Least Squares Support Vector Machine Kalman Filter for Physiological Tremor Suppression in Minimally Invasive Surgical Robot

This paper studies the physiological tremor filtering in minimally invasive surgical robot.The surgeon􀆳s physiological tremor of the hand can cause the vibration of the tip of the surgical instrument,which may reduce operative accuracy and limit the application of surgical robots.Aiming at the vibration caused by physiological tremor of hand,we propose a Least Squares Support Vector Machine Kalman Filter(LSSVMKF),which can filter the tremor by estimating and modeling the tremor signal by Kalman filter and then superimposing it reversely in the control signal.When estimating and modeling the tremor signal,the filter uses the Least Squares Support Vector Machine(LS⁃SVM)to build the regression model of the constant parameters(Process Noise Covariance and Measurement Noise Covariance)of the traditional Kalman filter,which can dynamically adjust these parameters during the operation and improve the accuracy of Kalman filter.The simulation results show that the LSSVMKF can effectively filter out the tremor signal,thereby improving the accuracy of surgery.

Method for Latency Measurement of Visual Feedback-Based Master–Slave Minimally Invasive Surgical Robot

To measure the latency between human motion stimulation and stereo image display response in a visual feedback-based minimally invasive surgical(MIS) robotic system,a method was proposed by comparing the orientations of input and output events through image-processing technology. This method used a black bar to keep pace with the measured joint rotating at a number of speeds. During tests,an external camera was placed in front of the apparatus with a proper visual field,so that it can simultaneously view orientations of both bars fixed on the corresponding joints. After quantitatively analyzing the accuracy of the proposed measurement method,the method was applied to a visual feedback-based master–slave robotic system with two-degrees-of-freedom. Experimental results show that the latency of the overall system was approximately 250 ms,and the opposite clearance of the measured joint was in the range of 1.7°–1.9°.

State-of-the-art of intelligent minimally invasive surgical robots Masakatsu

A number of developed countries are rapidly turning into super-aged societies.Consequently,the demand for reduced surgical invasiveness and enhanced efficiency in the medical field has increased due to the need to reduce the physical burden on older patients and shorten their recovery period.Intelligent surgical robot systems offer high precision,high safety,and reduced invasiveness.This paper presents a review of current intelligent surgical robot systems.The history of robots and three types of intelligent surgical robots are discussed.The problems with current surgical robot systems are then analyzed.Several aspects that should be considered in designing new surgical systems are discussed in detail.The paper ends with a summary of the work and a discussion of future prospects for surgical robot development.

Review of surgical robotic systems for keyhole and endoscopic procedures:state of the art and perspectives

Minimally invasive surgery,including laparoscopic and thoracoscopic procedures,benefits patients in terms of improved postoperative outcomes and short recovery time.The challenges in hand–eye coordination and manipulation dexterity during the aforementioned procedures have inspired an enormous wave of developments on surgical robotic systems to assist keyhole and endoscopic procedures in the past decades.This paper presents a systematic review of the state-of-the-art systems,picturing a detailed landscape of the system configurations,actuation schemes,and control approaches of the existing surgical robotic systems for keyhole and endoscopic procedures.The development challenges and future perspectives are discussed in depth to point out the need for new enabling technologies and inspire future researches.

Development of a novel hand-eye calibration for intuitive control of minimally invasive surgical robot

Robotic-assisted surgical system has introduced a powerful platform through dexterous instrument and hand-eye coordination intuitive control.The knowledge of laparoscopic vision is a crucial piece of information for robot-assisted minimally invasive surgery focusing on improved surgical outcomes.Obtaining the transformation with respect to the laparoscope and robot slave arm frames using hand-eye calibration is essential,which is a key component for developing intuitive control algorithm.We proposed a novel two-step modified dual quaternion for hand-eye calibration in this study.The dual quaternion was exploited to solve the hand-eye calibration simultaneously and powered by an iteratively separate solution.The obtained hand-eye calibration result was applied to the intuitive control by using the hand-eye coordination criterion.Promising simulations and experimental studies were conducted to evaluate the proposed method on our surgical robot system.We extensively compared the proposed method with state-of-the-art methods.Results demonstrate this method can improve the calibration accuracy.The effectiveness of the intuitive control algorithm was quantitatively evaluated,and an improved hand-eye calibration method was developed.The relationship between laparoscope and robot kinematics can be established for intuitive control.

