The advent of robot-assisted surgery in the operating room has led to many advantages, such as reduced patient trauma and recovery time, increased surgeon dexterity, reduced surgeon fatigue, and the possibility of remote surgical procedures.
However, the lack of haptic feedback in these robotic surgical systems eliminates the ability of the surgeon to characterize and diagnose tissue at the surgical margin using their sense of touch. The purpose of this research was the design and development of a teleoperation platform with force feedback capability for robotic surgery. Towards the development of the teleoperation platform, we have presented 1) the development of laparoscopic graspers with force measurement capability, 2) the development of a seven degree-of-freedom haptic device with four degrees of force feedback, 3) experimental studies evaluating the role of vision and force feedback in robotic surgery, 4) a teleoperation platform with force feedback capability incorporating an automated laparoscopic grasper, Mitsubishi PA-10 robot arm, and seven DOF haptic device, and 5) preliminary experiments evaluating the teleoperation platform with force feedback capability through tissue characterization and surgical knot tying tasks.
The development of the teleoperation platform with force feedback capability requires laparoscopic instruments capable of accurately measuring surgical forces in robot-assisted surgery. Therefore, our research work focused on the design and development of a novel laparoscopic grasper for use in robot-assisted surgery. Four generations of our grasper with force measurement capability were developed. The first generation consisted of a conventional laparoscopic grasper with strain gages and a position sensor to record the applied force on the jaws and the position of the jaws.
While this grasper can not be readily incorporated into a robotic surgical system, this prototype was a ‘proof-of-concept’ for initial characterization trials using simulated tissue
137 samples. The second generation grasper was the first automated grasper which used a DC motor and cable transmission assembly. The use of the cable transmission provided the advantages of low friction and no backlash in our design compared to previous research on automated laparoscopic tools. The third generation laparoscopic grasper improved on the previous prototype by incorporating sensors for force measurement in three directions using a novel ‘floating jaw’ design. Unlike previous research, this grasper provided the advantage of direct force measurement for grasping and manipulation forces at the jaws and also a tissue probing capability. The fourth prototype of the laparoscopic grasper further improved on the grasper by providing a compact and modular design for use in a surgical setting. This grasper provided the advantage of a compact design similar to conventional laparoscopic instruments with the inclusion of tri-directional force measurement capability. Tissue characterization experiments using each of these graspers demonstrated the capability of each prototype to distinguish between simulated tissue samples of varying stiffness. While the current prototype addresses most of the constraints for laparoscopic tools, future work to optimize the design through custom sensors or the incorporation of a wrist joint similar to current commercial robotic surgical systems could further improve the tool.
In addition to instruments for the measurement of surgical forces, our research also focused on the reflection of these forces to the surgeon. While some researchers have developed general purpose or procedure-specific haptic devices, our development has focused on a seven degree-of-freedom haptic device with four degrees of force feedback for most types of surgical procedures. This device consists of an ergonomic user interface with a grasping mechanism for the hand and wrist of the surgeon. While the user interface is a passive mechanism, the grasping mechanism provides force feedback to two fingers of the surgeon for grasping/parting tasks. The end-effector of the user interface is connected to a spatial force feedback mechanism for reflection of
138 forces in three directions (X, Y, and Z). This novel design of the haptic device allows for higher actuator forces, a large workspace, and the capability to use the device in robotic, laparoscopic, and open surgical procedures. The kinematics of the mechanism were analyzed to determine the position and orientation of the haptic device while our estimation of the reachable workspace allows the surgeon to evaluate the haptic device for use in a particular surgical procedure or the need for adjustments, such as a clutch or scaling parameter. An estimation of the friction for each of the actuated joints increases the transparency of the device through the feed forward controller. Using a low velocity motion for estimation of the friction created a simple estimation of the coulomb friction in the mechanism. As mentioned in Chapter 4, experiments to model additional friction components, such as viscous friction and mechanism asymmetries, could further improve the transparency of the haptic device. Finally, the calibration of the force feedback of each actuated joint, the force bandwidth, and system model of the spatial mechanism were also determined.
