A Haptic Feedback Glove for Minimally Invasive Surgery

The objective of this article is to provide a thorough examination of the current state of haptic information feedback in minimally invasive surgery (MIS), including research conducted between 1985 and the present. Despite the fact that haptic information input in MIS is currently scarce, the comprehensive analysis emphasises that it represents a potential option. Surgeons might potentially get substantial benefits from receiving more input about force information, which would therefore enhance their surgical accuracy and control. The extant literature highlights a significant knowledge deficit regarding the intricate ramifications of haptic feedback, specifically with regard to the sense of slip and gripping forces. It is crucial to investigate the possible advantages of incorporating supplementary haptic information in order to protect against tissue damage when performing manipulation treatments. It is of the utmost importance to fill this void, since doing so might revolutionise the field of MIS via the mitigation of unintended tissue injury and the improvement of surgical results. By capitalising on technology progress to provide more extensive haptic feedback, surgeons have the ability to enhance their tactile perception, optimise the application of force, and reduce the likelihood of tissue injuries when performing complex surgical procedures.

An important obstacle in Minimally Invasive Surgery (MIS) is the significant degradation of haptic feedback (sensation of touch) to the surgeon about surgical instrument s interaction with tissue. This monograph is concerned with devices and methods required for incorporating haptic feedback in master-slave robotic MIS systems. In terms of devices, novel mechanisms are designed including a surgical end-effector (slave) with full force sensing capabilities and a surgeon-robot interface (master) with full force feedback capabilities. Using the master-slave system, various haptic teleoperation control schemes are compared in terms of stability and performance, and passivity-based time delay compensation for haptic teleoperation over a long distance is investigated. The monograph also compares haptic feedback with visual feedback and with substitution for haptic feedback by other sensory cues in terms of surgical task performance. Contents: Introduction; Sensorized Surgical Effector (Slave); Haptic User Interface (Master); Unilateral Teleoperation Control; Bilateral Teleoperation Control; Substitution for Haptic Feedback: Bilateral Teleoperation Control Under Time Delay.

Cardiovascular diseases remain as the most common cause of death worldwide. Remotely manipulated robotic systems are utilized to perform minimally invasive endovascular interventions. The main benefits of this methodology include reduced recovery time, improvement of clinical skills and procedural facilitation. Currently, robotic assistance, precision, and stability of instrument manipulation are compensated by the lack of haptic feedback and an excessive amount of radiation to the patient. This paper proposes a novel master-slave robotic platform that aims to bring the haptic feedback benefit on the master side, providing an intuitive user interface, and clinical familiar workflow. The slave robot is capable of manipulating conventional catheters and guidewires in multi-modal imaging environments. The system has been initially tested in a phantom cannulation study under fluoroscopic guidance, evaluating its reliability and procedural protocol. As the slave robot has been entirely produced by additive manufacturing and using pneumatic actuation, MR compatibility is enabled and was evaluated in a preliminary study. Results of both studies strongly support the applicability of the robot in different imaging environments and prospective clinical translation.

Haptic feedback provides an essential sensory stimulus crucial for interaction and analyzing three-dimensional spatio-temporal phenomena on surface visualizations. Given its ability to provide enhanced spatial perception and scene maneuverability, virtual reality (VR) catalyzes haptic interactions on surface visualizations. Various interaction modes, encompassing both mid-air and on-surface interactions-with or without the application of assisting force stimuli-have been explored using haptic force feedback devices. In this paper, we evaluate the use of on-surface and assisted on-surface haptic modes of interaction compared to a no-haptic interaction mode. A force-based haptic stylus is used for all three modalities; the on-surface mode uses collision based forces, whereas the assisted on-surface mode is accompanied by an additional snapping force. We conducted a within-subjects user study involving fundamental interaction tasks performed on surface visualizations. Keeping a consistent visual design across all three modes, our study incorporates tasks that require the localization of the highest, lowest, and random points on surfaces; and tasks that focus on brushing curves on surfaces with varying complexity and occlusion levels. Our findings show that participants took almost the same time to brush curves using all the interaction modes. They could draw smoother curves using the on-surface interaction modes compared to the no-haptic mode. However, the assisted on-surface mode provided better accuracy than the on-surface mode. The on-surface mode was slower in point localization, but the accuracy depended on the visual cues and occlusions associated with the tasks. Finally, we discuss participant feedback on using haptic force feedback as a tangible input modality and share takeaways to aid the design of haptics-based tangible interactions for surface visualizations.

