Haptic Intracorporeal Palpation Using a Cable-Driven Parallel Robot: A User Study

Objective: Intraoperative palpation is a surgical gesture jeopardized by the lack of haptic feedback which affects robotic minimally invasive surgery. Restoring the force reflection in teleoperated systems may improve both surgeons’ performance and procedures’ outcome. Methods: A force-based sensing approach was developed, based on a cable-driven parallel manipulator with anticipated seamless and low-cost integration capabilities in teleoperated robotic surgery. No force sensor on the end-effector is used, but tissue probing forces are estimated from measured cable tensions. A user study involving surgical trainees (n = 22) was conducted to experimentally evaluate the platform in two palpation-based test-cases on silicone phantoms. Two modalities were compared: visual feedback alone and both visual + haptic feedbacks available at the master site. Results: Surgical trainees’ preference for the modality providing both visual and haptic feedback is corroborated by both quantitative and qualitative metrics. Hard nodules detection sensitivity improves (94.35 ± 9.1% vs 76.09 ± 19.15% for visual feedback alone), while also exerting smaller forces (4.13 ± 1.02 N vs 4.82 ± 0.81 N for visual feedback alone) on the phantom tissues. At the same time, the subjective perceived workload decreases. Conclusion: Tissue-probe contact forces are estimated in a low cost and unique way, without the need of force sensors on the end-effector. Haptics demonstrated an improvement in the tumor detection rate, a reduction of the probing forces, and a decrease in the perceived workload for the trainees. Significance: Relevant benefits are demonstrated from the usage of combined cable-driven parallel manipulators and haptics during robotic minimally invasive procedures. The translation of robotic intraoperative palpation to clinical practice could improve the detection and dissection of cancer nodules.

[1]  Kaspar Althoefer,et al.  Real-Time Vision-Based Stiffness Mapping † , 2018, Sensors.

[2]  A. Okamura Haptic feedback in robot-assisted minimally invasive surgery , 2009, Current opinion in urology.

[3]  Arianna Menciassi,et al.  Haptic feedback in the da Vinci Research Kit (dVRK): A user study based on grasping, palpation, and incision tasks , 2019, The international journal of medical robotics + computer assisted surgery : MRCAS.

[4]  Guang-Zhong Yang,et al.  Emerging Robotic Platforms for Minimally Invasive Surgery , 2013, IEEE Reviews in Biomedical Engineering.

[5]  Abdulmotaleb El Saddik,et al.  Haptics: General Principles , 2011 .

[6]  Theodoros N. Arvanitis,et al.  Objective surgical performance evaluation based on haptic feedback. , 2002, Studies in health technology and informatics.

[7]  Kaspar Althoefer,et al.  Evaluating Manual Palpation Trajectory Patterns in Tele-manipulation for Soft Tissue Examination , 2013, 2013 IEEE International Conference on Systems, Man, and Cybernetics.

[8]  Gerald E. Loeb,et al.  Using the BioTac as a tumor localization tool , 2014, 2014 IEEE Haptics Symposium (HAPTICS).

[9]  D. Saslow,et al.  Performance and Reporting of Clinical Breast Examination: A Review of the Literature , 2004, CA: a cancer journal for clinicians.

[10]  Kaspar Althoefer,et al.  Intra-operative Tumor Localization in Robot-assisted Minimally Invasive Surgery: A Review , 2016 .

[11]  J. F. Greenleaf,et al.  Magnetic resonance elastography: Non-invasive mapping of tissue elasticity , 2001, Medical Image Anal..

[12]  W. Kraus,et al.  An Elastic Cable Model for Cable-Driven Parallel Robots Including Hysteresis Effects , 2015 .

[13]  Carlo Alberto Avizzano,et al.  Encountered-type haptic interface for virtual interaction with real objects based on implicit surface haptic rendering for remote palpation , 2015, 2015 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS).

[14]  Kaspar Althoefer,et al.  Force-velocity modulation strategies for soft tissue examination , 2013, 2013 IEEE/RSJ International Conference on Intelligent Robots and Systems.

[15]  Allison M. Okamura,et al.  Effects of haptic and graphical force feedback on teleoperated palpation , 2009, 2009 IEEE International Conference on Robotics and Automation.

[16]  George P. Mylonas,et al.  Dynamic Control of Cable Driven Parallel Robots with Unknown Cable Stiffness: a Joint Space Approach , 2018, 2018 IEEE International Conference on Robotics and Automation (ICRA).

[17]  Thomas B. Sheridan,et al.  Telerobotics , 1989, Autom..

[18]  Torsten Kuhlen,et al.  Haptic Palpation for Medical Simulation in Virtual Environments , 2012, IEEE Transactions on Visualization and Computer Graphics.

