Surgical Robotic Applications Research Articles

Surgical robots: history, applications and future prospects

PurposeThe purpose of this study is to provide details of the development and applications of surgical robots.Design/methodology/approachFollowing a short introduction, this first provides a historical background to surgical robot developments. The following sections discuss applications, specialised systems and their uses, remote telesurgery and a short consideration of future prospects. Finally, brief conclusions are drawn.FindingsCatalysed by the needs of NASA and the US Department of Defence, robotic surgery was first conducted in the 1980s with modified industrial robots and the first dedicated surgical robots emerged commercially in the 1990s. These allow surgeons to conduct minimally invasive procedures which lead to significant patient benefits. Advances in communications have enabled long-range telesurgery based on commercial networks. In 2024, a telesurgical technique was conducted on simulated tissue on the International Space Station. Advances in artificial intelligence (AI), augmented reality and virtual reality will enhance the capabilities of future systems as well as contributing to improved surgeon training. In the longer term, AI-assisted surgery may be conducted with limited human intervention and full automation of certain procedures may ultimately arise.Originality/valueThis provides a detailed account of surgical robot developments and applications from their inception in the 1980s to the present day.

Adjustment of the Length Variation With Wire-driven Using the Stand Looper Tension Technique for Surgical Robot Applications.

The wire-driven method used in the field of surgical robots has the advantage of light weight. However, in the process of pull and push for the operation of forceps, the length of the wire is not match, causing malfunction. To solve this problem, the application of looper-tension technology would be suitable. This paper contributes to adjusting the length of the wire by inserting a stand between the wire-driven joints and adding a looper-tension between the stands to adjust the rotation radius of the roll. The method consisting of three rolls and loopers for connection between the stands minimizes errors by adjusting the length of the loop in a balanced state due to the rotation change of the roll during the pull and push of the robot arm. The angle and tension applied to the looper are 25° and 8.6MPa, respectively. An output response can be obtained when the reference operating point fluctuates by ± 50% of the input angle and tension, and if the reference operating point fluctuates by ± 30% while the input angle and tension are fixed, the output response occurs oppositely. When a .15kg object is loaded up/down with 1.5newton using forceps, the change in length of pull and push coincides. The advantage is that the error of wire pull, and push operation can be reduced, and accurate operation can be expected. Since the proposed technology is applied between joints, the integration process is not complicated, and the weight is light.

High sensitivity vector torsion sensor based on a single Stress-Applying fiber Sagnac interferometer

A vector torsion sensor based on a Single Stress-Applying Fiber (SSAF) Sagnac interferometer is proposed and experimentally demonstrated. Taking use of the high birefringence and structural asymmetry of the SSAF, the spectrum of SSAF based Sagnac interferometer shows both wavelength shift and intensity variation with the change of torsion angle. A torsion sensitivity as high as 53.3 nm/(rad/m) can be achieved by wavelength demodulation and 4.3 dB/(rad/m) by intensity demodulation. In addition, the torsion direction can be also recognized in the torsion angle range from −50° to 50°. The temperature cross sensitivity is 0.03 rad/m/℃ by wavelength demodulation in the temperature range from 20℃ to 38℃. The advantages of high sensitivity, direction recognition, multi-parameter demodulation and simple structure make the sensor great potential in civil engineering, surgical robot and other applications.

Control of Magnetic Surgical Robots With Model-Based Simulators and Reinforcement Learning.

Magnetically manipulated medical robots are a promising alternative to current robotic platforms, allowing for miniaturization and tetherless actuation. Controlling such systems autonomously may enable safe, accurate operation. However, classical control methods require rigorous models of magnetic fields, robot dynamics, and robot environments, which can be difficult to generate. Model-free reinforcement learning (RL) offers an alternative that can bypass these requirements. We apply RL to a robotic magnetic needle manipulation system. Reinforcement learning algorithms often require long runtimes, making them impractical for many surgical robotics applications, most of which require careful, constant monitoring. Our approach first constructs a model-based simulation (MBS) on guided real-world exploration, learning the dynamics of the environment. After intensive MBS environment training, we transfer the learned behavior from the MBS environment to the real-world. Our MBS method applies RL roughly 200 times faster than doing so in the real world, and achieves a 6 mm root-mean-square (RMS) error for a square reference trajectory. In comparison, pure simulation-based approaches fail to transfer, producing a 31 mm RMS error. These results demonstrate that MBS environments are a good solution for domains where running model-free RL is impractical, especially if an accurate simulation is not available.