The primary contribution of this thesis is the development of a teleoperation platform with force feedback capabilities for robot-assisted surgery. This platform consisted of the Mitsubishi PA-10 robot arm with our automated laparoscopic grasper mounted on the end-effector of the robot arm and controlled using the seven DOF haptic device.
Using a bilateral controller, the haptic device controls the position and orientation of the robot arm and automated grasper while reflecting the measured forces from the grasper to the surgeon. A preliminary version of the teleoperation platform using the second generation prototype of the laparoscopic grasper with the PHANToM haptic interface device was used to evaluate the role of vision and force feedback in robotic surgery.
The results from a human subject study have shown that simultaneous vision and force feedback leads to better tissue characterization than only vision feedback or only force feedback. Therefore, incorporating force feedback into robotic surgical systems will
139 improve the ability of the surgeon to correctly diagnose a tissue as healthy or unhealthy.
The current teleoperation platform that consisted of the Mitsubishi PA-10 robot arm, laparoscopic grasper, and haptic device was used in further experiments to evaluate the role of force feedback in surgical tasks. A tissue characterization task using hydrogels of varying stiffness and a knot tying task using a suture were conducted to demonstrate the operation of the system and determine preliminary benefits of the system. The results of the tissue characterization experiment show an operator was able to distinguish between different hydrogels using the feedback of the normal grasping force. A scaling factor of 1.5 for the reflection of the grasping force was used in this experiment; however, future work should focus on optimization of this factor through an analysis of the human perception of these grasping/parting forces. The knot tying experiment demonstrated a lower mean force needed for tightening a knot on a suture when comparing the platform with force feedback to the platform without force feedback. While these experiments involved only one operator, future human subject studies using many subjects could be used to statistically evaluate the teleoperation platform. In addition, optimization of the controller of the platform could further improve these experiments.
Future work in this research area includes additional human subject studies with surgeons and non-surgeons using the teleoperation platform followed by clinical trials using animals. Specifically, tissue characterization and suturing experiments should be performed that provide a quantitative analysis of our teleoperation platform with force feedback and without force feedback. Further optimization of the design of the automated grasper and haptic device could lead to improvement of the robotic system.
In addition to the use of our teleoperation platform in robot-assisted surgery, the platform could be used as a surgical simulator for pre-operative planning, surgical training, or improving the skills of a surgeon. Also, the data from a recorded surgical
140 procedure could be incorporated into the teleoperation platform to assess the results of a particular procedure or act as a training tool for novice surgeons.
The results of this research provide a foundation for the incorporation of force feedback into robot-assisted surgery and demonstrate these technologies in a teleoperation platform. The preliminary experimental work shows the potential advantages of a robotic surgical system with force feedback capability and provides an important first step towards the use of this system in an operating room.
141
List of References
1. A. R. Lanfranco, A. E. Castellanos, J. P. Desai, et al., Robotic Surgery: A Current Perspective, in Annals of Surgery, 2004, vol. 239(1), pp. 14-21.
2. K. V. Siva, A. A. Dumbreck, P. J. Fischer, et al., Development of a general purpose hand controller for advanced teleoperation, presented at International Symposium on Teleoperation and Control, Bristol, England, 1988, pp. 277-290.
3. B. T. Bethea, A. M. Okamura, M. Kitagawa, et al., Application of Haptic Feedback to Robotic Surgery, in Journal of Laparoendoscopic and Advanced Surgical Techniques, 2004, vol. 14(3), pp. 191-195.
4. C. R. Wagner, N. Stylopoulos, and R. D. Howe, The Role of Force Feedback in Surgery:
Analysis of Blunt Dissection, presented at Symposium on Haptic Interfaces for Virtual Environments and Teleoperator Systems, Orlando, FL, 2002, pp. 68-74.
5. J. M. Hollerbach, Some Current Issues in Haptics Research, presented at IEEE International Conference on Robotics and Automation, San Francisco, CA, 2000, pp.
757-762.
