aided guidance under various medical imaging and sensing modalities. While these methods may displace some tasks of surgical teams and individual surgeons, they also present new capabilities in interventions that are too difficult or go beyond the skills of a human. In this chapter, we provide an overview of robot autonomy in commercial use and in research, and present some of the challenges faced in developing autonomous surgical robots