Development of a Soft Tactile Sensor Array for Contact Localization Estimations

Contact localization is an essential feature of tactile sensors for biomedical, rehabilitation, surgical, and service robot applications where interaction with the environment is needed. In this work, we have developed a piezoelectric (PZT) based soft tactile sensor using the layer-by-layer fabrication technique. We placed <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$4\times 4$ </tex-math></inline-formula> mm2 size PZT elements in <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$3\times 3$ </tex-math></inline-formula> matrix form with 3 mm spaces and embedded them in silicone layers. Although the sensor has discrete brittle sensing elements, the silicone layer distributes the contact force on the surface area, which enables continuous contact localization on the sensor. Here, we studied the estimation using the collected and conditioned output voltage signals of PZT elements. First, we used a logic-based algorithm that gives results qualitatively using a developed user interface. Then we used machine learning algorithms to estimate the contact position coordinates numerically. Finally, we applied Artificial Neural Network (ANN), Decision Tree (DT), Support Vector Machine (SVM), and k-Nearest Neighbor (KNN) algorithms and compared the results. We got our best results using a two-layer ANN algorithm which provides a mean deviation of 0.08 mm for the X-axis and 0.07 mm for the Y-axis. Besides, we had 97.20% of testing estimations with an error lower than 0.35 mm. Therefore, we believe our tactile sensor gives promising results and can be used in small-scale applications where contact localization estimation is desired.

Automatic Design of Compliant Surgical Forceps With Adaptive Grasping Functions

In this paper, we present a novel method for achieving automatic design of compliant surgical forceps with adaptive grasping functions. Compliant forceps are much easier to assemble and sterilize than conventional rigid-joint forceps, hence their use is spreading from traditional open surgery to robot-assisted minimally invasive applications. However, many compliant forceps still perform stiff grasping, and thus can damage sensitive organs and tissues during the operation. Adaptive grasping function is therefore required for safe manipulation of vulnerable structures. Currently, it is difficult and time consuming to use empirical methods for designing adaptive compliant forceps for different surgical robotic applications. To cope with this problem, we developed a topology-optimization-based method able to synthesize adaptive compliant forceps automatically. Simulation and experimental tests were conducted to evaluate the adaptive grasping function of designed surgical forceps. The results demonstrated that the developed method greatly simplifies the design process and makes it possible to efficiently realize task-specific compliant forceps.

Real time estimation and suppression of hand tremor for surgical robotic applications

In this work, an algorithm was developed to record and suppress the physiological tremor present in the hands of surgeon doing robotic surgical procedure due to fatigue or otherwise. A prototype setup of master handle having six degree of freedom with a vibration motor was designed and fabricated to record the hand tremor. The work involved recording the composite simulated motion consisting of both voluntary motion of surgeon’s hand and associated involuntary motion of tremor in real time, determination of peak frequencies of both the motions and providing necessary information on the graphical user interface. The adaptive algorithm is capable to cancel out the involuntary motion from the recorded raw signal in real time. After filtration, only voluntary motion remains for further processing. The developed algorithm promises potential to make robotic surgery more precise and error free.

Band-Pass Filter for Fluorescein Interference Rejection Using Microscope with Surgical Robot Applications

Band-Pass Filter for Fluorescein Interference Rejection Using Microscope with Surgical Robot Applications

A new approach for an ultrasensitive tactile sensor covering an ultrawide pressure range based on the hierarchical pressure-peak effect.