6. Robotics and Automation Handbook. New York: CRC Press, 2005.
7. O. R. Astley and V. Hayward, Design constraints for haptic surgery simulation., presented at Proc. 2000 IEEE Internat. Conf. Robotics and Automation, 2000, pp. 2446-2451.
8. P. Fischer, R. Daniel, and K. V. Siva, Specification and Design of Input Devices for Teleoperation, presented at IEEE International Conference on Robotics and Automation, Cincinnati, OH, 1990, pp. 540-545.
9. Y. S. Kwoh, J. Hou, E. A. Jonckheere, et al., A Robot with Improved Absolute Positioning Accuracy for CT Guided Stereotactic Brain Surgery, in IEEE Trans Biomed Eng., 1988, vol. 35(2), pp. 153-160.
10. S. J. Harris, F. Arambula-Cosio, Q. Mei, et al., The Probot—an active robot for prostate resection, in Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine., 1997, vol. 211(4), pp. 317-325.
11. P. Kazanzides, Force Sensing and Control for a Surgical Robot, presented at IEEE International Conference on Robotics and Automation, Nice, France, 1992, pp. 612-617.
12. P. Kazanzides, B. D. Mittelstadt, B. L. Musits, et al., An integrated system for cementless hip replacement, in IEEE Eng. Med. Biol., 1995, vol. 14(3), pp. 307-313.
13. G. S. Guthart and S. J.K., The Intuitive Telesurgical System: Overview and Application, presented at IEEE International Conference on Robotics and Automation, 2000, pp. 618-621.
14. Intuitive Surgical - da Vinci Surgical System, 2007, February 9, 2007,
<http://www.intuitivesurgical.com/products/davinci_surgicalsystem/index.aspx>.
142 15. A. M. Okamura, Methods for haptic feedback in teleoperated robot-assisted surgery, in
Industrial Robot, 2004, vol. 31(6), pp. 499-508.
16. S. M. Sukthankar and N. P. Reddy, Towards Force Feedback in Laparoscopic Surgical Tools, presented at IEEE Engineering in Medicine & Biology Conference, Baltimore, MD, 1994, pp. 1041-1042.
17. V. Gupta, N. P. Reddy, and P. Batur, Forces in Surgical Tools: Comparison between Laparoscopic and Surgical Forceps, presented at International Conference of the IEEE Engineering in Medicine and Biology Society, Amsterdam, 1996, pp. 223-224.
18. A. Bicchi, G. Canepa, D. DeRossi, et al., A sensor-based minimally invasive surgery tool for detecting tissue elastic properties, presented at IEEE International Conference on Robotics and Automation, 1996, pp. 884-888.
19. E. Scilingo, D. DeRossi, A. Bicchi, et al., Sensor and devices to enhance the performance of a minimally invasive surgery tool for replicating surgeon's haptic perception of the manipulated tissues, presented at IEEE International Conference on Engineering in Medicine and Biology, 1997, pp. 961-964.
20. A. K. Morimoto, R. D. Foral, J. L. Kuhlman, et al., Force Sensor for Laparoscopic Babcock, presented at Medicine Meets Virtual Reality, 1997, pp. 354-361.
21. J. Rosen, B. Hannaford, C. G. Richards, et al., Markov modeling of minimally invasive surgery based on tool/tissue interaction and force/torque signatures for evaluating surgical skills, in IEEE Transactions on Biomedical Engineering, 2001, vol. 48(5), pp. 579 -591.
22. S. K. Prasad, M. Kitagawa, G. S. Fischer, et al., A Modular 2-DOF Force-Sensing Instrument for Laparoscopic Surgery, presented at International Society and Conference Series on Medical Image Computing and Computer-Aided Intervention, Montreal, Canada, 2003, pp. 279-286.
23. J. Dargahi, M. Parameswaran, and S. Payandeh, A Micromachined Piezoelectric Tactile Sensor for use in Endoscopic Graspers, presented at International Conference on Intelligent Robots and Systems, Victoria, B.C., Canada, 1998, pp. 1503-1508.
