A methodology for design and appraisal of surgical robotic systems

A robotic system for solo surgery in flexible ureteroscopy: development and evaluation with clinical users

PURPOSE

The robotic system CoFlex for kidney stone removal via flexible ureteroscopy (fURS) by a single surgeon (solo surgery, abbreviated SSU) is introduced. It combines a versatile robotic arm and a commercially available ureteroscope to enable gravity compensation and safety functions like virtual walls. The haptic feedback from the operation site is comparable to manual fURS, as the surgeon actuates all ureteroscope DoF manually.

METHODS

The system hardware and software as well as the design of an exploratory user study on the simulator model with non-medical participants and urology surgeons are described. For each user study task both objective measurements (e.g., completion time) and subjective user ratings of workload (using the NASA-TLX) and usability (using the System Usability Scale SUS) were obtained.

RESULTS

CoFlex enabled SSU in fURS. The implemented setup procedure resulted in an average added setup time of 341.7 ± 71.6 s, a NASA-TLX value of 25.2 ± 13.3 and a SUS value of 82.9 ± 14.4. The ratio of inspected kidney calyces remained similar for robotic (93.68 %) and manual endoscope guidance (94.74 %), but the NASA-TLX values were higher (58.1 ± 16.0 vs. 48.9 ± 20.1) and the SUS values lower (51.5 ± 19.9 vs. 63.6 ± 15.3) in the robotic scenario. SSU in the fURS procedure increased the overall operation time from 1173.5 ± 355.7 s to 2131.0 ± 338.0 s, but reduced the number of required surgeons from two to one.

CONCLUSIONS

The evaluation of CoFlex in a user study covering a complete fURS intervention confirmed the technical feasibility of the concept and its potential to reduce surgeon working time. Future development steps will enhance the system ergonomics, minimize the users' physical load while interacting with the robot and exploit the logged data from the user study to optimize the current fURS workflow.

Robot-Assisted Surgery in Gynecology

The advancement of robotics-based procedures in the medical industry is the subject of this review article. The purpose of the surgical robot is to increase surgical abilities and address human shortcomings. The robot's success has been predicated on its ability to accurately and consistently repeat tasks. The following are a few objectives and quantifiable benefits of robotic technology improving surgical maneuverability and physical capabilities. In 2005, the FDA granted gynecological surgery approval for the Da Vinci surgical system. It has been quickly embraced and has already taken on a significant role at many of the locations where it is offered. It consists of a cart with robotic branches next to the patient and a high-resolution three-dimensional (3D) vision system. This study covers laparoscopy via robots in benign gynecological surgeries, myomectomy surgery, hysterectomies, endometriosis, tubal anastomosis, and sacrocolpopexy. The appropriate published studies were evaluated after a PubMed search was conducted. Additionally, procedures that may be used in the future are highlighted. In benign gynecological illness, most currently available research does not show a substantial benefit over traditional laparoscopic surgery. Robotics, however, does provide help in more complicated operations. Compared to laparoscopy, robotic assistance has a lower conversion rate to open procedures. Endo wrist movement of an automated machine during myomectomy surgery can perform proper and better suturing than traditional laparoscopy. The automated program is a noticeable improvement over laparoscopic surgery and, if price issues are resolved, can gain popularity among gynecological surgeons around the globe.

Comparative Analysis of Cutting Forces, Torques, and Vibration in Drilling of Bovine, Porcine, and Artificial Femur Bone with Considerations for Robot Effector Stiffness

