scholarly journals Autonomy in surgical robots and its meaningful human control

2019 ◽  
Vol 10 (1) ◽  
pp. 30-43 ◽  
Author(s):  
Fanny Ficuciello ◽  
Guglielmo Tamburrini ◽  
Alberto Arezzo ◽  
Luigi Villani ◽  
Bruno Siciliano
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Case Studies ◽  
Invasive Surgery ◽  
Ethical Issues ◽  
Soft Or ◽  
Surgical Robots ◽  
Human Control ◽  
Significant Difference

AbstractThis article focuses on ethical issues raised by increasing levels of autonomy for surgical robots. These ethical issues are explored mainly by reference to state-ofart case studies and imminent advances in Minimally Invasive Surgery (MIS) and Microsurgery. In both area, surgicalworkspace is limited and the required precision is high. For this reason, increasing levels of robotic autonomy can make a significant difference there, and ethically justified control sharing between humans and robots must be introduced. In particular, from a responsibility and accountability perspective suitable policies for theMeaningfulHuman Control (MHC) of increasingly autonomous surgical robots are proposed. It is highlighted how MHC should be modulated in accordance with various levels of autonomy for MIS and Microsurgery robots. Moreover, finer MHC distinctions are introduced to deal with contextual conditions concerning e.g. soft or rigid anatomical environments.

scholarly journals A learning robot for cognitive camera control in minimally invasive surgery

2021 ◽  
Author(s):  
Martin Wagner ◽  
Andreas Bihlmaier ◽  
Hannes Götz Kenngott ◽  
Patrick Mietkowski ◽  
Paul Maria Scheikl ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Autonomous Systems ◽  
Robot Kinematics ◽  
Learning Context ◽  
Surgical Robots ◽  
Camera Control ◽  
Context Sensitive ◽  
Robotic Camera

Abstract Background We demonstrate the first self-learning, context-sensitive, autonomous camera-guiding robot applicable to minimally invasive surgery. The majority of surgical robots nowadays are telemanipulators without autonomous capabilities. Autonomous systems have been developed for laparoscopic camera guidance, however following simple rules and not adapting their behavior to specific tasks, procedures, or surgeons. Methods The herein presented methodology allows different robot kinematics to perceive their environment, interpret it according to a knowledge base and perform context-aware actions. For training, twenty operations were conducted with human camera guidance by a single surgeon. Subsequently, we experimentally evaluated the cognitive robotic camera control. A VIKY EP system and a KUKA LWR 4 robot were trained on data from manual camera guidance after completion of the surgeon’s learning curve. Second, only data from VIKY EP were used to train the LWR and finally data from training with the LWR were used to re-train the LWR. Results The duration of each operation decreased with the robot’s increasing experience from 1704 s ± 244 s to 1406 s ± 112 s, and 1197 s. Camera guidance quality (good/neutral/poor) improved from 38.6/53.4/7.9 to 49.4/46.3/4.1% and 56.2/41.0/2.8%. Conclusions The cognitive camera robot improved its performance with experience, laying the foundation for a new generation of cognitive surgical robots that adapt to a surgeon’s needs.

scholarly journals Clinical effect of minimally invasive surgery for inguinal cryptorchidism

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yunjin Wang ◽  
Liu Chen ◽  
Xu Cui ◽  
Chaoming Zhou ◽  
Qing Zhou ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Laparoscopic Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Clinical Effect ◽  
Testicular Atrophy ◽  
Surgery Group ◽  
Significant Difference ◽  
Good Cosmetic ◽  
Scrotal Hematoma