Shape Sensing for Single-Port Continuum Surgical Robot Using FewMulticore Fiber Bragg Grating Sensors

We proposed a method for shape sensing using a few multicore fiber Bragg grating (FBG) sensors ina single-port continuum surgical robot (CSR). The traditional method of utilizing a forward kinematic model tocalculate the shape of a single-port CSR is limited by the accuracy of the model. If FBG sensors are used forshape sensing, their accuracy will be affected by their number, especially in long and flexible CSRs. A fusionmethod based on an extended Kalman filter (EKF) was proposed to solve this problem. Shape reconstructionwas performed using the CSR forward kinematic model and FBG sensors, and the two results were fused usingan EKF. The CSR reconstruction method adopted the incremental form of the forward kinematic model, whilethe FBG sensor method adopted the discrete arc-segment assumption method. The fusion method can eliminatethe inaccuracy of the kinematic model and obtain more accurate shape reconstruction results using only a smallnumber of FBG sensors. We validated our algorithm through experiments on multiple bending shapes underdifferent load conditions. The results show that our method significantly outperformed the traditional methodsin terms of robustness and effectiveness.

Progress in Force-Sensing Techniques for Surgical Robots

Force sensing is vital for situational awareness and safe interaction during minimally invasive surgery.Consequently,surgical robots with integrated force-sensing techniques ensure precise and safe operations.Over the past few decades,there has been considerable progress in force-sensing techniques for surgical robots.This review summarizes the existing electrically-and optically-based force sensors for surgical robots,including piezoresistive,piezoelectric,capacitive,intensity/phase-modulated,andfiber Bragg gratings.Their principles,applications,advantages,and limitations are also discussed.Finally,we summarize our conclusions regarding state-of-the-art force-sensing technologies for surgical robotics.

A compliant surgical robotic instrument with integrated IPMC sensing and actuation

Robotic assisted surgery is becoming widely adopted by surgeons for a number of reasons,which include improved instrumentation control and dexterity as well as faster patient recovery times and cosmetic advantages.Robotic assisted surgery is currently one of the fastest growing applications in robotics.Although the traditional robotic actuators which are currently used have advanced performance which can,in some aspects,surpass that of humans,they simply do not have the capabilities and diversity required to meet the demand for new applications in robotic surgery.Novel transducers which have advanced capabilities and which allow safe operation in delicate environments are needed.Ionic polymer-metal composites(IPMCs)have extensive desirable characteristics when compared with traditional actuators and as their transduction mechanisms can mimic biological muscle they have much potential for future advanced biomedical and surgical robotics.In this research,a complete two degree-of-freedom(2DOF)surgical robotic instrument has been developed,which with the attachment of surgical tools(scalpel,etc.)has the ability to undertake surgical procedures.The system integrates an IPMC sensor and actuator at each joint.A gain scheduled(GS)controller,which is tuned with an iterative feedback tuning(IFT)algorithm,has been developed to ensure an accurate and adaptive response.The main advantages of this device over traditional devices are the improved safety through a natural compliance of the joints as well as the mechanical simplicity which ensures ease of miniaturisation for minimally invasive surgery(MIS).The components of the system have been tested and shown to have the capabilities required to operate the device for certain surgical procedures,specifically a device work envelope of 1600 mm^(2),compliance of 0.0668 m/N while still maintaining enough force to cut tissue,IPMC sensor accuracy between 3-22%and a control system which has shown to guarantee zero steady state error.