This article gives an overview of research performed in the field of haptic information feedback during minimally invasive surgery (MIS). Literature has been consulted from 1985 to present. The studies show that currently, haptic information feedback is rare, but promising, in MIS. Surgeons benefit from additional feedback about force information. When it comes to grasping forces and perceiving slip, little is known about the advantages additional haptic information can give to prevent tissue trauma during manipulation. Improvement of haptic perception through augmented haptic information feedback in MIS might be promising.

Most prosthetic hand users are limited to visual feedback of movement performance. To characterize the benefit of vibrotactile feedback for a task that lacks haptic feedback, a virtual environment was used to experimentally manipulate visual, task-relevant haptic, and remote vibrotactile feedback on simple object manipulation for unimpaired subjects. The combination of visual and remote vibrotactile feedback was compared to visual feedback alone, and to simultaneous visual and direct haptic feedback to represent ideal performance. Visual and vibrotactile feedback resulted in improvement of most performance variables including difficulty ratings relative to visual feedback alone. However addition of sensory cues to visual feedback increased trial times and the increase was steeper for vibrotactile than for haptic feedback. Specifically, during vibrotactile feedback the velocity did not change, but the duration of execution increased due to improved performance, resulting in increased trial times. This result suggests future exploration of performance improvement and execution speed for augmented sensory feedback.

The challenges imposed by Minimally Invasive Surgery (MIS) have been the subject of significant research in the last decade. In the case of cancer surgery, a significant limitation is the inability to effectively palpate the target tissue to localize tumor nodules for treatment or removal. Current clinical technologies are still limited and tumor localization efforts often result in the need to increase the size of the incision to allow finger access for direct palpation. New methods of MIS tumor localization under investigation involve restoring the sense of touch, or haptic feedback. The two most commonly investigated modes of haptic perception include kinesthetic and tactile sensing, each with its own advantages and disadvantages. Work in this area includes the development of customized instruments with embedded sensors that aim to solve the problem of limited haptic feedback in MIS. This chapter provides a review of the work to date in the use of kinesthetic and tactile sensing information in MIS for tissue palpation, with the goal of highlighting the benefits and limitations of each mode when used to locate hidden tumors during MIS.

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, J., Ottensmeier, M., & Sheridan, T. 1999. Human Factors in Telesurgery, Telmed Journal, 5 (2) 129–137.).

The small scale of minimally-invasive surgery (MIS) presents significant challenges to developing robust, smart, and dexterous tools for manipulating millimeter and sub-millimeter anatomical structures (vessels, nerves) and surgical equipment (sutures, staples). Robotic MIS systems offer the potential to transform this medical field by enabling precise repair of these miniature tissue structures through the use of teleoperation and haptic feedback. However, this effort is currently limited by the inability to make robust and accurate MIS end effectors with integrated force and contact sensing. In this paper, we demonstrate the use of the novel Pop-Up Book MEMS manufacturing method to fabricate the mechanical and sensing elements of an instrumented MIS grasper. A custom thin-foil strain gage was manufactured in parallel with the mechanical components of the grasper to realize a fully-integrated electromechanical system in a single manufacturing step, removing the need for manual assembly, bonding and alignment. In preliminary experiments, the integrated grasper is capable of resolving forces as low as 30 mN, with a sensitivity of approximately 408 mV/N. This level of performance will enable robotic surgical systems that can handle delicate tissue structures and perform dexterous procedures through the use of haptic feedback guidance.

In this article, we present an application specific integrated circuit (ASIC) for gripper finger haptic force feedback in minimally invasive surgery (MIS). It consists of a driving current source, a sensing channel, a digital to analog converter (DAC), a power management unit (PMU), a clock generator and a digital control unit (DCU). The driving current source features a 6-bit DAC to provide a temperature-insensitive current from 0.27 mA to 1.15 mA for the sensor array. The sensing channel contains a programmable instrumentation amplifier (PIA), a low-pass filter (LPF), an incremental analog-to-digital converter (ADC) with its input buffer (BUF). The gain of the sensing channel ranges from 2.76 to 140. The DAC generates a tunable reference voltage to compensate possible sensor array offset. The input referred noise of the sensing channel is around 3.6 μVrms at a sampling rate of 850S/s. A custom 2-wire communication protocol is implemented to support two chips on gripper fingers operating in parallel with low latency, ensuring real-time surgical condition estimation for surgeons. Manufactured in the TSMC 180nm CMOS technology, this chip occupies only 1.37 mm2 core area, and the entire system requires only 4 wires (including power / ground) to operate. Combined with its high accuracy, low latency, and high integration level, this work allows real-time, high-performance haptic force feedback with compact system size, particularly suitable for MIS applications.

