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Tyree A, Bhatia A, Hong M, Hanna J, Kasper KA, Good B, Perez D, Govalla DN, Hunt A, Sathishkumaraselvam V, Hoffman JP, Rozenblit JW, Gutruf P. Biosymbiotic haptic feedback - Sustained long term human machine interfaces. Biosens Bioelectron 2024; 261:116432. [PMID: 38861810 DOI: 10.1016/j.bios.2024.116432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 06/13/2024]
Abstract
Haptic technology permeates diverse fields and is receiving renewed attention for VR and AR applications. Advances in flexible electronics, facilitate the integration of haptic technologies into soft wearable systems, however, because of small footprint requirements face challenges of operational time requiring either large batteries, wired connections or frequent recharge, restricting the utility of haptic devices to short-duration tasks or low duty cycles, prohibiting continuously assisting applications. Currently many chronic applications are not investigated because of this technological gap. Here, we address wireless power and operation challenges with a biosymbiotic approach enabling continuous operation without user intervention, facilitated by wireless power transfer, eliminating the need for large batteries, and offering long-term haptic feedback without adhesive attachment to the body. These capabilities enable haptic feedback for robotic surgery training and posture correction over weeks of use with neural net computation. The demonstrations showcase that this device class expands use beyond conventional brick and strap or epidermally attached devices enabling new fields of use for imperceptible therapeutic and assistive haptic technologies supporting care and disease management.
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Affiliation(s)
- Amanda Tyree
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Aman Bhatia
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Minsik Hong
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Jessica Hanna
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Kevin Albert Kasper
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Brandon Good
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Dania Perez
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Dema Nua Govalla
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Abigail Hunt
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | | | | | - Jerzy W Rozenblit
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, AZ, 85721, USA; Bio5 Institute, University of Arizona, Tucson, AZ, 85721, USA.
| | - Philipp Gutruf
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA; Department of Electrical and Computer Engineering, University of Arizona, Tucson, AZ, 85721, USA; Bio5 Institute, University of Arizona, Tucson, AZ, 85721, USA; Neroscience GIDP, University of Arizona, Tucson, AZ, 85721, USA.
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Yatabe Y, Hanaoka M, Hanazawa R, Hirakawa A, Mukai T, Kimura K, Yamanoi K, Kono J, Yokota M, Takahashi H, Kobayashi A, Kobayashi K, Ichikawa N, Yasui M, Nakane K, Yamamoto M, Takenaka A, Nakamura Y, Takemasa I, Yabusaki N, Akamoto S, Tatarano S, Murata K, Manabe T, Fujimura T, Kawamura M, Egi H, Yamaguchi S, Terai Y, Inoue S, Ito A, Kinugasa Y. Robotic versus open and laparoscopic pelvic exenterations for pelvic cancer: a multicenter propensity-matched analysis in Japan. Surg Endosc 2024:10.1007/s00464-024-10966-w. [PMID: 38886231 DOI: 10.1007/s00464-024-10966-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/26/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Pelvic exenteration (PE) is the last resort for achieving a complete cure for pelvic cancer; however, it is burdensome for patients. Minimally invasive surgeries, including robot-assisted surgery, have been widely used to treat malignant tumors and have also recently been used in PE. This study aimed to evaluate the safety and efficacy of robot-assisted PE (RPE) by comparing the outcomes of open PE (OPE) with those of conventional laparoscopic PE (LPE) for treating pelvic tumors. METHODS Following the ethics committee approval, a multicenter retrospective analysis of patients who underwent pelvic exenteration between January 2012 and October 2022 was conducted. Data on patient demographics, tumor characteristics, and perioperative outcomes were collected. A 1:1 propensity score-matched analysis was performed to minimize group selection bias. RESULTS In total, 261 patients met the study criteria, of whom 61 underwent RPE, 90 underwent OPE, and 110 underwent LPE. After propensity score matching, 50 pairs were created for RPE and OPE and 59 for RPE and LPE. RPE was associated with significantly less blood loss (RPE vs. OPE: 408 mL vs. 2385 ml, p < 0.001), lower transfusion rate (RPE vs. OPE: 32% vs. 82%, p < 0.001), and lower rate of complications over Clavien-Dindo grade II (RPE vs. OPE: 48% vs. 74%, p = 0.013; RPE vs. LPE: 48% vs. 76%, p = 0.002). CONCLUSION This multicenter study suggests that RPE reduces blood loss and transfusion compared with OPE and has a lower rate of complications compared with OPE and LPE in patients with locally advanced and recurrent pelvic tumors.
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Affiliation(s)
- Yusuke Yatabe
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Marie Hanaoka
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Ryoichi Hanazawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kei Kimura
- Division of Lower Gastrointestinal Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, Hyogo, Japan
| | - Koji Yamanoi
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jin Kono
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuru Yokota
- Department of General Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Kenji Kobayashi
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Aichi, Japan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Keita Nakane
- Department of Urology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yuya Nakamura
- Department of Surgery, National Hospital Organization, Himeji Medical Center, Hyogo, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Hokkaido, Japan
| | | | | | - Shuichi Tatarano
- Department of Urology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kohei Murata
- Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Tatsuya Manabe
- Department of Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | | | - Mikio Kawamura
- Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, Mie, Japan
| | - Hiroyuki Egi
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Ehime, Japan
| | - Shigeki Yamaguchi
- Division of Colorectal Surgery, Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Shigetaka Inoue
- Department of Surgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.
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von Bechtolsheim F, Franz A, Schmidt S, Schneider A, La Rosée F, Radulova-Mauersberger O, Krause-Jüttler G, Hümpel A, Bodenstedt S, Speidel S, Weitz J, Distler M, Oehme F. The development of tissue handling skills is sufficient and comparable after training in virtual reality or on a surgical robotic system: a prospective randomized trial. Surg Endosc 2024; 38:2900-2910. [PMID: 38632120 PMCID: PMC11078795 DOI: 10.1007/s00464-024-10842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Virtual reality is a frequently chosen method for learning the basics of robotic surgery. However, it is unclear whether tissue handling is adequately trained in VR training compared to training on a real robotic system. METHODS In this randomized controlled trial, participants were split into two groups for "Fundamentals of Robotic Surgery (FRS)" training on either a DaVinci VR simulator (VR group) or a DaVinci robotic system (Robot group). All participants completed four tasks on the DaVinci robotic system before training (Baseline test), after proficiency in three FRS tasks (Midterm test), and after proficiency in all FRS tasks (Final test). Primary endpoints were forces applied across tests. RESULTS This trial included 87 robotic novices, of which 43 and 44 participants received FRS training in VR group and Robot group, respectively. The Baseline test showed no significant differences in force application between the groups indicating a sufficient randomization. In the Midterm and Final test, the force application was not different between groups. Both groups displayed sufficient learning curves with significant improvement of force application. However, the Robot group needed significantly less repetitions in the three FRS tasks Ring tower (Robot: 2.48 vs. VR: 5.45; p < 0.001), Knot Tying (Robot: 5.34 vs. VR: 8.13; p = 0.006), and Vessel Energy Dissection (Robot: 2 vs. VR: 2.38; p = 0.001) until reaching proficiency. CONCLUSION Robotic tissue handling skills improve significantly and comparably after both VR training and training on a real robotic system, but training on a VR simulator might be less efficient.
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Affiliation(s)
- Felix von Bechtolsheim
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany.
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.
| | - Andreas Franz
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Sofia Schmidt
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Alfred Schneider
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Felicitas La Rosée
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Olga Radulova-Mauersberger
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Grit Krause-Jüttler
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Anja Hümpel
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Sebastian Bodenstedt
- Department of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC Dresden), Dresden, Germany
| | - Stefanie Speidel
- Department of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC Dresden), Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Florian Oehme
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
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Masui K, Kume N, Nakao M, Magaribuchi T, Hamada A, Kobayashi T, Sawada A. Vision-based estimation of manipulation forces by deep learning of laparoscopic surgical images obtained in a porcine excised kidney experiment. Sci Rep 2024; 14:9686. [PMID: 38678091 PMCID: PMC11055910 DOI: 10.1038/s41598-024-60574-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024] Open
Abstract
In robot-assisted surgery, in which haptics should be absent, surgeons experience haptics-like sensations as "pseudo-haptic feedback". As surgeons who routinely perform robot-assisted laparoscopic surgery, we wondered if we could make these "pseudo-haptics" explicit to surgeons. Therefore, we created a simulation model that estimates manipulation forces using only visual images in surgery. This study aimed to achieve vision-based estimations of the magnitude of forces during forceps manipulation of organs. We also attempted to detect over-force, exceeding the threshold of safe manipulation. We created a sensor forceps that can detect precise pressure at the tips with three vectors. Using an endoscopic system that is used in actual surgery, images of the manipulation of excised pig kidneys were recorded with synchronized force data. A force estimation model was then created using deep learning. Effective detection of over-force was achieved if the region of the visual images was restricted by the region of interest around the tips of the forceps. In this paper, we emphasize the importance of limiting the region of interest in vision-based force estimation tasks.
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Affiliation(s)
- Kimihiko Masui
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Naoto Kume
- Department of Medical Informatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Megumi Nakao
- Department of Advanced Medical Engineering and Intelligence, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Toshihiro Magaribuchi
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akihiro Hamada
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Kobayashi
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Atsuro Sawada
- Department of Urology, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki, 889-1692, Japan.
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Ferrari FA, Youssef Y, Naem A, Ferrari F, Odicino F, Krentel H, Moawad G. Robotic surgery for deep-infiltrating endometriosis: is it time to take a step forward? Front Med (Lausanne) 2024; 11:1387036. [PMID: 38504917 PMCID: PMC10948538 DOI: 10.3389/fmed.2024.1387036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
Endometriosis is a chronic debilitating disease that affects nearly 10% of women of the reproductive age. Although the treatment modalities of endometriosis are numerous, surgical excision of the endometriotic implants and nodules remains the sole cytoreductive approach. Laparoscopic excision of endometriosis was proven to be beneficial in improving the postoperative pain and fertility. Moreover, it was also proved to be safe and efficient in treating the visceral localization of deep endometriosis, such as urinary and colorectal endometriosis. More recently, robotic-assisted surgery gained attention in the field of endometriosis surgery. Although the robotic technology provides a 3D vision of the surgical field and 7-degree of freedom motion, the safety, efficacy, and cost-effectiveness of this approach are yet to be determined. With this paper, we aim to review the available evidence regarding the role of robotic surgery in the management of endometriosis along with the current practices in the field.
