In robotic surgery, the surgeon controls robotic instruments using dedicated interfaces. One critical limitation of current interfaces is that they are designed to be operated by only the hands. This means that the surgeon can only control at most two robotic instruments at one time while many interventions require three instruments. This paper introduces a novel four-degree-of-freedom foot-machine interface which allows the surgeon to control a third robotic instrument using the foot, giving the surgeon a "third hand". This interface is essentially a parallel-serial hybrid mechanism with springs and force sensors. Unlike existing switch-based interfaces that can only unintuitively generate motion in discrete directions, this interface allows intuitive control of a slave robotic arm in continuous directions and speeds, naturally matching the foot movements with dynamic force & position feedbacks. An experiment with ten naive subjects was conducted to test the system. In view of the significant variance of motion patterns between subjects, a subject-specific mapping from foot movements to command outputs was developed using Independent Component Analysis (ICA). Results showed that the ICA method could accurately identify subjects' foot motion patterns and significantly improve the prediction accuracy of motion directions from 68% to 88% as compared with the forward kinematics-based approach. This foot-machine interface can be applied for the teleoperation of industrial/surgical robots independently or in coordination with hands in the future.

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Perforations in flexible endoscopy are life-threatening. Defect closure or suturing in flexible endoscopy has long been a critical challenge due to the confined space of the access routes and surgical sites, high dexterity and force demands of suturing tasks, as well as critical size and strength requirements of wound closure. This paper introduces a novel robotic suturing system for flexible endoscopic surgery. This system features a flexible, through-the-scope, five-degree-of-freedom robotic suturing instrument. This instrument allows the surgeon to endoscopically manipulate a needle via a master console to create running stitches and knots in flexible endoscopy, which is not possible with existing devices. Successful ex-vivo trials were conducted inside porcine colons to show how surgical stitches and knots can be endoscopically created and secured in a completely new way. This new technology will change the way how surgeons close defects or perforations in flexible endoscopic surgery.

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Accurate haptic feedback is a critical challenge for surgical robots, especially for flexible endoscopic surgical robots whose transmission systems are Tendon-Sheath Mechanisms (TSMs) with highly nonlinear friction profiles and force hysteresis. For distal end haptic sensing of TSMs, this paper, for the first time, proposes to measure the compression force on the sheath at the distal end so that the tension force on the tendon, which equals the compression force on the sheath, can be obtained. A new force sensor, i.e., a nitinol tube attached with an optical Fiber Bragg Grating (FBG) fiber, is proposed to measure the compression force on the sheath. This sensor, with similar diameter and configuration (hollow) as the sheath, can be compactly integrated with TSMs and surgical end-effectors. In this paper, mechanics analysis and verification tests are presented to reveal the relationship between the tension force on the tendon and the compression force on the sheath. The proposed force sensor was calibrated in tests with a sensitivity of 24.28 pm/N and integrated with a tendon-sheath driven grasper to demonstrate the effectiveness of the proposed approach and sensor. The proposed approach and sensor can also be applied for a variety of TSMs-driven systems, such as robotic fingers/hands, wearable devices, and rehabilitation devices.

If a perforation occurs as a result of a flexible endoscopic procedure, suturing through urgent laparoscopy or open surgery may be required to repair the perforation because suturing is normally stronger than closure using existing endoscopic devices. Suturing with stitches and knots, widely adopted in open or laparoscopic surgery, is still not possible in flexible endoscopy. This is because of the confined space of the natural orifice and target area, high levels of motion dexterity and force needed for stitching and knot-tying, and critical size and strength requirements of wound closure. We present a novel flexible endoscopic robotic suturing system that is able to suture gastrointestinal defects without opening up the patient's body like in open or laparoscopic surgery. This system features a robotic needle driver and a robotic grasper, both of which are flexible, through-the-scope (small in sizes), and dexterous with five degrees of freedom. The needle driver, facilitated by the grasper, enables the surgeon to control a needle through teleoperation to make stitches and knots in flexible endoscopy. Successful in vivo trials were conducted in the rectum of a live pig to confirm the feasibility of endoscopic suturing and knot-tying using the system in a realistic surgical scenario (not possible with existing devices which are all manually driven). This new technology will change the way how surgeons close gastrointestinal defects.

Many teleoperation tasks require three or more tools working together, which need the cooperation of multiple operators. The effectiveness of such schemes may be limited by communication. Trimanipulation by a single operator using an artificial third arm controlled together with their natural arms is a promising solution to this issue. Foot-controlled interfaces have previously shown the capability to be used for the continuous control of robot arms. However, the use of such interfaces for controlling a supernumerary robotic limb (SRLs) in coordination with the natural limbs, is not well understood. In this paper, a teleoperation task imitating physically coupled hands in a virtual reality scene was conducted with 14 subjects to evaluate human performance during trimanipulation. The participants were required to move three limbs together in a coordinated way mimicking three arms holding a shared physical object. It was found that after a short practice session, the three-hand trimanipulation using a single subject's hands and foot was still slower than dyad operation, however, they displayed similar performance in success rate and higher motion efficiency than two person's cooperation.