Haptic Training Simulator for Pedicle Screw Insertion in Scoliosis Surgery

This thesis develops a haptic training simulator that imitates the sensations experienced by a surgeon in pedicle screw insertions in a scoliosis surgery. Pedicle screw insertion is a common treatment for fixing spinal deformities in idiopathic scoliosis. Surgeons using the free hand technique are guided primarily by haptic feedback. A vital step in this free hand technique is the use of a probe to make a channel through the vertebrae pedicle. This is a sensitive process which carries risk of serious mechanical, neurological and vascular complications. Surgeons are currently trained using cadavers or live patients. Cadavers often have vertebrae that are softer than the real surgeons would typically encounter, while training on live patients carries the obvious issue of increased risk of complications to the patient. In this thesis, a haptic virtual reality simulator is designed and studied as a training tool for surgeons in this procedure. Creating a pathway through the pedicle by the free-hand technique is composed of two main degrees of freedom: rotation and linear progression. The rotary stage of the device which was developed by a previous student, is enhanced in this research by adding hardware, improving the haptic model and proposing techniques to couple the rotary and linear degree of freedom. Haptic model parameters for a spine surgery with normal bone density are then clinically tuned within a user study. Over ten surgeons of varying experience levels used the simulator and were able to change various parameters in order to tune the simulator to what felt most realistic. The surgeons also evaluated the simulator for its feasibility and usefulness. Four research questions were investigated. First, can a reference set of values be found that replicate the surgeon's interpretation of the surgical scenario? Second, how are the rotary stage parameters influenced in the presence of linear effects? Third, do the results differ across different expertise levels? Finally, can the simulator serve as a useful tool in the education of surgical trainees for teaching channel creation in pedicle screw insertion? Statistical analysis are carried out to examine the research questions. The results indicates the feasibility of the simulator for surgical education

Conception of a simulator for a TEL system in orthopaedic surgery.

Within a research project whose aim is to promote the learning of percutaneous operation in orthopedic surgery, we investigate some representation models of empirical, deductive, and perceptivo-gestural knowledge. From these models, we design an TEL system (Tecnological Enhaced Learning) This project belongs to a multidisciplinary field including computer, orthopedic surgery, medical imaging, didactic and cognitive sciences. The article presents the design principles of TEL with a particular interest in the development of a simulator. This simulator allows a virtual exercise interacting with the learner in visual, temporal and haptic dimension

Augmented reality (AR) for surgical robotic and autonomous systems: State of the art, challenges, and solutions

Despite the substantial progress achieved in the development and integration of augmented reality (AR) in surgical robotic and autonomous systems (RAS), the center of focus in most devices remains on improving end-effector dexterity and precision, as well as improved access to minimally invasive surgeries. This paper aims to provide a systematic review of different types of state-of-the-art surgical robotic platforms while identifying areas for technological improvement. We associate specific control features, such as haptic feedback, sensory stimuli, and human-robot collaboration, with AR technology to perform complex surgical interventions for increased user perception of the augmented world. Current researchers in the field have, for long, faced innumerable issues with low accuracy in tool placement around complex trajectories, pose estimation, and difficulty in depth perception during two-dimensional medical imaging. A number of robots described in this review, such as Novarad and SpineAssist, are analyzed in terms of their hardware features, computer vision systems (such as deep learning algorithms), and the clinical relevance of the literature. We attempt to outline the shortcomings in current optimization algorithms for surgical robots (such as YOLO and LTSM) whilst providing mitigating solutions to internal tool-to-organ collision detection and image reconstruction. The accuracy of results in robot end-effector collisions and reduced occlusion remain promising within the scope of our research, validating the propositions made for the surgical clearance of ever-expanding AR technology in the future

