Optimal port placement planning method for laparoscopic gastrectomy

A Review of Cognitive Support Systems in the Operating Room

BACKGROUND

In recent years, numerous innovative yet challenging surgeries, such as minimally invasive procedures, have introduced an overwhelming amount of new technologies, increasing the cognitive load for surgeons and potentially diluting their attention. Cognitive support technologies (CSTs) have been in development to reduce surgeons' cognitive load and minimize errors. Despite its huge demands, it still lacks a systematic review.

METHODS

Literature was searched up until May 21st, 2021. Pubmed, Web of Science, and IEEExplore. Studies that aimed at reducing the cognitive load of surgeons were included. Additionally, studies that contained an experimental trial with real patients and real surgeons were prioritized, although phantom and animal studies were also included. Major outcomes that were assessed included surgical error, anatomical localization accuracy, total procedural time, and patient outcome.

RESULTS

A total of 37 studies were included. Overall, the implementation of CSTs had better surgical performance than the traditional methods. Most studies reported decreased error rate and increased efficiency. In terms of accuracy, most CSTs had over 90% accuracy in identifying anatomical markers with an error margin below 5 mm. Most studies reported a decrease in surgical time, although some were statistically insignificant.

DISCUSSION

CSTs have been shown to reduce the mental workload of surgeons. However, the limited ergonomic design of current CSTs has hindered their widespread use in the clinical setting. Overall, more clinical data on actual patients is needed to provide concrete evidence before the ubiquitous implementation of CSTs.

Preoperative planning of three axis intersection surgical laparoscopic arm system based on characteristic parameters

PURPOSE

The application of robotics in the field of minimally invasive surgery solves some shortcomings of traditional minimally invasive surgery. Preoperative planning is an important prerequisite for the successful completion of robot-assisted surgery. The optimization of surgical incision position and the initial location of surgical robot are two important parts of preoperative planning. In this paper, a novel structure and preoperative planning method of a three-axis intersection surgical manipulator are proposed.

METHODS

Firstly, a mathematical model of human abdominal wall was established. Three characteristic parameters between the lesion and the incision are defined and used to optimize the surgical incisions. Then, the spatial position relationship between the laparoscopic arm and the incision was analyzed to obtain the effective solution groups of each passive joint of the laparoscopic arm. Lastly, the optimal initial location of the laparoscopic arm was determined by taking the total joint variables of the telecentric mechanism as the optimization index.

RESULTS

According to a given set of lesion parameters and the position of laparoscopic arm base, the optimal incision position was obtained using the surgical incision characteristic parameters and the optimal triangle criterion, and the positioning angles of the laparoscopic arm were optimized by using the Total Joint Variable (TJV) as the evaluation index.

CONCLUSIONS

The proposed preoperative planning method is verified by simulation. The proposed method can realize the preoperative planning process of the three axis intersection laparoscopic arm. The proposed method of preoperative planning will provide important reference to improve the intelligence of robot-assisted surgery.

A Metric for Finding Robust Start Positions for Medical Steerable Needle Automation

Steerable needles are medical devices with the ability to follow curvilinear paths to reach targets while circumventing obstacles. In the deployment process, a human operator typically places the steerable needle at its start position on a tissue surface and then hands off control to the automation that steers the needle to the target. Due to uncertainty in the placement of the needle by the human operator, choosing a start position that is robust to deviations is crucial since some start positions may make it impossible for the steerable needle to safely reach the target. We introduce a method to efficiently evaluate steerable needle motion plans such that they are safe to variation in the start position. This method can be applied to many steerable needle planners and requires that the needle's orientation angle at insertion can be robotically controlled. Specifically, we introduce a method that builds a funnel around a given plan to determine a safe insertion surface corresponding to insertion points from which it is guaranteed that a collision-free motion plan to the goal can be computed. We use this technique to evaluate multiple feasible plans and select the one that maximizes the size of the safe insertion surface. We evaluate our method through simulation in a lung biopsy scenario and show that the method is able to quickly find needle plans with a large safe insertion surface.

Ergonomic port placement in robotic colorectal surgery

AIM

The aim of the study was to determine how spacing between ports and alignment of ports (oblique or vertical) influences manipulation angles in robotic colorectal surgery.

METHOD

Abdominal CT scans of 10 consecutive robotic right hemicolectomy and 10 consecutive robotic high anterior resection patients were analysed. The manipulation angles were calculated using fixed points on the preoperative abdominal coronal CT scan. Port placements were marked on the CT scan. The fixed points used to measure the manipulation angles were from the most lateral part of the caecum, hepatic flexure, splenic flexure, the descending colon/sigmoid colon junction and the sigmoid colon/rectum junction.

RESULTS

For right hemicolectomy and high anterior resection surgery, a port spacing of 8 cm compared with 6 cm resulted in greater manipulation angles. With 6-cm port spacing, wider manipulation angles were not achieved with vertical port alignment compared with oblique alignment except for dissection at the splenic flexure.

CONCLUSIONS

The greatest manipulation angles were achieved with the oblique 8-cm port spacing, which should be used in most cases.

Optimizing Motion-Planning Problem Setup via Bounded Evaluation with Application to Following Surgical Trajectories

A motion-planning problem's setup can drastically affect the quality of solutions returned by the planner. In this work we consider optimizing these setups, with a focus on doing so in a computationally-efficient fashion. Our approach interleaves optimization with motion planning, which allows us to consider the actual motions required of the robot. Similar prior work has treated the planner as a black box: our key insight is that opening this box in a simple-yet-effective manner enables a more efficient approach, by allowing us to bound the work done by the planner to optimizer-relevant computations. Finally, we apply our approach to a surgically-relevant motion-planning task, where our experiments validate our approach by more-efficiently optimizing the fixed insertion pose of a surgical robot.