A third hand to the surgeon: the use of an endoscope holding arm in endonasal sinus surgery and well beyond

Background Extended endoscopic endonasal operations of the sinuses and the frontal skull base require a bimanual action of the surgeon in many cases. Thus, typically an assistant guides the endoscope and centers the field of view. In this study, we investigate in which cases an endoscope holding arm can be used alternatively. Materials and methods The electromagnetic system ENDOFIXexo was used in different surgical interventions of the paranasal sinuses and beyond questioning ergonomics and geometrical limitations. The realized degrees of freedom were documented, and a topography of possible applications compiled. Results The presented system is limited by the anatomy of the anterior ethmoid and dynamic working conditions in the sagittal direction. Especially in extended interventions in the posterior ethmoid, in which parts of the nasal septum have been resected and a static position of the endoscope is desired the surgeon can greatly benefit from the robotic arm. Moreover, through the high flexibility of the endoscopic arm surgeries of the pharynx and larynx were performed, questioning the current gold standard of microscope-assisted surgical procedures. Conclusion Under the impression of an urging staff shortage and due to its unlimited patience, the ENDOFIXexo arm seems promising. Taking into account the complex anatomy and the limited access, we especially see a favorable field of application in the surgery of the pituitary gland and skull base tumors.

Shared control–based bimanual robot manipulation

Human-centered environments provide affordances for and require the use of two-handed, or bimanual, manipulations. Robots designed to function in, and physically interact with, these environments have not been able to meet these requirements because standard bimanual control approaches have not accommodated the diverse, dynamic, and intricate coordinations between two arms to complete bimanual tasks. In this work, we enabled robots to more effectively perform bimanual tasks by introducing a bimanual shared-control method. The control method moves the robot’s arms to mimic the operator’s arm movements but provides on-the-fly assistance to help the user complete tasks more easily. Our method used a bimanual action vocabulary, constructed by analyzing how people perform two-hand manipulations, as the core abstraction level for reasoning about how to assist in bimanual shared autonomy. The method inferred which individual action from the bimanual action vocabulary was occurring using a sequence-to-sequence recurrent neural network architecture and turned on a corresponding assistance mode, signals introduced into the shared-control loop designed to make the performance of a particular bimanual action easier or more efficient. We demonstrate the effectiveness of our method through two user studies that show that novice users could control a robot to complete a range of complex manipulation tasks more successfully using our method compared to alternative approaches. We discuss the implications of our findings for real-world robot control scenarios.

Motor control hierarchy in joint action that involves bimanual force production

The concept of hierarchical motor control has been viewed as a means of progressively decreasing the number of variables manipulated by each higher control level. We tested the hypothesis that turning an individual bimanual force-production task into a joint (two-participant) force-production task would lead to positive correlation between forces produced by the two hands of the individual participant (symmetric strategy) to enable negative correlation between forces produced by two participants (complementary strategy). The present study consisted of individual and joint tasks that involved both unimanual and bimanual conditions. In the joint task, 10 pairs of participants produced periodic isometric forces, such that the sum of forces that they produced matched a target force cycling between 5% and 10% of maximum voluntary contraction at 1 Hz. In the individual task, individuals attempted to match the same target force. In the joint bimanual condition, the two hands of each participant adopted a symmetric strategy of force, whereas the two participants adopted a complementary strategy of force, highlighting that the bimanual action behaved as a low level of a hierarchy, whereas the joint action behaved as an upper level. The complementary force production was greater interpersonally than intrapersonally. However, whereas the coherence was highest at 1 Hz in all conditions, the frequency synchrony was stronger intrapersonally than interpersonally. Moreover, whereas the bimanual action exhibited a smaller error and variability of force than the unimanual action, the joint action exhibited a less-variable interval and force than the individual action.