Abstract Background The purpose of this study was to investigate the clinical effect of minimally invasive surgery for inguinal cryptorchidism. Methods The patients were divided into the minimally invasive surgery group (n = 100) and the traditional surgery group (n = 58). In the minimally invasive surgery group, patients with low inguinal cryptorchidism (n = 54) underwent surgery with a transscrotal incision, and patients with high inguinal cryptorchidism (n = 46) underwent laparoscopic surgery. Results There was no difference in the hospital stay duration or cost between the minimally invasive surgery group and the traditional surgery group (P > 0.05). As for the operative time, minimally invasive surgery of low inguinal cryptorchidism was shorter than traditional surgery (P = 0.033), while minimally invasive surgery of high inguinal cryptorchidism was comparable to traditional surgery (P = 0.658). Additionally, there were no cases of testicular atrophy, testicular retraction, inguinal hernia or hydrocele in either group. There was no significant difference in the incidence of poor wound healing between the two groups (P > 0.05). Although there was no significant difference in the incidence of scrotal hematoma between the two groups (P > 0.05), the incidence in the minimally invasive surgery group was higher than that in the traditional surgery group. Conclusions Minimally invasive surgery including a transscrotal incision for low inguinal cryptorchidism and laparoscopic surgery for high inguinal cryptorchidism is as safe and effective as traditional surgery, and could also provide a good cosmetic effect for children.

Conception of Arm of Medical Robot Dedicated to Application of Minimally Invasive Surgery

2013 ◽  
Vol 198 ◽  
pp. 3-8 ◽  
Author(s):  
Roman Trochimczuk
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Forward Kinematics ◽  
Kinematic Structure ◽  
Kinematics Analysis ◽  
Medical Robot ◽  
Surgical Robots

In this article only a few aspects of designing the surgical manipulator's arm will be chosen with the consideration of the kinematic structure of mechanical actuators system together with the description of requirements and the assumption for the execution system. The conception of surgical robots arm will be presented with parallelogram mechanism which increases the rigidity of the construction along with defining of kinematics matrix which describes a forward kinematics task. The aspect of limitation of the Denavit-Hartenberg method encountered by the author during the kinematics analysis of mechanism will be discussed and the solution of this systems issue will be given in this paper.

scholarly journals Clinical effect of minimally invasive surgery for inguinal cryptorchidism

2020 ◽  
Author(s):  
Yunjin Wang ◽  
Liu Chen ◽  
Xu Cui ◽  
Chaoming Zhou ◽  
Qing Zhou ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Laparoscopic Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Clinical Effect ◽  
Testicular Atrophy ◽  
Surgery Group ◽  
Significant Difference ◽  
Good Cosmetic ◽  
Scrotal Hematoma

Abstract Background: The purpose of this study was to investigate the clinical effect of minimally invasive surgery for inguinal cryptorchidism.Methods: The patients were divided into the minimally invasive surgery group (n=100) and the traditional surgery group (n=58). In the minimally invasive surgery group, patients with low inguinal cryptorchidism (n=54) underwent surgery with a transscrotal incision, and patients with high inguinal cryptorchidism (n=46) underwent laparoscopic surgery. Results: There was no difference in the hospital stay duration or cost between the minimally invasive surgery group and the traditional surgery group (P>0.05). As for the operative time, minimally invasive surgery of low inguinal cryptorchidism was shorter than traditional surgery (P=0.033), while minimally invasive surgery of high inguinal cryptorchidism was comparable to traditional surgery (P=0.658). Additionally, there were no cases of testicular atrophy, testicular retraction, inguinal hernia or hydrocele in either group. There was no significant difference in the incidence of poor wound healing between the two groups (P>0.05). Although there was no significant difference in the incidence of scrotal hematoma between the two groups (P>0.05), the incidence in the minimally invasive surgery group was higher than that in the traditional surgery group. Conclusions: Minimally invasive surgery including a transscrotal incision for low inguinal cryptorchidism and laparoscopic surgery for high inguinal cryptorchidism is as safe and effective as traditional surgery, and could also provide a good cosmetic effect for children.

scholarly journals Comparison of Minimally Invasive Surgery versus Laparotomy for Surgical Staging of Endometrial Carcinoma: A Retrospective Study

