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Li C, Zhang G, Zhao B, Xie D, Du H, Duan X, Hu Y, Zhang L. Advances of surgical robotics: image-guided classification and application. Natl Sci Rev 2024; 11:nwae186. [PMID: 39144738 PMCID: PMC11321255 DOI: 10.1093/nsr/nwae186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 08/16/2024] Open
Abstract
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.
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Affiliation(s)
- Changsheng Li
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Gongzi Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100141, China
| | - Baoliang Zhao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Dongsheng Xie
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Hailong Du
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100141, China
| | - Xingguang Duan
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Ying Hu
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Lihai Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100141, China
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
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Xia G, Jiang Z, Dai Y. Pedicle drilling force control of a robotic surgical system via spine-soft tissue coupling model and parameters optimization. Comput Biol Med 2024; 169:107710. [PMID: 38141450 DOI: 10.1016/j.compbiomed.2023.107710] [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: 07/17/2023] [Revised: 10/12/2023] [Accepted: 11/15/2023] [Indexed: 12/25/2023]
Abstract
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.
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Affiliation(s)
- Guangming Xia
- Institute of Robotics and Automatic Information Systems, Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, 300350, China.
| | - Zifeng Jiang
- Viterbi School of Engineering, University of Southern California, Los Angeles, CA, 90007, United States.
| | - Yu Dai
- Institute of Robotics and Automatic Information Systems, Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, 300350, China.
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Huber M, Katzky U, Müller K, Blätzinger M, Goetz W, Grechenig P, Popp D, Angerpointner K. Evaluation of a New Virtual Reality Concept Teaching K-Wire Drilling With Force Feedback Simulated Haptic in Orthopedic Skills Training. J Hand Surg Am 2022; 47:1225.e1-1225.e7. [PMID: 34857404 DOI: 10.1016/j.jhsa.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 07/05/2021] [Accepted: 09/02/2021] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Michaela Huber
- Department of Trauma Surgery & Emergency Department, University Medical Center Regensburg, Regensburg, Germany.
| | | | - Karolina Müller
- Centre for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | | | - Wolfgang Goetz
- Department of Cardiothoracic-Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Peter Grechenig
- Department of Orthopedics and Traumatology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Daniel Popp
- Department of Trauma Surgery & Emergency Department, University Medical Center Regensburg, Regensburg, Germany
| | - Katharina Angerpointner
- Department of Trauma Surgery & Emergency Department, University Medical Center Regensburg, Regensburg, Germany; Centre for Hand- and Elbow Surgery, Microsurgery and Plastic Surgery, Schoen Clinic München Harlaching, Munich, Germany
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Hagmann K, Hellings-Kuß A, Klodmann J, Richter R, Stulp F, Leidner D. A Digital Twin Approach for Contextual Assistance for Surgeons During Surgical Robotics Training. Front Robot AI 2021; 8:735566. [PMID: 34621791 PMCID: PMC8491613 DOI: 10.3389/frobt.2021.735566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Katharina Hagmann
- German Aerospace Center (DLR), Institute of Robotics and Mechatronics Center, Weßling, Germany
| | - Anja Hellings-Kuß
- German Aerospace Center (DLR), Institute of Robotics and Mechatronics Center, Weßling, Germany
| | - Julian Klodmann
- German Aerospace Center (DLR), Institute of Robotics and Mechatronics Center, Weßling, Germany
| | - Rebecca Richter
- German Aerospace Center (DLR), Institute of Robotics and Mechatronics Center, Weßling, Germany
| | - Freek Stulp
- German Aerospace Center (DLR), Institute of Robotics and Mechatronics Center, Weßling, Germany
| | - Daniel Leidner
- German Aerospace Center (DLR), Institute of Robotics and Mechatronics Center, Weßling, Germany
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Negrillo-Cárdenas J, Jiménez-Pérez JR, Madeira J, Feito FR. A virtual reality simulator for training the surgical reduction of patient-specific supracondylar humerus fractures. Int J Comput Assist Radiol Surg 2021; 17:65-73. [PMID: 34365526 PMCID: PMC8738450 DOI: 10.1007/s11548-021-02470-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/29/2021] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- José Negrillo-Cárdenas
- Fundación I+D del Software Libre (FIDESOL), Granada, Spain. .,Department of Computer Science, Graphics and Geomatics Group of Jaén, University of Jaén, Jaén, Spain.
| | | | - Joaquim Madeira
- Department of Electronics, Telecommunications and Informatics, Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal
| | - Francisco R Feito
- Department of Computer Science, Graphics and Geomatics Group of Jaén, University of Jaén, Jaén, Spain
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Künstliche Intelligenz in der Ausbildung. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00425-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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