A development of assistant surgical robot system based on surgical-operation-by-wire and hands-on-throttle-and-stick
© The Author(s). 2016
Received: 13 August 2015
Accepted: 11 May 2016
Published: 20 May 2016
Robot-assisted laparoscopic surgery offers several advantages compared with open surgery and conventional minimally invasive surgery. However, one issue that needs to be resolved is a collision between the robot arm and the assistant instrument. This is mostly caused by miscommunication between the surgeon and the assistant. To resolve this limitation, an assistant surgical robot system that can be simultaneously manipulated via a wireless controller is proposed to allow the surgeon to control the assistant instrument.
The system comprises two novel master interfaces (NMIs), a surgical instrument with a gripper actuated by a micromotor, and 6-axis robot arm. Two NMIs are attached to master tool manipulators of da Vinci research kit (dVRK) to control the proposed system simultaneously with patient side manipulators of dVRK. The developments of the surgical instrument and NMI are based on surgical-operation-by-wire concept and hands-on-throttle-and-stick concept from the earlier research, respectively. Tests for checking the accuracy, latency, and power consumption of the NMI are performed. The gripping force, reaction time, and durability are assessed to validate the surgical instrument. The workspace is calculated for estimating the clinical applicability. A simple peg task using the fundamentals of laparoscopic surgery board and an in vitro test are executed with three novice volunteers.
The NMI was operated for 185 min and reflected the surgeon’s decision successfully with a mean latency of 132 ms. The gripping force of the surgical instrument was comparable to that of conventional systems and was consistent even after 1000 times of gripping motion. The reaction time was 0.4 s. The workspace was calculated to be 8397.4 cm3. Recruited volunteers were able to execute the simple peg task within the cut-off time and successfully performed the in vitro test without any collision.
Various experiments were conducted and it is verified that the proposed assistant surgical robot system enables collision-free and simultaneous operation of the dVRK’s robot arm and the proposed assistant robot arm. The workspace is appropriate for the performance of various kinds of surgeries. Therefore, the proposed system is expected to provide higher safety and effectiveness for the current surgical robot system.
KeywordsAssistant surgical robot system Minimally invasive surgery (MIS) End-effector of surgical robot Novel master interface (NMI) da Vinci research kit (dVRK) Surgical-operation-by-wire (SOBW) Hands-on-throttle-and-stick (HOTAS)
Conventional minimally invasive surgery (MIS) has become one of the most advocated surgical operation approach because it offers benefits such as low blood loss, reduced time to drain removal, shorter hospital stay, better pain score, fewer follow-ups, smaller incision, and reduced complication rate than open surgery [1, 2]. However, MIS has the following disadvantages: (i) operating time is relatively longer than that of conventional open surgery and (ii) because the degrees of freedom (DOFs) of the surgical instrument is low, surgical operations such as suturing are difficult for inexpert surgeons to perform, resulting in the need for highly-trained surgeons to perform surgical operations [3, 4]. Consequently, robot-assisted laparoscopic surgery has been developed to overcome the limitations of both types of surgeries [5–8]. Introduction of the surgical robot has resulted in benefits such as shorter operating time, reduced blood loss, less surgeon fatigue, better pain score, reduced time to drain removal, shorter hospital stay, reduced complication rate, and fewer follow-ups, even compared with conventional MIS . Furthermore, it facilitates improved surgical precision, better visualization, and more intuitive and ergonomic instrument control—resulting in shorter learning curves for surgeons .
The da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA, USA), one of the most advanced surgical robots, has been used in 1.5 million laparoscopic surgical operations globally over the past decade . Nevertheless, there remain some issues to be resolved. One such issue is the collision that sometimes occurs between the operation robot arms and the assistant instrument during robotic surgery, which can cause injury to patients [9, 11–13]. This collision can be caused by an inexperienced assistant or miscommunication and misaligned intent between the surgeon and the assistant [14, 15]. Several solutions have been proposed. For example, a manipulator with a relatively small mass, which reduces the collision force, and force-feedback system has been proposed . A surgery simulator for real-time collision processing and visualization that is able to prevent several types of collisions has also been developed . A novel surgical robot design that minimizes the operating envelope during surgery has also been proposed . In the proposed design, the operating envelope is minimized to help the assistant to work alongside the robot, and also results in fewer collisions during surgery. A fourth arm that the operating surgeon can utilize for key steps and maneuvering during operations has also been proposed for the da Vinci surgical robot system . This system avoids collisions between the operating robot arm and the assistant’s instrument by turning over control of the assistant’s instrument to the surgeon. Although these systems have been proposed partially based on the issue of collision between the operating robot arm and the assistant’s instrument, they have several deficiencies: (i) they are limited to simulation and cannot be directly applied to the surgical robot system , (ii) they can only minimize or reduce, not prevent, collisions [12, 17], and (iii) the surgeon cannot simultaneously manipulate both the assistant robot arm and the operation robot arm, resulting in discontinuous surgical operation . In addition, this assistant robot arm cannot perform surgical operations such as removal of resected tissue because it cannot move outside the incision.