[19]  Saeed Behzadipour,et al.  Stiffness of Cable-based Parallel Manipulators With Application to Stability Analysis , 2006 .

[20]  Kaspar Althoefer,et al.  Palpation force modulation strategies to identify hard regions in soft tissue organs , 2017, PloS one.

[21]  L. Jones,et al.  Perception of force and weight: theory and research. , 1986, Psychological bulletin.

[22]  M. E. Hagen,et al.  Visual clues act as a substitute for haptic feedback in robotic surgery , 2008, Surgical Endoscopy.

[23]  Lynette A. Jones,et al.  Shape Localization and Recognition Using a Magnetorheological-Fluid Haptic Display , 2018, IEEE Transactions on Haptics.

[24]  Bin Yao,et al.  Modeling of Transmission Characteristics Across a Cable-Conduit System , 2010, IEEE Transactions on Robotics.

[25]  Pietro Valdastri,et al.  Wireless Tissue Palpation for Intraoperative Detection of Lumps in the Soft Tissue , 2014, IEEE Transactions on Biomedical Engineering.

[26]  Kaspar Althoefer,et al.  Implementation of Tactile Sensing for Palpation in Robot-Assisted Minimally Invasive Surgery: A Review , 2014, IEEE Sensors Journal.

[27]  Akihito Sano,et al.  Visual and tactile feedback for a direct‐manipulating tactile sensor in laparoscopic palpation , 2018, The international journal of medical robotics + computer assisted surgery : MRCAS.

[28]  Allison M. Okamura,et al.  A single-use haptic palpation probe for locating subcutaneous blood vessels in robot-assisted minimally invasive surgery , 2015, 2015 IEEE International Conference on Automation Science and Engineering (CASE).

[29]  Claudio Pacchierotti,et al.  Cutaneous haptic feedback to ensure the stability of robotic teleoperation systems , 2015, Int. J. Robotics Res..

[30]  J. Bisley,et al.  Evaluating tactile feedback in robotic surgery for potential clinical application using an animal model , 2016, Surgical Endoscopy.

[31]  Ming Zhao,et al.  ESD CYCLOPS: A New Robotic Surgical System for GI Surgery , 2017, 2018 IEEE International Conference on Robotics and Automation (ICRA).

[32]  David B. Camarillo,et al.  Robotic technology in surgery: past, present, and future. , 2004, American journal of surgery.

[33]  Christopher R. Wagner,et al.  The role of force feedback in surgery: analysis of blunt dissection , 2002, Proceedings 10th Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems. HAPTICS 2002.

[34]  P. Stark Bounded-Variable Least-Squares: an Algorithm and Applications , 2008 .

[35]  R H LaMotte,et al.  Softness discrimination with a tool. , 2000, Journal of neurophysiology.

[36]  Clément Gosselin,et al.  Cable-driven parallel mechanisms: state of the art and perspectives , 2014 .

[37]  Dominiek Reynaerts,et al.  Evaluation of Haptic Feedback on Bimanually Teleoperated Laparoscopy for Endometriosis Surgery , 2018, IEEE Transactions on Biomedical Engineering.

[38]  M. Roobol,et al.  Digital rectal examination can detect early prostate cancer , 2015, Evidence-Based Medicine.

[39]  George P. Mylonas,et al.  A cable-driven parallel manipulator with force sensing capabilities for high-accuracy tissue endomicroscopy , 2018, International Journal of Computer Assisted Radiology and Surgery.

[40]  Guang-Zhong Yang,et al.  CYCLOPS: A versatile robotic tool for bimanual single-access and natural-orifice endoscopic surgery , 2014, 2014 IEEE International Conference on Robotics and Automation (ICRA).

[41]  Lesley Uttley,et al.  Routine thyroglobulin, neck ultrasound and physical examination in the routine follow up of patients with differentiated thyroid cancer—Where is the evidence? , 2018, Endocrine.

[42]  Claudio Pacchierotti,et al.  Cutaneous Feedback of Fingertip Deformation and Vibration for Palpation in Robotic Surgery , 2016, IEEE Transactions on Biomedical Engineering.

[43]  Allison M. Okamura,et al.  Force-Feedback Surgical Teleoperator: Controller Design and Palpation Experiments , 2008, 2008 Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems.

[44]  Jung Kim,et al.  New approach for abnormal tissue localization with robotic palpation and mechanical property characterization , 2011, 2011 IEEE/RSJ International Conference on Intelligent Robots and Systems.

[45]  Barnett S Kramer,et al.  The bimanual ovarian palpation examination in the Prostate, Lung, Colorectal and Ovarian cancer screening trial: Performance and complications , 2017, Journal of medical screening.

[46]  Nima Enayati,et al.  Haptics in Robot-Assisted Surgery: Challenges and Benefits , 2016, IEEE Reviews in Biomedical Engineering.