Autonomous Surgical Robotics Nicols Prez de Olaguer Santamara - - PowerPoint PPT Presentation

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Autonomous Surgical Robotics Nicols Prez de Olaguer Santamara - - PowerPoint PPT Presentation

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MIN Faculty Department of Informatics Autonomous Surgical Robotics Nicols Prez de Olaguer Santamara University of Hamburg Faculty of Mathematics, Informatics and Natural Sciences Department of Informatics Technical Aspects of Multimodal

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MIN Faculty Department of Informatics

Autonomous Surgical Robotics

Nicolás Pérez de Olaguer Santamaría

University of Hamburg Faculty of Mathematics, Informatics and Natural Sciences Department of Informatics Technical Aspects of Multimodal Systems

  • 04. December 2017

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 1 / 29

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Outline

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

  • 1. Motivation
  • 2. Non-Autonomous Surgical Robots
  • 3. Supervised Autonomous Robots
  • 4. STAR surgical Robot
  • 5. Discussion
  • 6. Conclusions

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 2 / 29

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Motivation

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

Would you trust on a robot to perform you a surgical intervention?

https://youtu.be/hulnz902gWo

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 3 / 29

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Why use surgical Robots?

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

They provide:

◮ Enhanced effectiveness ◮ Safety ◮ Optimal techniques

◮ Minimally invasive surgery

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 4 / 29

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Why use surgical Robots?

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

They provide:

◮ Enhanced effectiveness ◮ Safety ◮ Optimal techniques

◮ Minimally invasive surgery

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 4 / 29

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Why use surgical Robots?

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

They provide:

◮ Enhanced effectiveness ◮ Safety ◮ Optimal techniques

◮ Minimally invasive surgery

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 4 / 29

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Brief history

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ First surgical robot: Arthrobot, Vancouver 1983. ◮ PUMA 560

◮ 1985 1st neurosurgical biopsy.

◮ ROBODOC, 1992, used to crave a cavity in the femur to

perfectly fit a hip prosthesis in the patient.

Arthrobot [1] Puma 560 [2] ROBODOC [3]

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 5 / 29

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Brief history (cont.)

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

Da Vinci Surgical System, 2000

◮ Minimally invasive surgery. ◮ Teleoperated system. ◮ Four interactive robot arms. ◮ To replace laparoscopic tools. ◮ US 2 million.

Da Vinci surgical system[5] Laparoscopic Tools [4]

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 6 / 29

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Brief history (cont.)

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

  • No. of operations worldwide by the Da Vinci Surgical System [5].

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 7 / 29

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Brief history (cont.)

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

Concentric Tube Robots (2005)

youtu.be/IUg4Jco-Apc [6]

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 8 / 29

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Autonomy of surgical robots

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

Level of Autonomy

Da Vinci surgical system[5] STAR Robot[7]

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 9 / 29

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Non-Autonomous Surgical Robots

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ The action is completely performed by the surgeon. Hand-eye

coordination.

◮ We do not have an ’intelligent’ system. ◮ Benefits:

◮ Reduce human fatigue. ◮ Allow high precision. ◮ Minimal Invasive Surgery

◮ Drawbacks:

◮ Relies on the dexterity of the surgeon. ◮ Slow learning curve.

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 10 / 29

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Autonomy

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

“an ability to perform intended tasks based on current state and sensing without human intervention”

(ISO 8373:2012)

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 11 / 29

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State of the art

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ The robot perform a certain task with the supervision of the

doctor.

◮ Surgeon asses the automated planning of the robot before

implementation.

◮ Discrete control of the system. ◮ Used in rigid tissues surgeries i.e. bone interventions. ◮ Never tested in human soft tissue.

◮ Increased complexity by tissue deformation.

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 12 / 29

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Features

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Reduce human errors. ◮ Deal with different sensory data. ◮ Execute predefined motions. ◮ Improve safety, consistency and quality of intervention.

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 13 / 29

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Paper

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

Supervised autonomous robotic soft tissue surgery

  • A. Shademan, R. S. Decker, J. D. Opfermann, S. Leonard, A.

Krieger, and P. C. Kim

Published 4 May 2016, Sci Transl Med 8 (337), 337ra64337ra64 DOI : 10.1126/scitranslmed.aad9398

Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA. Department of Computer Science, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA.

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Hypothesis

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Smart Tissue Autonomous Robot (STAR). Defined in [7] ◮ Designed to perform anastomosis of soft tissue (suture). ◮ Hypothesis posed: Can this complex intervention be done

autonomously and perform better than other surgical techniques?

[7]

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 15 / 29

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Tests

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

Tested in:

◮ In-vivo and ex-vivo pig intestine. ◮ Against: manual surgery (OPEN), laparoscopy (LAP) and

robot-assisted surgery (RAS).

