Biomedical Engineering Reference
In-Depth Information
is placed on the surgeon, notwithstanding the enhanced visual skill and movements that
this procedure otherwise provides [13].
9.1 Robotic System for Endoscopic Heart Surgery
Because robotic devices are able to perform repeated and routine manipulation tasks with
greater dexterity and frequency than a human, their place in the medical and surgical
markets is all but assured. Some of the weaknesses in current robotic devices, such as
substantial lack of haptic feedback and adaptability, will be discussed. At the present
time it is not possible to 'program' a robot to perform steps of a surgical operation
autonomously. Nevertheless, these limitations do not prevent robots from being useful
in the operating room, although extensive human, technical and surgical input, guidance,
and intervention are still required. Surgical robots can be viewed as 'extending' and
'enhancing' human capabilities rather than replacing surgeons, in contrast to the example
of industrial replacement of humans by robots.
Intuitive Surgical
Surgical Sys-
tem, a conception of a surgeon-robot interface so transparent to the surgeon that his/her
set of skills could be used in a natural and instinctive manner. Its accurate visualization
is critical since visual cues are used to compensate for the loss of haptic feedback. Hap-
tic feedback is currently limited to interaction with rigid structures, such as tool-on-tool
interfaces, not soft tissue, which requires the surgeon to rely on visual feedback in tasks
such as suturing. Research groups began to analyze the use of haptic feedback when
using fine suture material [14, 15], but their findings were of little or no interest to the
medical fraternity, including heart surgeons. The basic consideration is to offer the heart
surgeon an additional sensory channel, in addition to the visual channel, not only to avoid
breaking surgical suture material with ensuing tissue damage, but also to decrease visual
fatigue. In this regard, 17 new applications of this technology are beginning to emerge
in conjunction with feedback from creative surgeons [16, 17]. Nevertheless, present-day
robotic surgical systems have limitations that have slowed its widespread introduction and
continuation. One major problem, as previously mentioned, is the lack of haptic feedback
[18, 19]. A second major concern is the cumbersome and none-too versatile nature of the
robotic system itself, so it is quite easy to envision integrated imaging, navigation, and
enhanced sensory capabilities being available in the next generation of telesurgical systems
[20, 21]. Braun
et al
. [22] conducted experiments to examine claims about the necessity of
force feedback for robot-assisted surgical procedures in cardiac surgery. They presented a
novel approach of a robotic system for minimally invasive and endoscopic surgery, with
the main purposes of evaluating force feedback and machine learning. However, in their
experimental setup, although the feel for different and radically changed tissues could not
be analyzed in sufficient depth, their experiments did, nonetheless, show that haptic feed-
back can be employed to prevent the surgeon from making potentially harmful mistakes.
Tension of thread material and tissue parts can be measured and displayed in order to
restrict force application to tolerable amplitudes. In addition, the collision of instruments
can be detected and intercepted by the evaluation of real-time forces. In their proposed
system, forces are measured at the surgical instruments using multi-dimensional haptic
styluses, and fed back to the surgeon's hands. They also incorporated the results of their
experiments into control software, for modeling and simulation of haptic interaction with
™
intended to create, in conjunction with the da Vinci
™