Flexible tactile sensors that imitate the skin tactile system have attracted extensive research interest due to their potential applications in medical diagnosis, intelligent robots and so on. However, it is still a great challenge to date to fabricate tactile sensors with both high sensitivity and wide detection range due to the difficulties in modulating the resistance variation in the sensing materials in a wide pressure range. Here, a tactile sensor with a novel design based on the hierarchical pressure-peak effect (HPPE) consisting of PVP nanowires and electroless deposition (ELD) silver PDMS micro-pyramids is reported. The HPPE can effectively modulate the resistance change rate by adjusting the change of contact area during compression deformation, and the HPPE tactile sensor was demonstrated to have both ultrahigh sensitivity (11.60-1108.75 kPa-1) and ultrawide pressure range (0.04-600 kPa). The designed HPPE tactile sensor is successfully utilized in detecting multi-level pressures including respiration, finger heart rate, pulse and foot pressures. Moreover, it is used to sense a subtle clamping force in the Leonardo Da Vinci surgical robot demonstrating the potential of the sensor in surgical robot applications. In all these cases, the sensor exhibits enough capability to respond quickly to ultrawide-range pressures with high accuracy and stability.

Modelling and Intelligent Control of Micro PMBLDC for Surgical Robotic Applications

Abstract Micro motors in the robotic application have the advantage of lightweight, small size, more reliable and highly efficient. The objective of this study is to improve the speed characteristics of micro PMBLDC for surgical robot applications. In this paper, the micro PMBLDC for various configurations of inter pole is developed to obtain the desired torque and magnetic flux. The PID controller and fuzzy logic controller using ANFIS is proposed to regulate the speed response of the BLDC motor. The combination of PID and fuzzy logic in the closed-loop gives a steady-state error of 2.376%, and the use of a PID controller alone gives a steady-state error of 12.5%. With the proposed design of the controller for BLDC motor, the desired speed with lesser steady-state error obtained for surgical stapler application.

Utilization of Cable Guide Channels for Compact Articulation Within a Dexterous Three Degrees-of-Freedom Surgical Wrist Design

Pin-jointed wrist mechanisms provide compact articulation for surgical robotic applications, but are difficult to miniaturize at scales suitable for small body cavity surgery. Solid surface cable guide channels, which eliminate the need for pulleys and reduce overall length to facilitate miniaturization, were developed within a three-degree-of-freedom cable-driven pin-jointed wrist mechanism. A prototype was 3D printed in steel at 5 mm diameter. Friction generated by the guide channels was experimentally tested to determine increases in cable tension during constant cable velocity conditions. Cable tension increased exponentially from 0 to 37% when the wrist pitched from 0 deg to 90 deg. The shape of the guide channel groove and angle, where the cable exits the channel impacts the magnitude of cable tension. A spring tensioning and cam actuation mechanism were developed to account for changing cable circuit path lengths during wrist pitch. This work shows that pulley-free cable wrist mechanisms can facilitate miniaturization below current feasible sizes while retaining compact articulation at the expense of increases in friction under constant cable velocity conditions.

A cable-driven parallel manipulator with force sensing capabilities for high-accuracy tissue endomicroscopy

PurposeEndomicroscopy (EM) provides high resolution, non-invasive histological tissue information and can be used for scanning of large areas of tissue to assess cancerous and pre-cancerous lesions and their margins. However, current robotic solutions do not provide the accuracy and force sensitivity required to perform safe and accurate tissue scanning.MethodsA new surgical instrument has been developed that uses a cable-driven parallel mechanism (CPDM) to manipulate an EM probe. End-effector forces are determined by measuring the tensions in each cable. As a result, the instrument allows to accurately apply a contact force on a tissue, while at the same time offering high resolution and highly repeatable probe movement.Results0.2 and 0.6 N force sensitivities were found for 1 and 2 DoF image acquisition methods, respectively. A back-stepping technique can be used when a higher force sensitivity is required for the acquisition of high quality tissue images. This method was successful in acquiring images on ex vivo liver tissue.ConclusionThe proposed approach offers high force sensitivity and precise control, which is essential for robotic EM. The technical benefits of the current system can also be used for other surgical robotic applications, including safe autonomous control, haptic feedback and palpation.