[7]

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 16 / 29

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Technologies

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Actuated suturing tools. ◮ Fluorescent and 3D imaging. ◮ Force sensing. ◮ Submilimiter positioning.

[7]

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Technologies

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Actuated suturing tools. ◮ Fluorescent and 3D imaging. ◮ Force sensing. ◮ Submilimiter positioning.

[7]

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 17 / 29

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Technologies

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Actuated suturing tools. ◮ Fluorescent and 3D imaging. ◮ Force sensing. ◮ Submilimiter positioning.

[7]

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 17 / 29

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Technologies

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Actuated suturing tools. ◮ Fluorescent and 3D imaging. ◮ Force sensing. ◮ Submilimiter positioning.

[7]

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 17 / 29

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Robot Arm, Suturing Tool and Force Sensor

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Seven-DOF KUKA LBR4 robotic arm + one-DOF suturing

tool.

◮ Suturing tool designed for manual actuation. ◮ Repeatable 0.05 mm positioning. ◮ Force sensor placed in between the last link of the robot arm

and the suturing tool → ideally should be on the end of the suturing tool.

◮ Threshold of 1N.

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 18 / 29

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Imaging and 3D tracking

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Near-Infrared fluorescent (NIRF) Imaging. ◮ Chemical solution. ◮ NIRF markers manually placed by the surgeons. ◮ Real-time positioning information.

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 19 / 29

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Imaging and 3D tracking (cont.)

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Plenoptic 3D surface reconstruction (1.14mm). ◮ 3D visual tracking to the markers. ◮ Combination of both avoid problem of occlusion and

recognition of the tissue targets.

[7]

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Suture Planning

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Model the deformation of the tissue showed unpredictable

behaviour from 0 to 6.5mm.

◮ Lead to real-time detection and plan adjusting using the

imaging technologies.

◮ Algorithm of suture plan computed regarding cut length and

thickness (manual or sensor input).

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Suture Planning (Algorithm)

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Polyline fitted through the NIRF markers. ◮ Tissue thickness T, bite depth H, spacing between consecutive

sutures S, lumen diameter D and circumference C = πD.

◮ Leak-free suture achieved with S < H/1.25 ◮ Optimal number of sutures is:

N = C/S = ceil(1.25C/H) = ceil(1.25πD/3T)

◮ With T = 1.3mm and D = 1.5mm, N = 16 with suture

spacing S = C/N = 2.95mm.

[7]

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[7]

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Benefits

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Optimized techniques. ◮ Better performance

◮ Proof of their hypothesis.

◮ Liberation of the surgeon to only supervise the work. ◮ Reduced recovery time.

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Problems

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ Higher expenses. ◮ Longer anaesthesia exposure. ◮ Only valid for this specific problem. Moreover, this problem can

be solved easily by staples.

◮ Lots of ethical issues. ◮ Hard to implement soon.

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 25 / 29

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Conclusions

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

◮ It is a first step on the field of robotic autonomy in the OR. ◮ Highly risky environment leads to slow down the introduction

  • f the technology.

◮ Change the role of the doctors to decision-making rather than

actuating.

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Conclusions

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

Are we going to accept the increase of risk in health care as we did in other fields i.e. self driving cars?

Nicolás Pérez de Olaguer Santamaría – Autonomous Surgical Robotics 27 / 29

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References

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

1 The Medical Post, Volume 21, No. 23, 12/11/1985 2 30 Years of Robotic Surgery – Past, Present and Future, Trevor Hackman, MD, FACS Department of Otolaryngology / Head and Neck Surgery University of North Carolina at Chapel Hill, 2015 IEEE RoboResearch Seminar, 3 ROBODOC - surgical robot success story, Joanne Pransky, Industrial Robot: An International Journal 1997 4 Wikimedia foundation Inc., 2017-11-29, Laparoscopic Surgery, https://en.wikipedia.org/wiki/Laparoscopic_surgery/, Wikipedia, Accessed 2017-12-01

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References

Motivation Non-Autonomous Surgical Robots Supervised Autonomous Robots STAR surgical Robot Discussion Conclusions

5 Surgical Robotics: The Next 25 Years, UK-RAS White papers, 2016 6 Burgner, J., Gilbert, H. B., & Webster, R. J. (2013, May). On the computational design of concentric tube robots: Incorporating volume-based objectives. In Robotics and Automation (ICRA), 2013 IEEE International Conference on (pp. 1193-1198). IEEE. 7 A. Shademan, R. S. Decker, J. D. Opfermann, S. Leonard,

  • A. Krieger, and P. C. Kim, Supervised autonomous robotic

soft tissue surgery, Science translational medicine. 8 (337), 337ra64337ra64, (2016)

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