Force-feedback assisted and virtual fixtures based K-wire drilling simulation

Advances of surgical robotics: image-guided classification and application

Surgical robotics application in the field of minimally invasive surgery has developed rapidly and has been attracting increasingly more research attention in recent years. A common consensus has been reached that surgical procedures are to become less traumatic and with the implementation of more intelligence and higher autonomy, which is a serious challenge faced by the environmental sensing capabilities of robotic systems. One of the main sources of environmental information for robots are images, which are the basis of robot vision. In this review article, we divide clinical image into direct and indirect based on the object of information acquisition, and into continuous, intermittent continuous, and discontinuous according to the target-tracking frequency. The characteristics and applications of the existing surgical robots in each category are introduced based on these two dimensions. Our purpose in conducting this review was to analyze, summarize, and discuss the current evidence on the general rules on the application of image technologies for medical purposes. Our analysis gives insight and provides guidance conducive to the development of more advanced surgical robotics systems in the future.

Pedicle drilling force control of a robotic surgical system via spine-soft tissue coupling model and parameters optimization

Bone drilling is a crucial operation in spinal fusion surgery that requires precise control of the applied force to ensure surgical safety. This manuscript aims to enhance the force servo performance of the orthopedic robot during automatic bone drilling operations. Firstly, an analytical model is introduced to describe the spinal mobility of the spine-soft tissue coupling structure. Then, the model is calibrated using force data obtained from stress relaxation tests. Next, optimal force controller parameters are determined through drilling force control simulations based on the identified model. The dynamic performance and robustness of the closed-loop control system are analyzed to ensure safe drilling procedures. Finally, bone drilling experiments are conducted in a force control mode to verify the effectiveness of the proposed method. The step drilling force response's steady-state error is less than 0.15 N, the relative control error is less than 3 %, and there is no noticeable force overshoot. The amplitude of the sinusoidal force response decays to -3 dB when the target force frequency is up to 3.49 rad/s, indicating a wide control bandwidth. These results demonstrate that the proposed method can rapidly and safely provide an adequate force servo to carry out automatic bone drilling.

Evaluation of a New Virtual Reality Concept Teaching K-Wire Drilling With Force Feedback Simulated Haptic in Orthopedic Skills Training

PURPOSE

Surgical simulations are becoming increasingly relevant in musculoskeletal training. They provide the opportunity to develop surgical skills in a controlled environment while reducing the risks for patients. For K-wire internal fixation in musculoskeletal surgery, a force feedback virtual reality (VR) simulator was developed. The aim of this study was to evaluate training results using this technology and compare the results with that of standard teaching on cadavers.

METHODS

Twenty participants attending an AO Trauma Course during 2020 were randomly allocated in 2 groups. On day 1, group A was trained by senior surgeons using a cadaver and group B was trained by the VR simulator for K-wire insertion in the distal radius. On day 2, all participants performed K-wire insertion on the cadaver model, without assistance, to validate the training effect.

RESULTS

On a surgical skills test, group B performed better than group A. In group B, the entry point of the first K-wire was closer to the targeted styloid process of the radius, and the protrusion of the K-wires into soft tissue was less than that in group A.

CONCLUSIONS

Training with the VR simulator for K-wire insertion resulted in better surgical skills than training by a surgeon and cadaver model.

CLINICAL RELEVANCE

Training with the VR simulator provides the opportunity to improve and refine surgical skills without the risk of harming patients. It offers easier access, unlimited repetitions, and is more cost-effective compared with training sessions with cadavers.

A Digital Twin Approach for Contextual Assistance for Surgeons During Surgical Robotics Training

Minimally invasive robotic surgery copes with some disadvantages for the surgeon of minimally invasive surgery while preserving the advantages for the patient. Most commercially available robotic systems are telemanipulated with haptic input devices. The exploitation of the haptics channel, e.g., by means of Virtual Fixtures, would allow for an individualized enhancement of surgical performance with contextual assistance. However, it remains an open field of research as it is non-trivial to estimate the task context itself during a surgery. In contrast, surgical training allows to abstract away from a real operation and thus makes it possible to model the task accurately. The presented approach exploits this fact to parameterize Virtual Fixtures during surgical training, proposing a Shared Control Parametrization Engine that retrieves procedural context information from a Digital Twin. This approach accelerates a proficient use of the robotic system for novice surgeons by augmenting the surgeon's performance through haptic assistance. With this our aim is to reduce the required skill level and cognitive load of a surgeon performing minimally invasive robotic surgery. A pilot study is performed on the DLR MiroSurge system to evaluate the presented approach. The participants are tasked with two benchmark scenarios of surgical training. The execution of the benchmark scenarios requires basic skills as pick, place and path following. The evaluation of the pilot study shows the promising trend that novel users profit from the haptic augmentation during training of certain tasks.

A virtual reality simulator for training the surgical reduction of patient-specific supracondylar humerus fractures

PURPOSE

Virtual reality has been used as a training platform in medicine, allowing the repetition of a situation/scenario as many times as needed and making it patient-specific prior to an operation. Of special interest is the minimally invasive plate osteosynthesis (MIPO). It represents a novel technique for orthopedic trauma surgery, but requires intensive training to acquire the required skills. In this paper, we propose a virtual reality platform for training the surgical reduction of supracondylar fractures of the humerus using MIPO. The system presents a detailed surgical theater where the surgeon has to place the bone fragments properly.

METHODS

Seven experienced users were selected to perform a surgical reduction using our proposal. Two paired humeri were scanned from a dataset obtained from the Complejo Hospitalario de Jaén. A virtual fracture was performed in one side of the pair, using the other as contralateral part. Users have to simulate a reduction for each case and fill out a survey about usability, using a five-option Likert scale.

RESULTS

The subjects have obtained excellent scores in both simulations. The users have notably reduced the time employed in the second experiment, being 60% less in average. Subjects have valued the usability (5.0), the intuitiveness (4.6), comfort (4.5), and realism (4.9) in a 1-5 Likert scale. The mean score of the usability survey was 4.66.

CONCLUSION

The system has shown a high learning rate, and it is expected that the trainees will reach an expert level after additional runs. By focusing on the movement of bone fragments, specialists acquire motor skills to avoid the malrotation of MIPO-treated fractures. A future study can fulfill the requirements needed to include this training system into the protocol of real surgeries. Therefore, we expect the system to increase the confidence of the trainees as well as to improve their decision making.