Bone drilling is known as one of the most sensitive milling processes in biomedical engineering field. Fracture behavior of this cortical bone during drilling has attracted the attention of many researchers; however, there are still impending concerns such as necrosis, tool breakage, and microcracks due to high cutting forces, torques, and high vibration while drilling. This paper presents a comparative analysis of the cutting forces, torques, and vibration resulted on different bone samples (bovine, porcine, and artificial femur) using a 6dof Robot arm effector with considerations of its stiffness effects. Experiments were conducted on two spindle speeds of 1000 and 1500 rpm with a drill bit diameter of 2.5 mm and 6 mm depth of cut. The results obtained from the specimens were processed and analyzed using MATLAB R2015b and Visio 2000 software; these results were then compared with a prior test using manual and conventional drilling methods. The results obtained show that there is a significant drop in the average values of maximum drilling force for all the bone specimens when the spindle speed changes from 1000 rev/min to 1500 rev/min, with a drop from (20.07 to 12.34 N), approximately 23.85% for bovine, (11.25 to 8.14 N) with 16.03% for porcine, and (5.62 to 3.86 N) with 33.99% for artificial femur. The maximum average values of torque also decrease from 41.2 to 24.2 N·mm (bovine), 37.0 to 21.6 N·mm (porcine), and 13.6 to 6.7 N·mm (artificial femur), respectively. At an increase in the spindle speed, the vibration amplitude on all the bone samples also increases considerably. The variation in drilling force, torque, and vibration in our result also confirm that the stiffness of the robot effector joint has negative effect on the bone precision during drilling process.

Design and Study of a Next-Generation Computer-Assisted System for Transoral Laser Microsurgery

Objective

To present a new computer-assisted system for improved usability, intuitiveness, efficiency, and controllability in transoral laser microsurgery (TLM).

Study Design

Pilot technology feasibility study.

Setting

A dedicated room with a simulated TLM surgical setup: surgical microscope, surgical laser system, instruments, ex vivo pig larynxes, and computer-assisted system.

Subjects and Methods

The computer-assisted laser microsurgery (CALM) system consists of a novel motorized laser micromanipulator and a tablet- and stylus-based control interface. The system setup includes the Leica 2 surgical microscope and the DEKA HiScan Surgical laser system. The system was validated through a first-of-its-kind observational study with 57 international surgeons with varied experience in TLM. The subjects performed real surgical tasks on ex vivo pig larynxes in a simulated TLM scenario. The qualitative aspects were established with a newly devised questionnaire assessing the usability, efficiency, and suitability of the system.

Results

The surgeons evaluated the CALM system with an average score of 6.29 (out of 7) in ease of use and ease of learning, while an average score of 5.96 was assigned for controllability and safety. A score of 1.51 indicated reduced workload for the subjects. Of 57 subjects, 41 stated that the CALM system allows better surgical quality than the existing TLM systems.

Conclusions

The CALM system augments the usability, controllability, and efficiency in TLM. It enhances the ergonomics and accuracy beyond the current state of the art, potentially improving the surgical safety and quality. The system offers the intraoperative automated scanning of customized long incisions achieving uniform resections at the surgical site.

A gesture-based design tool: Assessing 2DOF vs. 4DOF steerable instrument control

Iterative prototyping is costly and time-consuming. Particularly when designing medical instruments, human factors related design choices significantly impact performance and safety. A tool is presented that allows for the evaluation of steerable instrument controls before the onset of the prototyping stage. The design tool couples gestural input to virtually simulated instrument motions using hand motion tracking. We performed a human-subject evaluation of two manual control strategies that differed in their degrees of freedom (DOF). 2DOF thumb control was compared to 4DOF thumb-index finger control. Results identified regions within the instrument workspace that are difficult to reach and showed participants to favor using the thumb for gross and fine-tuning motions at both control strategies. Index finger ab/adduction was found to be least functional. A strong learning effect was observed at 4DOF control. Based on the results, gesture-based instrument design is a viable design tool.