A cable-pulley transmission mechanism for surgical robot with backdrivable capability

Abstract Compact actuators, low friction and back-drivable transmissions are essential components in haptic and impedance type surgical robotic systems, since their performances affect overall volume, force feedback capability and power consumption. An innovative miniaturized, low friction, back-drivable reducing mechanism for haptic or surgical robot applications has been designed, developed and evaluated. A new differential mechanism having a cable comprises a sheave wheel supported by a yolk is also implemented. Low friction and back-drivable, compared to conventional non-back-drivable mechanisms based on gear coupling, is achieved by means of differential cable driven method. The system has been integrated with a permanent-magnet DC motor and a drum on which a tendon is wound, and then finally connected to the remote end joint. Several experiments to validate the feasibility of the reducing device were carried out.

Disposable Fluidic Actuators for Miniature In-Vivo Surgical Robotics.

Fusion of robotics and minimally invasive surgery (MIS) has created new opportunities to develop diagnostic and therapeutic tools. Surgical robotics is advancing from externally actuated systems to miniature in-vivo robotics. However, with miniaturization of electric-motor-driven surgical robots, there comes a trade-off between the size of the robot and its capability. Slow actuation, low load capacity, sterilization difficulties, leaking electricity and transferring produced heat to tissues, and high cost are among the key limitations of the use of electric motors in in-vivo applications. Fluid power in the form of hydraulics or pneumatics has a long history in driving many industrial devices and could be exploited to circumvent these limitations. High power density and good compatibility with the in-vivo environment are the key advantages of fluid power over electric motors when it comes to in-vivo applications. However, fabrication of hydraulic/pneumatic actuators within the desired size and pressure range required for in-vivo surgical robotic applications poses new challenges. Sealing these types of miniature actuators at operating pressures requires obtaining very fine surface finishes which is difficult and costly. The research described here presents design, fabrication, and testing of a hydraulic/pneumatic double-acting cylinder, a limited-motion vane motor, and a balloon-actuated laparoscopic grasper. These actuators are small, seal-less, easy to fabricate, disposable, and inexpensive, thus ideal for single-use in-vivo applications. To demonstrate the ability of these actuators to drive robotic joints, they were modified and integrated in a robotic arm. The design and testing of this surgical robotic arm are presented to validate the concept of fluid-power actuators for in-vivo applications.

A unified system identification approach for a class of pneumatically-driven soft actuators

The class of Pneumatically-driven Low-pressure Soft Actuators (PLSA) is a popular choice potentially used in the surgical robotic applications. One fundamental problem lying in the PLSA research is the lack of a generally validated model for the complex nonlinear dynamic behaviours. In this paper, a unified identification approach for the general PLSAs is proposed. It is a parameter-independent way directly used to identify the dynamical relation between the actuating pressures and the principal degrees of freedom of a PLSA, the bending and the steering. The approach is based on a modified auxiliary kinematic setting and a newly developed identification model structure, named DIO–PWL–OBF. Following the concluded identification procedure, the implementations for the single chamber bending and the double chamber bending and steering are demonstrated separately. The results show that the proposed approach can accurately capture the nonlinear pressure–shape dynamical relation. The approach is also efficient in real-time applications. It can be further used to improve the current control design for the PLSAs in robotic applications.

An IPMC actuated robotic surgery end effector with force sensing

Growth in patient acceptance of robotic-assisted surgery has led to increased demand and has stimulated research in many new surgical robotic applications. In some cases, the performance of robotic surgery has proven to surpass that of human surgeons alone. A new research area which uses the inherently force-compliant and back-drivable properties of polymers, ionic polymer–metal composite (IPMC) in this case, has shown potential to undertake precise surgical procedures in the delicate environments related to medical practice. This is because IPMCs have similar actuation characteristics to real biological systems, which can help ensure safety. Despite this, little has been done in developing IPMCs for a rotary joint actuator for functional surgical devices. This research proposes and demonstrates the design of a single degree of freedom (1-DOF) robotic surgical instrument with one skeleton-joint mechanism actuated by IPMC with an embedded strain gauge as a feedback unit. The system performance with a developed gain-schedule PI controller is demonstrated. Despite the simplicity of the system, it was proven to be able to cut to the desired depth using the implemented force control (up to 8 gf cutting force).

