Improving robot arm control for safe and robust haptic cooperation in orthopaedic procedures.

BACKGROUND: This paper presents the ongoing results of an effort to achieve the integration of a navigated cooperative robotic arm into computer-assisted orthopaedic surgery. A seamless integration requires the system acting in direct cooperation with the surgeon instead of replacing him. METHODS: Two technical issues are discussed to improve the haptic operating modes for interactive robot guidance. The concept of virtual fixtures is used to restrict the range of motion of the robot according to pre-operatively defined constraints, and methodologies to assure a robust and accurate motion through singular arm configurations are investigated. RESULTS: A new method for handling singularities is proposed, which is superior to the commonly used damped-least-squares method. It produces no deviations of the end-effector in relation to the virtually constrained path. CONCLUSIONS: A solution to assure a good performance of a hands-on robotic arm at singularity configurations is proposed.

[Manipulator assisted endoscope guidance in functional endoscopic sinus surgery: proof of concept]. / Ein Konzept für eine automatisierte Endoskopführung für die Nasennebenhöhlenchirurgie.

BACKGROUND: Functional endoscopic sinus surgery (FESS) is characterized by single-handed preparation and guidance of the endoscope by the nondominant hand. This results in an additional extension of operation time by up to 15% and ergonomic deficits. The aim of this study is the conception of an automated assistance system for FESS in view of the following questions: (1) Which degree of surgical automation is suitable for FESS? (2) Which design is suitable? (3) What are the properties of the technical system (planning, time, accuracy, precision) of the selected system? (4) Does the system offer potential for a clinical application? METHODS: In all 49 FESS were analyzed for surgical workflows. Measurement of the maximum forces within FESS was performed with 40 trials on an anatomical model. Three different mechanical systems were used in ten FESS and evaluated using the ICCAS Human-Machine Evaluation Scale. For realization of automated endoscope guidance an engine-driven and -braked manipulator (PA10-6c, Mitsubishi, Japan) was used. The technical parameters determined were expenditure of time for the preoperative planning of workspace, surgical accuracy and precision of the intraoperative endoscope positioning, maximal forces, and time. RESULTS: Concept-conditioned instrument changes amount to an average of 41.1 and 18.9% (5.21 min) time requirement for each FESS side. Maximum forces on the mucous membrane during a conventional FESS were measured at 9.8 N (5.9-9.8). Usability of the mechanical endoscope holder was estimated in 18 of 20 cases to be inferior to the standard procedure. The time needed for segmenting the intranasal workspace was 15.2 min (10.0-23.0). The maximum deviation of the automatically driven endoscope from a planned position amounted to 0.85 mm (manually 4.64 mm). The maximum force was measured with 1.1 N in the z direction (manually 9.8 N). Automated guidance of the endoscope to an intranasal position needed 7.25 s (6.4-7.9); manually 12.64 s (5.9-43.0). CONCLUSION: Guidance of the endoscope for FESS by an automated motor-driven system is possible. The conception which is based on workflow analysis favors a system with automatic definition of the workspace and a manual movement of the endoscope. The examined system offers a potential for clinical application. Definition of the automation level and development of a man-machine interface is more important than selection or reconstruction of a special manipulator for endoscope guidance in FESS from a surgical point of view.

A navigated mechatronic system with haptic features to assist in surgical interventions.

OBJECTIVE: In orthopaedic surgery, the development of new computer-based technologies such as navigation systems and robotics will facilitate more precise, reproducible results in surgical interventions. There are already commercial systems available for clinical use, though these still have some limitations and drawbacks. This paper presents an alternative approach to a universal modular surgical assistant system for supporting less or minimally invasive surgery. MATERIALS AND METHODS: The position of a mechatronic arm, which is part of the system, is controlled by a navigation system so that small patient movements are automatically detected and compensated for in real time. Thus, the optimal tool position can be constantly maintained without the need for rigid bone or patient fixation. Furthermore, a force control mode of the mechatronic assistant system, based on a force-torque sensor, not only increases safety during surgical interventions but also facilitates hand-driven direct positioning of the arm. RESULTS: A prototype has been successfully tested in clinical applications at the Orthopadische Universitätsklinik Frankfurt. For the first time worldwide, implantation of the cup prosthesis in total hip replacement surgery has been carried out with the assistance of a mechatronic arm. According to measurements by the digitizing system, operating tool angle deviation remained below 0.5 degrees, relative to the preoperative planning. CONCLUSION: The presented approach to a new kind of surgical mechatronic assistance system supports the surgeon as needed by optimal positioning of the surgical instruments. Due to its modular design, it is applicable to a wide range of tasks in surgical interventions, e.g., endoscope guidance, bone preparation, etc.

[Thoughts on the use of mechatronic implantation aids in minimal approaches in hip prostheses]. / Uberlegungen zum Einsatz mechatronischer Implantationshilfen bei Minimalzugängen für Hüftendoprothesen.

A new concept of THR surgery is presented: A combination of limited surgical approach, intraoperative digitizing, and use of a semi-active robot shows the important advantage of easy registration, reproducible positioning of surgical instruments, and less invasive surgery. Using this system originally designed for accurate socket implantation, it will be possible to perform total THR in the future. For preoperative planning, we are currently investigating the use of biplanar digital radiographics with transformation into a 3D-model in order to avoid CT scans in the pelvic area.