Haptic Feedback in Laparoscopic and Robotic Surgery Dr. Warren Grundfest Professor Bioengineering, Electrical Engineering & Surgery UCLA, Los Angeles, California
Acknowledgment This Presentation & Research Project Has Been The Result Of Collaboration Between UCLA School Of Medicine, Bioengineering & Electrical Engineering Collaborators: Dr. Erik Dutson, Dr. Robert Candler, Ahmad Abiri, Dr. George Saddik, Dr. Brian Nowroozi, Dr. Yen-Yi Juo Project Partially Supported by National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health under award number R01EB019473
Center for Advanced Surgical and Interventional Technologies (CASIT) Established In 1994 At University Of California, Los Angeles Mission: Define And Advance The State Of The Art Surgical And Interventional Technologies Goals: Revolutionize Surgical Training Deliver Novel Surgical And Interventional Therapies Enable The Development Of Novel Surgical Technologies And Develop A Greater Interventional Capacity Through Robotics, Informatics, And Simulation
Laparoscopic Surgery Minimally Invasive Surgery (MIS): A surgical technique in which operations are performed through small incisions. Benefits Reduced trauma to patient Reduced hospital stay & cost Drawbacks Additional Technical Training Required Loss of dexterity Loss of 3D vision Loss of tactile information 4
Robotic Minimally Invasive Surgery (RMIS) Benefits Improved 3-D vision Improved dexterity (wrist motion) Improved ergonomics Reduction of hand tremors Drawbacks High equipment costs Maintenance Cost Additional Training Required Complete Loss of Haptic Feedback Robotic Instrument da Vinci robotic surgical system Control Console 5
The Problem Limited force feedback available in Laparoscopic Surgery Complete loss of tactile and force feedback in robotic surgery
Clinical Need Excessive Forces During Surgery Increase risk of tissue damage while grasping delicate tissue Increase risk of tissue tearing while retracting Intra- and Post-operative Suture Breakage Potential Injury: cannot palpate to detect vessels, nerves, ureter, lymph nodes
Clinical Need Other Issues Caused By Loss Of Tactile Senses Eliminates diagnostic abilities (soft vs. hard tissue, thick vs thin adhesions) Increases possibility of mistakes Poor Visual-Spatial Integration: Prolonged learning curve for novices
Basic Elements in a Haptic Feedback System (HFS) Sense Forces Filter & Control Actuate: Provide Feedback 9
CASIT s Pneumatic Tactile Feedback System Piezoresistive Normal Force Sensing 1) High Forces in Small Pneumatic Actuator 2) Low Latency Actuation (100-180ms) [1] CR., W. (2013). University of California, Los Angeles. Retrieved from https://escholarship.org/uc/item/7w74q3wh.pdf 10
Effectiveness of HFS in Laparoscopy When installed on laparoscopic instruments, HFS was effective in reduction of grip forces Peak Grip Force Average Grip Force [1] CR., W. (2013). University of California, Los Angeles. Retrieved from https://escholarship.org/uc/item/7w74q3wh.pdf 11
Effectiveness of HFS in Robotic Surgery Haptic Feedback Reduces Grip Forces for Robotic Surgical Tasks [1] CR., W. (2013). University of California, Los Angeles. Retrieved from https://escholarship.org/uc/item/7w74q3wh.pdf 12
Results of UCLA Studies 1. Haptic Feedback Partially Restores Tactile Sensation 2. Pneumatic Haptic Feedback Has Significant Advantages Over Other Feedback Mechanisms 3. Pneumatic Haptic Feedback Can Be Synergistically Combined With Other Feedback Mechanisms To Enhance Performance
The Future of Haptic Feedback in Surgery
Bi-Axial Capacitive Sensors Detection of Normal and Bi-Axial Shear Forces Goals Prevent Suture Breakage Improve Quality of Anastomoses Improve Quality of a Knot