Multistep Prediction of Physiological Tremor for Surgical Robotics Applications

Accurate canceling of physiological tremor is extremely important in robotics-assisted surgical instruments/procedures. The performance of robotics-based hand-held surgical devices degrades in real time due to the presence of phase delay in sensors (hardware) and filtering (software) processes. Effective tremor compensation requires zero-phase lag in filtering process so that the filtered tremor signal can be used to regenerate an opposing motion in real time. Delay as small as 20 ms degrades the performance of human-machine interference. To overcome this phase delay, we employ multistep prediction in this paper. Combined with the existing tremor estimation methods, the procedure improves the overall accuracy by 60% for tremor estimation compared to single-step prediction methods in the presence of phase delay. Experimental results with developed methods for 1-DOF tremor estimation highlight the improvement.

The evolution of robotic thyroidectomy: from inception to neck dissection.

Over the past decade, the application of surgical robotics is bringing about dramatic changes in various surgical fields. Robotic thyroidectomy has achieved safe and accurate management of thyroid disease with remarkable cosmetic and functional benefits. As experiences with robotic techniques accumulate, its indications will expand to include more advanced cases with higher levels of difficulty.

Estimation and filtering of physiological tremor for real‐time compensation in surgical robotics applications

Physiological tremor is the main cause of imprecision in microsurgical procedures/robotics applications. Existing methods, such as weighted-frequency Fourier linear combiner (WFLC), rely on estimating the tremor under the assumption that it has a single dominant frequency. This paper focuses on developing a new algorithm for accurate tremor filtering in real time. A study conducted on several novice subjects and microsurgeons showed the tremor to contain several dominant frequencies in a band, rather than a single dominant frequency. Based on the tremor characteristics, a new algorithm band-limited multiple Fourier linear combiner (BMFLC) has been developed to estimate a band of signals with multiple dominant frequencies. A separation procedure to separate the intended motion/drift from the tremor portion is also discussed. A simulation study was first conducted to validate the theoretical development on recorded tremor data. The experimental set-up was designed to study the real-time performance of the proposed algorithm. Tremor sensing using accelerometers is also discussed, with the proposed algorithm. Our experiments showed that the developed BMFLC algorithm had an average tremor compensation of 64% compared to 43% for the WFLC algorithm in real-time for one degree of freedom (1-DOF) cancellation of tremor. The BMFLC algorithm can be applied for the three axes separately and 3-DOF cancellation of tremor can be achieved. Further research is required to deal with complex gestures involved during microsurgery.

Human tactile perception as a standard for artificial tactile sensing—a review

In this paper, we examine the most important features of human skin tactile properties with special emphasis on the characteristics which are vital in the design of artificial systems. Contrary to the visual and auditory senses, the touch signal is not a well-defined quantity. As a result, the researchers of this field are still dealing with the basics of collecting the most relevant data. Following this, mimicking the sense of touch by producing artificial tactile skin is a challenging process. Although the sense of touch is widely distributed all over the human body, the tactile perception in the human hand is of great importance in terms of surgical and medical robotics applications. In this study, the role of various mechanoreceptors in the human hand, such as, RA, SA I, SA II, and PC units are discussed in relation to the stimuli like force, position, softness, and surface texture. Taking human hand as a suitable tactile model, the necessary engineering features of an artificial tactile sensor, such as, spatial and temporal resolutions, force sensitivity, and linearity, are being reviewed. In this work, we also report on the current and possible future applications of tactile sensors in various surgical procedures.