An Introduction to Robotically Assisted Surgical Systems: Current Developments and Focus Areas of Research

Robotic assistance systems for diagnosis and therapy have become technically mature and widely available. Thus, they play an increasingly important role in patient care. This paper provides an overview of the general concepts of robotically assisted surgical systems, briefly revisiting historical and current developments in the surgical robotics market and discussing current focus areas of research. Comprehensiveness cannot be achieved in this format, but besides the general overview, references to further readings and more comprehensive reviews with regard to particular aspects are given. Therefore, the work at hand is considered as an introductory paper into the topic and especially addresses investigators, researchers, medical device manufacturers, and clinicians, who are new to this field

A Robotic System for Solo Surgery in Flexible Ureterorenoscopy

Urolithiasis is a common disease with increasing prevalence across all ages. A common treatment option for smaller kidney stones is flexible ureterorenoscopy (fURS), where a flexible ureteroscope (FU) is used for stone removal and to inspect the renal collecting system. The handling of the flexible ureteroscope and end effectors (EEs), however, is challenging and requires two surgeons. In this article, we introduce a modular robotic system for endoscope manipulation, which enables solo surgery (SSU) and is adaptable to various hand-held FUs. Both the developed hardware components and the proposed workflow and its representation in software are described. We then present and discuss the results of an initial user study. Finally, we describe subsequent developmental steps towards more extensive testing by clinical staff

DLR MIDAS: A Transport and Docking Device for the DLR MiroSurge System for Minimally Invasive Robotic Surgery

Light-weight surgical robots like the DLR MIRO can be mounted on the side rails of the surgical table. Using this normed mechanical interface reduces the introduction costs and enhances the flexibility of robotic systems in surgery. Lifting the robot arms manually on the side rails and fixate them there, however, is arduous for the OR staff and bears the risk of accidentally dropping the robot. The DLR MIDAS is a manually driven transport and docking device for up to four MIRO robot arms. Its design guarantees a safe transfer of the robot arms from the transport cart to the side rails of the surgical table and vice versa: During the whole docking procedure the robot is connected to the cart or to the side rails

Konzeption und Entwicklung eines Transport- und Dockingsystem für Medizinroboter im Operationssaal

The Robotics and Mechatronics Center (RMC) of the German Aerospace Center (DLR) has developed MIRO, a new lightweight robot for surgery. The existing prototypes are optimized for minimal invasive surgery, but since flexibility was one of the central aims during the design process they can easily be adapted to a wide range of different medical procedures by using specialized instruments. In this work, a transportation and docking-system for up to four MIRO robots was developed. It should be able to position the robot arms based on a preoperative planning correctly at the side rails of the operating table. At the same time it should offer the possibility to serve as stand for one to four robots during surgery. First of all the requirements for such a system were collected from different sources: the organization of a typical operating room, the clinical workflow, the Medical Devices Act (MPG) and ergonomics. The received results were organized in a requirement list. Subsequently the central functions and structures of the system were identified based on this list. As fulfilling all the requirements in one system would have resulted in a very high complexity and size, it was decided to develop two independent systems: The support-system Maia, which can serve as base for the MIROs during the operation, and the transport- and docking-system Revolver, from which the robot arms can be transferred to the side rails of the operating table. Since it does not have to keep the robots in position during the operation, Revolver can be designed significantly slighter and lighter than Maia. Adjacently the solution principles for the most important functions of these two systems were determined. Wherever it was possible and reasonable, commercially available solutions were used. Afterwards the different modules of Maia and Revolver were constructed, assembled and optimized in PRO/ENGINEER. All necessary data for the building of the two systems (drawings, list of parts etc.) was created and composed. Finally the fulfilling of the requirements list was checked and possible improvements for both systems were investigated and assessed

Robot Integrated User Interface for Physical Interaction with the DLR MIRO in Versatile Medical Procedures

To enhance the capability of the DLR MIRO for physical human robot interaction (pHRI), six buttons were integrated as additional input interface along the robot structure. A ring of eight RGB-LEDs at the instrument interface informs the user as additional output interface about the robot's state. The mechatronic design, which is transferable to other robots, adapts to the existing communication infrastructure of the robot and therefore offers real-time capability. Besides the interaction with the robot itself, it also allows the control of third party devices connected to its communication network. Both interfaces can be flexibly programmed e.g. in C++ or Simulink

Design of a robotic instrument for minimally invasive waterjet surgery

Using a pressurized waterjet for cutting or abrasing tissue is a well established method in surgery. This paper presents a robotic tool for minimally invasive waterjet surgery with two degrees of freedom, integrated suction and an optional splash protection. The function of the tool and the effect of the splash protection on the suction of the applicated water was successfully evaluated in tests with ballistic gelatine. Based on this evaluated design, a concept for further increasing the oscillation frequency of the instrument tip is introduced and the results of preliminary tests of a simplified mockup are shown

Adaption of the DLR MiroSurge System's Kinematics to Surgical Table Based Patient Repositioning in Minimally Invasive Surgery

In the context of minimally invasive surgery, an intraoperative repositioning of the patient may be required. Usually this is done by means of electrically actuated surgical tables. The well introduced DLR MIRO robots of the DLR MiroSurge system can be mounted to the side rails of surgical tables due to their light weight structure. In this case, however, the poses of the robot bases change with respect to each other depending on the table configuration. This paper addresses maintenance of fulcrum point, instrument tool center point (TCP), and hand-eye coordination despite variable robot bases to enhance the practical use of the MiroSurge system. Experimental results were verified with optical measuring methods, showing encouraging results

Robotische Assistenzsysteme für die Chirurgie - Aktuelle Entwicklungen und Schwerpunkte der Forschung

Da robotische Systeme mittlerweile technisch ausgereift und breit verfügbar sind, spielen sie auch im klinischen Umfeld eine immer wichtigere Rolle. So zeigen zahlreiche robotische Assistenzsysteme für Diagnose und Therapie ihr Potenzial zur Unterstützung der Patientenversorgung. Dieser Artikel beschreibt, nach einer kurzen Betrachtung der Historie, derzeit verfügbare robotische Assistenzsysteme für die Chirurgie, insbesondere mit Ursprung in Deutschland und Europa, sowie aktuelle Forschungsschwerpunkte. Darüber hinaus werden Herausforderungen in diesem Bereich sowie auch Möglichkeiten zu einer engen, aktiven und interdisziplinären Zusammenarbeit der Stakeholder aus Klinik, Industrie und Wissenschaft zur Bewältigung dergleichen vorgestellt