Development of Localized Cutaneous Force Feedback System for Robotics Assisted Surgery Systems

Robot-assisted surgery systems are a recent breakthrough in minimally invasive surgeries, offering numerous benefits to both patients and surgeons including, but not limited to, greater visualization of the operation site, greater precision during operation and shorter hospitalization times. Training on robot-assisted surgery (RAS) systems begins with the use of high-fidelity simulators. Hence, the increasing demand of employing RAS systems has led to a rise in using RAS simulators to train medical doctors. The aim of this study was to investigate the brain activity changes elicited during the skill acquisition of resident surgeons by measuring hemodynamic changes from the prefrontal cortex area via a neuroimaging sensor, namely, functional near-infrared spectroscopy (fNIRS). Twenty-four participants, who are resident medical doctors affiliated with different surgery departments, underwent an RAS simulator training during this study and completed the sponge suturing tasks at three different difficulty levels in two consecutive sessions/blocks. The results reveal that cortical oxygenation changes in the prefrontal cortex were significantly lower during the second training session (Block 2) compared to the initial training session (Block 1) (p < 0.05).

Chinese expert consensus on remote-controlled robot-assisted gynecological surgery (2025 Edition)

The existing surgical robots for laparoscopic surgery offer no or limited force feedback, and there are many problems for the traditional sensor-based solutions. This paper builds a teleoperation surgical system and validates the effectiveness of sensorless force feedback. The tool-tissue interaction force at the surgical grasper tip is estimated using the driving motor’s current, and fed back to the master robot with position-force bilateral control algorithm. The stiffness differentiation experiment and tumor detection experiment were conducted. In the stiffness differentiation experiment, 43 out of 45 pairs of ranking relationships were identified correctly, yielding a success rate of 96%. In the tumor detection experiment, 4 out of 5 participants identified the correct tumor location with force feedback, yielding a success rate of 80%. The proposed sensorless force-feedback system for robot-assisted laparoscopic surgery can help surgeons regain tactile information and distinguish between the healthy and cancerous tissue.

Robotic surgery has gained worldwide acceptance in the past decade, and several studies have shown that this technique is safe and feasible. The innovation of this system is the open surgical console with an HD-3D display, a system tower, and four independent arm carts. We describe the first robot-assisted cholecystectomy performed with the new Hugo RAS (robotic-assisted surgery) system (Medtronic, Minneapolis, MN, USA) in Spain. The procedure was completed without conversion. No intraoperative complication or technical failure of the system was recorded. The operative time was 70min. The docking time was 3min. Hospital length of stay was 1days. This case report shows the safety and feasibility of cholecystectomy with the Hugo RAS system and provides relevant data that may be of help to early adopters of this surgical platform.

IntroductionThe Hugo™ Robotic-Assisted Surgery (RAS) system is a recent development in minimally invasive gynecologic surgery. Following regulatory approval, its clinical use has expanded. However, comprehensive evidence on feasibility, safety and surgical outcomes has not been established. This systematic review synthesizes the available clinical data on the application of this robotic system across gynecologic procedures.Materials and methodsA systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42024519329), interrogating PubMed, Web of Science and Embase databases. Manuscripts reporting data on patients undergoing gynecologic surgical procedures with the Hugo™ RAS platform were included in the analysis.ResultsQualitative analysis was conducted on twelve studies including 445 patients. Hysterectomy was the main procedure (either total or supracervical; n = 289, 64.9%), with primary indications including fibromatosis (n = 149, 33.5%) and endometriosis (n = 92, 20.7%). Some studies (n = 5, 41.7%) included patients with gynecologic malignancies, mainly endometrial cancer; one reported robotic management of a perivesical recurrence. Few conversions (laparotomy n = 1, 0.22%; laparoscopy n = 5, 1.12%), intraoperative complications (n = 4, 0.90%), and postoperative complications (Clavien-Dindo grade ≥ II, 1.57%) occurred. Weighted mean operative, console and docking times were 141.84 ± 28.73, 97.98 ± 28.13, and 5.90 ± 0.94 min, respectively. Estimated blood loss averaged 110.75 ± 84.16 mL, and mean hospital stay was 2 ± 1 days. Reported system malfunctions were generally manageable without significant clinical consequences.ConclusionsCurrent evidence indicates that the system can be safely implemented by gynecologic surgeons in routine clinical practice. Nevertheless, further high-quality research is required to determine long-term outcomes and to assess its integration within the evolving landscape of digital surgical technologies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11701-025-02973-3.