Minimally Invasive Surgeries (MIS) such as laparoscopic procedures are increasingly preferred over conventional surgeries due to many different advantages. Laparoscopic surgical procedures are very complex compared to open surgeries and require high level of experience and expertise. Hybrid surgery simulators available for training using physical phantoms are expensive and not readily available in majority of health care facilities around the world. Therefore, computer simulation or Virtual Reality (VR) is a better way to obtain skills for MIS. A VR simulator incorporated with haptic feedback provides a comprehensive training closer to real world experience. In this paper, we present a novel approach to incorporate force feedback to VR laparoscopic surgery training. The proposed interface incorporates force feedback in all three axes to provide three levels of force feedback. Computational models of abdomen organs were generated using the cryosection data of Visible Human Project of the National Library of Medicine, USA. The organ models were developed with three basic force categories: soft, mild and hard. A hardware interface is developed to provide the force feedback for the interaction of virtual tools with the said organ models while generating the tool navigation information for the VR simulator.

The need to minimize trauma in surgical interventions has led to a continuous evolution of surgical techniques. The robotization of minimally invasive surgeries (MIS) through robotized instruments, provided with 2 or 3 degrees of freedom, aims to increase dexterity, accuracy… and thus, assist the surgeons. This work presents the challenges faced during the development of a surgical instrument, from the work carried out in the design and implementation of a complete surgical robotic system. After an overview of the surgical instruments associated to the alternative techniques in MIS, the process of designing laparoscopic instruments for the developed robotic system is described. Our approach focusses on the technological challenges of achieving a user-friendly laparoscopy, affordable for hospitals. These include the complexity of designing small-sized tools, which match the surgical requirements and introduce additional features, as haptic feedback. In addition, we explain the non-technological obstacles overcome to satisfy the commercialization requirements. The huge number of patents in this field acts as a spider web, which led us to seek for novelty. Although specific parts of the robotic system were not the core of our project, we needed to fit their design and obtain our own patents to grant the complete robotic system was free of patent infringement. On the other hand, complex regulatory procedures turn the whole commercialization process dilated and tedious. Finally, we present some of our ongoing research to improve performance of this kind of robot assisted surgery, as well as to other surgical fields.

In minimally invasive surgery (MIS), haptic or force feedback control is used when the visual feedback is insufficient or unavailable. Haptics, or haptic technology, which is essential in simulating touch, provides both the kinesthetic and the tactile feedback. The lack of haptics in robotic-assisted MIS hinders the progression of operation when visual feedback reaches its limit. This paper aims to develop a single degree-of-freedom (DOF) haptic handle controller, using a proportional-integral (PI) control, that can quantify up to 1-N of force.

Visually impaired or blind people are unable to assess or analyze obstacles and tasks they wishes to perform. Lack of visual feedback has kept their lives restricted. Therefore, numerous techniques are available for sensing hurdles and irregularities in their paths. The real challenge is to develop a fast and spontaneous actuating technique. From manual white cane to Electronic Traveling Aid (ETA) and haptic feedback assistive bracelet, each has its own importance in the field. In this paper, two techniques of haptic feedback are explored namely, Vibrotactile and Skin Stroking. Skin stroking is a novel technique to be incorporated in haptic feedback systems, it is a painless and comfortable form of a tactile display. Requirements of this system is not limited to guidance and navigation purposes only that is why this device was experimented in maneuvering guidance, rotational and translational motion of hands. Vibrotactile and Skin stroking mechanism were connected with an android application via bluetooth which controls the motion of subjects throughout the experiments. The results gathered from experiments signifies that directional differentiating cues were better while using skin stroking haptic feedback mechanism and more can be expected from this field in the future.

This paper demonstrates the development, implementation, and testing of full-body haptic cueing algorithms for augmented pilot perception. Full-body haptics is in the form of localized electrical muscle stimulation (EMS) is achieved via a commercial, off-the-shelf product called TESLASUIT. Cueing algorithms are developed for roll-axis compensatory tracking tasks where the pilot acts on the displayed error between a desired input and the comparable vehicle output motion to produce a control action. The error is displayed to the pilot using three different cueing modalities: visual, haptic, and combined visual and haptic. For the visual and combined visual and haptic modalities, visual cues are also considered in degraded visual environments (DVE). Full-body haptic cueing algorithms that are based on a proportional-derivative (PD) compensation strategy on the tracking error are found to provide satisfactory pilot vehicle system (PVS) performance for the task in consideration when using haptic feedback only (no visual cues) and to improve PVS performance in DVE when using combined visual and haptic feedback. These results indicate that the use of secondary sensory cues such as full-body haptics to augment the pilot perception can lead to improved/partially-restored PVS performance when primary sensory cues like vision are impaired or denied.