Robot-assisted microsurgical forceps with haptic feedback for transoral laser microsurgery

In this paper, a novel, motorized, multi-degrees-of-freedom (DoF), microsurgical forceps tool is presented, which is based on a master-slave teleoperation architecture. The slave device is a 7-DoF manipulator with: (i) 6-DoF positioning and orientation, (ii) 1 open/close gripper DoF; and (iii) an integrated force/torque sensor for tissue grip-force measurement. The master device is a 7-DoF haptic interface which teleoperates the slave device, and provides haptic feedback in its gripper interface. The combination of the device and the surgeon interface replaces the manual, hand-held device providing easy-to-use and ergonomic tissue control, simplifying the surgical tasks. This makes the system suitable to real surgical scenarios in the operating room (OR). The performance of the system was analysed through the evaluation of teleoperation control and characterization of gripping force. The new system offers an overall positioning error of less than 400 μm demonstrating its safety and accuracy. Improved system precision, usability, and ergonomics point to the potential suitability of the device for the OR and its ability to advance haptic-feedback-enhanced transoral laser microsurgeries.

A research review on clinical needs, technical requirements, and normativity in the design of surgical robots

Nowadays robots play an important role in society, mainly due to the significant benefits they provide when utilized for assisting human beings in the execution of dangerous or repetitive tasks. Medicine is one of the fields in which robots are gaining greater use and development, especially those employed in minimally invasive surgery (MIS). However, due to the particular conditions of the human body where robots have to act, the design of these systems is complex, not only from a technical point of view, but also because the clinical needs and the normativity aspects are important considerations that have to be taken into account in order to achieve better performances and more secure systems for patients and surgeons. Thus, this paper explores the clinical needs and the technical requirements that will trace the roadmap for the next scientific and technological advances in the field of robotic surgery, the metrics that should be defined for safe technology development and the standards that are being elaborated for boosting the industry and facilitating systems integration.

Minimally Invasive Surgery for the Treatment of Colorectal Cancer

BACKGROUND

Reduction in operative trauma along with an improvement in endoscopic access has undoubtedly occupied surgical minds for at least the past 3 decades. It is not at all surprising that minimally invasive colon surgery has come a long way since the first laparoscopic appendectomy by Semm in 1981. It is common knowledge that the recent developments in video and robotic technologies have significantly furthered advancements in laparoscopic and minimally invasive surgery. This has led to the overall acceptance of the treatment of benign colorectal pathology via the endoscopic route. Malignant disease, however, is still primarily treated by conventional approaches.

METHODS AND RESULTS

This review article is based on a literature search pertaining to advances in minimally invasive colorectal surgery for the treatment of malignant pathology, as well as on personal experience in the field over the same period of time. Our search was limited to level I and II clinical papers only, according to the evidence-based medicine guidelines. We attempted to present our unbiased view on the subject relying only on the evidence available.

CONCLUSION

Focusing on advances in colorectal minimally invasive surgery, it has to be stated that there are still a number of unanswered questions regarding the surgical management of malignant diseases with this approach. These questions do not only relate to the area of boundaries set for the use of minimally invasive techniques in this field but also to the exact modality best suited to the treatment of every particular case whilst maintaining state-of-the-art oncological principles.

Surgical Robots

Information technology and robotics have been integrated into interventional medicine for over 25 years. Their primary aim has always been to provide patient benefits through increased precision, safety, and minimal invasiveness. Nevertheless, robotic devices should allow for sophisticated treatment methods that are not possible by other means. Several hundreds of different surgical robot prototypes have been developed, while only a handful passed clearance procedures, and was released to the market. This is mostly due to the difficulties associated with medical device development and approval, especially in those cases when some form of manipulation and automation is involved. This chapter is intended to present major aspects of surgical robotic prototyping and current trends through the analysis of various international projects. It spans across the phases from system planning, to development, validation, and clearance.

Surgical Robots

Information technology and robotics have been integrated into interventional medicine for over 25 years. Their primary aim has always been to provide patient benefits through increased precision, safety, and minimal invasiveness. Nevertheless, robotic devices should allow for sophisticated treatment methods that are not possible by other means. Several hundreds of different surgical robot prototypes have been developed, while only a handful passed clearance procedures, and was released to the market. This is mostly due to the difficulties associated with medical device development and approval, especially in those cases when some form of manipulation and automation is involved. This chapter is intended to present major aspects of surgical robotic prototyping and current trends through the analysis of various international projects. It spans across the phases from system planning, to development, validation, and clearance.