The Hugo™ Robotic-Assisted Surgery (RAS) system is an emerging robotic platform; evidence on its performance for extraperitoneal robot-assisted radical prostatectomy (eRARP) remains limited.Between June 2023 and September 2024, 100 patients with prostate cancer underwent eRARP using the Hugo™ RAS system. Preoperative, intraoperative, pathological and postoperative data were collected prospectively. To assess temporal trends related to platform adoption, the cohort was divided into the first 50 and last 50 cases and learning-curve dynamics were analyzed (including CUSUM for console time). We report 12-month follow-up.Across the entire series, the median operative duration was 252.5min (Q1-Q3 200-290), with no instances of intraoperative conversion or intraoperative complications. Major postoperative events classified as Clavien-Dindo grade III or higher were observed in 2% of patients. At the 12-month assessment, an undetectable PSA (< 0.1 ng/mL) was documented in 80% of individuals, social continence (≤ 1 pad per day) in 87%, and erectile function recovery in 51%. Overall positive surgical margin (PSM) rate was 40%, with clinically significant PSM (≥ 3mm or multifocal) of 21%. Comparison of two groups revealed a learning effect: median operative time decreased from 275 to 210min (p < 0.00001); docking time improved modestly (p = 0.0271). Both clinically significant PSMs (28%→14%) and overall complication rates (26%→4%, p = 0.0006) declined in the second cohort.In this prospective, single-center series, eRARP using the Hugo™ RAS system was feasible and safe. A learning-curve effect produced substantially shorter operative times and fewer complications, while oncological and functional outcomes were preserved. Longer follow-up and larger multicenter studies are needed to verify long-term equivalency with well-established robotic platforms.

Background Pancreaticoduodenectomy (Whipple procedure) is among the most demanding operations in HPB surgery. Early diagnosis and meticulous perioperative optimization, combined with recent technical advances, especially robotic platforms, are key contributors to improved postoperative outcomes. Robotic pancreaticoduodenectomy (RPD) may enhance dexterity and ergonomics in complex HPB procedures. The Hugo™ Robotic-Assisted Surgery (RAS) system has recently entered clinical practice, yet RPD on this platform has not been reported. Methods We describe a single-center, first reported case of RPD using the Hugo™ RAS system. Preoperative evaluation, OR layout, port mapping, arm configuration, instruments, docking strategy, and stepwise operative workflow are detailed. Primary endpoints were technical feasibility and intra/perioperative safety. Secondary endpoints included operative time, estimated blood loss (EBL), conversion, 30-day complications (Clavien–Dindo), length of stay, and pathology concerning oncological principles. Results The procedure was completed robotically without conversion. Docking time was 4 min 35 s and console time 5 h 14 min, EBL 200 mL. No high-priority system alarms or device-related adverse events occurred. Final pathology showed pT1 Duodenal Gastro-Intestinal Stroma Tumour (GIST), tumor size 1,8*1,4*1,4 cm, R0 resection, and 10 lymph nodes retrieved. Postoperative course was notable. Hospital discharge on postoperative day 7 with no postoperative pancreatic fistula (ISGPS), no delayed gastric emptying (ISGPS), and no readmission within 30 days. Conclusion RPD using the Hugo™ RAS system was feasible and safe in this first reported case, with a reproducible setup and workflow. These findings support further prospective evaluation and standardization of RPD on this platform.

