Objektív sebészet – robotok és szimulátorok használata a sebészeti képességek felmérésére

A laparoscopos sebészet sikerességére alapozva a robotsebészet az egyik legmeghatározóbb irányzattá vált a nyugati ellátásban, elsősorban a hasi beavatkozások tekintetében. Míg a kézi laparoscopos eljárások elsajátítása hosszú és fáradsá- gos feladat, a da Vinci típusú robotizált alkalmazások számos intuitív vezérlési és ergonómiai funkciót kínálnak. Mindkét esetben alapvető fontosságú, hogy a sebészek valós technikai képességeivel, készségeivel tisztában legyünk. A robotizált sebészeti eszközök használata radikálisan új mérési módszereket tesz lehetővé a műtéti folyamatok számos paraméterét tekintve, amely alapján új tananyagok és vizsgáztatási módszerek kerültek kidolgozásra. Ezek forradalmasíthatják a laparoscopos sebészet oktatását, hiszen objektív kritériumrendszer bevezetését teszik lehetővé. A robotos környezetben és szimulátorokon alkalmazott alapvető metrikákat és módszereket viszi végig ez a cikk, részletesen kitérve az egyes módszerek validáltságára és hasznosságára. Az elkövetkező pár évben várhatóan ezek fogják meghatározni a modern laparoscopos sebészeti képzések összetételét

Infrastructural Requirements and Regulatory Challenges of a Sustainable Urban Air Mobility Ecosystem

The United Nations has long put on the discussion agenda the sustainability challenges of ur- banization, which have both direct and indirect effects on future regulation strategies. Undoubtedly, most initiatives target better quality of life, improved access to services & goods and environment pro- tection. As commercial aerial urban transportation may become a feasible research goal in the near future, the connection possibilities between cities and regions scale up. It is expected that the growing number of vertical takeoff & landing vehicles used for passenger and goods transportation will change the infrastructure of the cities, and will have a significant effect on the cityscapes as well. In addition to the widely discussed regulatory and safety issues, the introduction of elevated traffic also raises environmental concerns, which influences the existing and required service and control infrastructure, and thus significantly affects sustainability. This paper provides narrated overview of the most common aspects of safety, licensing and regulations for passenger vertical takeoff & landing vehicles, and highlights the most important aspects of infrastructure planning, design and operation, which should be taken into account to maintain and efficiently operate this new way of transportation, leading to a sustainable urban air mobility ecosystem

Autonomous Applied Robotics: Ultrasound-Based Robot-Assisted Needle Insertion System Concept and Development

Ultrasound (US) is a popular imaging modality for image-guided minimally invasive surgery (MIS), enabling the faster and more reliable execution of numerous procedures, such as biopsy, electrode placement and vessel cannulation. Blood vessel cannulation is a common, routine intervention, e.g., for blood oxygen level testing. Yet, in particular cases, when the vessel is located deep or veins less stable (with the loss of subcutaneous tissue), it is hard to complete it without US assistance. In this paper, we present a solution for US-guided, robot-assisted needle insertion for vein cannulation. We developed an image-guided system to aid needle insertion via active targeting and anatomy-relevant positioning, together with safeguarding features, such as a kinematically enforced Remote Center of Motion (RCM) mechanism. The proposed system comprises a portable US transducer mounted on a KUKA iiwa collaborative robot, a custom designed needle insertion mechanism with adjacent controllers. The US and needle insertion mechanism are attached to the robot through a 3D printed custom designed mounting part with integrated force sensor. The robot arm is responsible for moving the needle to target position with impedance control. The needle insertion mechanism allows the manipulation of the needle along 3 axes. The mechanism was designed for near-surface vein cannulation with an RCM kinematic structure to avoid damage to the vein. The developed system was tested with different types of gelatin phantoms. Vein deformation and tissue motion was examined during US imaging. The control loop of our system is supplemented with vein deformation tissue model and US-based visual servoing

