Assessment of first-touch skills in robotic surgical training using hi-Sim and the hinotori surgical robot system among surgeons and novices.

PURPOSE: Surgeons' adaptability to robotic manipulation remains underexplored. This study evaluated the participants' first-touch robotic training skills using the hinotori surgical robot system and its simulator (hi-Sim) to assess adaptability. METHODS: We enrolled 11 robotic surgeons (RS), 13 laparoscopic surgeons (LS), and 15 novices (N). After tutorial and training, participants performed pegboard tasks, camera and clutch operations, energizing operations, and suture sponge tasks on hi-Sim. They also completed a suture ligation task using the hinotori surgical robot system on a suture simulator. Median scores and task completion times were compared. RESULTS: Pegboard task scores were 95.0%, 92.0%, and 91.5% for the RS, LS, and N groups, respectively, with differences between the RS group and LS and N groups. Camera and clutch operation scores were 93.1%, 49.7%, and 89.1%, respectively, showing differences between the RS group and LS and N groups. Energizing operation scores were 90.9%, 85.2%, and 95.0%, respectively, with a significant difference between the LS and N groups. Suture sponge task scores were 90.6%, 43.1%, and 46.2%, respectively, with differences between the RS group and LS and N groups. For the suture ligation task, completion times were 368 s, 666 s, and 1095 s, respectively, indicating differences among groups. Suture scores were 12, 10, and 7 points, respectively, with differences between the RS and N groups. CONCLUSION: First-touch simulator-based robotic skills were partially influenced by prior robotic surgical experience, while suturing skills were affected by overall surgical experience. Thus, robotic training programs should be tailored to individual adaptability.

Bone enhancement filtering: application to sinus bone segmentation and simulation of pituitary surgery.

The simulation of pituitary gland surgery requires a precise classification of soft tissues, vessels and bones. Bone structures tend to be thin and have diffuse edges in CT data, and thus the common method of thresholding can produce incomplete segmentations. In this paper, we present a novel multi-scale sheet enhancement measure and apply it to paranasal sinus bone segmentation. The measure uses local shape information obtained from an eigenvalue decomposition of the Hessian matrix. It attains a maximum in the middle of a sheet, and also provides local estimates of its width and orientation. These estimates are used to create a vector field orthogonal to bone boundaries, so that a flux maximizing flow algorithm can be applied to recover them. Hence, the sheetness measure has the essential properties to be incorporated into the computation of anatomical models for the simulation of pituitary surgery, enabling it to better account for the presence of sinus bones. We validate the approach quantitatively on synthetic examples, and provide comparisons with existing segmentation techniques on paranasal sinus CT data.

Mechanical properties of brain tissue in tension.

This paper contains experimental results of in vitro, uniaxial tension of swine brain tissue in finite deformation as well as proposes a new hyper-viscoelastic constitutive model for the brain tissue. The experimental results obtained for two loading velocities, corresponding to strain rates of 0.64 and 0.64 x 10(-2)s(-1), are presented. We believe that these are the first ever experiments of this kind. The applied strain rates were similar to those applied in our previous study, focused on explaining brain tissue properties in compression. The stress-strain curves are convex downward for all extension rates. The tissue response stiffened as the loading speed increased, indicating a strong stress-strain rate dependence. Swine brain tissue was found to be considerably softer in extension than in compression. Previously proposed in the literature brain tissue constitutive models, developed based on experimental data collected in compression are shown to be inadequate to explain tissue behaviour in tension. A new, non-linear, viscoelastic model based on the generalisation of the Ogden strain energy hyper-elastic constitutive equation is proposed. The new model accounts well for brain tissue deformation behaviour in both tension and compression (natural strain in <-0.3,0.2>) for strain rates ranging over five orders of magnitude.

Coaxial needle insertion assistant for epidural puncture effect of lateral force on needle.

We validated the effectiveness of a coaxial needle insertion assistant under the condition that the needles were laterally deformed. The coaxial needle insertion assistant separates the cutting force at the needle tip from shear friction on the needle shaft, and haptically display it to a user in order to assists her/his perception during epidural puncture. An outer needle covers the side of an inner needle, preventing the shear friction from acting on the inner needle. However when the needles are laterally deformed and make contact to each other, it is concerned that the effect of the separation is degraded. In this paper, the users punctured an artificial tissue with variable insertion angles, so that the needle is intentionally laterally deformed. The overshoot and user confidence in detecting puncture was examined.

Coaxial needle insertion assistant with enhanced force feedback.

