Robotic manipulators for single access surgery

This thesis explores the development of cooperative robotic manipulators for enhancing surgical precision and patient outcomes in single-access surgery and, specifically, Transanal Endoscopic Microsurgery (TEM). During these procedures, surgeons manipulate a heavy set of instruments via a mechanical clamp inserted in the patient’s body through a surgical port, resulting in imprecise movements, increased patient risks, and increased operating time. Therefore, an articulated robotic manipulator with passive joints is initially introduced, featuring built-in position and force sensors in each joint and electronic joint brakes for instant lock/release capability. The articulated manipulator concept is further improved with motorised joints, evolving into an active tool holder. The joints allow the incorporation of advanced robotic capabilities such as ultra-lightweight gravity compensation and hands-on kinematic reconfiguration, which can optimise the placement of the tool holder in the operating theatre. Due to the enhanced sensing capabilities, the application of the active robotic manipulator was further explored in conjunction with advanced image guidance approaches such as endomicroscopy. Recent advances in probe-based optical imaging such as confocal endomicroscopy is making inroads in clinical uses. However, the challenging manipulation of imaging probes hinders their practical adoption. Therefore, a combination of the fully cooperative robotic manipulator with a high-speed scanning endomicroscopy instrument is presented, simplifying the incorporation of optical biopsy techniques in routine surgical workflows. Finally, another embodiment of a cooperative robotic manipulator is presented as an input interface to control a highly-articulated robotic instrument for TEM. This master-slave interface alleviates the drawbacks of traditional master-slave devices, e.g., using clutching mechanics to compensate for the mismatch between slave and master workspaces, and the lack of intuitive manipulation feedback, e.g. joint limits, to the user. To address those drawbacks a joint-space robotic manipulator is proposed emulating the kinematic structure of the flexible robotic instrument under control.Open Acces

SurReal: enhancing Surgical simulation Realism using style transfer

Surgical simulation is an increasingly important element of surgical education. Using simulation can be a means to address some of the significant challenges in developing surgical skills with limited time and resources. The photo-realistic fidelity of simulations is a key feature that can improve the experience and transfer ratio of trainees. In this paper, we demonstrate how we can enhance the visual fidelity of existing surgical simulation by performing style transfer of multi-class labels from real surgical video onto synthetic content. We demonstrate our approach on simulations of cataract surgery using real data labels from an existing public dataset. Our results highlight the feasibility of the approach and also the powerful possibility to extend this technique to incorporate additional temporal constraints and to different applications

Affordable Mobile-based Simulator for Robotic Surgery

Robotic surgery and novel surgical instrumentation present great potentials towards safer, more accurate and consistent minimally invasive surgery. However, their adoption is dependent to the access to training facilities and extensive surgical training. Robotic instruments require different dexterity skills compared to open or laparoscopic. Surgeons, therefore, are required to invest significant time by attending extensive training programs. Contrary, hands on experiences represent an additional operational cost for hospitals as the availability of robotic systems for training purposes is limited. All these technological and financial barriers for surgeons and hospitals hinder the adoption of robotic surgery. In this paper, we present a mobile dexterity training kit to develop basic surgical techniques within an affordable setting. The system could be used to train basic surgical gestures and to develop the motor skills needed for manoeuvring robotic instruments. Our work presents the architecture and components needed to create a simulated environment for training sub-tasks as well as a design for portable mobile manipulators that can be used as master controllers of different instruments. A preliminary study results demonstrate usability and skills development with this system.Comment: Hamlyn Symposium on Medical Robotics 201

Intraoperative robotic-assisted large-area high-speed microscopic imaging and intervention

Objective: Probe-based confocal endomicroscopy is an emerging high-magnification optical imaging technique that provides in-vivo and in-situ cellular-level imaging for real-time assessment of tissue pathology. Endomicroscopy could potentially be used for intraoperative surgical guidance, but it is challenging to assess a surgical site using individual microscopic images due to the limited field-of-view and difficulties associated with manually manipulating the probe. Methods: In this paper, a novel robotic device for large-area endomicroscopy imaging is proposed, demonstrating a rapid, but highly accurate, scanning mechanism with image-based motion control which is able to generate histology-like endomicroscopy mosaics. The device also includes, for the first time in robotic-assisted endomicroscopy, the capability to ablate tissue without the need for an additional tool. Results: The device achieves pre-programmed trajectories with positioning accuracy of less than 30um, the image-based approach demonstrated that it can suppress random motion disturbances up to 1.25mm/s. Mosaics are presented from a range of ex-vivo human and animal tissues, over areas of more than 3mm², scanned in approximate 10s. Conclusion: This work demonstrates the potential of the proposed instrument to generate large-area, high-resolution microscopic images for intraoperative tissue identification and margin assessment. Significance: This approach presents an important alternative to current histology techniques, significantly reducing the tissue assessment time, while simultaneously providing the capability to mark and ablate suspicious areas intraoperatively

Three-dimensional robotic-assisted endomicroscopy with a force adaptive robotic arm

Effective in situ, in vivo tumour margin assessment is an important, yet unmet, clinical demand in surgical oncology. Recent advances in probe-based optical imaging tools such as confocal endomicroscopy is making inroads in clinical applications. In practice, maintaining consistent tissue contact whilst ensuring large area surveillance is crucial for its practical adoption and for this reason there is a great demand for robotic assistance so that high-speed endomicroscopes can be combined with autonomous scanning, thus simphfying its incorporation in routine surgical workflows. In this paper, a cooperatively controlled robotic manipulator is developed, which provides a stable mechatronicaUy-enhanced platform for micro-scanning tools to perform local high resolution mosaics over 3D undulating moving surfaces. Detailed kinematic and overall system performance analyses are provided and the results demonstrate the adaptabUity in terms of both contact force and orientation control of the system, and thus its simplicity in practical deployment and value for clinical adoption