Journal of Medical Robotics Research

Optimal orthopaedic implant placement is a major contributing factor to the long term success of all common joint arthroplasty procedures. Devices such as three-dimensional (3D) printed, bespoke guides and orthopaedic robots are extensively described in the literature and have been shown to enhance prosthesis placement accuracy. These technologies, however, have significant drawbacks, such as logistical and temporal inefficiency, high cost, cumbersome nature and difficult theatre integration. A new technology for the rapid intraoperative production of patient-specific instrumentation, which overcomes many of the disadvantages of existing technologies, is presented here. The technology comprises a reusable table side machine, bespoke software and a disposable element comprising a region of standard geometry and a body of moldable material. Anatomical data from computed tomography (CT) scans of 10 human scapulae was collected and, in each case, the optimal glenoid guidewire position was digitally planned and recorded. The achieved accuracy compared to the pre-operative bespoke plan was measured in all glenoids, from both a conventional group and a guided group (GG). The technology was successfully able to intraoperatively produce sterile, patient-specific guides according to a pre-operative plan in 5min, with no additional manufacturing required prior to surgery. Additionally, the average guidewire placement accuracy was $1.58$mm and 6.82${}^{\circ }$ in the manual group, and $0.55$mm and $1.76^{\circ }$ in the guided group, also demonstrating a statistically significant improvement.

Minimally-invasive laparoscopic procedures have proven efficacy for a wide range of surgical procedures, but have notable shortcomings, including limited instrument motion and reduced dexterity. Endoscopic robots, like the intuitive surgical da Vinci system, have become an effective tool for many types of surgeries; however, these tools still have fundamental limitations with manipulator access, which reduces their effectiveness for many surgical procedures, like colectomy, cholecystectomy, and gynecologic oncology. Laparo-endoscopic single-site (LESS) robots operate in vivo, and overcome many of these limitations. Here, a four-degrees of freedom (DOF) surgical robot is presented as a tool to enable refinement of the LESS platform as a surgical tool, while also looking forward to applications in telesurgery and haptic feedback.

Minimally invasive surgical systems are being widely used to aid operating rooms across the globe. Although arguably successful in laparoscopic surgery, the da Vinci robotic system has limitations mostly regarding cost and lack of patient physiological motion compensation. To obtain a more cost-effective alternative, earlier works used general-purpose fully actuated serial-link robots to control instruments in laparoscopic research using constrained Jacobian techniques. In contrast with those works, we present a new technique to solve the laparoscopic constraints for the serial-link manipulator by using a constrained trajectory. This novel technique allows complex 3D remote center-of-motion trajectories to be taken into account. Moreover, it does not have problems related to drifting, and is less prone to singularity related issues as it can be used with redundant manipulators. The proof-of-concept experiments are done by performing artificial trajectories with static and moving trocar points using a physical robot manipulator. Furthermore, the system is tested using user input of 13 medically untrained personnel in an endoscope navigation task. The experiments show that the system can be operated reliably under arbitrary and unpredictable user inputs.

The research on medical robotics is starting to address the autonomous execution of surgical tasks, without effective intervention of humans apart from supervision and task configuration. This paper addresses the complete automation of a surgical robot by combining advanced sensing, cognition and control capabilities, developed according to rigorous assessment of surgical requirements, formal specification of robotic system behavior and software design and implementation based on solid tools and frameworks. In particular, the paper focuses on the cognitive control architecture and its development process, based on formal modeling and verification methods as best practices to ensure safe and reliable behavior. Full implementation of the proposed architecture has been tested on an experimental setup including a novel robot specifically designed for surgical applications, but adaptable to different selected tasks (i.e. needle insertion, wound suturing).