Many medical procedures involving needle insertion into soft tissues, such as anesthesia, biopsy, brachytherapy, and placement of electrodes, are performed without image guidance. In such procedures, haptic detection of changing tissue properties at different depths during needle insertion is important for needle localization and detection of subsurface structures. However, changes in tissue mechanical properties deep inside the tissue are difficult for human operators to sense, because the relatively large friction force between the needle shaft and the surrounding tissue masks the smaller tip forces. A novel robotic coaxial needle insertion assistant, which enhances operator force perception, is presented. This one-degree-of-freedom cable-driven robot provides to the operator a scaled version of the force applied by the needle tip to the tissue, using a novel design and sensors that separate the needle tip force from the shaft friction force. The ability of human operators to use the robot to detect membranes embedded in artificial soft tissue was tested under the conditions of 1) tip force and shaft force feedback, and 2) tip force only feedback. The ratio of successful to unsuccessful membrane detections was significantly higher (up to 50%) when only the needle tip force was provided to the user.

Surgical bedside master console for neurosurgical robotic system.

PURPOSE: We are currently developing a neurosurgical robotic system that facilitates access to residual tumors and improves brain tumor removal surgical outcomes. The system combines conventional and robotic surgery allowing for a quick conversion between the procedures. This concept requires a new master console that can be positioned at the surgical bedside and be sterilized. METHODS: The master console was developed using new technologies, such as a parallel mechanism and pneumatic sensors. The parallel mechanism is a purely passive 5-DOF (degrees of freedom) joystick based on the author's haptic research. The parallel mechanism enables motion input of conventional brain tumor removal surgery with a compact, intuitive interface that can be used in a conventional surgical environment. In addition, the pneumatic sensors implemented on the mechanism provide an intuitive interface and electrically isolate the tool parts from the mechanism so they can be easily sterilized. RESULTS: The 5-DOF parallel mechanism is compact (17 cm width, 19cm depth, and 15cm height), provides a 505,050 mm and 90° workspace and is highly backdrivable (0.27N of resistance force representing the surgical motion). The evaluation tests revealed that the pneumatic sensors can properly measure the suction strength, grasping force, and hand contact. In addition, an installability test showed that the master console can be used in a conventional surgical environment. CONCLUSION: The proposed master console design was shown to be feasible for operative neurosurgery based on comprehensive testing. This master console is currently being tested for master-slave control with a surgical robotic system.

Experimental evaluation of a coaxial needle insertion assistant with enhanced force feedback.

During needle insertion in soft tissue, detection of change in tissue properties is important both for diagnosis to detect pathological tissue and for prevention to avoid puncture of important structures. The presence of a membrane located deep inside the tissue results in a relatively small force variation at the needle tip that can be masked by relatively large friction force between the needle shaft and the surrounding tissue. Also, user perception of force can be limited due to the overall small force amplitude in some applications (e.g. brain surgery). A novel robotic coaxial needle insertion assistant was developed to enhance operator force perception. The coaxial needle separates the cutting force at the needle tip from shear friction on the needle shaft. The assistant is force controlled (admittance control), providing the operator with force feedback that is a scaled version of the force applied by the needle tip to the tissue. The effectiveness of the assistant in enhancing the detection of different tissue types was tested experimentally. Users were asked to blindly insert a needle into artificial tissues with membranes at various depths under two force feedback conditions: (1) shaft and tip force together, and (2) only tip force. The ratio of successful to unsuccessful membrane detection was significantly higher when only the needle tip force is displayed to the user. The system proved to be compliant with the clinical applications requirements.

Open core control software for surgical robots.

