Abstract
Endoscopic endonasal surgery (EES) is a minimally invasive technique for removal of pituitary adenomas or cysts at the skull base. This approach can reduce the invasiveness and recovery time compared to traditional open surgery techniques. However, it represents challenges to surgeons because of the constrained workspace imposed by the nasal cavity and the lack of dexterity with conventional surgical instruments. While robotic surgical systems have been previously proposed for EES, issues concerned with proper interface design still remain. In this paper, we present a cooperative, compact, and versatile bimanual human-robot interface aimed to provide intuitive and safe operation in robot-assisted EES. The proposed interface is attached to a robot arm and holds a multi-degree-of-freedom (DOF) articulated forceps. In order to design the required functionalities in EES, we consider a simplified surgical task scenario, with four basic instrument operations such as positioning, insertion, manipulation, and extraction. The proposed cooperative strategy is based on the combination of force based robot control for tool positioning, a virtual remote-center-of-motion (VRCM) during insertion/extraction tasks, and the use of a serial-link interface for precise and simultaneous control of the position and the orientation of the forceps tip. Virtual workspace constraints and motion scaling are added to provide safe and smooth control of our robotic surgical system. We evaluate the performance and usability of our system considering reachability, object manipulability, and surgical dexterity in an anatomically realistic human head phantom compared to the use of conventional surgical instruments. The results demonstrate that the proposed system can improve the precision, smoothness and safety of the forceps operation during an EES.
Highlights
Endoscopic endonasal surgery (EES) has become a common procedure for the removal of pituitary adenomas and tumors at the skull base [1]
The following four tasks were performed by the participants using both the conventional surgical instruments and the proposed cooperative interface: (1) a reachability task to test the ability of the robot to reach anatomic areas of interest in endonasal surgery such as pituitary tumors in the sellar area, (2) a pick-and-place task to determine if the users can manipulate objects and translate them dexterously in a constrained environment, (3) a block-in-the-hole task to add the need of orientation adjustments in object manipulation, and (4) a needle stitching task to evaluate the performance in a common surgical task in endonasal surgery
We proposed a cooperative human-robot interface for robot-assisted endoscopic endonasal surgery based on a hybrid concept of a force based and a serial-link interface to enhance intuitiveness and safety during highly dexterous anatomically constrained surgical tasks in EES
Summary
Endoscopic endonasal surgery (EES) has become a common procedure for the removal of pituitary adenomas and tumors at the skull base [1]. Traditional open approaches, either transcranial or transfacial, require traumatic access through the patient’s forehead or cheek. EES can significantly reduce invasiveness and improve surgery and recovery times with the benefits of less resultant trauma and fewer complications for the patient. EES is a mononostril or binostril technique performed via the insertion of an endoscope and long surgical instruments through the nostril orifices into the sphenoid sinus cavity (Figure 1a). One of the major limitations is the anatomic constraint imposed by the nasal cavity, which limits the access and maneuverability of these instruments.
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