A Robotic System for Solo Surgery in Flexible Ureterorenoscopy

Schlenk, Christopher; Klodmann, Julian; Hagmann, Katharina; Kolb, Alexander; Hellings-Kus, Anja; Steidle, Florian; Schoeb, Dominik S.; Jürgens, Thorsten; Miernik, Arkadiusz; Albu-Schäffer, Alin

doi:10.1109/lra.2022.3194668

Cited by 3 publications

(5 citation statements)

References 37 publications

(50 reference statements)

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“…A dial indicator holder Hoffmann 440 610 400 3 and a gooseneck Gravity MA Goose L 4 serve as fixture and auxiliary arm in the PSU. Two membrane buttons FTWS-01 5 and a position encoder AMT103-V 6 were integrated in the RSU. The disposables for the user study included two Flexor Ureteral Access Sheaths FUS-120035, one Flexor Ureteral Access Sheat FUS-120045 and a stone extractor NGage NGE-017115.…”

Section: Methodsmentioning

confidence: 99%

“…Figure 5 shows the software architecture of CoFlex . The workflow activates the Cartesian impedance controller for the FU operation triggered by the capacitive sensor in the RSU (instead of a button in [ 5 ]). Thus, the surgeon starts and stops the robot motion by grasping and releasing the RSU.…”

Section: Methodsmentioning

confidence: 99%

“…Table 1 Properties of ureteroscope accessories (UAs), attachable actuation units (AAUs) and telemanipulation systems (TSs) (degrees of property fulfillment: + high, • medium, − low; table modified from [5]) Several robotic systems for the control of flexible endoscopes have been developed in the past. They can be classified into attachable actuation units (AAUs), which actuate some or all DoFs at the endoscope handle and are either hand-held or mounted on a passive arm, and robotic telemanipulation systems (TSs), which allow the teleoperation of the endoscope from a remote surgeon console (compare [5] for a detailed overview).…”

Section: Introductionmentioning

confidence: 99%

“…Several robotic systems for the control of flexible endoscopes have been developed in the past. They can be classified into attachable actuation units (AAUs), which actuate some or all DoFs at the endoscope handle and are either hand-held or mounted on a passive arm, and robotic telemanipulation systems (TSs), which allow the teleoperation of the endoscope from a remote surgeon console (compare [ 5 ] for a detailed overview).…”

Section: Introductionmentioning

confidence: 99%

“…To overcome these shortcomings, we propose the robotic system CoFlex , which enables a single surgeon to perform a fURS intervention (solo surgery or SSU). In a previous publication we introduced a first prototype and tested its feasibility for stone grasping with non-medical participants [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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A robotic system for solo surgery in flexible ureteroscopy: development and evaluation with clinical users

et al. 2023

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Purpose The robotic system CoFlex for kidney stone removal via flexible ureteroscopy (fURS) by a single surgeon (solo surgery, abbreviated SSU) is introduced. It combines a versatile robotic arm and a commercially available ureteroscope to enable gravity compensation and safety functions like virtual walls. The haptic feedback from the operation site is comparable to manual fURS, as the surgeon actuates all ureteroscope DoF manually. Methods The system hardware and software as well as the design of an exploratory user study on the simulator model with non-medical participants and urology surgeons are described. For each user study task both objective measurements (e.g., completion time) and subjective user ratings of workload (using the NASA-TLX) and usability (using the System Usability Scale SUS) were obtained. Results CoFlex enabled SSU in fURS. The implemented setup procedure resulted in an average added setup time of 341.7 ± 71.6 s, a NASA-TLX value of 25.2 ± 13.3 and a SUS value of 82.9 ± 14.4. The ratio of inspected kidney calyces remained similar for robotic (93.68 %) and manual endoscope guidance (94.74 %), but the NASA-TLX values were higher (58.1 ± 16.0 vs. 48.9 ± 20.1) and the SUS values lower (51.5 ± 19.9 vs. 63.6 ± 15.3) in the robotic scenario. SSU in the fURS procedure increased the overall operation time from 1173.5 ± 355.7 s to 2131.0 ± 338.0 s, but reduced the number of required surgeons from two to one. Conclusions The evaluation of CoFlex in a user study covering a complete fURS intervention confirmed the technical feasibility of the concept and its potential to reduce surgeon working time. Future development steps will enhance the system ergonomics, minimize the users’ physical load while interacting with the robot and exploit the logged data from the user study to optimize the current fURS workflow.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A robotic system for solo surgery in flexible ureteroscopy: development and evaluation with clinical users

et al. 2023

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An ORB-SLAM3-based Approach for Surgical Navigation in Ureteroscopy

Maza

Steidle

Klodmann

et al. 2022

Computer Methods in Biomechanics and Biomedical Engineering: Im

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In ureteroscopy a flexible ureteroscope is used to inspect the kidneys and the ureters. In this context, we investigate robotic solutions that leverage recent developments from Simultaneous Localization and Mapping (SLAM) to provide a 3D map of the organ to be explored, as well as an estimate of the pose of the ureteroscope. With this aid, the surgeon can navigate through the organ more precisely. Additionally, for the final organ inspection, the risk of missing certain regions of the organ is minimized.In this paper we propose a visual, monocular SLAM system based on ORB-SLAM3 that is able to estimate the pose of the ureteroscope's tip. In order to fulfill this task, we introduce two preprocessing steps. The first one aims at increasing the contrast of the image and the second one helps to avoid detecting features in non-desired regions (e.g., reflections). Additionally, we extend ORB-SLAM3 with A-KAZE and SuperPoint features and compare their performances to ORB features. The proposed method is evaluated in two experiments. The first experiment shows that we are able to estimate the trajectory of the ureteroscope and the map of a synthetic kidney with low errors. The second experiment shows that the method also gives promising results in cystoscopy, where we evaluated it with videos captured during a polyp removal procedure in a real bladder.

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CoFlex TOP: A Teleoperation System for Flexible Ureteroscopy

Schlenk,

Hellings-Kuß,

Hagmann

et al. 2024

IEEE Robot. Autom. Lett.

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In flexible ureteroscopy (fURS) for kidney stones, the renal collecting system is inspected and stones are removed with a flexible ureteroscope (FU). One alternative to the fragmentation of stones and their removal with the help of graspers or extraction baskets is the dusting of stones with laser light. To support a single surgeon during a fURS procedure, in particular with the fine manipulation during dusting, we developed the CoFlex TOP system for the teleoperation of a handheld FU with three degrees of freedom. This paper describes the overall structure of the system, its kinematics and the hardware and software components. Subsequently, the system properties and its position repeatability are investigated and the system's feasibility for a tip positioning task in virtual reality is evaluated in a user study. Finally, we discuss the implications of the evaluation and sketch possible foci of a user study with urology surgeons.

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A Robotic System for Solo Surgery in Flexible Ureterorenoscopy

Cited by 3 publications

References 37 publications

A robotic system for solo surgery in flexible ureteroscopy: development and evaluation with clinical users

A robotic system for solo surgery in flexible ureteroscopy: development and evaluation with clinical users

An ORB-SLAM3-based Approach for Surgical Navigation in Ureteroscopy

CoFlex TOP: A Teleoperation System for Flexible Ureteroscopy

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