OBJECT: In these days, patients and doctors in operation room are surrounded by many medical devices as resulting from recent advancement of medical technology. However, these cutting-edge medical devices are working independently and not collaborating with each other, even though the collaborations between these devices such as navigation systems and medical imaging devices are becoming very important for accomplishing complex surgical tasks (such as a tumor removal procedure while checking the tumor location in neurosurgery). On the other hand, several surgical robots have been commercialized, and are becoming common. However, these surgical robots are not open for collaborations with external medical devices in these days. A cutting-edge "intelligent surgical robot" will be possible in collaborating with surgical robots, various kinds of sensors, navigation system and so on. On the other hand, most of the academic software developments for surgical robots are "home-made" in their research institutions and not open to the public. Therefore, open source control software for surgical robots can be beneficial in this field. From these perspectives, we developed Open Core Control software for surgical robots to overcome these challenges. MATERIALS AND METHODS: In general, control softwares have hardware dependencies based on actuators, sensors and various kinds of internal devices. Therefore, these control softwares cannot be used on different types of robots without modifications. However, the structure of the Open Core Control software can be reused for various types of robots by abstracting hardware dependent parts. In addition, network connectivity is crucial for collaboration between advanced medical devices. The OpenIGTLink is adopted in Interface class which plays a role to communicate with external medical devices. At the same time, it is essential to maintain the stable operation within the asynchronous data transactions through network. In the Open Core Control software, several techniques for this purpose were introduced. Virtual fixture is well known technique as a "force guide" for supporting operators to perform precise manipulation by using a master-slave robot. The virtual fixture for precise and safety surgery was implemented on the system to demonstrate an idea of high-level collaboration between a surgical robot and a navigation system. The extension of virtual fixture is not a part of the Open Core Control system, however, the function such as virtual fixture cannot be realized without a tight collaboration between cutting-edge medical devices. By using the virtual fixture, operators can pre-define an accessible area on the navigation system, and the area information can be transferred to the robot. In this manner, the surgical console generates the reflection force when the operator tries to get out from the pre-defined accessible area during surgery. RESULTS: The Open Core Control software was implemented on a surgical master-slave robot and stable operation was observed in a motion test. The tip of the surgical robot was displayed on a navigation system by connecting the surgical robot with a 3D position sensor through the OpenIGTLink. The accessible area was pre-defined before the operation, and the virtual fixture was displayed as a "force guide" on the surgical console. In addition, the system showed stable performance in a duration test with network disturbance. CONCLUSION: In this paper, a design of the Open Core Control software for surgical robots and the implementation of virtual fixture were described. The Open Core Control software was implemented on a surgical robot system and showed stable performance in high-level collaboration works. The Open Core Control software is developed to be a widely used platform of surgical robots. Safety issues are essential for control software of these complex medical devices. It is important to follow the global specifications such as a FDA requirement "General Principles of Software Validation" or IEC62304. For following these regulations, it is important to develop a self-test environment. Therefore, a test environment is now under development to test various interference in operation room such as a noise of electric knife by considering safety and test environment regulations such as ISO13849 and IEC60508. The Open Core Control software is currently being developed software in open-source manner and available on the Internet. A communization of software interface is becoming a major trend in this field. Based on this perspective, the Open Core Control software can be expected to bring contributions in this field.

MRI-compatible micromanipulator: Positioning repeatability tests & kinematic calibration.

In this paper, we report results from positioning repeatability tests and kinematic calibration of our magnetic resonance imaging (MRI)-compatible micromanipulator. This manipulator provides medical and biological scientists with the ability to concurrently manipulate and observe micrometer size objects inside an MRI-gantry. We have already reported on its design, implementation, and the results of preliminary testing of MRI compatibility. Here we test positioning repeatability, which is essential for micromanipulation. The results show that the manipulator has high repeatability (0.7 microm in longitude and 3.0 microm in latitude). In addition, we performed a calibration of kinematics and discussed the experimental result in comparison with the theoretical model. The results show that its workspace is 50-70% smaller than theoretically expected. The results also show that the absolute positioning errors are 16, 9, 5 microm in x, y, and z directions, respectively.

MRI-compatible micromanipulator; design and implementation and MRI-compatibility tests.

In this paper, we present a magnetic resonance imaging (MRI)-compatible micromanipulator, which can be employed to provide medical and biological scientists with the ability to concurrently manipulate and observe micron-scale objects inside an MRI gantry. The micromanipulator formed a two-finger micro hand, and it could handle a micron-scale object using a chopstick motion. For performing operations inside the MRI gantry in a manner such that the MRI is not disturbed, the system was designed to be nonmagnetic and electromagnetically compatible with the MRI. The micro-manipulator was implemented with piezoelectric transducers (PZT) as actuators for micro-motion, strain gauges as sensors for closed-loop control, and a flexure parallel mechanism made of acrylic plastic. Its compatibility with a 2-Tesla MRI was preliminarily tested by checking if the MRI obtained with the micromanipulator were similar to those obtained without the micromanipulator. The tests concluded that the micromanipulator caused no distortion but small artifacts on the MRI. The signal-to-noise ratio (SNR) of the MRI significantly deteriorated mainly due to the wiring of the micromanipulator. The MRI caused noise of the order of ones of volts in the strain amplifier.

Bone enhancement filtering: application to sinus bone segmentation and simulation of pituitary surgery.

We present a novel multi-scale bone enhancement measure that can be used to drive a geometric flow to segment bone structures. This measure has the essential properties to be incorporated in the computation of anatomical models for the simulation of pituitary surgery, enabling it to better account for the presence of sinus bones. We present synthetic examples that validate our approach and show a comparison between existing segmentation techniques of paranasal sinus CT data.