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Affiliation(s)
| | - Youssef Youssef
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology-Maimonides Medical Center, Brooklyn, NY, United States
| | - Antoine Naem
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
- Department of Obstetrics, Gynecology, Gynecologic Oncology, and Senology, Bethesda Hospital Duisburg, Duisburg, Germany
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Harald Krentel
- Department of Obstetrics, Gynecology, Gynecologic Oncology, and Senology, Bethesda Hospital Duisburg, Duisburg, Germany
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, United States
- The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC, United States
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Yamasaki Y, Tokunaga M, Sakai Y, Kayasuga H, Nishihara T, Tadano K, Kawashima K, Haruki S, Kinugasa Y. Effects of a force feedback function in a surgical robot on the suturing procedure. Surg Endosc 2024; 38:1222-1229. [PMID: 38092971 DOI: 10.1007/s00464-023-10617-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/26/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Currently, widely used robotic surgical systems do not provide force feedback. This study aimed to evaluate the impact and benefits of a force feedback function on the suturing procedure. METHODS Twenty surgeons were recruited and divided into young (Y-group, n = 11) and senior (S-group, n = 9) groups, based on their years of surgical experience. The effect of the force feedback function on suturing quality was evaluated using an objective assessment system (A-LAP mini, Kyoto Kagaku Co., Ltd., Kyoto, Japan). Each participant completed the suturing task on intestinal model sheets with the robotic contact force feedback on and off. The task accomplishment time (s), maximal force (Newton, N) applied to the robotic forceps, and quality of suturing (assessed by A-LAP mini) were recorded as performance parameters. RESULTS In total, the maximal force applied to the robotic forceps was significantly decreased with the robotic force feedback switched on (median [interquartile range]: 2.8 N (2.3-3.2)) as compared with when the feedback was switched off (3.4 N (2.7-4.0), P < 0.001). The contact force feedback function did not affect the objectively assessed suturing score (18 points (17.7-19.0) versus 18 points (17.0-19.0), P = 0.421). The contact force feedback function slightly shortened the task accomplishment time in the Y-group (552.5 s (466.5-832) versus 605.5 s (476.2-689.7), P = 0.851) but not in the S-group (566 s (440.2-703.5) versus 470.5 s (419.7-560.2), P = 0.164). CONCLUSIONS With the contact force feedback function, the suturing task was completed with a smaller maximal force, while maintaining the quality of suturing. Because the benefits are more apparent in young surgeons, robots with the contact force feedback function will facilitate the educational process in novice surgeons.
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Affiliation(s)
- Yoshimi Yamasaki
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yoshihiro Sakai
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | | | | | | | | | - Shigeo Haruki
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Lin YC, Yuan LH, Tseng CS, Hsieh TY, Huang YW, Huang CY, Huang SW. Comparison of senhance and da vinci robotic radical prostatectomy: short-term outcomes, learning curve, and cost analysis. Prostate Cancer Prostatic Dis 2024; 27:116-121. [PMID: 37660219 DOI: 10.1038/s41391-023-00717-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/04/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND The Senhance® Robotic System is a new laparoscopy-based platform that has been increasingly used in radical prostatectomy (RP) procedures. The purpose of this study is to compare the outcome of Senhance RP (SRP) with da Vinci RP (DRP) cases. METHODS From August 2019 to April 2022, we prospectively recruited 63 cases of SRP. We compared the perioperative data, postoperative complication rates, short-term surgical outcomes (3-month postoperative undetectable prostate-specific antigen (PSA) and incontinence rates), learning curves, and cost analysis with data from 63 matched da Vinci Xi RP cases. RESULTS There was no difference in BL (180 versus 180 ml, p = 0.86) and postoperative surgical complication rate (Clavient -Dindo grade I-IV, 25.3 versus 22.2%, p = 0.21) between the SRP cases and the DRP. Regarding the oncologic and continence function, there was no difference between positive margin rate (36.5% versus 41.3%, p = 0.58), rate of undetectable PSA level at postoperative 3 months (68.3 versus 66.7%, p = 0.85), and incontinence rate (14.3 versus 15.9%, p = 1.0) at postoperative 3 months between the two cohorts. The learning curve showed a quick downward slope for laparoscopic experienced surgeons. The median pocket cost for SRP patients in our hospital was $4170, which was lower than $7675 for the DRP patients. CONCLUSIONS Safety and short-term outcomes are comparable between SRP and DRP. For experienced LRP surgeons, using the Senhance system to perform RP is straightforward. With a more affordable price as its biggest advantage, the Senhance system may serve as a safe and effective alternative for robotic RP.
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Affiliation(s)
- Yen-Chun Lin
- Department of Urology, National Taiwan University Hospital, Yunlin branch, Yunlin, Taiwan
| | - Lun-Hsiang Yuan
- Department of Urology, National Taiwan University Hospital, Yunlin branch, Yunlin, Taiwan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Shin Tseng
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Yi Hsieh
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Wen Huang
- Department of Urology, National Taiwan University Hospital, Yunlin branch, Yunlin, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shi-Wei Huang
- Department of Urology, National Taiwan University Hospital, Yunlin branch, Yunlin, Taiwan.
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8
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Huang X, Wang P, Chen J, Huang Y, Liao Q, Huang Y, Liu Z, Peng D. An intelligent grasper to provide real-time force feedback to shorten the learning curve in laparoscopic training. BMC MEDICAL EDUCATION 2024; 24:161. [PMID: 38378608 PMCID: PMC10880316 DOI: 10.1186/s12909-024-05155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/09/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND A lack of force feedback in laparoscopic surgery often leads to a steep learning curve to the novices and traditional training system equipped with force feedback need a high educational cost. This study aimed to use a laparoscopic grasper providing force feedback in laparoscopic training which can assist in controlling of gripping forces and improve the learning processing of the novices. METHODS Firstly, we conducted a pre-experiment to verify the role of force feedback in gripping operations and establish the safe gripping force threshold for the tasks. Following this, we proceeded with a four-week training program. Unlike the novices without feedback (Group A2), the novices receiving feedback (Group B2) underwent training that included force feedback. Finally, we completed a follow-up period without providing force feedback to assess the training effect under different conditions. Real-time force parameters were recorded and compared. RESULTS In the pre-experiment, we set the gripping force threshold for the tasks based on the experienced surgeons' performance. This is reasonable as the experienced surgeons have obtained adequate skill of handling grasper. The thresholds for task 1, 2, and 3 were set as 0.731 N, 1.203 N and 0.938 N, respectively. With force feedback, the gripping force applied by the novices with feedback (Group B1) was lower than that of the novices without feedback (Group A1) (p < 0.005). During the training period, the Group B2 takes 6 trails to achieve gripping force of 0.635 N, which is lower than the threshold line, whereas the Group A2 needs 11 trails, meaning that the learning curve of Group B2 was significantly shorter than that of Group A2. Additionally, during the follow-up period, there was no significant decline in force learning, and Group B2 demonstrated better control of gripping operations. The training with force feedback received positive evaluations. CONCLUSION Our study shows that using a grasper providing force feedback in laparoscopic training can help to control the gripping force and shorten the learning curve. It is anticipated that the laparoscopic grasper equipped with FBG sensor is promising to provide force feedback during laparoscopic training, which ultimately shows great potential in laparoscopic surgery.
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Affiliation(s)
- Xuemei Huang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Pingping Wang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Jie Chen
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Yuxin Huang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Qiongxiu Liao
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Yuting Huang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Zhengyong Liu
- Guangdong Provincial Key Laboratory of Optoelectronic Information Processing Chips and Systems, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, 510275, China.
| | - Dongxian Peng
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.
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9
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Aguilera Saiz L, Groen HC, Heerink WJ, Ruers TJM. The influence of the da Vinci surgical robot on electromagnetic tracking in a clinical environment. J Robot Surg 2024; 18:54. [PMID: 38280064 PMCID: PMC10821979 DOI: 10.1007/s11701-023-01812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/23/2023] [Indexed: 01/29/2024]
Abstract
Robot-assisted surgery is increasingly used in surgery for cancer. Reduced overview and loss of anatomical orientation are challenges that might be solved with image-guided surgical navigation using electromagnetic tracking (EMT). However, the robot's presence may distort the electromagnetic field, affecting EMT accuracy. The aim of this study was to evaluate the robot's influence on EMT accuracy. For this purpose, two different electromagnetic field generators were used inside a clinical surgical environment: a table top field generator (TTFG) and a planar field generator (PFG). The position and orientation of sensors within the electromagnetic field were measured using an accurate in-house developed 3D board. Baseline accuracy was measured without the robot, followed by stepwise introduction of potential distortion sources (robot and robotic instruments). The absolute accuracy was determined within the entire 3D board and in the clinical working volume. For the baseline setup, median errors in the entire tracking volume within the 3D board were 0.9 mm and 0.3° (TTFG), and 1.1 mm and 0.4° (PFG). Adding the robot and instruments did not affect the TTFG's position accuracy (p = 0.60), while the PFG's accuracies decreased to 1.5 mm and 0.7° (p < 0.001). For both field generators, when adding robot and instruments, accuracies inside the clinical working volume were higher compared to the entire tracking 3D board volume, 0.7 mm and 0.3° (TTFG), and 1.1 mm and 0.7° (PFG). Introduction of a surgical robot and robotic instruments shows limited distortion of the EMT field, allowing sufficient accuracy for surgical navigation in robotic procedures.
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Affiliation(s)
- L Aguilera Saiz
- Department of Surgical Oncology, Netherlands Cancer Institute, 1066 CX, Amsterdam, The Netherlands.
| | - H C Groen
- Department of Surgical Oncology, Netherlands Cancer Institute, 1066 CX, Amsterdam, The Netherlands
| | - W J Heerink
- Department of Surgical Oncology, Netherlands Cancer Institute, 1066 CX, Amsterdam, The Netherlands
| | - T J M Ruers
- Department of Surgical Oncology, Netherlands Cancer Institute, 1066 CX, Amsterdam, The Netherlands
- Faculty of Science and Technology (TNW), Nanobiophysics Group (NBP), University of Twente, 7500 AE, Enschede, The Netherlands
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10
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Ueda Y, Miyahara S, Tokuishi K, Nakajima H, Waseda R, Shiraishi T, Sato T. Impact of a pneumatic surgical robot with haptic feedback function on surgical manipulation. Sci Rep 2023; 13:22615. [PMID: 38114613 PMCID: PMC10730604 DOI: 10.1038/s41598-023-49876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
Although robotic-assisted surgery has the advantages of low patient burden and high precision without unsteady hand movements, the lack of tactile sensations may result in unexpected iatrogenic organ damage. The Saroa (Riverfield Inc., Tokyo, Japan) is a pneumatically driven robot that provides real-time haptic feedback to the surgeon. Using the Saroa robot, six examinees performed puffed rice transfer and four of them performed pig lung resection tasks with the feedback function turned on and off. The puffed rice transfer task consisted of transferring 20 grains of puffed rice from the left to the right compartment in the training box. The mean grasping forces during the puffed rice transfer task with the haptic feedback function turned off and on were 2.14 N and 0.63 N, respectively (P = 0.003). The mean grasping forces during the pig lung resection task were lower with the feedback turned on than turned off. The force that the forceps exerted on the grasping object was weaker in both tasks when the haptic feedback function was turned on, suggesting that the feedback function allows gentler handling of tissues, improving patient safety during robotic surgery.