Sensor Biocompatibility & Instrument Integration Laparoscopic Tools with Built-in Sensors Force Sensors Fitted Directly Into The Robotic Instruments Biocompatible Coating Elimination of Noise in Capacitive Sensors Fully Wireless Sensors
Differential Force Sensor Arrays Increasing the Number of Force Sensors Provides More Accurate Readings Utilizing Reference Sensors and Software Algorithms to Eliminate False Readings Wider Set of Applications Palpation During Surgery Quantification of Tissue Viscosity and Elasticity
Kinesthetic Force Feedback Complements Normal Force Tactile Feedback Activation of Golgi Tendons and Muscle Spindles Feedback Motor Ideal Feedback for Higher Forces Towards a Hybrid HFS Pneumatic Tactile Feedback WiFi/TCP HFS Controller Sensor Sensor Board UART Laptop WiFi/UDP RAVEN Console Controller Kinesthetic Force Feedback
Vibrotactile Haptic Feedback Hybrid HFS: Multiple Modes of Tactile Feedback Normal Force Feedback for High Resolution Feedback Vibration as a Warning Mechanism 3-D Printed Actuators Allow For Development Of More Complex, Multi-Function Feedback Systems
Detection of Hidden Structures in Soft Tissue Haptics Can Help in Detection of Tumors, Vessels, Lymph Nodes in Soft Tissue Instrument Mounted Sensor Arrays and Software Algorithms can Automatically Detect and Warn Surgeons
Remote Palpation Haptics for Telemedicine Utilizing Force Sensor Arrays for Diagnostics Applications Allows for Remote Palpation & Diagnostics
Suture Breakage Prevention Shear Sensors Detect Forces on Sutures During Surgery Haptic System Software Can Be Pre-Programmed With Suture Failure Loads Vibration Feedback As Warning To Prevent Suture Failure [1] Abiri, A., Paydar, O., Tao, A., LaRocca, M., Liu, K., Genovese, B., Dutson, E. (2017). Suture Strength For Robotic Surgery. Surgical Endoscopy.
Virtual Walls and Reduction of Risks Utilizing Kinesthetic Feedback & Vibro-Tactile Feedback to Develop Virtual Walls to Reduce Risks During Surgery Minimize and Eliminate Tissue Damage Minimize and Eliminate Intra- and Post-Operative Suture Failure
Improving Surgical Training Haptics Already Used in Many Surgical Training and Simulation Systems Haptic Feedback Has Been Effective In Improving Performance In Robotic Surgical Tasks That Are Affected By Visual-Perceptual Mismatch * * **** ***
Neurosurgery Instruments for Neurosurgery Can Be Fitted With Force Sensors & Strain Gauges Can Help Prevent Damage to Tissue Improve Training By Quantifying Surgical Performance Zareinia, K., Maddahi, Y., Gan, L. S., Ghasemloonia, A., Lama, S., Sugiyama, T., Sutherland, G. R. (2016). A Force-Sensing Bipolar Forceps to Quantify Tool-Tissue Interaction Forces in Microsurgery. IEEE/ASME Transactions on Mechatronics, 21(5), 2365 2377. http://doi.org/10.1109/tmech.2016.2563384
Economics of Haptic Feedback in Robotic & Laparoscopic Surgery Haptic Feedback Improves Performance Reduces Cognitive Load Reduced Risk of Errors Reduced Time-to-Completion Economical Benefits Reduced OR Time Reduced Intra- and Post-Operative Complications [1] Cao, C. G. L., Zhou, M., Jones, D. B., & Schwaitzberg, S. D. (2007). Can surgeons think and operate with haptics at the same time? Journal of Gastrointestinal Surgery, 11(11), 1564 1569. http://doi.org/10.1007/s11605-007-0279-8 [2] Abiri, A., Tao, A., LaRocca, M., Guan, X., Askari, S. J., Bisley, J. W., Grundfest, W. S. (2016). Visual--perceptual mismatch in robotic surgery. Surgical Endoscopy, 1 8. http://doi.org/10.1007/s00464-016-5358-z
Conclusions Inclusion of Haptic Feedback Will Enable A New Generation of Minimally Invasive Surgical Procedures Hybrid Haptic Feedback Systems Will Provide the Means to Simulate Many Aspects of Real Touch, Decreasing Errors and Reducing OR Time Instrument Mounted Sensors Can Help Improve both Surgical Training and Surgical Outcomes
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