Tactile feedback is a major missing feature in minimally invasive procedures; it is an essential means of diagnosis and orientation during surgical procedures. Previous works have presented a remote palpation feedback system based on the coupling between a pressure sensor and a general haptic interface. Here a new approach is presented based on the direct estimation of the tissue mechanical properties and finally their presentation to the operator by means of a haptic interface. The approach presents different technical difficulties and some solutions are proposed: the implementation of a fast Young&#x2019;s modulus estimation algorithm, the implementation of a real time finite element model, and finally the implementation of a stiffness estimation approach in order to guarantee the system&#x2019;s stability. The work is concluded with an experimental evaluation of the whole system.

Mauro M. Sette

Hendrik Van Brussel

Jos Vander Sloten

Teletactile System Based on Mechanical Properties Estimation

Paolo Fiorini

Special Issue on Surgical Robotics

The automation of recurrent tasks and force feedback are complex problems in medical robotics. We present a novel approach that extends human-machine skill-transfer by a scaffolding framework. It assumes a consolidated working environment for both, the trainee and the trainer. The trainer provides hints and cues in a basic structure which is already understood by the learner. In this work, the scaffolding is constituted by abstract patterns, which facilitate the structuring and segmentation of information during &#x201c;Learning by Demonstration&#x201d; (LbD). With this concept, the concrete example of knot-tying for suturing is exemplified and evaluated. During the evaluation, most problems and failures arose due to intrinsic system imprecisions of the medical robot system. These inaccuracies were then improved by the visual guidance of the surgical instruments. While the benefits of force feedback in telesurgery has already been demonstrated and measured forces are also used during task learning, the transmission of signals between the operator console and the robot system over long-distances or across-network remote connections is still a challenge due to time-delay. Especially during incision processes with a scalpel into tissue, a delayed force feedback yields to an unpredictable force perception at the operator-side and can harm the tissue which the robot is interacting with. We propose a XFEM-based incision force prediction algorithm that simulates the incision contact-forces in real-time and compensates the delayed force sensor readings. A realistic 4-arm system for minimally invasive robotic heart surgery is used as a platform for the research.

Christoph Staub

Keita Ono

Hermann Mayer

Alois Knoll

Heinz Ulbrich

Robert Bauernschmitt

Remote Minimally Invasive Surgery &#x2013; Haptic Feedback and Selective Automation in Medical Robotics

A testing environment that imitates gastric geometry and contractile activity is necessary to analyse and validate endoluminal surgical robotic devices developed for gastric pathologies. To achieve this goal, a silicone stomach model and a mechanical setup to simulate gastric contractile motion were designed and fabricated. The developed stomach simulator was validated and its usefulness was demonstrated by means of internal pressure measurements and self-assembly tests of mock-ups of capsule devices. The results demonstrated that the stomach simulator is helpful for quantitative evaluation of endoluminal robotic devices before in-vitro/in-vivo experiments.

Sara Condino

Kanako Harada

Nicola Ng Pak

Marco Piccigallo

Arianna Menciassi

Paolo Dario

Stomach Simulator for Analysis and Validation of Surgical Endoluminal Robots

Minimally invasive robotic surgery has gained wide acceptance recently. Computer-aided features to assist the surgeon during these interventions may help to develop safer, faster, and more accurate procedures. Especially physiological motion compensation of the beating heart and online soft tissue modelling are promising features that were developed recently. This paper presents the integration of these new features into the minimally invasive robotic surgery platform MiroSurge. A central aim of this research platform is to enable evaluation and comparison of new functionalities for minimally invasive robotic surgery. The system structure of MiroSurge is presented as well as the interfaces for the new functionalities. Some details about the modules for motion tracking and for soft tissue simulation are given. Results are shown with an experimental setup that includes a heart motion simulator and dedicated silicone organ models. Both features are integrated seamlessly and work reliably in the chosen setup. The MiroSurge platform thus shows the potential to provide valuable results in evaluating new functionalities for minimally invasive robotic surgery.