Flexible robotic device for spinal surgery

Surgical robots have proliferated in recent years, with well-established benefits including: reduced patient trauma, shortened hospitalisation, and improved diagnostic accuracy and therapeutic outcome. Despite these benefits, many challenges in their development remain, including improved instrument control and ergonomics caused by rigid instrumentation and its associated fulcrum effect. Consequently, it is still extremely challenging to utilise such devices in cases that involve complex anatomical pathways such as the spinal column. The focus of this thesis is the development of a flexible robotic surgical cutting device capable of manoeuvring around the spinal column. The target application of the flexible surgical tool is the removal of cancerous tumours surrounding the spinal column, which cannot be excised completely using the straight surgical tools in use today; anterior and posterior sections of the spine must be accessible for complete tissue removal. A parallel robot platform with six degrees of freedom (6 DoFs) has been designed and fabricated to direct a flexible cutting tool to produce the necessary range of movements to reach anterior and posterior sections of the spinal column. A flexible water jet cutting system and a flexible mechanical drill, which may be assembled interchangeably with the flexible probe, have been developed and successfully tested experimentally. A model predicting the depth of cut by the water jet was developed and experimentally validated. A flexion probe that is able to guide the surgical cutting device around the spinal column has been fabricated and tested with human lumber model. Modelling and simulations show the capacity for the flexible surgical system to enable entering the posterior side of the human lumber model and bend around the vertebral body to reach the anterior side of the spinal column. A computer simulation with a full Graphical User Interface (GUI) was created and used to validate the system of inverse kinematic equations for the robot platform. The constraint controller and the inverse kinematics relations are both incorporated into the overall positional control structure of the robot, and have successfully established a haptic feedback controller for the 6 DoFs surgical probe, and effectively tested in vitro on spinal mock surgery. The flexible surgical system approached the surgery from the posterior side of the human lumber model and bend around the vertebral body to reach the anterior side of the spinal column. The flexible surgical robot removed 82% of mock cancerous tissue compared to 16% of tissue removed by the rigid tool.Open Acces

Recent Advancements in Augmented Reality for Robotic Applications: A Survey

Robots are expanding from industrial applications to daily life, in areas such as medical robotics, rehabilitative robotics, social robotics, and mobile/aerial robotics systems. In recent years, augmented reality (AR) has been integrated into many robotic applications, including medical, industrial, human–robot interactions, and collaboration scenarios. In this work, AR for both medical and industrial robot applications is reviewed and summarized. For medical robot applications, we investigated the integration of AR in (1) preoperative and surgical task planning; (2) image-guided robotic surgery; (3) surgical training and simulation; and (4) telesurgery. AR for industrial scenarios is reviewed in (1) human–robot interactions and collaborations; (2) path planning and task allocation; (3) training and simulation; and (4) teleoperation control/assistance. In addition, the limitations and challenges are discussed. Overall, this article serves as a valuable resource for working in the field of AR and robotic research, offering insights into the recent state of the art and prospects for improvement

Haptics-based Modeling and Simulation of Micro-Implants Surgery

Ph.DDOCTOR OF PHILOSOPH

Augmented Reality (AR) for Surgical Robotic and Autonomous Systems: State of the Art, Challenges, and Solutions

Despite the substantial progress achieved in the development and integration of augmented reality (AR) in surgical robotic and autonomous systems (RAS), the center of focus in most devices remains on improving end-effector dexterity and precision, as well as improved access to minimally invasive surgeries. This paper aims to provide a systematic review of different types of state-of-the-art surgical robotic platforms while identifying areas for technological improvement. We associate specific control features, such as haptic feedback, sensory stimuli, and human–robot collaboration, with AR technology to perform complex surgical interventions for increased user perception of the augmented world. Current researchers in the field have, for long, faced innumerable issues with low accuracy in tool placement around complex trajectories, pose estimation, and difficulty in depth perception during two-dimensional medical imaging. A number of robots described in this review, such as Novarad and SpineAssist, are analyzed in terms of their hardware features, computer vision systems (such as deep learning algorithms), and the clinical relevance of the literature. We attempt to outline the shortcomings in current optimization algorithms for surgical robots (such as YOLO and LTSM) whilst providing mitigating solutions to internal tool-to-organ collision detection and image reconstruction. The accuracy of results in robot end-effector collisions and reduced occlusion remain promising within the scope of our research, validating the propositions made for the surgical clearance of ever-expanding AR technology in the future

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

Investigation of a holistic human-computer interaction (HCI) framework to support the design of extended reality (XR) based training simulators

In recent years, the use of Extended Reality (XR) based simulators for training has increased rapidly. In this context, there is a need to explore novel HCI-based approaches to design more effective 3D training environments. A major impediment in this research area is the lack of an HCI-based framework that is holistic and serves as a foundation to integrate the design and assessment of HCI-based attributes such as affordance, cognitive load, and user-friendliness. This research addresses this need by investigating the creation of a holistic framework along with a process for designing, building, and assessing training simulators using such a framework as a foundation. The core elements of the proposed framework include the adoption of participatory design principles, the creation of information-intensive process models of target processes (relevant to the training activities), and design attributes related to affordance and cognitive load. A new attribute related to affordance of 3D scenes is proposed (termed dynamic affordance) and its role in impacting user comprehension in data-rich 3D training environments is studied. The framework is presented for the domain of orthopedic surgery. Rigorous user-involved assessment of the framework and simulation approach has highlighted the positive impact of the HCI-based framework and attributes on the acquisition of skills and knowledge by healthcare users