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Affiliation(s)
- Yuichiro Ueda
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - So Miyahara
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Keita Tokuishi
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hiroyasu Nakajima
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Ryuichi Waseda
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takeshi Shiraishi
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Toshihiko Sato
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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11
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Hanaoka M, Kinugasa Y, Sakai Y, Tokunaga M. World's first report of sigmoidectomy for sigmoid cancer using the Saroa surgical system with tactile feedback. Updates Surg 2023; 75:2395-2401. [PMID: 37840105 DOI: 10.1007/s13304-023-01659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/23/2023] [Indexed: 10/17/2023]
Abstract
Increasing evidence based on the safety and benefits of robot-assisted surgery indicates the disadvantage of the lack of tactile feedback. A lack of tactile feedback increases the risk of intraoperative complications, prolongs operative times, and delays the learning curve. A 40-year-old female patient presented to our hospital with a positive fecal occult blood test. A colonoscopy revealed type 2 advanced cancer of the sigmoid colon, and histological examination showed a well-differentiated adenocarcinoma. Furthermore, abdominal contrast-enhanced computed tomography revealed a tumor in the sigmoid colon and several swollen lymph nodes in the colonic mesentery without distant metastases. The patient was diagnosed with cStage IIIb (cT3N1bM0) sigmoid cancer and underwent sigmoidectomy using the Saroa Surgical System, which was developed by RIVERFIELD, a venture company at the Tokyo Medical and Dental University, and the Tokyo Institute of Technology. Based on adequate simulation, surgery was safely performed with appropriate port placement and arm base-angle adjustment. The operating time was 176 min, with a console time of 116 min and 0 ml blood loss. The patient was discharged 6 days postoperatively without complications. The pathological diagnosis was adenocarcinoma, tub1, tub2, pT2N1bM0, and pStage IIIa. Herein, we report the world's first surgery for sigmoid cancer using the Saroa Surgical System with tactile feedback in which a safe and appropriate oncological surgery was performed.
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Affiliation(s)
- Marie Hanaoka
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, Japan.
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, Japan
| | - Yoshihiro Sakai
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, Japan
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12
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Bergholz M, Ferle M, Weber BM. The benefits of haptic feedback in robot assisted surgery and their moderators: a meta-analysis. Sci Rep 2023; 13:19215. [PMID: 37932393 PMCID: PMC10628231 DOI: 10.1038/s41598-023-46641-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023] Open
Abstract
Robot assisted surgery (RAS) provides medical practitioners with valuable tools, decreasing strain during surgery and leading to better patient outcomes. While the loss of haptic sensation is a commonly cited disadvantage of RAS, new systems aim to address this problem by providing artificial haptic feedback. N = 56 papers that compared robotic surgery systems with and without haptic feedback were analyzed to quantify the performance benefits of restoring the haptic modality. Additionally, this study identifies factors moderating the effect of restoring haptic sensation. Overall results showed haptic feedback was effective in reducing average forces (Hedges' g = 0.83) and peak forces (Hedges' g = 0.69) applied during surgery, as well as reducing the completion time (Hedges' g = 0.83). Haptic feedback has also been found to lead to higher accuracy (Hedges' g = 1.50) and success rates (Hedges' g = 0.80) during surgical tasks. Effect sizes on several measures varied between tasks, the type of provided feedback, and the subjects' levels of surgical expertise, with higher levels of expertise generally associated with smaller effect sizes. No significant differences were found between virtual fixtures and rendering contact forces. Implications for future research are discussed.
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Affiliation(s)
- Max Bergholz
- Department of Ergonomics, Technical University of Munich, 85748, Garching, Germany
- Institute of Robotics and Mechatronics, German Aerospace Center, 82234, Wessling, Germany
| | - Manuel Ferle
- Department of Ergonomics, Technical University of Munich, 85748, Garching, Germany.
| | - Bernhard M Weber
- Institute of Robotics and Mechatronics, German Aerospace Center, 82234, Wessling, Germany
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13
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Li X, Xu W, Fan S, Xiong S, Dong J, Wang J, Dai X, Yang K, Xie Y, Liu G, Meng C, Zhang Z, Cai L, Zhang C, Zhang Z, Ji Z, Shen C, Zhou L. Robot-assisted Partial Nephrectomy with the Newly Developed KangDuo Surgical Robot Versus the da Vinci Si Surgical System: A Double-center Prospective Randomized Controlled Noninferiority Trial. Eur Urol Focus 2023; 9:133-140. [PMID: 36446724 DOI: 10.1016/j.euf.2022.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The KangDuo surgical robot (KD-SR) was recently developed in China. OBJECTIVE To compare the safety and efficacy of the KD-SR versus the da Vinci Si Surgical System (DV-SS-Si) for robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS A double-center prospective randomized controlled noninferiority trial of patients aged 18-75 yr with a suspicion of T1a N0M0 renal cancer (RENAL nephrometry score ≤9) was conducted. INTERVENTION RAPN with the KD-SR versus the DV-SS-Si. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the success rate of operation. The operation was successful if (1) there was no open or laparoscopic conversion, (2) the warm ischemia time was <30 min for RENAL nephrometry scores of 4-6 or 40 min for RENAL nephrometry scores of 7-9, and (3) the pathological margin was negative. The secondary endpoint was the estimated glomerular filtration rate (eGFR). A threshold of 10% was set to demonstrate noninferiority. RESULTS AND LIMITATIONS From September 2020 to March 2021, 100 participants were enrolled, of whom 99 (49 in the KD-SR group and 50 in the DV-SS-Si group) were finally included in the full analysis set and 98 (49 in the KD-SR group and -49 in the DV-SS-Si group) in the per-protocol set. Baseline demographic and clinical characteristics were similar between the two groups. All surgeries were completed successfully. The eGFR at postoperative weeks 4-12 and adverse events were similar between the two groups. The docking time and suture time per stitch were longer in the KD-SR group. The main limitation was that a negative margin was considered as the primary outcome rather than survival. CONCLUSIONS The KD-SR achieved noninferior outcomes as compared with the DV-SS-Si regarding safety and efficacy for T1a tumors. PATIENT SUMMARY The first trial comparing the KangDuo surgical robot (KD-SR) versus the da Vinci Si Surgical System for robot-assisted partial nephrectomy showed that the KD-SR is a viable option for minimally invasive treatment of T1a renal tumors.
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Affiliation(s)
- Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Weifeng Xu
- Department of urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Jie Dong
- Department of urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Xiaofei Dai
- Department of Urology, Civil Aviation General Hospital, Civil Aviation Medical College of Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Yi Xie
- Department of urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guanghua Liu
- Department of urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Zheng Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Lin Cai
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Cuijian Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Zhongyuan Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Zhigang Ji
- Department of urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China.
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14
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Wang P, Zhang S, Liu Z, Huang Y, Huang J, Huang X, Chen J, Fang B, Peng D. Smart laparoscopic grasper integrated with fiber Bragg grating based tactile sensor for real-time force feedback. JOURNAL OF BIOPHOTONICS 2022; 15:e202100331. [PMID: 35020276 DOI: 10.1002/jbio.202100331] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Minimally invasive surgery, such as laparoscopic surgery, has developed rapidly due to its small wound, less bleeding and quick recovery. However, a lack of force feedback, which leads to tissue damage, is still unsolved. Many sensors have been used to offer force feedback but still limited by their large size, low security and high complexity. Based on the advantages of small size, high sensitivity and immunity to electromagnetic interferences, we propose a tactile sensor integrated with fiber Bragg gratings (FBGs) at the tip of laparoscopic grasper to offer real-time force feedback in the laparoscopic surgery. The tactile sensor shows a force sensitivity of 0.076 nm/N with a repeatable accuracy of 0.118 N. A bench test is conducted in a laparoscopic training box to verify its feasibility. Test results illustrate that gripping force exerted on the laparoscopic grasper in terms of peak and standard deviation values reduce significantly for the novice subjects with force feedback compared to those without force feedback. The proposed sensor integrated at the tip of the laparoscopic grasper demonstrates a better control of the gripping force among the novice surgeons and indicates that the smart grasper can help surgeons achieve precise gripping force to reduce unnecessary tissue trauma.
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Affiliation(s)
- Pingping Wang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shengqi Zhang
- Guangdong Provincial Key Laboratory of Optoelectronic Information Processing Chips and Systems, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, China
| | - Zhengyong Liu
- Guangdong Provincial Key Laboratory of Optoelectronic Information Processing Chips and Systems, School of Electronics and Information Technology, Sun Yat-Sen University, Guangzhou, China
- Southern Marine Science and Engineering Guangdong Laboratory (Zhuhai), Zhuhai, China
| | - Yuxin Huang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Huang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xuemei Huang
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Chen
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Bimei Fang
- Department of Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Dongxian Peng
- Obstetrics and Gynecology Center, Department of Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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15
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Callari TC, Mortimer M, Moody L, Seyedmahmoudian M, Lewis R, Horan B. Smooth and safe tram journeys: tram driver perspectives and opportunities using a haptic master controller in a virtual reality environment. ERGONOMICS 2022; 65:445-466. [PMID: 34487483 DOI: 10.1080/00140139.2021.1977844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
Tram drivers operate a master controller to control the acceleration and braking of the tram. Operation should ensure passenger comfort and safety through smooth tram motion and the avoidance of jerkiness that may cause passengers to fall in the carriage. This work investigates current driver practices and strategies for tram driving in normal operations through interviews and the capacity of a new haptic master controller to support drivers in achieving smooth and safe tram journeys. A haptic feedback algorithm based on viscosity was implemented on the master controller to provide drivers with feedback on the rate at which they were accelerating and braking the tram. This aspect was tested in a virtual tram within a simulated inner city virtual reality environment. Results indicate that the haptic master controller and coupled viscosity feedback algorithm did not increase smoothness of driving during the simulated experiences. Despite this, the drivers indicated a preference for the provision of further haptic information to support driving tasks and the overall journey safety and smoothness. Practitioner Summary: This research comprises two studies. The first investigates strategies currently used by drivers to operate a tram smoothly in order to elicit design requirements for a haptic tram master controller. The second study evaluates the impact of a novel haptic master controller on journey smoothness within a virtual environment.
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Affiliation(s)
- Tiziana C Callari
- Centre for Arts, Memory and Communities, Coventry University, Coventry, UK
| | | | - Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, UK
| | - Mehdi Seyedmahmoudian
- School of Software and Electrical Engineering, Swinburne University, Hawthorn, Australia
| | - Ryan Lewis
- National Transport Design Centre, Coventry University, Coventry, UK
| | - Ben Horan
- School of Engineering, Deakin University, Geelong, Australia
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16
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The role of data-driven artificial intelligence on COVID-19 disease management in public sphere: a review. DECISION 2021. [PMCID: PMC8482354 DOI: 10.1007/s40622-021-00289-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease with acute intense respiratory syndrome which spread around the world for the very first time impacting the way of life with drastic uncertainty. It rapidly reached almost every nook and corner of the world and the World Health Organization (WHO) has announced COVID-19 as a pandemic. The health care institutions around the globe are looking for viable and real-time technological solutions to handle the virus for evading its spread and circumvent probable demises. Importantly, the artificial intelligence tools and techniques are playing a major role in fighting the effect of virus on the economic jolt by mimicking human intelligence by screening, analyzing, predicting and tracking the existing and likely future patients. Since the first reported case, all the government organizations in the world jumped into action to prevent it and many studies reported the role of AI in taking decisions analyzing big data available in public sphere. Thereby, this review focuses on identifying the significant implication of AI techniques used for the COVID-19 disease management in the public sphere by agglomerating the latest available information. It also discusses the pitfalls and future directions in handling sensitive big data required for advanced neural networks.