This paper proposes an assistant surgical robot system that overcomes these issues. The system, which consists of an assistant robot arm and its wireless controller, aims to remove the cause of collisions due to tiredness or miscommunication and misaligned intent between the surgeon and the assistant by allowing the surgeon to control the assistant instrument. Further, a wireless controller is developed for simultaneous control of the operating robot arm and the assistant robot arm, thereby preventing discontinuous surgical operation. The assistant robot arm consists of 6-DOFs external robot arm and a surgical instrument developed based on the surgical-operation-by-wire (SOBW) concept that has been reported in our previous study [2, 19]. SOBW was inspired by the fly-by-wire (FBW) system in aerospace engineering, in which the wing control is based on electrical wires for reliable control , instead of a mechanical wires [21–24]. The concept is applied in the medical field with the mechanical strings in the surgical robot system replaced with electrical wires. In this sense, all the motions of the proposed assistant robot arm, including the external robot arm and the surgical instrument, are actuated by electrical actuators such as alternating current servo motors and micromotor. Further, the yawing and pitching motions are removed from the surgical instrument as they are not necessary for the performance of dexterous movements. In exchange, the diameter of the proposed surgical instrument is 6 mm. This is smaller than that of the most extensively used da Vinci surgical robot system’s 8 mm EndoWrist. The rolling, translational, and fulcrum point motions of the surgical instrument are performed by the 6-DOFs external robot arm. The gripping motion is achieved by converting the rotational motion of the micromotor into translational motion using male and female screws, with the female screw linked to the gripper. Consequently, the gripping force can be controlled by adjusting the position of the micromotor. The durability of the surgical instrument developed was verified via a 1000 times of repeated durability tests. A da Vinci research kit (dVRK), donated by Intuitive Surgical, Inc., was used in this study to perform as the operation robot arm system. The dVRK is a research kit consisting of several parts, including master tool manipulators (MTMs), patient side manipulators (PSMs), stereo viewer, and foot pedal, from the first generation da Vinci surgical robot system. A novel master interface (NMI), a wireless communication interface for the assistant robot arm, was developed to simultaneously control the assistant robot arm and the operation robot arm in order to avoid the surgeon having to stop the operation robot arm to manipulate the assistant robot arm. The NMI is based on the hands-on-throttle-and-stick (HOTAS) controller, which is widely used in aerospace for flight control . The concept of HOTAS controller has been reported in our previous study [2, 25]. In this study, a multi-way switch and a wireless microprocessor were used to reflect the surgeon’s decision. Further, the NMI developed is relatively small and can easily be attached to the MTMs of the dVRK system for easy access when the surgeon is manipulating the MTMs. The accuracy, latency, and power consumption of the developed NMI were verified by repeated experiments. Simple peg tasks using the assistant robot arm system were also performed to evaluate the clinical applicability of the proposed assistant robot arm system. In addition, an in vitro test of semi-automatic resected object removal was conducted using the proposed assistant surgical robot system and the dVRK system to examine the performance of the proposed system. The results indicate that this novel surgical robot system can be effectively utilized for laparoscopic robotic surgery.
The surgical robot system developed to overcome the limitations stated above comprises four parts: (i) dVRK system to perform as the operation robot, (ii) surgical instrument with the diameter of 6 mm, (iii) 6-axis external robot arm that provides translational, fulcrum point, and rolling motions, and (iv) two NMIs that respectively reflect the surgeon’s decision to control the external robot arm and the surgical instrument.
da Vinci research Kit
External robot arm
Novel master interface (NMI)
Novel master interface
The accuracy of the NMI was evaluated by intercepting the data it transferred using a specific LabVIEWⓇ algorithm. The data transferred in both directions, along with the center push of the NMI were measured for 50 separate trials. No error occurred during these trials, indicating that the NMI can reflect the surgeon’s decision with high precision.
