This review examines the dichotomy between automatic and autonomous behaviors in surgical robots, maps the possible levels of autonomy of these robots, and describes the primary enabling technologies that are driving research in this field. It is organized in five main sections that cover increasing levels of autonomy. At level 0, where the bulk of commercial platforms are, the robot has no decision autonomy. At level 1, the robot can provide cognitive and physical assistance to the surgeon, while at level 2, it can autonomously perform a surgical task. Level 3 comes with conditional autonomy, enabling the robot to plan a task and update planning during execution. Finally, robots at level 4 can plan and execute a sequence of surgical tasks autonomously. Expected final online publication date for the Annual Review of Control, Robotics, and Autonomous Systems, Volume 4 is May 3, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
In surgical robotics, the ability to achieve high levels of autonomy is often limited by the complexity of the surgical scene. Autonomous interaction with soft tissues requires machines able to examine and understand the endoscopic video streams in real-time and identify the features of interest. In this work, we show the first example of spatio-temporal neural networks, based on the U-Net, aimed at segmenting soft tissues in endoscopic images. The networks, equipped with Long Short-Term Memory and Attention Gate cells, can extract the correlation between consecutive frames in an endoscopic video stream, thus enhancing the segmentation's accuracy with respect to the standard U-Net. Initially, three configurations of the spatiotemporal layers are compared to select the best architecture. Afterwards, the parameters of the network are optimised and finally the results are compared with the standard U-Net. An accuracy of 83.77% ± 2.18% and a precision of 78.42% ± 7.38% are achieved by implementing both Long Short Term Memory (LSTM) convolutional layers and Attention Gate blocks. The results, although originated in the context of surgical tissue retraction, could benefit many autonomous tasks such as ablation, suturing and debridement.
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