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17
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Juo YY, Pensa J, Sanaiha Y, Abiri A, Sun S, Tao A, Vogel SD, Kazanjian K, Dutson E, Grundfest W, Lin A. Reducing retraction forces with tactile feedback during robotic total mesorectal excision in a porcine model. J Robot Surg 2021; 16:1083-1090. [PMID: 34837593 DOI: 10.1007/s11701-021-01338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022]
Abstract
Excessive tissue-instrument interaction forces during robotic surgery have the potential for causing iatrogenic tissue damages. The current in vivo study seeks to assess whether tactile feedback could reduce intraoperative tissue-instrument interaction forces during robotic-assisted total mesorectal excision. Five subjects, including three experts and two novices, used the da Vinci robot to perform total mesorectum excision in four pigs. The grip force in the left arm, used for retraction, and the pushing force in the right arm, used for blunt pelvic dissection around the rectum, were recorded. Tissue-instrument interaction forces were compared between trials done with and without tactile feedback. The mean force exerted on the tissue was consistently higher in the retracting arm than the dissecting arm (3.72 ± 1.19 vs 0.32 ± 0.36 N, p < 0.01). Tactile feedback brought about significant reductions in average retraction forces (3.69 ± 1.08 N vs 4.16 ± 1.12 N, p = 0.02), but dissection forces appeared unaffected (0.43 ± 0.42 vs 0.37 ± 0.28 N, p = 0.71). No significant differences were found between retraction and dissection forces exerted by novice and expert robotic surgeons. This in vivo animal study demonstrated the efficacy of tactile feedback in reducing retraction forces during total mesorectal excision. Further research is required to quantify the clinical impact of such force reduction.
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Affiliation(s)
- Yen-Yi Juo
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA.
| | - Jake Pensa
- UCLA Henry Samueli School of Engineering and Applied Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Yas Sanaiha
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
| | - Ahmad Abiri
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
- UCLA Henry Samueli School of Engineering and Applied Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Songping Sun
- UCLA Henry Samueli School of Engineering and Applied Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Anna Tao
- UCLA Henry Samueli School of Engineering and Applied Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sandra Duarte Vogel
- Division of Laboratory Animal Medicine, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Kevork Kazanjian
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
| | - Erik Dutson
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
| | - Warren Grundfest
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
- UCLA Henry Samueli School of Engineering and Applied Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Anne Lin
- Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA
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18
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Hadi Hosseinabadi AH, Salcudean SE. Force sensing in robot-assisted keyhole endoscopy: A systematic survey. Int J Rob Res 2021. [DOI: 10.1177/02783649211052067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Instrument–tissue interaction forces in minimally invasive surgery (MIS) provide valuable information that can be used to provide haptic perception, monitor tissue trauma, develop training guidelines, and evaluate the skill level of novice and expert surgeons. Force and tactile sensing is lost in many robot-assisted surgery (RAS) systems. Therefore, many researchers have focused on recovering this information through sensing systems and estimation algorithms. This article provides a comprehensive systematic review of the current force sensing research aimed at RAS and, more generally, keyhole endoscopy, in which instruments enter the body through small incisions. Articles published between January 2011 and May 2020 are considered, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The literature search resulted in 110 papers on different force estimation algorithms and sensing technologies, sensor design specifications, and fabrication techniques.
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Affiliation(s)
- Amir Hossein Hadi Hosseinabadi
- Robotics and Controls Laboratory (RCL), Electrical and Computer Engineering Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - Septimiu E. Salcudean
- Robotics and Controls Laboratory (RCL), Electrical and Computer Engineering Department, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Ershad M, Rege R, Majewicz Fey A. Adaptive Surgical Robotic Training Using Real-Time Stylistic Behavior Feedback Through Haptic Cues. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2021; 3:959-969. [PMID: 38250511 PMCID: PMC10798657 DOI: 10.1109/tmrb.2021.3124128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Surgical skill directly affects surgical procedure outcomes; thus, effective training is needed to ensure satisfactory results. Many objective assessment metrics have been developed that provide the trainee with descriptive feedback about their performance however, often lack feedback on how to improve performance. The most effective training method is one that is intuitive, easy to understand, personalized to the user,and provided in a timely manner. We propose a framework to enable user-adaptive training using near real-time detection of performance, based on intuitive styles of surgical movements, and design a haptic feedback framework to assist with correcting styles of movement. We evaluate the ability of three types of force feedback (spring, damping, and spring plus damping feedback), computed based on prior user positions, to improve different stylistic behaviors of the user during kinematically constrained reaching movement tasks. The results indicate that five out of six styles studied here were improved using at least one of the three types of force feedback. Task performance metrics were compared in the presence of the three types of feedback. Task time was statistically significantly lower when applying spring feedback, compared to the other two types of feedback. Path straightness and targeting error were statistically significantly improved when using spring-damping feedback compared to the other two types of feedback. This study presents a groundwork for adaptive training in robotic surgery based on near real-time human-centric models of surgical behavior.
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Affiliation(s)
- Marzieh Ershad
- Department of Electrical Engineering, University of Texas at Dallas, Richardson, TX, 75080
| | - Robert Rege
- Department of Surgery at UT Southwestern Medical Center, Dallas, TX, 75390
| | - Ann Majewicz Fey
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX 78712
- Department of Surgery at UT Southwestern Medical Center, Dallas, TX, 75390
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20
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Farinha R, Puliatti S, Mazzone E, Amato M, Rosiello G, Yadav S, De Groote R, Piazza P, Bravi CA, Koukourikis P, Rha KH, Cacciamani G, Micali S, Wiklund P, Rocco B, Mottrie A. Potential Contenders for the Leadership in Robotic Surgery. J Endourol 2021; 36:317-326. [PMID: 34579555 DOI: 10.1089/end.2021.0321] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: To summarize the scientific published literature on new robotic surgical platforms with potential use in the urological field, reviewing their evolution from presentation until the present day. Our goal is to describe the current characteristics and possible prospects for these platforms. Materials and Methods: A nonsystematic search of the PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases was conducted to identify scientific literature about new robotic platforms other than the Da Vinci® system, reviewing their evolution from inception until December 2020. Only English language publications were included. The following keywords were used: "new robotic platforms," "Revo-I robot," "Versius robot," and "Senhance robot." All relevant English-language original studies were analyzed by one author (R.F.) and summarized after discussion with an independent third party (E.M., S.Y., S.P., and M.A.). Results: Since 1995, Intuitive Surgical, Inc., with the Da Vinci surgical system, is the leading company in the robotic surgical market. However, Revo-I®, Versius®, and Senhance® are the other three platforms that recently appeared on the market with available articles published in peer-reviewed journals. Among these three new surgical systems, the Senhance robot has the most substantial scientific proof of its capacity to perform minimally invasive urological surgery and as such, it might become a contender of the Da Vinci robot. Conclusions: The Da Vinci surgical platform has allowed the diffusion of robotic surgery worldwide and showed the different advantages of this type of technique. However, its use has some drawbacks, especially its price. New robotic platforms characterized by unique features are under development. Of note, they might be less expensive compared with the Da Vinci robotic system. We found that these new platforms are still at the beginning of their technical and scientific validation. However, the Senhance robot is in a more advanced stage, with clinical studies supporting its full implementation.
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Affiliation(s)
- Rui Farinha
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Urology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,Urology Department, Lusíadas Hospital, Lisbon, Portugal
| | - Stefano Puliatti
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elio Mazzone
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Amato
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Rosiello
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Siddharth Yadav
- Department of Urology & Renal Transplant, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ruben De Groote
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Pietro Piazza
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Andrea Bravi
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Periklis Koukourikis
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Second Department of Urology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Giovanni Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
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21
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Braun D, Weik D, Elsner S, Hunger S, Werner M, Drossel WG. Position Control and Force Estimation Method for Surgical Forceps Using SMA Actuators and Sensors. MATERIALS 2021; 14:ma14175111. [PMID: 34501197 PMCID: PMC8434184 DOI: 10.3390/ma14175111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
Minimally invasive surgery is increasingly used in many medical operations because of the benefits for the patients. However, for the surgeons, accessing the situs through a small incision or natural orifice comes with a reduction of the degrees of freedom of the instrument. Due to friction of the mechanical coupling, the haptic feedback lacks sensitivity that could lead to damage of the tissue. The approach of this work to overcome these problems is to develop a control concept for position control and force estimation with shape memory alloys (SMA) which could offer haptic feedback in a novel handheld instrument. The concept aims to bridge the gap between manually actuated laparoscopic instruments and surgical robots. Nickel-titanium shape memory alloys are used for actuation because of their high specific energy density. The work includes the manufacturing of a functional model as a proof of concept comprising the development of a suitable forceps mechanism and electronic circuit for position control and gripping force measurement, as well as designing an ergonomic user interface with haptic force feedback.
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Affiliation(s)
- Dennis Braun
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
- Correspondence:
| | - David Weik
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Sophia Elsner
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Sandra Hunger
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Michael Werner
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Welf-Guntram Drossel
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
- Professorship for Adaptronics and Lightweight Design in Production, Chemnitz University of Technology, Straße der Nationen 62, 09111 Chemnitz, Germany
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22
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Battaglia E, Boehm J, Zheng Y, Jamieson AR, Gahan J, Majewicz Fey A. Rethinking Autonomous Surgery: Focusing on Enhancement over Autonomy. Eur Urol Focus 2021; 7:696-705. [PMID: 34246619 PMCID: PMC10394949 DOI: 10.1016/j.euf.2021.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/28/2021] [Accepted: 06/17/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT As robot-assisted surgery is increasingly used in surgical care, the engineering research effort towards surgical automation has also increased significantly. Automation promises to enhance surgical outcomes, offload mundane or repetitive tasks, and improve workflow. However, we must ask an important question: should autonomous surgery be our long-term goal? OBJECTIVE To provide an overview of the engineering requirements for automating control systems, summarize technical challenges in automated robotic surgery, and review sensing and modeling techniques to capture real-time human behaviors for integration into the robotic control loop for enhanced shared or collaborative control. EVIDENCE ACQUISITION We performed a nonsystematic search of the English language literature up to March 25, 2021. We included original studies related to automation in robot-assisted laparoscopic surgery and human-centered sensing and modeling. EVIDENCE SYNTHESIS We identified four comprehensive review papers that present techniques for automating portions of surgical tasks. Sixteen studies relate to human-centered sensing technologies and 23 to computer vision and/or advanced artificial intelligence or machine learning methods for skill assessment. Twenty-two studies evaluate or review the role of haptic or adaptive guidance during some learning task, with only a few applied to robotic surgery. Finally, only three studies discuss the role of some form of training in patient outcomes and none evaluated the effects of full or semi-autonomy on patient outcomes. CONCLUSIONS Rather than focusing on autonomy, which eliminates the surgeon from the loop, research centered on more fully understanding the surgeon's behaviors, goals, and limitations could facilitate a superior class of collaborative surgical robots that could be more effective and intelligent than automation alone. PATIENT SUMMARY We reviewed the literature for studies on automation in surgical robotics and on modeling of human behavior in human-machine interaction. The main application is to enhance the ability of surgical robotic systems to collaborate more effectively and intelligently with human surgeon operators.
