Haptic Feedback in a Telepresence System for Endoscopic Heart Surgery

Abstract

The implementation of telemanipulator systems for cardiac surgery enabled heart surgeons to perform delicate minimally invasive procedures with high precision under stereoscopic view. At present, commercially available systems do not provide force-feedback or Cartesian control for the operating surgeon. The lack of haptic feedback may cause damage to tissue and can cause breaks of suture material. In addition, minimally invasive procedures are very tiring for the surgeon due to the need for visual compensation for the missing force feedback. While a lack of Cartesian control of the end effectors is acceptable for surgeons (because every movement is visually supervised), it prevents research on partial automation. In order to improve this situation, we have built an experimental telemanipulator for endoscopic surgery that provides both force-feedback (in order to improve the feeling of immersion) and Cartesian control as a prerequisite for automation. In this article, we focus on the inclusion of force feedback and its evaluation. We completed our first bimanual system in early 2003 (EndoPAR Endoscopic Partial Autonomous Robot). Each robot arm consists of a standard robot and a surgical instrument, hence providing eight DOF that enable free manipulation via trocar kinematics. Based on the experience with this system, we introduced an improved version in early 2005. The new ARAMIS system (Autonomous Robot Assisted Minimally Invasive Surgery) has four multi-purpose robotic arms mounted on a gantry above the working space. Again, the arms are controlled by two force-feedback devices, and 3D vision is provided. In addition, all surgical instruments have been equipped with strain gauge force sensors that can measure forces along all translational directions of the instrument's shaft. Force-feedback of this system was evaluated in a scenario of robotic heart surgery, which offers an impression very similar to the standard, open procedures with high immersion. It enables the surgeon to palpate arteriosclerosis, to tie surgical knots with real suture material, and to feel the rupture of suture material. Therefore, the hypothesis that haptic feedback in the form of sensory substitution facilitates performance of surgical tasks was evaluated on the experimental platform described in the article (on the EndoPAR version). In addition, a further hypothesis was explored: The high fatigue of surgeons during and after robotic operations may be caused by visual compensation due to the lack of force-feedback (Thompson,

Micro camera augmented endoscopic instruments: Towards superhuman performance in remote surgical cutting

“…IMPLEMENTATION The algorithms described above were implemented on our system for robot-assisted minimally invasive surgery. We briefly describe the setup, more details can be found in [1]. The master console of the telepresence system offers surgeons the ability to operate the slave-side robots via two PHANToM TM Premium 1.5 haptic devices.…”

“…A distinction is made between the direct feedback of forces, measured by means of dedicated force sensors [1] and the feedback of artificially generated forces. The later group includes virtual fixtures (VF), originally defined by Rosenberg [2] as an "abstract perceptual sensory information overlaid on top of reflected sensory feedback from a remote environment".…”

“…The direction of movement is therefore *The authors want to thank Awaiba GmbH and S. Voltz for their support and for providing us the NanEye sensors. 1 Robotics and Embedded Systems, Department of Informatics, Technische Universität München, Germany staub at in.tum.de subject to an active influence by the system, which overlays the user input.…”

Vision-Based Haptic Feedback with Physically-Based Model for Telemanipulation

“…VR-based simulation systems used haptic information for various applications such as gaming (Morris, 2004), surgical simulations (Basdogan et al, 2004), or molecular simulations in order to provide realistic virtual experiences along with sound and graphic rendering. In telemanipulation, haptic feedback has been studied in the fields of robotic guidance and obstacle avoidance (Hassanzadeh et al, 2005), robotic surgery (Mayer et al, 2007;Wagner et al, 2007) and micro/nano manipulation (Sitti & Hashimoto, 2003, Ammi et al, 2006. According to these studies, the feedback of haptic information to an operator can improve performance and provide telepresence.…”

“…The force sensor, however, has a low signalto-noise ratio (SNR) for force feedback and can be damaged through physical contact with the environment or by exposure to biological and chemical materials. Although the use of a strain-gauge sensor or a commercial six-axes force/torque sensor in teleoperated robotic surgery has been examined (Mayer et al, 2007;Wagner et al, 2007), current commercial surgery robots hardly provide an adequate haptic feedback due to safety and effectiveness issues, partially associated with the reliability of the force sensor in a noisy environment. Very-small-scale force sensing for micromanipulation is more difficult because of the design of small force sensors that needs to meet challenging requirements for such applications, including micro-sensing for multiple degrees of freedom (DOF) with high resolution and accuracy while maintaining a high SNR.…”