Modular multiple sensors information management for computer-integrated surgery

BACKGROUND

In the past 20 years, technological advancements have modified the concept of modern operating rooms (ORs) with the introduction of computer-integrated surgery (CIS) systems, which promise to enhance the outcomes, safety and standardization of surgical procedures. With CIS, different types of sensor (mainly position-sensing devices, force sensors and intra-operative imaging devices) are widely used. Recently, the need for a combined use of different sensors raised issues related to synchronization and spatial consistency of data from different sources of information.

METHODS

In this study, we propose a centralized, multi-sensor management software architecture for a distributed CIS system, which addresses sensor information consistency in both space and time. The software was developed as a data server module in a client-server architecture, using two open-source software libraries: Image-Guided Surgery Toolkit (IGSTK) and OpenCV. The ROBOCAST project (FP7 ICT 215190), which aims at integrating robotic and navigation devices and technologies in order to improve the outcome of the surgical intervention, was used as the benchmark. An experimental protocol was designed in order to prove the feasibility of a centralized module for data acquisition and to test the application latency when dealing with optical and electromagnetic tracking systems and ultrasound (US) imaging devices.

RESULTS

Our results show that a centralized approach is suitable for minimizing synchronization errors; latency in the client-server communication was estimated to be 2 ms (median value) for tracking systems and 40 ms (median value) for US images.

CONCLUSION

The proposed centralized approach proved to be adequate for neurosurgery requirements. Latency introduced by the proposed architecture does not affect tracking system performance in terms of frame rate and limits US images frame rate at 25 fps, which is acceptable for providing visual feedback to the surgeon in the OR.

Trackerless ultrasound-integrated bone cement detection using a modular minirobot in revision total hip replacement

Medical robots are superior to freehand manipulation if an accurate, precise, and time-efficient implementation of a preplanned intervention is required. In the first part of this contribution a new modular minirobot for automatic ultrasound-based bone cement detection followed by subsequent cement milling in revision total hip replacement is presented. A minirobot integrated ultrasound module eliminates the need for external position tracking (e.g. by an optical system) as well as patient registration since the scanned contours can be directly provided within the robot's coordinate system. Further, the modular minirobot concept allows kinematics, workspace, and mechanical parameters to be easily adapted to the requirements of related or even new surgical applications. In the experimental part, the impact of ultrasound module integration on the implementation of optimized scanning strategies is investigated and evaluated in a laboratory set-up. As wave mode conversion and refraction artefacts due to angular sound incidence influence the detection accuracy, the transducer alignment can be optimized with respect to the number of degrees of freedom (DOFs) provided by the minirobot. A model-based scanning approach using two degrees of freedom (2DOFs), three degrees of freedom (3DOFs), and four degrees of freedom (4DOFs) respectively is presented. For automated scanning path calculation, a 2DOF distal-proximal prescan has been performed to estimate the principal components of the cement cavity's geometry using either a model-based or a statistical approach. In a cadaver study, the model-based approach consistently outperformed the statistical approach. The 3DOFs and 4DOFs scanning strategies yielded a significantly higher scanning accuracy if compared with the 2DOFs approach whereas the 3DOFs approach represents a trade-off between system complexity and detection accuracy.

Cutting tool system to minimize soft tissue damage for robot-assisted minimally invasive orthopedic surgery

Minimally invasive surgery in orthopedic field is considered to be a challenging problem with a milling robot. One objective of this study is to minimize collision of the cutting tool with soft tissue. The authors have developed a robot with redundant axis to avoid the collision so far. Some important components are modeled based on physical requirements, and a geometric optimization approach based on the model has been also proposed to improve performance. In this paper, a protective mechanism to cover the non-working part of the cutting edge is proposed to avoid soft tissue damage. Hardware and software have been developed for this application and the effectiveness of this technique was evaluated with urethane bone.

A robot-assisted orthopedic telesurgery system

A robot-assisted orthopedic telesurgery system, named HIT-RAOTS, has been developed according to Chinese conventional operation method. Its main function includes obtaining images with information of position and orientation of fracture, providing fracture information for doctors, assisting the doctors to complete the reposition of fracture and locking operation of intramedullary nail. In this system, a 6-dof force-reflecting master device, with a pantographic parallelogram mechanisms driven by harmonic DC servomotors, is used to control the slave manipulator movement and to translate the force from the operating room to the surgeon console; A slave robot system integrated a 6-dof force sensor, with a parallel manipulator actuated by six AC servomotors, is applied for the accurate repositioning; A virtual simulation system and human-machine interface are also developed. PI controller based on local network is used to realize the teleoperation. Only little irradiation is issued during the reposition. It can assist surgeons to perform bone-setting more safely by reducing irradiation damage to both surgeries and patients, more easily by releasing the surgeons from the heavy operation and more perfect by improving accuracy of reposition.

Body-Supported Medical Robots: A Survey

In medical robotics applications it is often advantageous for a robot to be directly mounted on or supported by the body of the patient during a medical procedure or examination. Whereas early medical robot systems were generally manipulator arms with a large base resting on the floor or mounted to the table next to the patient, several more recently developed systems rest directly on the patient. Body-supported medical robots can be designed to be much more compact and lightweight, leading to improved accuracy and safety and reduced cost, and are easier to set up and use in the operating room environment compared to conventional robot manipulator arms. Five examples of body-supported surgical robots are surveyed in this paper: The ARTHROBOT for total hip arthroplasty, PRAXITELES for knee arthroplasty, MARS for spinal pedicle screw placement and drill guiding, TER for remote ultrasound examinations, and LER for endoscope positioning in minimally invasive surgery.