Design of a Novel Macro-Micro Integrated Brain Surgery Robot Based on Modular Parallel Mechanisms

The advancement and development of medical surgical robots have provided new technological support for brain surgery and neurosurgical procedures,improving the reliability of highly complex and precise surgeries.In turn,this urges the design and development of novel surgical robots to possess higher precision,stability,and enhanced motion capabilities.In response to this practical demand,this paper introduces a macro-micro integrated medical brain surgery robot system based on the concept of modular PMs(parallel mechanisms),which have a total of 13 active DOFs(degrees of freedom).This system divides the motion process of brain surgery into a large-scale macro-motion space and a small-scale high-precision motion space for design and planning control.The introduction of the design concept that combines multiple modular parallel sub-mechanisms has brought a significant level of decoupling characteristics to the mechanism itself.A comprehensive introduction and analysis of the surgical robot are provided,covering aspects such as design,kinematics,motion planning,and performance indicators.To address the pose allocation and coordination of motion between the macro platform and the micro platform,a pose allocation algorithm based on the decoupling and non-decoupling characteristics in various dimensions of the macro-micro platform is proposed.The designed measurement experiments have demonstrated that the repeatability in positioning accuracy of the macro and micro platform reaches the level of micron and submicron respectively.Practical experiments of motion control and simulated brain electrode implantation validate the excellent performance and stability of the entire surgical robot system.This research contributes innovative insights to the development of medical surgical robot systems,particularly in the domain of mechanism design.

Robotic versus laparoscopic surgery for sporadic benign insulinoma:Short-and long-term outcomes

Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was conducted.The demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic groups.Results:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic approach.Enucleation was the preferred surgical procedure.Fifty-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,respectively.Robotic enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic enucleation.There were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and complications.After a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a recurrence.Conclusions:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.

Robotic-assisted low anterior resection for rectal cancer shows similar clinical efficacy to laparoscopic surgery: A propensity score matched study

BACKGROUND Rectal cancer ranks as the second leading cause of cancer-related mortality worldwide,necessitating surgical resection as the sole treatment option.Over the years,there has been a growing adoption of minimally invasive surgical techni-ques such as robotic and laparoscopic approaches.Robotic surgery represents an innovative modality that effectively addresses the limitations associated with traditional laparoscopic techniques.While previous studies have reported favo-rable perioperative outcomes for robot-assisted radical resection in rectal cancer patients,further evidence regarding its oncological safety is still warranted.AIM To conduct a comparative analysis of perioperative and oncological outcomes between robot-assisted and laparoscopic-assisted low anterior resection(LALAR)procedures.METHODS The clinical data of 125 patients who underwent robot-assisted low anterior resection(RALAR)and 279 patients who underwent LALAR resection at Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to November 2022 were retrospectively analyzed.After performing a 1:1 propensity score matching,the patients were divided into two groups:The RALAR group and the LALAR group(111 cases in each group).Subsequently,a comparison was made between the short-term outcomes within 30 d after surgery and the 3-year survival outcomes of these two groups.RESULTS Compared to the LALAR group,the RALAR group exhibited a significantly earlier time to first flatus[2(2-2)d vs 3(3-3)d,P=0.000],as well as a shorter time to first fluid diet[4(3-4)d vs 5(4-6)d,P=0.001].Additionally,the RALAR group demonstrated reduced postoperative indwelling catheter time[2(1-3)d vs 4(3-5)d,P=0.000]and decreased length of hospital stay after surgery[5(5-7)d vs 7(6-8)d,P=0.009].Moreover,there was an observed increase in total cost of hospitalization for the RALAR group compared to the LALAR group[10777(10780-11850)dollars vs 10550(8766-11715)dollars,P=0.012].No significant differences were found in terms of conversion rate to laparotomy or incidence of postoperative complications between both groups.Furthermore,no significant disparities were noted regarding the 3-year overall survival rate and 3-year disease-free survival rate between both groups.CONCLUSION Robotic surgery offers potential advantages in terms of accelerated recovery of gastrointestinal and urologic function compared to LALAR resection,while maintaining similar perioperative and 3-year oncological outcomes.