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Affiliation(s)
- Edoardo Battaglia
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Jacob Boehm
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Yi Zheng
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Andrew R Jamieson
- Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Gahan
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ann Majewicz Fey
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA.
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23
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Ouyang Q, Wu J, Sun S, Pensa J, Abiri A, Dutson E, Bisley J. Bio-inspired Haptic Feedback for Artificial Palpation in Robotic Surgery. IEEE Trans Biomed Eng 2021; 68:3184-3193. [PMID: 33905321 DOI: 10.1109/tbme.2021.3076094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adding haptic feedback has been reported to improve the outcome of minimally invasive robotic surgery. In this study, we seek to determine whether an algorithm based on simulating responses of a cutaneous afferent population can be implemented to improve the performance of presenting haptic feedback for robot-assisted surgery. We propose a bio-inspired controlling model to present vibration and force feedback to help surgeons localize underlying structures in phantom tissue. A single pair of actuators was controlled by outputs of a model of a population of cutaneous afferents based on the pressure signal from a single sensor embedded in surgical forceps. We recruited 25 subjects including 10 expert surgeons to evaluate the performance of the bio-inspired controlling model in an artificial palpation task using the da Vinci surgical robot. Among the control methods tested, the bio-inspired system was unique in allowing both novices and experts to easily identify the locations of all classes of tumors and did so with reduced contact force and tumor contact time. This work demonstrates the utility of our bio-inspired multi-modal feedback system, which resulted in superior performance for both novice and professional users, in comparison to a traditional linear and the existing piecewise discrete algorithms of haptic feedback.
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24
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Wong SW, Ang ZH, Yang PF, Crowe P. Robotic colorectal surgery and ergonomics. J Robot Surg 2021; 16:241-246. [PMID: 33886064 DOI: 10.1007/s11701-021-01240-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/11/2021] [Indexed: 11/26/2022]
Abstract
Improved ergonomics for the operating surgeon may be an advantage of robotic colorectal surgery. Perceived robotic ergonomic advantages in visualisation include better exposure, three-dimensional vision, surgeon camera control, and line of sight screen location. Postural advantages include seated position and freedom from the constraints of the sterile operating field. Manipulation benefits include articulated instruments with seven degrees of freedom movement, elimination of fulcrum effect, tremor filtration, and scaling of movement. Potential ergonomic detriments of robotic surgery include lack of haptic feedback, visual, and mental strain from increased operating time and interruptions to workflow from crowding.
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Affiliation(s)
- Shing Wai Wong
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
- Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia.
| | - Zhen Hao Ang
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Phillip F Yang
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Philip Crowe
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia
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25
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Khalil HA, Marshall MB. 10 Commandments of Robotic Segmentectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:127-131. [PMID: 33829926 DOI: 10.1177/15569845211004262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Hassan A Khalil
- 1861 Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Surgical Service, Veterans Affairs Boston Healthcare System, MA, USA
| | - M Blair Marshall
- 1861 Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Surgical Service, Veterans Affairs Boston Healthcare System, MA, USA
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26
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Golahmadi AK, Khan DZ, Mylonas GP, Marcus HJ. Tool-tissue forces in surgery: A systematic review. Ann Med Surg (Lond) 2021; 65:102268. [PMID: 33898035 PMCID: PMC8058906 DOI: 10.1016/j.amsu.2021.102268] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background Excessive tool-tissue interaction forces often result in tissue damage and intraoperative complications, while insufficient forces prevent the completion of the task. This review sought to explore the tool-tissue interaction forces exerted by instruments during surgery across different specialities, tissues, manoeuvres and experience levels. Materials & methods A PRISMA-guided systematic review was carried out using Embase, Medline and Web of Science databases. Results Of 462 articles screened, 45 studies discussing surgical tool-tissue forces were included. The studies were categorized into 9 different specialities with the mean of average forces lowest for ophthalmology (0.04N) and highest for orthopaedic surgery (210N). Nervous tissue required the least amount of force to manipulate (mean of average: 0.4N), whilst connective tissue (including bone) required the most (mean of average: 45.8). For manoeuvres, drilling recorded the highest forces (mean of average: 14N), whilst sharp dissection recorded the lowest (mean of average: 0.03N). When comparing differences in the mean of average forces between groups, novices exerted 22.7% more force than experts, and presence of a feedback mechanism (e.g. audio) reduced exerted forces by 47.9%. Conclusions The measurement of tool-tissue forces is a novel but rapidly expanding field. The range of forces applied varies according to surgical speciality, tissue, manoeuvre, operator experience and feedback provided. Knowledge of the safe range of surgical forces will improve surgical safety whilst maintaining effectiveness. Measuring forces during surgery may provide an objective metric for training and assessment. Development of smart instruments, robotics and integrated feedback systems will facilitate this. This review explores tool-tissue forces during surgery, a new and expanding field. Forces were lowest in ophthalmology (0.04N) and highest in orthopaedics (210N). Forces were lowest during sharp dissection (0.03N) and highest when drilling (14N). Being an expert (vs. novice) and having feedback mechanisms (e.g. haptic) reduced exerted forces. Development of force metrics will facilitate training, assessment & novel technology.
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Affiliation(s)
- Aida Kafai Golahmadi
- Imperial College London School of Medicine, London, United Kingdom.,HARMS Laboratory, The Hamlyn Centre, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Danyal Z Khan
- National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - George P Mylonas
- HARMS Laboratory, The Hamlyn Centre, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Hani J Marcus
- National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
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27
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Willuth E, Hardon SF, Lang F, Haney CM, Felinska EA, Kowalewski KF, Müller-Stich BP, Horeman T, Nickel F. Robotic-assisted cholecystectomy is superior to laparoscopic cholecystectomy in the initial training for surgical novices in an ex vivo porcine model: a randomized crossover study. Surg Endosc 2021; 36:1064-1079. [PMID: 33638104 PMCID: PMC8758618 DOI: 10.1007/s00464-021-08373-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
Background Robotic-assisted surgery (RAS) potentially reduces workload and shortens the surgical learning curve compared to conventional laparoscopy (CL). The present study aimed to compare robotic-assisted cholecystectomy (RAC) to laparoscopic cholecystectomy (LC) in the initial learning phase for novices. Methods In a randomized crossover study, medical students (n = 40) in their clinical years performed both LC and RAC on a cadaveric porcine model. After standardized instructions and basic skill training, group 1 started with RAC and then performed LC, while group 2 started with LC and then performed RAC. The primary endpoint was surgical performance measured with Objective Structured Assessment of Technical Skills (OSATS) score, secondary endpoints included operating time, complications (liver damage, gallbladder perforations, vessel damage), force applied to tissue, and subjective workload assessment. Results Surgical performance was better for RAC than for LC for total OSATS (RAC = 77.4 ± 7.9 vs. LC = 73.8 ± 9.4; p = 0.025, global OSATS (RAC = 27.2 ± 1.0 vs. LC = 26.5 ± 1.6; p = 0.012, and task specific OSATS score (RAC = 50.5 ± 7.5 vs. LC = 47.1 ± 8.5; p = 0.037). There were less complications with RAC than with LC (10 (25.6%) vs. 26 (65.0%), p = 0.006) but no difference in operating times (RAC = 77.0 ± 15.3 vs. LC = 75.5 ± 15.3 min; p = 0.517). Force applied to tissue was similar. Students found RAC less physical demanding and less frustrating than LC. Conclusions Novices performed their first cholecystectomies with better performance and less complications with RAS than with CL, while operating time showed no differences. Students perceived less subjective workload for RAS than for CL. Unlike our expectations, the lack of haptic feedback on the robotic system did not lead to higher force application during RAC than LC and did not increase tissue damage. These results show potential advantages for RAS over CL for surgical novices while performing their first RAC and LC using an ex vivo cadaveric porcine model. Registration number researchregistry6029 Graphic abstract ![]()
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Affiliation(s)
- E Willuth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - S F Hardon
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - F Lang
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - C M Haney
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - E A Felinska
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K F Kowalewski
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Horeman
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
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28
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Abstract
The advent of telerobotic systems has revolutionized various aspects of the industry and human life. This technology is designed to augment human sensorimotor capabilities to extend them beyond natural competence. Classic examples are space and underwater applications when distance and access are the two major physical barriers to be combated with this technology. In modern examples, telerobotic systems have been used in several clinical applications, including teleoperated surgery and telerehabilitation. In this regard, there has been a significant amount of research and development due to the major benefits in terms of medical outcomes. Recently telerobotic systems are combined with advanced artificial intelligence modules to better share the agency with the operator and open new doors of medical automation. In this review paper, we have provided a comprehensive analysis of the literature considering various topologies of telerobotic systems in the medical domain while shedding light on different levels of autonomy for this technology, starting from direct control, going up to command-tracking autonomous telerobots. Existing challenges, including instrumentation, transparency, autonomy, stochastic communication delays, and stability, in addition to the current direction of research related to benefit in telemedicine and medical automation, and future vision of this technology, are discussed in this review paper.
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29
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Wu C, Cha J, Sulek J, Zhou T, Sundaram CP, Wachs J, Yu D. Eye-Tracking Metrics Predict Perceived Workload in Robotic Surgical Skills Training. HUMAN FACTORS 2020; 62:1365-1386. [PMID: 31560573 PMCID: PMC7672675 DOI: 10.1177/0018720819874544] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/05/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The aim of this study is to assess the relationship between eye-tracking measures and perceived workload in robotic surgical tasks. BACKGROUND Robotic techniques provide improved dexterity, stereoscopic vision, and ergonomic control system over laparoscopic surgery, but the complexity of the interfaces and operations may pose new challenges to surgeons and compromise patient safety. Limited studies have objectively quantified workload and its impact on performance in robotic surgery. Although not yet implemented in robotic surgery, minimally intrusive and continuous eye-tracking metrics have been shown to be sensitive to changes in workload in other domains. METHODS Eight surgical trainees participated in 15 robotic skills simulation sessions. In each session, participants performed up to 12 simulated exercises. Correlation and mixed-effects analyses were conducted to explore the relationships between eye-tracking metrics and perceived workload. Machine learning classifiers were used to determine the sensitivity of differentiating between low and high workload with eye-tracking features. RESULTS Gaze entropy increased as perceived workload increased, with a correlation of .51. Pupil diameter and gaze entropy distinguished differences in workload between task difficulty levels, and both metrics increased as task level difficulty increased. The classification model using eye-tracking features achieved an accuracy of 84.7% in predicting workload levels. CONCLUSION Eye-tracking measures can detect perceived workload during robotic tasks. They can potentially be used to identify task contributors to high workload and provide measures for robotic surgery training. APPLICATION Workload assessment can be used for real-time monitoring of workload in robotic surgical training and provide assessments for performance and learning.