24. J. Dargahi, M. Parameswaran, and S. Payandeh, A Micromachined Piezoelectric Tactile Sensor for an Endoscopic Grasper - Theory, Fabrication and Experiments, in Journal of Microelectromechanical Systems, 2000, vol. 9(3), pp. 329-335.
25. J. Dargahi, A piezoelectric tactile sensor with three sensing elements for robotic, endoscopic, and prosthetic applications, in Sensors and Actuators A, 2000, vol. 80(1), pp.
23-30.
26. G. S. Fischer, T. Akinbiyi, S. Saha, et al., Ischemia and Force Sensing Surgical Instruments for Augmenting Available Surgeon Information, presented at International Conference on Biomedical Robotics and Biomechatronics, Pisa, Italy, 2006, pp. 1030-1035.
27. M. Lazeroms, A. L. Haye, W. Sjoerdsma, et al., A Hydraulic Forceps with Force Feedback for Use in Minimally Invasive Surgery, in Mechatronics, 1996, vol. 6(4), pp.
437-446.
143 28. J. Rosen, B. Hannaford, M. MacFarlane, et al., Force Controlled and Teleoperated
Endoscopic Grasper for Minimally Invasive Surgery - Experimental Performance Evaluation, in IEEE Transactions on Biomedical Engineering, 1999, vol. 46(10), pp. 1212-1221.
29. M. MacFarlane, J. Rosen, B. Hannaford, et al., Force Feedback Grasper Helps Restore the Sense of Touch in Minimally Invasive Surgery, in Journal of Gastrointestinal Surgery, 1999, vol. 3, pp. 278-285.
30. B. Hannaford, J. Trujillo, M. Sinanan, et al., Computerized Endoscopic Surgical Grasper, in Medicine Meets Virtual Reality, 1998 vol. 50, pp. 265-271.
31. V. V. H. t. Dingshoft, M. Lazeroms, A. v. d. Ham, et al., Force reflection for a laparoscopic forceps, presented at 18th Annual Intenational Conference of the IEEE Engineering in Medicine and Biology Society, 1996, pp. 210-211.
32. A. Faraz, S. Payandeh, and A. Salvarinov, Design of a force control grasper through stiffness modulation for endosurgery: theory and experiments, in Mechatronics, 2000, vol.
10(6), pp. 627-648.
33. J. D. Brown, J. Rosen, Y. Sang, et al., In-Vivo and In-Situ Compressive Properties of Porcine Abdominal Soft Tissues, presented at Medicine Meets Virtual Reality, Newport Beach, CA, 2003, pp. 26-32.
34. J. D. Brown, J. Rosen, M. Moreyra, et al., Computer-Controlled Motorized Endoscopic Grasper for In Vivo Measurement of Soft Tissue Biomechanical Characteristics, presented at Studies in Health Technology and Informatics - Medicine Meets Virtual Reality, Newport Beach, CA, 2002, pp. 71-73.
35. M. Tavakoli, R. V. Patel, and M. Moallem, A Forcec Reflective Master-Slave System for Minimally Invasive Surgery, presented at IEEE International Conference on Intelligent Robots and Systems, Las Vegas, Nevada, 2003, pp. 3077-3082.
36. A. J. Madhani, G. Niemeyer, and J. K. Salisbury, The Black Falcon: A Teleoperated Surgical Instrument for Minimally Invasive Surgery, in IEEE/RSJ International Conference on Intelligent Robotic Systems, 1998, vol. 2, pp. 936-944.
37. T. Hoshino, H. Ishigaki, Y. Konishi, et al., A Master-Slave Manipulation System with a Force-Feedback Function for Endoscopic Surgery, presented at International Conference of the IEEE Engineering in Medicine and Biology Society, Istanbul, Turkey, 2001, pp.
3446-3449.
38. F. Pierrot, E. Dombre, E. Degoulange, et al., Hippocrate: a safe robot arm for medical applications with force feedback, in Medical Image Analysis, 1999, vol. 3(3), pp. 285-300.
