Purpose of Review
Robot-assisted minimally invasive surgery (RMIS) holds great promise for improving the accuracy and dexterity of a surgeon while minimizing trauma to the patient. However, widespread clinical success with RMIS has been marginal. It is hypothesized that the lack of haptic (force and tactile) feedback presented to the surgeon is a limiting factor. This review explains the technical challenges of creating haptic feedback for robot-assisted surgery and provides recent results that evaluate the effectiveness of haptic feedback in mock surgical tasks.

/pdf/haptic-feedback-in-robot-assisted-minimally-invasive-surgery-4w27jydcr7.pdf

Haptic Feedback in Robot-Assisted Minimally Invasive Surgery

Image-guided interventions are medical procedures that use computer-based systems to provide virtual image overlays to help the physician precisely visualize and target the surgical site. This field has been greatly expanded by the advances in medical imaging and computing power over the past 20 years. This review begins with a historical overview and then describes the component technologies of tracking, registration, visualization, and software. Clinical applications in neurosurgery, orthopedics, and the cardiac and thoracoabdominal areas are discussed, together with a description of an evolving technology named Natural Orifice Transluminal Endoscopic Surgery (NOTES). As the trend toward minimally invasive procedures continues, image-guided interventions will play an important role in enabling new procedures, while improving the accuracy and success of existing approaches. Despite this promise, the role of image-guided systems must be validated by clinical trials facilitated by partnerships between scientists and physicians if this field is to reach its full potential.

https://www.annualreviews.org/doi/pdf/10.1146/annurev-bioeng-070909-105249

Image-Guided Interventions: Technology Review and Clinical Applications

The impressive development of medical imaging technology during the last decades provided physicians with an increasing amount of patient specific anatomical and functional data. In addition, the increasing use of non-ionizing real-time imaging, in particular ultrasound and optical imaging, during surgical procedures created the need for design and development of new visualization and display technology allowing physicians to take full advantage of rich sources of heterogeneous preoperative and intraoperative data. During 90's, medical augmented reality was proposed as a paradigm bringing new visualization and interaction solutions into perspective. This paper not only reviews the related literature but also establishes the relationship between subsets of this body of work in medical augmented reality. It finally discusses the remaining challenges for this young and active multidisciplinary research community.

Advanced Medical Displays: A Literature Review of Augmented Reality

https://shura.shu.ac.uk/7180/1/Rodriggues_%2D_optical_techniques_%2D_Review_MIA_revision_v9.pdf

Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery.

Background This paper aims to move the debate forward regarding the potential for artificial intelligence (AI) and autonomous robotic surgery with a particular focus on ethics, regulation and legal aspects (such as civil law, international law, tort law, liability, medical malpractice, privacy and product/device legislation, among other aspects). Methods We conducted an intensive literature search on current or emerging AI and autonomous technologies (eg, vehicles), military and medical technologies (eg, surgical robots), relevant frameworks and standards, cyber security/safety- and legal-systems worldwide. We provide a discussion on unique challenges for robotic surgery faced by proposals made for AI more generally (eg, Explainable AI) and machine learning more specifically (eg, black box), as well as recommendations for developing and improving relevant frameworks or standards. Conclusion We classify responsibility into the following: (1) Accountability; (2) Liability; and (3) Culpability. All three aspects were addressed when discussing responsibility for AI and autonomous surgical robots, be these civil or military patients (however, these aspects may require revision in cases where robots become citizens). The component which produces the least clarity is Culpability, since it is unthinkable in the current state of technology. We envision that in the near future a surgical robot can learn and perform routine operative tasks that can then be supervised by a human surgeon. This represents a surgical parallel to autonomously driven vehicles. Here a human remains in the 'driving seat' as a 'doctor-in-the-loop' thereby safeguarding patients undergoing operations that are supported by surgical machines with autonomous capabilities.

Legal, regulatory, and ethical frameworks for development of standards in artificial intelligence (AI) and autonomous robotic surgery.

We present daVinci Canvas: a telerobotic surgical system with integrated robot-assisted laparoscopic ultrasound capability. DaVinci Canvas consists of the integration of a rigid laparoscopic ultrasound probe with the daVinci robot, video tracking of ultrasound probe motions, endoscope and ultrasound calibration and registration, autonomous robot motions, and the display of registered 2D and 3D ultrasound images. Although we used laparoscopic liver cancer surgery as a focusing application, our broader aim was the development of a versatile system that would be useful for many procedures.

/pdf/davinci-canvas-a-telerobotic-surgical-system-with-integrated-12ksvipd6k.pdf

DaVinci canvas: a telerobotic surgical system with integrated, robot-assisted, laparoscopic ultrasound capability

Background
The Trauma Pod (TP) vision is to develop a rapidly deployable robotic system to perform critical acute stabilization and/or surgical procedures, autonomously or in a teleoperative mode, on wounded soldiers in the battlefield who might otherwise die before treatment in a combat hospital could be provided.

Methods
In the first phase of a project pursuing this vision, a robotic TP system was developed and its capability demonstrated by performing selected surgical procedures on a patient phantom.

Results
The system demonstrates the feasibility of performing acute stabilization procedures with the patient being the only human in the surgical cell. The teleoperated surgical robot is supported by autonomous robotic arms and subsystems that carry out scrub-nurse and circulating-nurse functions. Tool change and supply delivery are performed automatically and at least as fast as performed manually by nurses. Tracking and counting of the supplies is performed automatically. The TP system also includes a tomographic X-ray facility for patient diagnosis and two-dimensional (2D) fluoroscopic data to support interventions. The vast amount of clinical protocols generated in the TP system are recorded automatically.

Conclusions
Automation and teleoperation capabilities form the basis for a more comprehensive acute diagnostic and management platform that will provide life-saving care in environments where surgical personnel are not present. Copyright © 2009 John Wiley & Sons, Ltd.

/pdf/trauma-pod-a-semi-automated-telerobotic-surgical-system-51fnwwb0tb.pdf

Trauma Pod: a semi-automated telerobotic surgical system.

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DaVinci canvas: a telerobotic surgical system with integrated, robot-assisted, laparoscopic ultrasound capability

Trauma Pod: a semi-automated telerobotic surgical system.