Data transfer time
The data transfer time of the NMI was determined by physically connecting it to the universal serial bus port to enable it to send data via wired communication. Then, the NMI transferred data both to the wireless data receiver and the universal serial bus port. The respective reception time for the data transferred through the two media types was each recorded using LabVIEWⓇ. This experiment was repeated 10 times. The resulting data transfer time for both media types was found to be 132 ms on average with a standard deviation (SD) of 5 ms.
Because the NMI is to be used during surgery, the amount of power it consumes has to be considered. As outlined above, the NMI utilizes a Li-MnO2 type Lithium button cell battery. To estimate the power consumption of the NMI, a LabVIEWⓇ algorithm that continuously received data from the NMI and which recorded the time when the NMI stops the data transfer—inferring that the NMI was out of power—was developed. This experiment was executed 10 times. The results indicate that the NMI operated for 185 min (SD: 9 min), which is longer than the average time for several types of robotic surgeries [1, 4, 29, 30]. Moreover, because the button cell battery of the NMI can be easily replaced with a new one, for surgeries that extend beyond the time duration of the NMI, this would cause minimum inconvenience. Furthermore, the system would be safe even when the NMI has run out of battery since it would not send any data that can control the assistant robot system.
Repeated experimental results of gripping force measurements
Revolution of the micro motor (rev)
Gripping force (N)
The reaction time of the surgical instrument’s gripping motion was estimated by performing a step function using its gripping force value. The performance result was then compared with the ideal step function after applying the Savitzky-Golay filter for the same reason as described above. For this experiment, a gripping force value of 4.37 N (SD: 0.16 N) was selected because performing the highest gripping force value for the purpose of the experiment is meaningless. The experiment was repeated 10 times with a 2 s time interval between every two gripping motions and the time duration of the gripping motion. For the experiment, a specific LabVIEWⓇ algorithm was developed to ensure that the intervals between the gripping motions were precise. The results obtained show that the step function generated by the gripping motion and the ideal step function have close conformability. The calculated mean of the time delay was 0.4 s.
To test the durability of the surgical instrument, a LabVIEWⓇ algorithm that continuously repeated the gripping motion was developed. The time intervals between every two gripping motions and the time duration of each gripping motion were set to 1 s. A gripping force of 4.37 N (SD: 0.16 N) was also selected in this experiment for the same reason as in the reaction time experiment. The gripping motion was repeated 1000 times and the gripping force values during the repetitions recorded. The mean gripping force was found to be 4.23 N with SD of 0.13 N, which is within the SD of the initial gripping force value.
Simple peg task
Execution time of block transfer task
In vitro test of semi-automatic resected object removal
Each volunteer repeated the in vitro test three times. All the volunteers were able to successfully remove the resected object using the assistant robot arm. Further, no collision occurred between the operation arm and the assistant arm during any of the tests.
Two NMIs were respectively attached to each of the MTMs of the dVRK system to enable simultaneous manipulation of the assistant surgical robot system. The accuracy of the NMIs was evaluated via an experiment that was repeated 50 times with no error occurring. The results of the latency and power consumption experiments showed that the motions of the proposed assistant surgical robot system, except for the gripping motion, are able to act on the decision of the surgeon in 132 ms via the NMI, which can be regarded as a real-time system , and the power capacity can cover several types of surgeries. Further, even if the power source might not be durable for the whole time of long surgeries, the NMI is still effective because its power source can be easily replaced. These experimental results demonstrate that the NMI can be used to reflect the surgeon’s decision wirelessly and to manipulate the assistant surgical robot system without errors.
The assistant surgical robot arm was developed by integrating the 6-DOFs external robot arm and the surgical instrument. The results of repeated gripping force of the surgical instrument indicate that the gripping force is comparable to that of conventional systems [2, 38, 39]. In addition, because the relationship between the micromotor’s revolution and the generated gripping force show good linearity with 1.00 of the coefficient of determination, the gripping force of the surgical instrument could be sensitively controlled by adjusting the micromotor’s position. The reaction time of the surgical instrument’s gripping motion was determined to be 400 ms. Thus, the total time delay from the surgeon giving the command to the surgical instrument actually gripping the object is 532 ms, which cannot be considered as a perfect real-time control due to its relatively long time delay. However, the gripping motion is still effective since the time delay around 500 ms is acceptable for surgical performance and can be adapted by human [40–43]. Furthermore, since the main cause of the time delay of the surgical instrument is the micromotor’s speed, which was set to 75 % of the maximum speed during the experiment, the time delay would be shorter if the speed of the micromotor was increased. The results of 1000 on and off motions to check the durability of the surgical instrument show that the effect on the surgical instrument’s force value was negligible. This experiment was adopted from previous research  because the durability of the surgical instrument developed cannot be tested based on the number of surgeries, as done in the case of the EndoWrist. For the final important step in the evaluation of the surgical instrument, the sterility issue has to be considered. Thus, sealing of the surgical instrument developed is planned for future work. As illustrated in Fig. 9, the workspace of the assistant robot arm was calculated using the joint information of the 6-DOFs external robot arm . The cone-like shape of the calculated workspace is a result of the fulcrum point motion of the surgical robot system. Because the workspace is much larger than the cholecystectomy workspace, the assistant surgical robot is expected to be able to perform many types of surgeries whose workspaces can be covered by the cholecystectomy. Furthermore, the size of the calculated workspace can be increased by adjusting the limits of the range of movement of the 6-DOFs external robot’s arm joints.