39. J. Rosen, J. D. Brown, M. Barreca, et al., The Blue DRAGON - A System for Monitoring the Kinematics and Dynamics of Endoscopic Tools in Minimally Invasive Surgery for Objective Laparoscopic Skill Assessment, presented at Medicine Meets Virtual Reality, Newport Beach, CA, 2002, pp. 412-418.
40. J. Rosen, J. D. Brown, L. Chang, et al., The BlueDRAGON - A System for Measuring the Kinematics and Dynamics of Minimally Invasive Surgical Tools In-Vivo, presented at IEEE International Conference on Robotics and Automation, Washington, D.C., 2002, pp.
1876-1881.
144 41. M. J. H. Lum, D. Trimble, J. Rosen, et al., Multidisciplinary Approach for Developing a
New Minimally Invasive Surgical Robotic System, presented at IEEE/RAS-EMBS International Conference on Biomedical Robotics and Biomechatronics, Pisa, Italy, 2006, pp. 841-846.
42. S. Shimachi, Y. Hakozaki, T. Tada, et al., Measurement of force acting on surgical instrument for force-feedback to master robot console, presented at Computer Assisted Radiology and Surgery, London, England, 2003, pp. 538-546.
43. R. H. Taylor, J. Funda, B. Eldridge, et al., A telerobotic assistant for laparoscopic surgery, in IEEE Engineering in Medicine and Biology, 1995, vol. 14, pp. 279-286.
44. A. Casals, J. Amat, and E. Laporte, Automatic Guidance of an Assistant Robot in Laparoscopic Surgery, presented at IEEE International Conference on Robotics and Automation, Minneapolis, MN, 1996, pp. 895-900.
45. A. Krupa, J. Gangloff, M. d. Mathelin, et al., Autonomous retrieval and positioning of surgical instruments in robotized laparoscopic surgery using visual servoing and laser pointers, presented at IEEE International Conference on Robotics and Automation, Washington, DC, 2002, pp. 3769-3774.
46. V. F. Munoz, C. Vara-Thorbeck, J. G. DeGabriel, et al., A medical robotic assistant for minimally invasive surgery, presented at IEEE International Conference on Robotics and Automation, 2000, pp. 2901-2906.
47. P. Berkelman, P. Cinquin, J. Troccaz, et al., A Compact, Compliant Laparoscopic Endoscope Manipulator, presented at IEEE International Conference on Robotics and Automation, Washington, DC, 2002, pp. 1870-1875.
48. M. C. Cavusoglu, F. Tendick, M. Cohn, et al., A Laparoscopic Telesurgical Workstation, in IEEE Trans Robotics and Automation, 1999, vol. 15(4), pp. 728-739.
49. F. Tendick, M. Downes, T. Goktekin, et al., A Virtual Environment Testbed for Training Laparoscopic Surgical Skills, in Presence, 2000, vol. 9(3), pp. 236-255.
50. R. Goertz and R. Thompson, Electronically controlled manipulator, in Nucleonics, 1954, pp. 46-47.
51. R. E. Ellis, O. M. Ismaeil, and M. G. Lipsett, Design and Evaluation of a High-Performance Haptic Interface, in Robotica, 1996, vol. 14, pp. 321-327.
52. M. Ueberle and M. Buss, Design, Control, and Evaluation of a New 6 DOF Haptic Device, presented at IEEE/RSJ International Conference on Intelligent Robots and Systems, Lausanne, Switzerland, 2002, pp. 2949-2954.
53. General Terminology Related to Parallel Mechanisms, 2001, February 8, 2007,
<http://www.parallemic.org/Terminology/General.html>.
54. L. Birglen, C. Gosselin, N. Pouliot, et al., SHaDe, A New 3-DOF Haptic Device, in IEEE Transactions on Robotics and Automation, 2002, vol. 18(2), pp. 166-175.
55. P. A. Millman and J. E. Colgate, Design of a Four Degree-of-Freedom Force-Reflecting Manipulandum with a Specified Force/Torque Workspace, presented at IEEE International Conference on Robotics and Automation, Sacramento, CA, 1991, pp. 1488-1493.