A Novel Tele-Operated Flexible Robot Targeted for Minimally Invasive Robotic Surgery

In this paper, a novel flexible robot system with a constrained tendon-driven serpentine manipulator(CTSM) is presented. The CTSM gives the robot a larger workspace, more dexterous manipulation, and controllable stiffness compared with the da Vinci surgical robot and traditional flexible robots. The robot is tele-operated using the Novint Falcon haptic device. Two control modes are implemented, direct mapping and incremental mode. In each mode, the robot can be manipulated using either the highest stiffness scheme or the minimal movement scheme. The advantages of the CTSM are shown by simulation and experimental results.

A Robotic System with Robust Remote Center of Motion Constraint for Endometrial Regeneration Surgery

Surgical robots have been widely used in diferent procedures to improve and facilitate the surgery.However,there is no robot designed for endometrial regeneration surgery,which is a new therapy for restoring fertility in women using stem cells.Endometrial regeneration surgery requires processing of the endometrium and transplantation of stem cells with minimal trauma to the uterus.In this paper,we introduce a surgical robotic system that consists of a dexterous hysteroscope,supporting arm,and additional novel instruments to facilitate the operation and decrease trauma to the uterus.Remote center of motion(RCM)constraint is required to protect the cervix of the uterus.First,the supporting arm and hysteroscope are controlled separately in kinematics to ensure that the RCM constraint and hysteroscope’s shape and posture are predictable.Then,a task-decoupled method is used to improve the robustness of the RCM constraint.Experiments confrm that the proposed method is more robust and achieves higher RCM accuracy.In addition,the master-slave control of a robot with RCM constraint is also verifed.This study proposes the realization of a robot with robust RCM control for endometrial regeneration surgery.

Techniques to resect the distal ureter in robotic/laparoscopic nephroureterectomy

Treatment of clinically-organ confined high grade urothelial carcinoma of the upper tract has historically comprised open nephroureterectomy,with the distal ureter and bladder cuff mobilized through a separate open pelvic incision.To decrease morbidity,urologists have increasingly adopted laparoscopy and robotics in performing nephroureterectomy.In many published series of laparoscopic nephroureterectomy,the distal ureter and bladder cuff are detached from the bladder endoscopically by a variation of the“pluck”technique,with the resulting bladder defect left to heal by prolonged indwelling urethral catheter drainage.While the distal ureter and bladder cuff can be excised laparoscopically,it does require advanced laparoscopic skills.With the wrist articulation and stereoscopic vision in robotic surgery,robotic nephroureterectomy(RNU)and bladder cuff excision can be performed in antegrade fashion to mimic the open technique together with the ability to intracorporeally close the bladder defect in a watertight,mucosa to mucosa fashion after excising the bladder cuff.In this review,we discuss the published minimally invasive techniques in resecting the distal ureter and bladder cuff during laparoscopic and RNU.

Clinical characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy:A report of 40 cases

AIM： To summarize the performing essentials and analyze the characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy. METHODS： Robot-assisted laparoscopic cholecystectomy was performed in 40 patients between May 2004 and July 2005. The operating procedures and a variety of clinical parameters were recorded and analyzed. RESULTS： Forty laparoscopic cholecystectomy procedures were successfully completed with Zeus robotic system. And there were no post-operative complications. Total operating time, system setup time and performing time were 100.3±18.5 min, 27.7±8.8 min and 65.6±18.3 min, respectively. The blood loss and postoperative hospital stay were 30.6±10.2 mL and 2.8±0.8 d, respectively. Camera clearing times and time used for operative field adjustment were 1.1±1.0 min and 2.0±0.8 rain, respectively. The operative error was 7.5%. CONCLUSION： Robot-assisted laparoscopic cholecystectomy following the principles of laparoscopic operation has specific performing essentials. It preserves the benefits of minimally invasive surgery and offers enhanced ability of controlling operation field, precise and stable operative manipulations.