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Affiliation(s)
| | - Jackie Cha
- Purdue University, West Lafayette, Indiana, USA
| | - Jay Sulek
- Indiana University, Indianapolis, USA
| | - Tian Zhou
- Purdue University, West Lafayette, Indiana, USA
| | | | | | - Denny Yu
- Purdue University, West Lafayette, Indiana, USA
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30
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Urias MG, Patel N, Ebrahimi A, Iordachita I, Gehlbach PL. Robotic Retinal Surgery Impacts on Scleral Forces: In Vivo Study. Transl Vis Sci Technol 2020; 9:2. [PMID: 32953242 PMCID: PMC7476674 DOI: 10.1167/tvst.9.10.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/26/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aims to map force interaction between instrument and sclera of in vivo rabbits during retinal procedures, and verify if a robotic active force control could prevent unwanted increase of forces on the sclera. Methods Experiments consisted in the performance of intraocular movements of a force sensing instrument, adjacent to the retinal surface, in radial directions, from the center to the periphery and back, and compared manual manipulations with robotic assistance and also robotic assistance with an active force control. This protocol was approved by the Animal Use and Ethical Committee and experiments were according to ARVO Statement of Animal Use. Results Mean forces using manual manipulations were 115 ± 51 mN. Using robotic assistance, mean forces were 118 ± 49 mN. Using an active force control method, overall mean forces reduced to 69 ± 15, with a statistical difference compared with other methods (P < 0.001). Comparing intraocular directions, superior sector required higher forces and the force control method reduced differences in forces between users and retained the same force pattern between them. Conclusions Results validate that the introduction of robotic assistance might increase the dynamic interactions between instrument and sclera, and the addition of an active force control method reduces the forces at levels lower than manual manipulations. Translational Relevance All marketing benefits from extreme accuracy and stability from robots, however, redundancy of safety mechanisms during intraocular manipulations, especially on force control and surgical awareness, would allow all utility of robotic assistance in ophthalmology.
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Affiliation(s)
- Müller G Urias
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA.,Federal University of Sao Paulo, São Paulo, Brazil
| | - Niravkumar Patel
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD
| | - Ali Ebrahimi
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD
| | - Peter L Gehlbach
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA.,Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
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Vlek SL, Burm R, Govers TM, Vleugels MPH, Tuynman JB, Mijatovic V. Potential Value of Haptic Feedback in Minimally Invasive Surgery for Deep Endometriosis. Surg Innov 2020; 27:623-632. [PMID: 32840445 PMCID: PMC7890691 DOI: 10.1177/1553350620944267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. Laparoscopic treatment of deep endometriosis (DE) is associated with intra- and post-operative morbidity. New technological developments, such as haptic feedback in laparoscopic instruments, could reduce the rate of complications. The aim of this study was to assess the room for improvement and potential cost-effectiveness of haptic feedback instruments in laparoscopic surgery. Methods. To assess the potential value of haptic feedback, a decision analytical model was constructed. Complications that could be related to the absence of haptic feedback were included in the model. Costs of complications were based on the additional length of hospital stay, operating time, outpatient visits, reinterventions, and/or conversions to laparotomy. The target population consists of women who are treated for DE in the Netherlands. A headroom analysis was performed to estimate the maximum value of haptic feedback in case it would be able to prevent all selected intra- and post-operative complications. Results. A total of 9.7 intraoperative and 47.0 post-operative complications are expected in the cohort of 636 patients annually treated for DE in the Netherlands. Together, these complications cause an additional length of hospital stay of 432.1 days, 10.2 additional outpatient visits, 73.9 reinterventions, and 4.2 conversions. Most consequences are related to post-operative complications. The total additional annual costs due to complications were €436 623, amounting to €687 additional costs per patient. Discussion. This study demonstrated that the potential value for improvement in DE laparoscopic surgery by using haptic feedback instruments is considerable, mostly caused by the potential prevention of major post-operative complications.
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Affiliation(s)
- Stijn L Vlek
- Endometriosis Center, Department of Surgery, 522567Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Rens Burm
- MedValue, Nijmegen, the Netherlands.,NewCompliance, The Hague, the Netherlands
| | | | | | - Jurriaan B Tuynman
- Endometriosis Center, Department of Surgery, 522567Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Velja Mijatovic
- Endometriosis Center, Department of Reproductive Medicine, 522567Amsterdam University Medical Center, Amsterdam, the Netherlands
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Saracino A, Oude-Vrielink TJC, Menciassi A, Sinibaldi E, Mylonas GP. Haptic Intracorporeal Palpation Using a Cable-Driven Parallel Robot: A User Study. IEEE Trans Biomed Eng 2020; 67:3452-3463. [PMID: 32746002 DOI: 10.1109/tbme.2020.2987646] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Intraoperative palpation is a surgical gesture jeopardized by the lack of haptic feedback which affects robotic minimally invasive surgery. Restoring the force reflection in teleoperated systems may improve both surgeons' performance and procedures' outcome. METHODS A force-based sensing approach was developed, based on a cable-driven parallel manipulator with anticipated seamless and low-cost integration capabilities in teleoperated robotic surgery. No force sensor on the end-effector is used, but tissue probing forces are estimated from measured cable tensions. A user study involving surgical trainees (n = 22) was conducted to experimentally evaluate the platform in two palpation-based test-cases on silicone phantoms. Two modalities were compared: visual feedback alone and both visual + haptic feedbacks available at the master site. RESULTS Surgical trainees' preference for the modality providing both visual and haptic feedback is corroborated by both quantitative and qualitative metrics. Hard nodules detection sensitivity improves (94.35 ± 9.1% vs 76.09 ± 19.15% for visual feedback alone), while also exerting smaller forces (4.13 ± 1.02 N vs 4.82 ± 0.81 N for visual feedback alone) on the phantom tissues. At the same time, the subjective perceived workload decreases. CONCLUSION Tissue-probe contact forces are estimated in a low cost and unique way, without the need of force sensors on the end-effector. Haptics demonstrated an improvement in the tumor detection rate, a reduction of the probing forces, and a decrease in the perceived workload for the trainees. SIGNIFICANCE Relevant benefits are demonstrated from the usage of combined cable-driven parallel manipulators and haptics during robotic minimally invasive procedures. The translation of robotic intraoperative palpation to clinical practice could improve the detection and dissection of cancer nodules.
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Iwai T, Kanno T, Miyazaki T, Haraguchi D, Kawashima K. Pneumatically driven surgical forceps displaying a magnified grasping torque. Int J Med Robot 2020; 16:e2051. [PMID: 31710158 PMCID: PMC7154778 DOI: 10.1002/rcs.2051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Sensing the grasping force and displaying the force for the operator are important for safe operation in robot-assisted surgery. Although robotic forceps that senses the force by force sensors or driving torque of electric motors is proposed, the force sensors and the motors have some problems such as increase in weight and difficulty of the sterilization. METHOD We developed a pneumatically driven robotic forceps that estimates the grasping torque and display the magnified torque for the operator. The robotic forceps has a master device and a slave robot, and they are integrated. In the slave side, the grasping torque is estimated by the pressure change in the pneumatic cylinder. A pneumatic bellows display the torque through a linkage. RESULTS We confirmed that the slave robot follows the motion of the master, and the grasping torque is estimated in the accuracy of 7 mNm and is magnified and displayed for the operator. CONCLUSIONS The pneumatically driven robotic forceps has the capability in the estimation of the grasping torque and display of the torque. Regarding future work, the usability and fatigues of the surgeons must be evaluated.
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Affiliation(s)
- Takuya Iwai
- Department of Biomechanics, Institute of Biomaterials and BioengineeringTokyo Medical and Dental UniversityTokyoJapan
| | - Takahiro Kanno
- Department of Biomechanics, Institute of Biomaterials and BioengineeringTokyo Medical and Dental UniversityTokyoJapan
| | - Tetsuro Miyazaki
- Department of Biomechanics, Institute of Biomaterials and BioengineeringTokyo Medical and Dental UniversityTokyoJapan
| | - Daisuke Haraguchi
- Department of Laboratory for Future Interdisciplinary Research of Science and TechnologyInstitute of Innovative Research, Tokyo Institute of TechnologyYokohamaJapan
| | - Kenji Kawashima
- Department of Biomechanics, Institute of Biomaterials and BioengineeringTokyo Medical and Dental UniversityTokyoJapan
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Electrically-Evoked Proximity Sensation Can Enhance Fine Finger Control in Telerobotic Pinch. Sci Rep 2020; 10:163. [PMID: 31932709 PMCID: PMC6957695 DOI: 10.1038/s41598-019-56985-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/19/2019] [Indexed: 11/24/2022] Open
Abstract
For teleoperation tasks requiring high control accuracy, it is essential to provide teleoperators with information on the interaction between the end effector and the remote environment. Real-time imaging devices have been widely adopted, but it delivers limited information, especially when the end effectors approach the target following the line-of-sight. In such situations, teleoperators rely on the perspective at the screen and can apply high force unintentionally at the initial contact. This research proposes to deliver the distance information at teleoperation to the fingertips of teleoperators, i.e., proximity sensation. Transcutaneous electrical stimulation was applied onto the fingertips of teleoperators, with the pulsing frequency inversely proportional to the distance. The efficacy of the proximity sensation was evaluated by the initial contact force during telerobotic pinch in three sensory conditions: vision only, vision + visual assistance (distance on the screen), and vision + proximity sensation. The experiments were repeated at two viewing angles: 30–60° and line-of-sight, for eleven healthy human subjects. For both cases, the initial contact force could be significantly reduced by either visual assistance (20–30%) or the proximity sensation (60–70%), without additional processing time. The proximity sensation is two-to-three times more effective than visual assistance regarding the amount of force reduction.
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35
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Ahuja AS. The impact of artificial intelligence in medicine on the future role of the physician. PeerJ 2019; 7:e7702. [PMID: 31592346 PMCID: PMC6779111 DOI: 10.7717/peerj.7702] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
The practice of medicine is changing with the development of new Artificial Intelligence (AI) methods of machine learning. Coupled with rapid improvements in computer processing, these AI-based systems are already improving the accuracy and efficiency of diagnosis and treatment across various specializations. The increasing focus of AI in radiology has led to some experts suggesting that someday AI may even replace radiologists. These suggestions raise the question of whether AI-based systems will eventually replace physicians in some specializations or will augment the role of physicians without actually replacing them. To assess the impact on physicians this research seeks to better understand this technology and how it is transforming medicine. To that end this paper researches the role of AI-based systems in performing medical work in specializations including radiology, pathology, ophthalmology, and cardiology. It concludes that AI-based systems will augment physicians and are unlikely to replace the traditional physician-patient relationship.