In a previous study, we proved that an experienced urologist is more likely to adapt to the Hugo RAS system. Based on this, we further examine various parameters in this study. Parameters included in this study consisted of console time, functional outcomes, and oncological outcomes. A total of 60 patients who underwent robot-assisted radical prostatectomy (RARP) performed by a single surgeon using the da Vinci (DV) system (n = 30) or the Hugo RAS system (n = 30) between March 2023 and August 2023 were included in the analysis. The intraoperative operative time was categorized into vesicourethral anastomosis time and overall console time. Functional and oncological outcomes were documented at the 1st and 3rd postoperative months. Parametric and non-parametric methods were adopted after checking skewness and kurtosis, and an α value of 5% was used to determine the significance. The vesicourethral anastomosis time was significantly lengthened (Hedge's g: 0.87; 95% confidence interval (CI): 0.34-1.39; J factor = 0.987). However, the overall console time was not affected. The functional (postoperative 3rd month: p = 0.130) and oncological outcomes (postoperative 3rd month: p = 0.103) were not significantly different. We also found that the adverse effect on surgical specimens and positive surgical margins was not affected (p = 0.552). During the process of adaptation, although intricate motions (such as the vesicourethral anastomosis time) would be lengthened, the overall console time would not change remarkably. In this process, the functional and oncological outcomes would not be compromised. This encourages urologists to adopt the Hugo RAS system in RARP if they have previous experiences of using the DV system, since their trifecta advantage would not be compromised.

Robotic-assisted bariatric surgery improves accuracy and patient safety

Augmented reality (AR) is used to enhance the perception of the real world by integrating virtual objects to an image sequence acquired from various camera technologies. Numerous AR applications in robotics have been developed in recent years. The aim of this paper is to provide an overview of AR research in robotics during the five year period from 2015 to 2019. We classified these works in terms of application areas into four categories: (1) Medical robotics: Robot-Assisted surgery (RAS), prosthetics, rehabilitation, and training systems; (2) Motion planning and control: trajectory generation, robot programming, simulation, and manipulation; (3) Human-robot interaction (HRI): teleoperation, collaborative interfaces, wearable robots, haptic interfaces, brain-computer interfaces (BCIs), and gaming; (4) Multi-agent systems: use of visual feedback to remotely control drones, robot swarms, and robots with shared workspace. Recent developments in AR technology are discussed followed by the challenges met in AR due to issues of camera localization, environment mapping, and registration. We explore AR applications in terms of how AR was integrated and which improvements it introduced to corresponding fields of robotics. In addition, we summarize the major limitations of the presented applications in each category. Finally, we conclude our review with future directions of AR research in robotics. The survey covers over 100 research works published over the last five years.

Intraoperative patient registration and tracking are key enabling components of Computer-Assisted Orthopaedic Surgery (CAOS). Optical tracking systems that detect rigidly-attached reference frames with reflective markers are the standard in current CAOS systems, due to their large field of view and high accuracy [1], [2]. Recent improvements in depth sensing technology have led to the widespread availability of RGBD stereo- cameras. Their adoption in CAOS is appealing, as it would allow to reconstruct a patient’s anatomy with a simple ‘snapshot’ of the scene [3], [4]. However, inte- grating such cameras into a CAOS system would not be straightforward, as would require changes to the layout traditionally used in current systems. Indeed, while the camera is normally positioned laterally to the patient, a markerless system would need to look directly into the surgical incision, at a much closer distance so as to maximise the density of points in the Region-of-Interest (RoI). While these constraints present some challenges, the light weight and small form factor of many state-of- the-art RGBD cameras allow to envision solutions that would not be possible with bulkier systems. In this abstract we present a preliminary study for an integrated solution composed of a lightweight RGBD camera connected to the robot-assisted burring tool of a commercial CAOS system. We present preliminary results on the tracking accuracy of the system, and discuss the advantages and disadvantages of such a solution.