Scaling the Autonomy of Surgical Robots

Computer-Integrated Surgery (CIS) has been around for almost three decades, covering the entire field of interventional technologies, from medical image guidance and augmented reality applications to automated tissue ablation. Numerous CIS systems are already on the market, adding technology-supported quality to the standard of care. Furthermore, a real breakthrough in medical robotics is just around the corner, yet there is practically no safety regulatory framework developed for them. The first surgical robot standards are just now becoming effective after many years of development, setting the concept of autonomy, and the assessment of autonomous functions into the center system of evaluation. New, community-level consensus should be reached regarding the scaling of surgical robot autonomy to facilitate product qualification, regulatory procedures and future product development

Surgical Robots of the Next Decade: New trends and paradigms in the 21th century

Robots in healthcare already have a stunning 40 years history, yet there is an unprecedented rise nowadays in new systems and clinical applications [1]. Surgical robotics is entering new domains, reaching new levels of integration, requiring highly sophisticated manipulation skills and decision making - on both the human and the mechatronic ends. The newest generation of robots does not only function as an agile extension of the human eyes and hands, but also becoming a skillful and smart co-worker of their MD counterpart [2]. Current trends include the seamless integration of preoperative and intra-operative images along with the (limited) decision-support offered to the clinicians, both in terms of surgical planning and navigation. Employment of smart tools, in vivo direct and indirect diagnostic methods are also on the rise. Microsurgery applications have been empowered by stable robotic platform both for hands-on and teleoperational control modes. Some companies are already talking about the introduction of cognitive surgical robots, which may open the era of Surgery 4.0, where procedures are boosted by Surgical Data Science and supported by big data analytics and optimization. These and many other technological advancements are to be presented. An emerging pattern is the cooperation of eminent research institutions, which is proved to benefit a lot the whole community. A great example of that is the Da Vinci Research Kit (DVRK) community, in which 25 outstanding labs (including the IROB at Óbuda University) synchronize their research, and share the results in an open source platform, relying on the open architecture research version of the famous da Vinci Classic robot [3]. Legislation an

Probabilistic Method to Improve the Accuracy of Computer-Integrated Surgical Systems

The technological development of the last decades resulted in the rise of entirely new paradigms in healthcare. Computer-Integrated Surgery (CIS) is providing innovative, minimally invasive solutions to heal complex injuries and diseases. It integrates robotic devices to the treatment delivery phase. By now, well over 6 million successful operations have been accomplished with various systems. In certain critical surgical procedures, where spatial accuracy is a must, physicians extensively rely on the help of CIS, and particularly on intra-operative navigation system. For these, the ways of use, including setup, registration and application accuracy metrics are provided by the manufacturers. Depending on the setup, inherent system errors can accumulate, and lead to significant deviation in position measurements. It is crucial to improve the precision of integrated setups, and to determine the overall task execution error. The stochastic approach proposed here offers an easy and straightforward solution to map and scale the error propagation. Applying pre-operative and on-site simulations, the optimal positioning of the navigation system can be achieved. This results in faster task execution and reduction of the probability of surgical errors. Surgical tracking systems have broader applications in endoscopic surgeries, and the method described in the article can be directly applied to these procedures too. It was tested in silico and on a neurosurgical prototype robot system developed at the Johns Hopkins University. The proposed features together can greatly increase the safety and reliability of all procedures where camera systems are involved, and ease the surgeon’s task and potentially reduce operating time

Sensorized Psychomotor Skill Assessment Platform Built on a Robotic Surgery Phantom

The spread of robot-assisted minimal invasive surgery presents new challenges to surgeons and researchers alike. The novel surgical tools, methods and processes require different skills from the clinicians, thus surgical training and skill-assessment has become increasingly important. In this article, we describe the modification process of a widely used training device, the Fundamentals of Robotic Surgery (FRS) Dome, that was made capable of automatic skill-assessment too, by applying different sensors on it. The basic principles and methods of the sensorization process are shown, together with the first results obtained on the amended training platform