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Affiliation(s)
- Abhimanyu S Ahuja
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States of America
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36
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Alleblas CCJ, Vleugels MPH, Stommel MWJ, Nieboer TE. Performance of a Haptic Feedback Grasper in Laparoscopic Surgery: A Randomized Pilot Comparison With Conventional Graspers in a Porcine Model. Surg Innov 2019; 26:573-580. [PMID: 31161876 DOI: 10.1177/1553350619848551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background. Compared with open surgery, minimally invasive surgery is limited by reduced sensation of tissue properties. A laparoscopic grasper with integrated haptic feedback technology that improves the ability to sense tissue properties might provide a solution. The force reflecting operation instrument (FROI) is a new laparoscopic grasper, designed to provide information about the interaction forces between the instrument and tissue through resistance in the handle. This pilot study aimed to assess the functionality of the FROI compared with a conventional grasper in an in vivo setting. Methods. In this randomized trial, we used a standard laparoscopic surgical setup to perform laparoscopic surgery in pigs. In all, 11 surgeons performed colorectal, gynecological, or urological procedures, once with the FROI and once with a conventional grasper. Participants were asked to complete the NASA Task Load Index Rating Scale and rate 5 specific features for both graspers. To capture opinions on the overall functionality of the FROI, participants were asked to answer 8 open questions. Results. The surgeons reported that the use of the FROI significantly improved tissue consistency perception, arterial pulse detection, and force control compared with the conventional grasper. No significant differences were found in surgeons' muscular strain or operative time. The most emphasized topics in the open questions were improved soft-tissue handling and importance for complex procedures. Conclusion. Through this first in vivo analysis of the functionality of the FROI, a multispecialty group of laparoscopic surgeons confirmed the added value of haptic feedback technology in a live surgical setting.
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Saracino A, Deguet A, Staderini F, Boushaki MN, Cianchi F, Menciassi A, Sinibaldi E. Haptic feedback in the da Vinci Research Kit (dVRK): A user study based on grasping, palpation, and incision tasks. Int J Med Robot 2019; 15:e1999. [PMID: 30970387 DOI: 10.1002/rcs.1999] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/24/2019] [Accepted: 04/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND It was suggested that the lack of haptic feedback, formerly considered a limitation for the da Vinci robotic system, does not affect robotic surgeons because of training and compensation based on visual feedback. However, conclusive studies are still missing, and the interest in force reflection is rising again. METHODS We integrated a seven-DoF master into the da Vinci Research Kit. We designed tissue grasping, palpation, and incision tasks with robotic surgeons, to be performed by three groups of users (expert surgeons, medical residents, and nonsurgeons, five users/group), either with or without haptic feedback. Task-specific quantitative metrics and a questionnaire were used for assessment. RESULTS Force reflection made a statistically significant difference for both palpation (improved inclusion detection rate) and incision (decreased tissue damage). CONCLUSIONS Haptic feedback can improve key surgical outcomes for tasks requiring a pronounced cognitive burden for the surgeon, to be possibly negotiated with longer completion times.
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Affiliation(s)
- Arianna Saracino
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.,Center for Micro-BioRobotics, Istituto Italiano di Tecnologia, Pontedera, Italy
| | - Anton Deguet
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland
| | - Fabio Staderini
- Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | | | - Fabio Cianchi
- Center of Oncological Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Edoardo Sinibaldi
- Center for Micro-BioRobotics, Istituto Italiano di Tecnologia, Pontedera, Italy
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38
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Abiri A, Pensa J, Tao A, Ma J, Juo YY, Askari SJ, Bisley J, Rosen J, Dutson EP, Grundfest WS. Multi-Modal Haptic Feedback for Grip Force Reduction in Robotic Surgery. Sci Rep 2019; 9:5016. [PMID: 30899082 PMCID: PMC6428814 DOI: 10.1038/s41598-019-40821-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 02/12/2019] [Indexed: 12/17/2022] Open
Abstract
Minimally invasive robotic surgery allows for many advantages over traditional surgical procedures, but the loss of force feedback combined with a potential for strong grasping forces can result in excessive tissue damage. Single modality haptic feedback systems have been designed and tested in an attempt to diminish grasping forces, but the results still fall short of natural performance. A multi-modal pneumatic feedback system was designed to allow for tactile, kinesthetic, and vibrotactile feedback, with the aims of more closely imitating natural touch and further improving the effectiveness of HFS in robotic surgical applications and tasks such as tissue grasping and manipulation. Testing of the multi-modal system yielded very promising results with an average force reduction of nearly 50% between the no feedback and hybrid (tactile and kinesthetic) trials (p < 1.0E-16). The multi-modal system demonstrated an increased reduction over single modality feedback solutions and indicated that the system can help users achieve average grip forces closer to those normally possible with the human hand.
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Affiliation(s)
- Ahmad Abiri
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, USA.
- UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, USA.
| | - Jake Pensa
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, USA
- UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, USA
| | - Anna Tao
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, USA
| | - Ji Ma
- UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, USA
| | - Yen-Yi Juo
- UCLA Department of Surgery, Los Angeles, USA
| | - Syed J Askari
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, USA
- UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, USA
| | - James Bisley
- UCLA Department of Neurobiology, Los Angeles, USA
| | - Jacob Rosen
- UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, USA
| | - Erik P Dutson
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, USA
- UCLA Department of Surgery, Los Angeles, USA
| | - Warren S Grundfest
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, USA
- UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, USA
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Solodova RF, Tolstykh MP, Isaev TK, Trushkin RN, Vtorenko VI, Staroverov VM, Sokolov ME. Instrumental palpation in endoscopic renal surgery: case reports and analysis. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2018. [DOI: 10.24075/brsmu.2018.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Palpation is one of the classic examination methods in open surgeries. In minimally invasive surgery, intra-operational manual palpation is impossible to use for assessing tactile characteristics of tissues. In Russia, the only available instrument for intra-operational assessment and objective registration of tissue visco-elastic properties is the Medical Tactile Endosurgical Complex (MTEC). The aim of this work was to study the performance of MTEC in renal surgery. The study was performed during nine elective laparoscopic surgeries for clear cell renal carcinoma and simple renal cysts. We have found several differences in the use of MTEC in renal surgery, as compared to its use in gastrointestinal or lung surgeries. The key factor determining these differences was the inverse relations between tissue visco-elastic properties: the studied tumors were softer than the surrounding tissue. Detection of intraparenchymal tumors by tactile methods was impossible. For surface tumors, in one case out of nine it was possible to strictly locate the border of the tumor by tactile examination. We were able to quantitatively assess and determine the difference in hardness of tumors and intact tissue using MTEC. This allows studying the prognostic value of objectively registered tactile characteristics of renal tumors.
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Affiliation(s)
- RF Solodova
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, Moscow
| | - MP Tolstykh
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow
| | - TK Isaev
- City Clinical Hospital №52, Moscow Health Department, Moscow
| | - RN Trushkin
- City Clinical Hospital №52, Moscow Health Department, Moscow
| | - VI Vtorenko
- City Clinical Hospital №52, Moscow Health Department, Moscow
| | - VM Staroverov
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, Moscow
| | - ME Sokolov
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, Moscow
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40
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Karponis D, Koya Y, Miyazaki R, Kanno T, Kawashima K. Evaluation of a pneumatic surgical robot with dynamic force feedback. J Robot Surg 2018; 13:413-421. [PMID: 30255361 DOI: 10.1007/s11701-018-0878-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022]
Abstract
Robot-assisted surgery is limited by the lack of haptic feedback and increased operating times. Force scaling adjusts feedback transmitted to the operator through the use of scaling factors. Herein, we investigate how force scaling affects forces exerted in robotic surgery during simple and complex tasks, using a pneumatic surgical robot, IBIS VI. Secondary objectives were to test the effects of force scaling on operating time, depth of needle insertion and user satisfaction. Two novice males performed simple (modified block transfer) and complex (needle insertion) tasks under four scaling factors: 0.0, 0.5, 1.0 and 2.0. Single-blind experiments were repeated five times, with alternating scaling factors in random order. Increasing the scaling factor from 0.0 to 2.0 reduces forces in block transfer (p = 0.04). All feedback conditions reduce forces in needle insertion compared to baseline (0.5: p < 0.001, 1.0: p = 0.001, 2.0: p = 0.001). Time to complete block transfer is shorter for scaling factor 0.5 (p = 0.02), but not for 1.0 (p = 0.05) or 2.0 (p = 0.48), compared to baseline. Depth of needle insertion decreases consistently with incremental scaling factors (p < 0.001). Further reductions are observed upon augmenting feedback (0.5-2.0: p = 0.02). User satisfaction in block transfer is highest for intermediate scaling factors (0.0-1.0: p = 0.01), but no change is observed in needle insertion (p = 0.99). Increments in scaling factor reduce forces exerted, particularly in tasks requiring precision. Depth of needle insertion follows a similar pattern, but operating time and user satisfaction are improved by intermediate scaling factors. In summary, dynamic adjustment of force feedback can improve operative outcomes and advance surgical automation.
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Affiliation(s)
- Dimitrios Karponis
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan. .,School of Medicine, Imperial College London, London, SW7 2AZ, UK.
| | - Yokota Koya
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Ryoken Miyazaki
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Takahiro Kanno
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Kenji Kawashima
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
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Diez SP, Borghesan G, Joyeux L, Meuleman C, Deprest J, Stoyanov D, Ourselin S, Vercauteren T, Reynaerts D, Poorten EBV. Evaluation of Haptic Feedback on Bimanually Teleoperated Laparoscopy for Endometriosis Surgery. IEEE Trans Biomed Eng 2018; 66:1207-1221. [PMID: 30235114 PMCID: PMC6488009 DOI: 10.1109/tbme.2018.2870542] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Robotic minimal invasive surgery is gaining acceptance in surgical care. In contrast with the appreciated three-dimensional vision and enhanced dexterity, haptic feedback is not offered. For this reason, robotics is not considered beneficial for delicate interventions such as the endometriosis. Overall, haptic feedback remains debatable and yet unproven except for some simple scenarios such as fundamentals of laparoscopic surgery exercises. Objective: This work investigates the benefits of haptic feedback on more complex surgical gestures, manipulating delicate tissue through coordination between multiple instruments. Methods: A new training exercise, “endometriosis surgery exercise” (ESE) has been devised approximating the setting for monocular robotic endometriosis treatment. A bimanual bilateral teleoperation setup was designed for laparoscopic laser surgery. Haptic guidance and haptic feedback are, respectively, offered to the operator. User experiments have been conducted to assess the validity of ESE and examine possible advantages of haptic technology during execution of bimanual surgery. Results: Content and face validity of ESE were established by participating surgeons. Surgeons suggested ESE also as a mean to train lasering skills, and interaction forces on endometriotic tissue were found to be significantly lower when a bilateral controller is used. Collisions between instruments and the environment were less frequent and so were situations marked as potentially dangerous. Conclusion: This study provides some promising results suggesting that haptics may offer a distinct advantage in complex robotic interventions were fragile tissue is manipulated. Significance:
Patients need to know whether it should be incorporated. Improved understanding of the value of haptics is important as current commercial surgical robots are widely used but do not offer haptics.