Robot-assisted laparoscopic pyeloureterostomy for ureteropelvic junction rupture sustained in a traffic accident:A case report

BACKGROUND Ureteral reconstruction is a highly technical type of laparoscopic or open surgery.The incidence of ureteral injury is low;however,ureteral injuries tend to be overtreated.Robotic surgery for urinary reconstructive surgery is growing in popularity,which has made procedures such as pyeloplasty,ureteroureterostomy,and ureteroneocystostomy possible,with minimal damage to the patient.To the best of our knowledge,this is the first report of robot-assisted laparoscopic pyeloureterostomy in Korea,in a 17-year-old female patient with a ureteral injury.CASE SUMMARY The patient,a 17-year-old girl without previous medical history,was presented at the emergency room and complained of abdominal and back pain.Tenderness in the right upper quadrant was observed on physical examination.Hemorrhage in the right perirenal space was observed without abdominal organ injuries on the initial enhanced abdomen computed tomography(CT)scan.Ureteral injury was not suspected at this time.The patient was stabilized via conservative treatment,but complained of right flank pain 3 wk later and revisited the emergency room.An enhanced abdominal CT scan revealed a huge urinoma in the right perirenal space with hydronephrosis of the right kidney.Retrograde and antegrade pyelography were performed.Extravasation and discontinuity of the ureter were found.A rupture of the ureteropelvic junction was diagnosed and reconstructive surgery was performed.After 3 mo,the patient did not complain of any symptoms without any abnormal radiologic findings.CONCLUSION This case report discusses the safety and effectiveness of this minimal invasive procedure as an alternative to conventional open or laparoscopic surgery.

Adult metaplastic hutch diverticulum with robotic-assisted diverticulectomy and reconstruction:A case report

BACKGROUND Hutch diverticulum arises from the compromised muscular development at the ureteral orifice.It is a congenital disease and extremely rare in adult,only accounting for about 3%occurrence worldwide.It can be either symptomatic or asymptomatic,and relies on image tools for diagnosis and preoperative planning.Indications for surgery are dependent on the complications from the diverticulum.Metaplasia is about 10%among those with hutch diverticulum,and it still has chances turning into malignancy,especially urothelial cell carcinoma.CASE SUMMARY A 27-year-old man was presented with frequently recurrent urinary tract infection for one year,and had suffered from intermittent right flank pain for 3 mo.No past medical histories were recorded before.No obvious abnormalities on laboratory data and urine examination were found.Under ultrasound,right hydronephrosis was seen and an anatomical abnormality was observed on intravenous pyelography.Further computed tomography urogram showed one diverticulum seated at superolateral side of right ureteral orifice.Cystoscopy was done and biopsy results showed focal metaplasia.After discussing with him,roboticassisted diverticulectomy with reconstruction was performed.Right hydronephrosis was greatly improved after surgery.He has completed his 1.5-year follow-ups,and no malignancies were seen from urine cytology and image of intravenous pyelography.CONCLUSION Robotic-assisted diverticulectomy and reconstruction to hutch diverticulum is a safe and efficient operation,providing several advantages over open and laparoscopic ones.

Biochemical recurrence of pathological T2+localized prostate cancer after robotic-assisted radical prostatectomy:A 10-year surveillance

BACKGROUND pT2+prostate cancer(PCa),a term first used in 2004,refers to organ-confined PCa characterized by a positive surgical margin(PSM)without extracapsular extension.Patients with a PSM are vulnerable to biochemical recurrence(BCR)following radical prostatectomy(RP);however,whether adjuvant radiotherapy(aRT)is imperative to PSM after RP remains controversial.This study had the longest follow-up on pT2+PCa after robotic-assisted RP since 2004.Moreover,we discussed our viewpoints on pT2+PCa based on real-world experiences.AIM To conclude a 10-year surveillance on pT2+PCa and compare our results with those of the published literature.METHODS Forty-eight patients who underwent robotic-assisted RP between 2008 and 2011 were enrolled.Two serial tests of prostate specific antigen(PSA)≥0.2 ng/mL were defined as BCR.Various designed factors were analyzed using statistical tools for BCR risk.SAS 9.4 was applied and significance was defined as P<0.05.Univariate,multivariate,linear regression,and receiver operating characteristic(ROC)curve analyses were performed for statistical analyses.RESULTS With a median follow-up period of 9 years,25(52%)patients had BCR(BCR group),and the remaining 23(48%)patients did not(non-BCR group).The median time for BCR test was 4 years from the first postoperative PSA nadir.Preoperative PSA was significantly different between the BCR and non-BCR groups(P<0.001),and ROC curve analysis of preoperative PSA suggested a cutoff value of 19.09 ng/mL(sensitivity,0.600;specificity:0.739).The linear regression analysis showed no correlation between time to BCR and preoperative PSA(Pearson’s correlation,0.13;adjusted R2=0.026).CONCLUSION Robotic-assisted RP in pT2+PCa of worse conditions can provide better BCR-free survival.A surgical technique limiting the PSM in favorable situations is warranted to lower the pT2+PCa BCR rate.Preoperative PSA cut-off value of 19.09 ng/mL is a predictive factor for BCR.Based on our experiences and review of the literature,we do not recommend routine aRT for pT2+PCa.

