Evaluation of Teleoperated Surgical Robots in an Enclosed Undersea Environment

Abstract

The ability to support surgical care in an extreme environment is a significant issue for both military medicine and space medicine. Telemanipulation systems, those that can be remotely operated from a distant site, have been used extensively by the National Aeronautics and Space Administration (NASA) for a number of years. These systems, often called telerobots, have successfully been applied to surgical interventions. A further extension is to operate these robotic systems over data communication networks where robotic slave and master are separated by a great distance. NASA utilizes the National Oceanographic and Atmospheric Administration (NOAA) Aquarius underwater habitat as an analog environment for research and technology evaluation missions, known as NASA Extreme Environment Mission Operations (NEEMO). Three NEEMO missions have provided an opportunity to evaluate teleoperated surgical robotics by astronauts and surgeons. Three robotic systems were deployed to the habitat for evaluation during NEEMO 7, 9, and 12. These systems were linked via a telecommunications link to various sites for remote manipulation. Researchers in the habitat conducted a variety of tests to evaluate performance and applicability in extreme environments. Over three different NEEMO missions, components of the Automated Endoscopic System for Optimal Positioning (AESOP), the M7 Surgical System, and the RAVEN were deployed and evaluated. A number of factors were evaluated, including communication latency and semiautonomous functions. The M7 was modified to permit a remote surgeon the ability to insert a needle into simulated tissue with ultrasound guidance, resulting in the world's first semi-autonomous supervisory-controlled medical task. The deployment and operation of teleoperated surgical systems and semi-autonomous, supervisory-controlled tasks were successfully conducted.

Determining the Threshold of Time-Delay for Teleoperation Accuracy and Efficiency in Relation to Telesurgery

“…The RAVEN surgical robot, developed by the University of Washington (in Seattle) BioRobotics Laboratory, was used to perform the Fundamentals of Laparoscopic Surgery (FLS) training tasks with simulated time-delays of 0, 250, and 500 ms in extreme environments (NEEMO 12 and the high desert). 5,6 These experiments showed a higher error rate with increased delay. 7 Sheridan and Ferrell 8 performed an experiment where the user operated a system that had two translations degrees of freedom (dof) and was required to grasp a small block with the slave system under simulated time-delays of 0.0, 1.0, 2.1, and 3.2 s. The subjects had a clear view of the slave system but not of the master system.…”

“…At the same time, NASA cannot guarantee that a surgeon would be present on all long-range flights (beyond low-Earth orbit). To address this need, the SRI International M7 robot has been used to perform telerobotic surgery on human phantoms in a weightless environment (NASA C-9 aircraft), 4 in the Aquarius subsea habitat (NEEMO 9 and 12), 5 and in the high desert using unmanned airborne vehicles for communication support. 6 Although telesurgery is conceivable in these scenarios, they all include inherent time-delay due to telecommunication latency, which can reduce accuracy and efficiency.…”

Telemedicine in Surgery: What are the Opportunities and Hurdles to Realising the Potential?

“…A number of experiments were conducted performing telesurgical procedures such as repair of a vascular injury, laparoscopic cholecystectomy and abdominal surgery on models [19]. Surgical operators were based 2500 km away using the commercially available AESOP robot as well as two prototypes, NASA's M7 and RAVEN robots.…”

Surgery in space: the future of robotic telesurgery

“…The nontrained crew members were able to perform satisfactorily by exactly following the guidance of a skilled mentor, outperforming the nonsurgeon physician. Based on a set of measurements, greater effectiveness of teleoperation was shown compared with telementoring; however, the latter took less time to complete [25].…”

“…Latency was set at up to 750 ms in these experiments. Significant performance degradation of the microwave connection was noticed during stormy weather, causing a jitter in latency of up to 1 s [25].…”