In the Special Research Centre 414 of the German Research Funding (DFG, Bonn) a system for robot-assisted cranial surgery was developed. It is designed for the accurate and safe execution of craniotomies and repositioning of bone pieces. The system is intended for use in the surgical therapy of craniosynostosis. Preoperatively, CT imaging is performed. In a computerized planning system the position and shape of the intended craniotomy is intuitively planned on a virtual model of the patient's skull. Intraoperatively, after conventional removal of the covering soft tissue, the robot performs the craniotomy autonomously. Extensive testing in phantom studies and animal tests confirmed the reliability and accuracy of the system. A thorough risk analysis of the system was performed. In this paper, the first clinical use of the system on a patient is described and the clinical importance is discussed.

In operational fields, there is a growing use of simulators during training protocols because of their versatility, the possibility of limiting costs and increasing efficiency. This work aimed at proposing an EEG-based neurometric of mental workload, previously validated in other contexts, as a taxonomic tool to evaluate the similarity, in terms of cognitive demands, of two different systems: the da Vinci surgical system, leader in the field of robotic surgery, and the Actaeon Console by BBZ, basically a cheaper simulator aimed to train students to use the da Vinci system. Such a neurophysiologic evaluation of the workload demand was also integrated by information derived by the task performance and self-reports. The results validated the proposed EEG-based workload index and indicated the potentially fruitful use of simulators because of their high similarity in terms of cognitive demands.

In recent years, robot-assisted surgery systems have developed rapidly, and are widely used in clinics. Ensuring the accuracy of the robot-assisted surgery system is the prerequisite for the safety and stability of the system. Hand-eye calibration is necessary for an eye-to-hand surgical navigation system. However, errors exist in the data of hand-eye calibration, including the positioning error of the robot and the measurement error of the navigation system, which seriously affects the accuracy of the results of hand-eye calibration. In order to unite the coordinate systems of each device to a common coordinate system in the eye-to-hand surgical navigation system, obtain the homogeneous transformation matrix (HTM) from the positioning target to the surgical tool (hand-target), and the HTM from the camera to the base of surgical robot (robot-camera), a novel calibration method is proposed in this paper. The calibration of the HTM of hand-target is divided into the translation part and the rotation part to calibrate respectively: the multi-point method is used to calculate the translation part, and the calibration of the rotation part is summarized as an AX=XB problem. The method solves the rotation part and translation part independently, without the problem of error propagation. And the Least squares method is used to solve the HTM of robot-camera. Experimental analyses have been carried out to verify the accuracy and effectiveness of the proposed method.

As in other areas, military surgery is being transformed by developments in artificial intelligence, robotics and digitalization. Although the prospect of operating with arobot-assisted surgery system in the country of deployment while the responsible surgeon is in Germany is still along way off, the training of military surgeons and the treatment of injured soldiers on deployment would nowadays be unimaginable without the digitalization of surgery in the armed forces. The structure of the medical environment in German clinics places restrictions on training that is close to operational reality. In the daily routine it is not possible to carry out the necessary numbers of deployment-relevant emergency surgical procedures under the expected conditions. Such procedures thus require the use of appropriate simulators or simulated scenarios that are as close to reality as possible. Although military surgeons are qualified in at least two specialist areas, the availability of telemedicine on deployment is helping to noticeably improve the treatment of injured soldiers. Telemedical consultation with colleagues in Germany makes it possible, for example, to reach joint decisions across different branches and disciplines. Until now it has not been possible to substitute the attending surgeon in the country of deployment with robot-assisted surgery systems or even robots for carrying out life-saving and stabilizing procedures; however, in order to provide surgeons with the necessary tools to successfully operate in situations where there is ashortage of personnel and materials in an inhospitable environment, use is made of the means that are currently available in the German medical services and constant efforts are made to explore the future possibilities of digital simulation. This article shows the reader the current status of digitalization in surgical training and deployments in the German armed forces.