Rainer Konietschke

Davide Zerbato

Rog&#xe9;rio Richa

Andreas Tobergte

Philippe Poignet

Florian A. Fr&#xf6;hlich

Debora Botturi

Gerd Hirzinger

Integration of New Features for Telerobotic Surgery into The Mirosurge System

Minimally invasive surgical procedures have improved the standard of patient care by reducing recovery time, chance of infection, and scarring. A recent review estimates that leaks occur in 3&#x25; to 6&#x25; of bowel anastomoses, resulting in &#x201c;increased morbidity and mortality and adversely [affecting] length of stay, cost, and cancer recurrence&#x201d; [23]. Many of these leaks are caused by poor handling and ischemic tissue.Detecting a change in temperature can indicate ischemic tissue. The optical absorption spectrum of a tissue can be used to detect tissue oxygen concentration and tissue ischemia. The electrical impedance of tissue changes as ischemia progresses.This article describes the development of a minimally invasive surgical tool with integrated sensors for replicating ischemia detection measurements during routine manipulation of the tissue. To be useful, this tool should be feasible for use in a real operating room, providing real-time feedback and diagnosis to the surgeon. The design of the tool and choice of the sensors leverages existing work in physiological measurements and surgical tool design.The tool includes a thermistor for measuring the temperature, four LEDs and a photodiode for measuring local optical absorption, and four electrodes for measuring the electrical impedance. The sensors are located on a 7 mm square sensor head, which is mounted to a minimally invasive grasper. A strain gauge and optical encoder monitor the applied force and position of the tool, and a motor controls both. This allows the tool to control the tool-tissue interface. Sensor accuracy has been validated through calibration.

Philip R. Roan

Andrew S. Wright

Thomas S. Lendvay

Mika N. Sinanan

Blake Hannaford

An Instrumented Minimally Invasive Surgical Tool: Design and Calibration

In recent years, new surgical tools have been designed to improve treatment results and lower patient trauma. Nevertheless, the dexterity and accuracy required for the positioning of new tools are often unreachable, if surgeons are not assisted by suitable systems. Significant advantages are derived from the introduction of computer and robot technologies. For that reason, the interaction between robotic systems and surgeons today is producing new interest worldwide both in medical and engineering fields. In particular, medical robotics has found fruitful ground in neurosurgical applications, since the high functional density of the central nervous system requires strict accuracy constraints on tool positioning. As a matter of fact, the major benefits of robots, such as precision, accuracy and repeatability, make them ideal as neurosurgeons&#x2019; assistants. This paper presents a master-slave haptic robotic system for minimally invasive neurosurgery, which can aid surgeons in performing safer and more accurate stereotactic neurosurgical treatments. The design of the proposed system is based on LANS (Linear Actuator for NeuroSurgery), which has been developed by our Research Group. Experimental test aimed at showing the added value of the DAANS system over its predecessor, the effectiveness of conformational caps and of the added rotational degree of freedom are scheduled for the upcoming months.

Vanni Zanotto

Paolo Boscariol

Alessandro Gasparetto

Albano Lanzutti

Renato Vidoni

Nicola Di Lorenzo

Pasquale Gallina

Aldo Dalla Via

Aldo Rossi

A Master-Slave Haptic System for Neurosurgery

The large volume and reduced dexterity of current surgical robotic systems are factors that restrict their effective performance. To improve the usefulness of surgical robots in minimally invasive surgery (MIS), a compact and accurate positioning mechanism, named Dionis, is proposed in this paper. This spatial hybrid mechanism based on a novel parallel kinematics is able to provide three rotations and one translation for single port procedures. The corresponding axes intersect at a remote center of rotation (RCM) that is the MIS entry port. Another important feature of the proposed positioning manipulator is that it can be placed below the operating table plane, allowing a quick and direct access to the patient, without removing the robotic system. This, besides saving precious space in the operating room, may improve safety over existing solutions. The conceptual design of Dionis is presented in this paper. Solutions for the inverse and direct kinematics are developed, as well as the analytical workspace and singularity analysis. Due to its unique design and kinematics, the proposed mechanism is highly compact, stiff and its dexterity fullfils the workspace specifications for MIS procedures.

R. Beira

L. Santos-Carreras

G. Rognini

H. Bleuler

R. Clavel

Dionis: A Novel Remote-Center-of-Motion Parallel Manipulator for Minimally Invasive Surgery

This study introduces a comparative performance analysis of the technological solutions that have been used to build distal active articulations for minimally invasive medical procedures. The aim is to provide a practical and concise database and classification tool for anyone that wants to learn more about the technologies involved in minimally invasive medical devices, or for any designer interested in further improving these devices. A review of the different articulations developed in this field is therefore performed and organized by both actuation technology and structural architecture. Details are presented concerning the mechanical structures as well as the actuation and the mechanical transmission technologies available. The solutions are evaluated keeping as a reference some chosen required performances and characteristics for minimally invasive surgical procedures. Finally, a quantified comparison chart of these devices is given regarding selected criteria of interest for minimally invasive surgical application.

Julien Catherine

Christine Rotinat-Libersa

Alain Micaelli

Comparative Review of Endoscopic Devices Articulations Technologies Developed for Minimally Invasive Medical Procedures

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Applied Bionics and Biomechanics publishes original research articles as well as review articles that seek to understand the mechanics of biological systems, or that use the functions of living organisms as inspiration for the design of new devices.

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Chief Editor, Professor Qiguo Rong, is the Vice Chair of the Department of Mechanics and Engineering Science at Peking University, China. His research focuses on the biomechanical behaviors of musculoskeletal systems.

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Applied Bionics and Biomechanics

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