145 56. J. Yoon and J. Ryu, Design and Analysis of a New Haptic Device Using a Parallel
Mechanism, presented at IEEE International Conference on Intelligent Robots and Systems, 2000, pp. 949-954.
57. S. S. Lee and J. M. Lee, Design of a general purpose 6-DOF haptic interface, in Mechatronics, 2003, vol. 13(7), pp. 697-722.
58. J. H. Lee, K. S. Eom, B. J. Yi, et al., Design of a New 6-DOF Parallel Haptic Device, presented at IEEE International Conference on Robotics and Automation, Seoul, Korea, 2001, pp. 886-891.
59. A. Frisoli, F. Salsedo, D. Ferrazzin, et al., Mechanical Design and Kinematic Optimization of a Novel Six-Degree-of-Freedom Parallel Mechanism, presented at International Conference on Parallel Kinematic Machines, Milan, Italy, 1999.
60. E. L. Faulring, J. E. Colgate, and M. A. Peshkin, A High Performance 6-DOF Haptic Cobot, presented at IEEE International Conference on Robotics and Automation, New Orleans, LA, 2004, pp. 1980-1985.
61. J. M. Sabater, R. J. Saltaren, and R. Aracil, Design, modeling and implementation of a 6 URS parallel haptic device, in Robotics and Autonomous Systems, 2004, vol. 47, pp. 1-10.
62. R. D. Howe, A Force-Reflecting Teleoperated Hand System for the Study of Tactile Sensing in Precision Manipulation, presented at IEEE International Conference on Robotics and Automation, Nice, France, 1992, pp. 1321-1326.
63. T. M. Massie and J. K. Salisbury, The PHANToM Haptic Interface: A device for Probing Virtual Objects, in Dynamic Systems and Control, 1994, vol. 1, pp. 295-301.
64. K. Kim, W. K. Chung, and Y. Yourn, Design and Analysis of a New 7-DOF Parallel Type Haptic Device: PATHOS-II, presented at IEEE International Conference on Intelligent Robots and Systems, Las Vegas, NV, 2003, pp. 2241-2246.
65. G. C. Burdea, Force and Touch Feedback for Virtual Reality. New York, NY: John Wiley and Sons, Inc., 1996.
66. Immersion Corporation - 3D Interaction: Products, 2006, October 23, 2006,
<http://www.immersion.com/3d/products/cyber_grasp.php>.
67. M. Bouzit, G. Burdea, G. Popescu, et al., The Rutgers Master II - New Design Force-Feedback Glove, in IEEE/ASME Transactions on Mechatronics, 2002, vol. 7(2), pp. 256-263.
68. C. A. Avizzano, F. Barbagli, A. Frisoli, et al., The Hand Force Feedback: Analysis and Control of a Haptic Device for the Human Hand, presented at IEEE International Conference on Systems, Man, and Cybernetics, 2000, pp. 989-994.
69. B. H. Choi and H. R. Choi, A Semi-direct Drive Hand Exoskeleton Using Ultrasonic Motor, presented at IEEE International Workshop on Robot and Human Interaction, Pisa, Italy, 1999, pp. 285-290.
70. T. Koyama, I. Yamano, K. Takemura, et al., Multi-Fingered Exoskeleton Haptic Device using Passive Force Feedback for Dexterous Teleoperation, presented at IEEE International Conference on Intelligent Robots and Systems, Lausanne, Switzerland, 2002, pp. 2905-2910.
146 71. C. Wusheng, W. Tianmiao, and H. Lei, Design of Data Glove and Arm Type Haptic
Interface, presented at IEEE Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems, Los Angeles, CA, 2003, pp. 422-427.
72. W. Chou, T. Wang, and J. Xiao, Haptic Interaction with Virtual Environment Using an Arm Type Exoskeleton Device, presented at IEEE International Conference on Robotics and
72. W. Chou, T. Wang, and J. Xiao, Haptic Interaction with Virtual Environment Using an Arm Type Exoskeleton Device, presented at IEEE International Conference on Robotics and