2020 ◽  
Vol 5 (1) ◽  
pp. 916-920
Author(s):  
Mona Priyadarshini ◽  
Rani Akhil Bhat
Keyword(s):  
Endometrial Cancer ◽  
Minimally Invasive Surgery ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Endometrial Carcinoma ◽  
Invasive Surgery ◽  
Surgical Staging ◽  
Duration Of Hospital Stay ◽  
Significant Difference

Introduction: Endometrial carcinoma is one of the commonest gynaecological cancer in developed countries as well as developing countries. The mainstay of initial treatment of endometrial carcinoma is surgical staging which may be performed by either the conventional abdominal approach or by minimally invasive route i.e. laparoscopic or robotic. Objectives: The purpose of this study was to compare and evaluate the surgical staging, safety and clinical benefits of minimally invasive surgeries versus. laparotomy in patients with endometrial cancer. Methodology: We retrospectively analyzed 105 patients with endometrial cancer over a period of five years and compared the outcome of total hysterectomy with pelvic and para-aortic lymphadenectomy by abdominal, laparoscopic approach or robotic-assisted surgery. Comparison was done with respect to operative time, blood loss, number of lymph nodes retrieved, length of hospital stay, intraoperative and postoperative complications. The data were analyzed using paired “t”- test / Wilcoxon signed rank test ,χ2 - test, Pearson correlation coefficient “r” whenever found suitable. P value of less than 0.05 was considered as statistically significant. Result: There was no statistically significant difference seen in the baseline characteristics like age and BMI between the two groups. The laparotomies were done in a shorter time than the minimally invasive approach (p<0.001). The amount of blood loss (p=0.002), and the duration of hospital stay (p<0.001) was significantly less in the minimally invasive surgery group than the laparotomies. Not much difference in the lymph node retrieval was observed between the two arms (p=0.614). The number of complications were almost similar in both the groups. Conclusion: Minimally invasive surgery for surgical staging of endometrial carcinoma is feasible and effective than laparotomy. The amount of blood loss and duration of hospital stay is seen much lesser with MIS than laparotomy.

scholarly journals Three and Five-Year Mortality in Ovarian Cancer after Minimally Invasive Compared to Open Surgery: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (8) ◽  
pp. 2507 ◽  
Author(s):  
Floriane Jochum ◽  
Muriel Vermel ◽  
Emilie Faller ◽  
Thomas Boisrame ◽  
Lise Lecointre ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Open Surgery ◽  
Meta Analysis ◽  
Perioperative Outcomes ◽  
Cochrane Library ◽  
Significant Difference ◽  
Advanced Stages

As regards ovarian cancer, the use of minimally invasive surgery has steadily increased over the years. Reluctance persists, however, about its oncological outcomes. The main objective of this meta-analysis was to compare the three and five-year mortality of patients operated by minimally invasive surgery (MIS) for ovarian cancer to those operated by conventional open surgery (OPS), as well as their respective perioperative outcomes. PubMed, Cochrane library and CinicalTrials.gov were systematically searched, using the terms laparoscopy, laparoscopic or minimally invasive in combination with ovarian cancer or ovarian carcinoma. We finally included 19 observational studies with a total of 7213 patients. We found no statistically significant difference for five-year (relative risk (RR) = 0.89, 95% CI 0.53–1.49, p = 0.62)) and three-year mortality (RR = 0.95, 95% CI 0.80–1.12, p = 0.52) between the patients undergoing MIS and those operated by OPS. When five and three-year recurrences were analyzed, no statistically significant differences were also observed. Analysis in early and advanced stages subgroups showed no significant difference for survival outcomes, suggesting oncological safety of MIS in all stages. Whether the surgery was primary or interval debulking surgery in advanced ovarian cancer, did not influence the comparative results on mortality or recurrence. Although the available studies are retrospective, and mostly carry a high risk for bias and confounding, an overwhelming consistency of the evidence suggests the likely effectiveness of MIS in selected cases of ovarian cancer, even in advanced stages. To validate the use of MIS, the development of future randomized interventional studies should be a priority.