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42
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Artificial palpation in robotic surgery using haptic feedback. Surg Endosc 2018; 33:1252-1259. [PMID: 30187198 DOI: 10.1007/s00464-018-6405-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 08/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The loss of tactile feedback in minimally invasive robotic surgery remains a major challenge to the expanding field. With visual cue compensation alone, tissue characterization via palpation proves to be immensely difficult. This work evaluates a bimodal vibrotactile system as a means of conveying applied forces to simulate haptic feedback in two sets of studies simulating an artificial palpation task using the da Vinci surgical robot. METHODS Subjects in the first study were tasked with localizing an embedded vessel in a soft tissue phantom using a single-sensor unit. In the second study, subjects localized tumor-like structures using a three-sensor array. In both sets of studies, subjects completed the task under three trial conditions: no feedback, normal force tactile feedback, and hybrid vibrotactile feedback. Recordings of correct localization, incorrect localization, and time-to-completion were used to evaluate performance outcomes. RESULTS With the addition of vibrotactile and pneumatic feedback, significant improvements in the percentage of correct localization attempts were detected (p = 0.0001 and p = 0.0459, respectively) during the first experiment with phantom vessels. Similarly, significant improvements in correct localization were found with the addition of vibrotactile (p = 2.57E-5) and pneumatic significance (p = 8.54E-5) were observed in the second experiment involving tumor phantoms. CONCLUSIONS This work demonstrates not only the superior benefits of a multi-modal feedback over traditional single-modality feedback, but also the effectiveness of vibration in providing haptic feedback to artificial palpation systems.
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Sorouri K, Podolsky DJ, Wang AMQ, Fisher DM, Wong KW, Looi T, Drake JM, Forrest CR. Utilization of a robotic mount to determine the force required to cut palatal tissue. J Mech Behav Biomed Mater 2018; 86:433-439. [PMID: 30031950 DOI: 10.1016/j.jmbbm.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 11/18/2022]
Abstract
Determination of the material properties of soft tissue is a growing area of interest that aids in the development of new surgical tools and surgical simulators. This study first aims to develop a robot-operated tissue testing system for determination of tissue cutting forces. Second, this system was used to ascertain the cutting properties of the hard and soft palate mucosa and soft palate musculature for the purpose of developing a robotic instrument for cleft palate surgery and a cleft-specific surgical simulator. The palate tissue was cut with a 15 blade mounted to the robot with varying angles (30°, 60°, 90°) and speeds (1.5, 2.5, 3.5 cm/s) of cutting to imitate typical operative tasks. The cutting force range for hard palate mucosa, soft palate mucosa and soft palate muscle were 0.98-3.30, 0.34-1.74 and 0.71-2.71 N, respectively. The break-in force of the cut (i.e. force required for the blade to penetrate the tissue) is significantly impacted by the angle of the blade relative to the tissue rather than the cutting speed. Furthermore, the total surface area of the tissue in contact with the blade during the cut has a significant impact on the total force expended on the tissue.
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Affiliation(s)
- Kimia Sorouri
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Center for Image Guided Innovation and Therapeutic Intervention (CIGITI), Toronto, Ontario, Canada.
| | - Dale J Podolsky
- Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada; Center for Image Guided Innovation and Therapeutic Intervention (CIGITI), Toronto, Ontario, Canada
| | - Annie M Q Wang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Center for Image Guided Innovation and Therapeutic Intervention (CIGITI), Toronto, Ontario, Canada
| | - David M Fisher
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen W Wong
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Thomas Looi
- Center for Image Guided Innovation and Therapeutic Intervention (CIGITI), Toronto, Ontario, Canada
| | - James M Drake
- Center for Image Guided Innovation and Therapeutic Intervention (CIGITI), Toronto, Ontario, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher R Forrest
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Olivieri E, Barresi G, Caldwell DG, Mattos LS, Olivieri E, Barresi G, Caldwell DG, Mattos LS, Olivieri E, Caldwell DG, Barresi G, Mattos LS. Haptic Feedback for Control and Active Constraints in Contactless Laser Surgery: Concept, Implementation, and Evaluation. IEEE TRANSACTIONS ON HAPTICS 2018; 11:241-254. [PMID: 29911981 DOI: 10.1109/toh.2017.2786243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Haptics has proven to be highly beneficial in surgical robotics, bringing enhanced safety and precision by complementing the surgeon's visual channel. However, most of the research body in this context is dedicated to applications involving traditional "cold steel" surgical instruments. This paper proposes to bring the benefits of haptics to contactless surgeries, and presents a novel method to achieve this. The specific case of robot-assisted laser microsurgery is investigated. Here, a fictitious force feedback is created through stereoscopic visualization and 3D reconstruction, allowing the surgeon to sense the surgical area haptically while controlling a non-contact surgical laser. This is shown to significantly improve system usability and the accuracy of laser incisions, especially in applications involving several passes of the laser over the same incision line. Validation of the system is performed through two series of experiments involving both naive users and expert surgeons. The obtained results demonstrate that haptics can indeed be introduced in contactless laser surgery, allowing the exploitation of active constraints and guidance techniques that significantly enhance laser control accuracy both in static and dynamic environments. Furthermore, the proposed haptic technology shows good acceptance and high usability, indicating it has great potential to positively impact real surgeries.
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Abstract
In the head and neck region, great potential is seen in robot-assisted surgery (RAS). Mainly in cancer surgery, the use of robotic systems seems to be of interest. Until today, two robotic systems (DaVinci® und FLEX®) have gained approval for clinical use in the head and neck region, and multiple other systems are currently in pre-clinical testing. Although, certain groups of patients may benefit from RAS, no unbiased randomized clinical studies are available. Until today, it was not possible to satisfactorily prove any advantage of RAS as compared to standard procedures. The limited clinical benefit and the additional financial burden seem to be the main reasons, why the comprehensive application of RAS has not been realized so far.This review article describes the large variety of clinical applications for RAS in the head and neck region. In addition, the financial and technical challenges, as well as ongoing developments of RAS are highlighted. Special focus is put on risks associated with RAS and current clinical studies. We believe, that RAS will find its way into clinical routine during the next years. Therefore, medical staff will have to increasingly face the technical, scientific and ethical features of RAS.
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Affiliation(s)
- Patrick J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
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Alleblas CCJ, Vleugels MPH, Coppus SFPJ, Nieboer TE. The effects of laparoscopic graspers with enhanced haptic feedback on applied forces: a randomized comparison with conventional graspers. Surg Endosc 2017; 31:5411-5417. [PMID: 28593415 PMCID: PMC5715038 DOI: 10.1007/s00464-017-5623-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/16/2017] [Indexed: 12/27/2022]
Abstract
Background Haptic feedback, which enables surgeons to perceive information on interaction forces between instrument and tissue, is deficient in laparoscopic surgery. This information, however, is essential for accurate tissue manipulation and recognition of tissue consistencies. To this end, a laparoscopic grasper with enhanced haptic feedback has been developed: the force reflecting operation instrument (FROI). This study tested the effects of enhanced haptic feedback on force control, tissue consistency interpretation, and the associated surgeons’ level of confidence through a randomized controlled crossover experiment. Methods A randomized three-period crossover trial was conducted, in which seven surgical residents and 13 medical students participated. The setup involved a box trainer in which slices of porcine organs (lung, small intestine, or liver) were presented. Participants performed three series of blinded palpation tasks involving three different graspers: the conventional grasper, the FROI with enhanced haptic feedback activated, and the FROI with enhanced haptic feedback deactivated. In each series, nine pairs of organ tissues were palpated to compare consistencies. The orders of presenting both instruments and tissues were randomized. Results The force applied during tissue palpation significantly decreased, by a mean factor of 3.1 with enhanced haptic feedback. Tissue consistency interpretation was significantly improved with more correct assessments and participants answered with significantly more confidence when enhanced haptic feedback was available. Conclusion The availability of enhanced haptic feedback enabled participants to operate with significantly reduced interaction force between instrument and tissues. This observation is expected to have multiple important clinical implications, such as less tissue damage, fewer complications, shorter operation times, and improved ergonomics.
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Affiliation(s)
- Chantal C J Alleblas
- Department of Obstetrics and Gynecology (791), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Michel P H Vleugels
- Department of Obstetrics and Gynaecology, Riverland Hospital, Tiel, The Netherlands
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynecology (791), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Theodoor E Nieboer
- Department of Obstetrics and Gynecology (791), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Tonutti M, Elson DS, Yang GZ, Darzi AW, Sodergren MH. The role of technology in minimally invasive surgery: state of the art, recent developments and future directions. Postgrad Med J 2016; 93:159-167. [DOI: 10.1136/postgradmedj-2016-134311] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/13/2016] [Accepted: 10/28/2016] [Indexed: 01/18/2023]
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Solodova RF, Galatenko VV, Nakashidze ER, Andreytsev IL, Galatenko AV, Senchik DK, Staroverov VM, Podolskii VE, Sokolov ME, Sadovnichy VA. Instrumental tactile diagnostics in robot-assisted surgery. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:377-382. [PMID: 27826218 PMCID: PMC5096743 DOI: 10.2147/mder.s116525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Robotic surgery has gained wide acceptance due to minimizing trauma in patients. However, the lack of tactile feedback is an essential limiting factor for the further expansion. In robotic surgery, feedback related to touch is currently kinesthetic, and it is mainly aimed at the minimization of force applied to tissues and organs. Design and implementation of diagnostic tactile feedback is still an open problem. We hypothesized that a sufficient tactile feedback in robot-assisted surgery can be provided by utilization of Medical Tactile Endosurgical Complex (MTEC), which is a novel specialized tool that is already commercially available in the Russian Federation. MTEC allows registration of tactile images by a mechanoreceptor, real-time visualization of these images, and reproduction of images via a tactile display. MATERIALS AND METHODS Nine elective surgeries were performed with da Vinci™ robotic system. An assistant performed tactile examination through an additional port under the guidance of a surgeon during revision of tissues. The operating surgeon sensed registered tactile data using a tactile display, and the assistant inspected the visualization of tactile data. First, surgeries where lesion boundaries were visually detectable were performed. The goal was to promote cooperation between the surgeon and the assistant and to train them in perception of the tactile feedback. Then, instrumental tactile diagnostics was utilized in case of visually undetectable boundaries. RESULTS In robot-assisted surgeries where lesion boundaries were not visually detectable, instrumental tactile diagnostics performed using MTEC provided valid identification and localization of lesions. The results of instrumental tactile diagnostics were concordant with the results of intraoperative ultrasound examination. However, in certain cases, for example, thoracoscopy, ultrasound examination is inapplicable, while MTEC-based tactile diagnostics can be efficiently utilized. CONCLUSION The study proved that MTEC can be efficiently used in robot-assisted surgery allowing correct localization of visually undetectable lesions and visually undetectable boundaries of pathological changes of tissues.
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Affiliation(s)
- Rozalia F Solodova
- Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
| | - Vladimir V Galatenko
- Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
| | | | | | | | - Dmitriy K Senchik
- Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
| | | | - Vladimir E Podolskii
- Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
| | - Mikhail E Sokolov
- Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
| | - Victor A Sadovnichy
- Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
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Kim DK, Park DW, Rha KH. Robot-assisted Partial Nephrectomy with the REVO-I Robot Platform in Porcine Models. Eur Urol 2016; 69:541-2. [DOI: 10.1016/j.eururo.2015.11.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
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