Surgical Robotics

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Surgical Robotics
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Updates

• Lab 5 starts this week (last lab)
• Lab 4 writeup due Thursday 4/26
• Next lecture on grasping, very special guest
  lecturer
• Robotics conference/exposition
• http//www.roboevent.com/

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Introduction

• Surgical robotics is a classic application of
  manipulator design and control
• Motivations why do we want to use robots in a
  surgical application?
• Repeatability (precision)
• Smaller incisions (less trauma)
• Versatility (surgeon doesnt need to be in the
  same room)
• Procedures on active organs (i.e. potentially a
  beating heart)
• Lower costs
• Current drawbacks
• Lack of dexterity
• Lack of sensory information
• Force feedback
• Tactile feedback
• Visual feedback
• High cost

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Robot-Assisted Surgery

• Thoracic
• Epicardial lead Placement
• Chondroma
• Esophagectomy
• IMA Harvest
• IMA Takedown
• Lobectomy
• Lung Biopsy
• Nodulectomy
• Thymectomy
• Tumor resection
• Urology
• Donor Nephrectomy
• Prostatectomy
• Ureter Harvest
• Vascular
• Aortic Abdominal Aneurysm

• Cardiac
• Atrial Septal Defect Repair 
• Mitral Valve Repair
• TECAB - Totally endoscopic coronary artery bypass
  
• General
• Adrenalectomy
• Cholecystectomy
• Esophagatomy
• Gastric Bypass
• Heller Myotomy
• Nissen Fundoplication
• Gynecology
• Cystocele Repair
• Hysterectormy
• Tubal Ligation
• Tubal Reanastomosis

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Introduction

• Outline
• Introduction to minimally invasive surgery
• Teleoperation
• Examples
• Haptics and tactile feedback

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Minimally invasive surgery

• Also called laparoscopic surgery
• The process of entering the body through small
  ports rather than large incisions
• Reduced trauma
• Reduced overall cost
• Typically involves at least three ports one for
  a camera and two for manipulators

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Minimally Invasive vs. Open Cholecystecomies
(Thousands, U.S., 1996)
gt 80 Cholecystecomies done with MIS! (likewise
for many other surgeries)
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Minimally Invasive Surgery

• Operations through small incisions
• Reduced trauma to healthy tissue
• Less pain, shorter hospital stay
• Reduced cost -- Patient returns to work sooner
• However, more difficult technique due to reduced
  access, dexterity, and perception
• Limited dexterity due to only having 4 DOF
• Reduced force feedback
• No tactile feedback
• Reduced hand-eye coordination
• Problems in spatial planning
• Many procedures cannot be performed with current
  MIS technology or are extremely difficult

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Overcoming MIS Limitations

• Replace the surgical instruments with robotic
  manipulators controlled by the surgeon through
  teleoperation
• Increase dexterity by added DOFs

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Teleoperation

• Teleoperation means simply to operate a vehicle
  or a system over a distance
• Distance can vary from tens of centimeters (micro
  manipulation) to millions of kilometers (space
  applications)
• (fancy word for remote control)
• Operator (master) human operator is the person
  who monitors the operated machine and makes the
  needed control actions
• Teleoperator (slave) the teleoperated machine. A
  sophisticated teleoperator can also be called as
  telerobot

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Definitions

• Mechanical manipulation
• The control commands are transmitted mechanically
  or hydraulically to the teleoperator. Visual
  feedback can be straight or via monitor.
• This is typical for manipulation of dangerous
  materials as well as micro manipulation

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Definitions

• Closed loop control (Direct teleoperation) The
  operator controls the actuators of the
  teleoperator by direct (analog) signals and gets
  real-time feedback. This is possible only when
  the delays in the control loop are minimal.
• Coordinated teleoperation The operator again
  controls the actuators, but now there is some
  internal control - remote loop - included.
  However, there is no autonomy included in the
  remote end. The remote loops are used only to
  close those control loops that the operator is
  unable to control because of the delay.
• Supervisory control low-level control is at the
  teleoperator end (compare coordinated
  teleoperation). The teleoperator can now perform
  part of the tasks more or less autonomously,
  while the operator mainly monitors and gives
  high-level commands. The term task based
  teleoperation is sometimes used here, but it is
  more limited than "supervisory control".

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Closed loop/Supervisory control
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MIS end effector concepts
Integrated Yaw Pitch (Single Joint)
5 DOF
Multi-Fingered Hand
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MIS end effector concepts (cont)
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Input devices
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Example Unimanual Telesurgical System
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Example surgical arm
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Matched Robot Arm Kinematics

Canula

Identical Kinematics
Robot Arm
Master input
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Telesurgery Concept
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Da Vinci System

• FDA - approved
• Insite Vision System
• Endowrist Instruments
• Video Tower

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Da Vinci Cart

• Endowrist instruments
• 3-4 robotic arms
• Interchangeable end effectors

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Da Vinci Console

• 3D vision
• Stereoscopic
• Maser controls
• Camera controls

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Da Vinci System
Robot arms
Video display
console
patient
surgeon
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Da Vinci System

• Master controller controls the motion of the end
  effector wrist

Surgeon at console
Master input
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Da Vinci System

• Multiple robotic arms
• For camera control and end effector control

Stereo endoscope
7DOF end effector
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Example surgery

• Patients chest is distended with CO2 to give
  room for the manipulators to operate

Ports called trocars
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Example surgery

• Connection between the robotic arm and the patient

Robotic arm enters the patient through the trocar
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Example surgery

• Camera view

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haptics

• Sensory information pertaining to touch
• Invaluable to surgeons performing laparoscopic
  surgery
• Tactile v. force feedback
• Force feedback gross forces transmitted to
  master
• Tactile feedback detailed surface forces
  transmitted to master

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Tactile feedback

• teletaction concept tactile feedback from
  catheter

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Tactile displays

• Various morhpologies
• Normal contact
• Pneumatic
• Pin-based
• SMA
• Shearing
• piezoelectric

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Next class

• Outline of active research areas
• Mobile robot navigation
• Sensors and actuators
• Computer vision
• Microrobotics
• Surgical robotics
• Grasping