scholarly journals Robust Orthogonal-View 2-D/3-D Rigid Registration for Minimally Invasive Surgery

Micromachines ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 844
Author(s):  
Zhou An ◽  
Honghai Ma ◽  
Lilu Liu ◽  
Yue Wang ◽  
Haojian Lu ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Test Cases ◽  
Surgical Robots ◽  
Anatomical Structures ◽  
The Public ◽  
Rigid Registration ◽  
Target Registration Error ◽  
Global Optima

Intra-operative target pose estimation is fundamental in minimally invasive surgery (MIS) to guiding surgical robots. This task can be fulfilled by the 2-D/3-D rigid registration, which aligns the anatomical structures between intra-operative 2-D fluoroscopy and the pre-operative 3-D computed tomography (CT) with annotated target information. Although this technique has been researched for decades, it is still challenging to achieve accuracy, robustness and efficiency simultaneously. In this paper, a novel orthogonal-view 2-D/3-D rigid registration framework is proposed which combines the dense reconstruction based on deep learning and the GPU-accelerated 3-D/3-D rigid registration. First, we employ the X2CT-GAN to reconstruct a target CT from two orthogonal fluoroscopy images. After that, the generated target CT and pre-operative CT are input into the 3-D/3-D rigid registration part, which potentially needs a few iterations to converge the global optima. For further efficiency improvement, we make the 3-D/3-D registration algorithm parallel and apply a GPU to accelerate this part. For evaluation, a novel tool is employed to preprocess the public head CT dataset CQ500 and a CT-DRR dataset is presented as the benchmark. The proposed method achieves 1.65 ± 1.41 mm in mean target registration error(mTRE), 20% in the gross failure rate(GFR) and 1.8 s in running time. Our method outperforms the state-of-the-art methods in most test cases. It is promising to apply the proposed method in localization and nano manipulation of micro surgical robot for highly precise MIS.

scholarly journals The Use of Barbed Suture for Cystotomy Repair --- A Novel Approach

2021 ◽  
Author(s):  
Robert E. Shapiro ◽  
Alec Sunyecz ◽  
Stanley Zaslau ◽  
Manuel C. Vallejo ◽  
Chad Crigger ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Retrospective Chart Review ◽  
Interval Data ◽  
Barbed Suture ◽  
Secondary Outcome ◽  
Suture Repair ◽  
Chi Square ◽  
Significant Difference

Abstract Background In this study, we aim to compare outcomes after cystotomy repair between standard sutures (910 polyglactin, poliglecaprone) versus barbed (V-Loc™ 90) suture. As a secondary outcome, we analyzed risk factors for suture preference between the two groups. Methods A retrospective chart review was undertaken for surgeries complicated by cystotomy, identified by ICD-9/10 codes from 2016 to 2019 at West Virginia University (WVU) Hospital. Comparisons were made between cystotomy repair using barbed suture versus standard braided suture. Injuries were categorized by procedure, surgeon specialty, surgical route, type of suture used in repair, and subsequent complications related to repair. Primary endpoints were examined by Pearson’s Chi-square test and interval data by t-test. A p < .05 was significant. Results Sixty-eight patients were identified with iatrogenic cystotomy at WVU. Barbed suture was used for cystotomy repair in 11/68 (16.2%) patients. No significant difference was seen in postoperative outcomes between patients repaired with barbed suture versus standard braided suture. Barbed suture was significantly more likely to be used for cystotomy repair in minimally invasive surgery (p = 0.001). It was most often utilized in a robotic approach 7/11 (63.6%) followed by laparoscopic 3/11 (27.3%). Body mass index (BMI) was significantly higher in patients receiving a barbed suture repair (p = .005). Conclusion Barbed suture is not inferior to standard braided suture for cystotomy repair and does not cause an increase in complication rate. Barbed suture offers a practical alternative to facilitate cystotomy repair in minimally invasive surgery, especially in patients with a high BMI.

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