The resulting mean time and SD of the simple peg tasks were shorter than those of other similar systems using the same FLS kit and following the same FLS peg transfer task curriculum to validate their systems, which demonstrated that a good performance and effectiveness can be provided by the proposed assistant surgical robot system [2, 34–36]. Furthermore, as shown in Table 2, the mean of each peg task’s execution time was gradually decreased. This can be interpreted that the volunteers quickly adapted to the system and therefore showed a better result trial by trial. However, the mean and SD of each peg task’s execution time were slightly longer when compared with the results using dVRK , which used only one MTM with one PSM and followed the same FLS peg transfer task curriculum using the same FLS peg transfer kit. The major cause of this result is the relatively slow speed of the external robot arm. Therefore, the results can be improved by developing a more stable control algorithm for the proposed system to enable higher speed.
The in vitro test of semi-automatic resected object removal indicated that the recruited volunteers were able to manipulate both of operation robot arms and assistant robot arm. Moreover, no collisions occurred during the tests. This means that using the proposed assistant surgical robot system, the surgeon can simultaneously perform the role of assistant to prevent collision between the operation robot arm and the assistant instrument.
Using the proposed surgical robot system, with its SOBW-type surgical instrument, NMI based on HOTAS, and the dVRK system, surgeons will be able to execute the functions of an assistant and thereby avoid collisions without having to stop surgical operations.
Robot-assisted laparoscopic surgery is a very desirable surgical operation because it provides several benefits compared with open surgery and conventional MIS. However, a major issue with robotic surgery has been the collision between the operation robot arm and the assistant instrument. Consequently, this research proposed an assistant robot system that can be simultaneously manipulated by the surgeon via a wireless controller. The assistant robot arm comprises a surgical instrument with a diameter of 6 mm and 6-DOFs external robot arm. The surgical instrument uses a micromotor to generate gripping motion and the external robot arm can perform translational, fulcrum point, and rolling motions with the surgical instrument. The surgical instrument, which is based on SOBW, was validated via a gripping force experiment, a reaction time test, and a durability test. The workspace of the assistant robot system has clinical applicability. A wireless communication interface designed based on the HOTAS concept, called NMI, facilitates simultaneous manipulation of the assistant robot arm and the operation robot arm. In this study, a tiny piece of hardware was developed which is attached to the MTM of the dVRK system, which was used as the operation robot. The results of accuracy tests, data transfer time experiments, and a power consumption test have confirmed that the proposed NMI is feasible & effective. The results of a simple peg task and an in vitro test using the dVRK system have also indicated that the proposed system can be utilized in various types of laparoscopic robotic surgeries. However, the sterility issue needs to be resolved for the clinical application and this issue will be handled as future work.
minimally invasive surgery
degrees of freedom
da Vinci research kit
master tool manipulator
patient side manipulator
novel master interface
remote center of motion
fundamentals of laparoscopic surgery
MK proposed the entire system of micro motor driven surgical instrument and the NMI for wireless control and conducted experiments with CL. WJP recommended system setup for the experiments. SK suggested SOBW concept and supervised all research activities. HJK advised for mechanical issues related to the proposed surgical robot system. YSS and HKY advised for clinical applicability of the proposed surgical robot system. All authors read and approved the final manuscript.
This work was supported by the Interdisciplinary Research Initiatives Program from College of Engineering and College of Medicine, Seoul National University (Grant No. 800-20150090) and Global Ph.D. Fellowship Program through the National Research Foundation of Korea funded by the Ministry of Education (Grant 2014H1A2A1020384). The da Vinci Research Kit was donated by Intuitive Surgical, Inc. (Sunnyvale, CA, USA) in 2014.
The authors declare that they have no competing interests.
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