Initial experience of laparoendoscopic single-site radical prostatectomy with a novel purpose-built robotic system

Objective This prospective single-arm clinical trial aimed to evaluated the feasibility and safety of the application of the SHURUI system(Beijing Surgerii Technology Co.,Ltd.,Beijing,China),a novel purpose-built robotic system,in single-port robotic radical prostatectomy.Methods Sixteen patients diagnosed with prostate cancer were prospectively enrolled in and underwent robotic radical prostatectomy from October 2021 to August 2022 by the SHURUI single-port robotic surgical system.The demographic and baseline data,surgical,oncological,and functional outcomes as well as follow-up data were recorded.Results The mean operative time was 226.3(standard deviation[SD]52.0)min,and the mean console time was 183.4(SD 48.3)min,with the mean estimated blood loss of 116.3(SD 90.0)mL.The mean length of postoperative hospital stay was 4.50(SD 0.97)days.Two patients had postoperative complications(Clavien-Dindo Grade II),and both patients improved after conservative treatment.All patients’postoperative prostate-specific antigen levels decreased to below 0.2 ng/mL 1 month after discharge.The mean prostate-specific antigen level further decreased to a mean of 0.0219(SD 0.0641)ng/mL 6 months after surgery.Thirty days postoperatively,12 out of 16 patients reported using no more than one urinary pad per day,and all patients reported satisfactory urinary control without the need for pads 6 months after surgery.Conclusion The SHURUI system is safe and feasible in performing radical prostatectomy via both transperitoneal and extraperitoneal approaches.Tumor control and urinary continence were satisfying for patients enrolled in.The next phase involves conducting a large-scale,multicenter randomized controlled trial to thoroughly assess the effectiveness and safety of the new technology in a broader population.

Robot-assisted retroperitoneal lymphadenectomy:The state of art

Objective:To perform a narrative review about the role of robot-assisted retroperitoneal lymphadenectomy(R-RPLND)in the management of testicular cancer.Methods:A PubMed search for all relevant publications regarding the R-RPLND series up until August 2019 was performed.The largest series were identified,and weighted means calculated for outcomes using the number of patients included in each study as the weighting factor.Results:Fifty-six articles of R-RPLND were identified and eight series with more than 10 patients in each were included.The weighted mean age was 31.12 years;primary and post chemotherapy R-RPLND were performed in 50.59%and 49.41%of patients.The clinical stage was I,II and III in 47.20%,39.57%and 13.23%of patients.A modified R-RPLND template was used in 78.02%of patients,while 21.98%underwent bilateral full template.The weighted mean node yield,operative time and estimated blood loss were,respectively,22.15 nodes,277.35 min and 131.94 mL.The weighted mean length of hospital stay was 2 days and antegrade ejaculation was preserved in 92.12%of patients.Major post-operative complications(Clavien III or IV)occurred in 5.34%.Positive pathological nodes were detected in 24.54%,while the recurrence free survival was 95.77%with a follow-up of 21.81 months.Conclusion:R-RPLND has proven to be a reproducible and safe approach in experienced centers;short-term oncologic outcomes are similar to the open approach with less morbidity and shorter convalescence related to its minimal invasiveness.However,longer follow-up and new trials comparing head-to-head both techniques are expected.