Helmholtz Institute for Biomedical Engineering, RWTH Aachen, Pauwelsstraße 20, 52074, Aachen, Germany.
Int J Comput Assist Radiol Surg. 2021 Feb;16(2):311-322. doi: 10.1007/s11548-020-02296-8. Epub 2020 Dec 23.
Cooperative surgical systems enable humans and machines to combine their individual strengths and collaborate to improve the surgical outcome. Cooperative telemanipulated systems offer the widest spectrum of cooperative functionalities, because motion scaling is possible. Haptic guidance can be used to assist surgeons and haptic feedback makes acting forces at the slave side transparent to the operator, however, overlapping and masking of forces needs to be avoided. This study evaluates the usability of a cooperative surgical telemanipulator in a laboratory setting.
Three experiments were designed and conducted for characteristic surgical task scenarios derived from field studies in orthopedics and neurosurgery to address bone tissue differentiation, guided milling and depth sensitive milling. Interaction modes were designed to ensure that no overlapping or masking of haptic guidance and haptic feedback occurs when allocating information to the haptic channel. Twenty participants were recruited to compare teleoperated modes, direct manual execution and an exemplary automated milling with respect to usability.
Participants were able to differentiate compact and cancellous bone, both directly manually and teleoperatively. Both telemanipulated modes increased effectiveness measured by the mean absolute depth and contour error for guided and depth sensitive millings. Efficiency is decreased if solely a boundary constraint is used in hard material, while a trajectory guidance and manual milling perform similarly. With respect to subjective user satisfaction trajectory guidance is rated best for guided millings followed by boundary constraints and the direct manual interaction. Haptic feedback only improved subjective user satisfaction.
A cooperative surgical telemanipulator can improve effectiveness and efficiency close to an automated execution and enhance user satisfaction compared to direct manual interaction. At the same time, the surgeon remains part of the control loop and is able to adjust the surgical plan according to the intraoperative situation and his/her expertise at any time.
协作式手术系统使人类和机器能够结合各自的优势进行协作，从而改善手术效果。协作式远程操纵系统提供了最广泛的协作功能，因为可以进行运动缩放。触觉引导可用于协助外科医生，并且触觉反馈使操作人员能够感知从从端传来的力，但是需要避免力的重叠和掩盖。本研究在实验室环境中评估了协作式手术远程操纵器的可用性。
设计并进行了三项实验，这些实验是根据矫形外科和神经外科领域研究中的典型手术任务场景得出的，旨在解决骨组织分化、引导铣削和深度敏感铣削问题。交互模式的设计确保在将信息分配到触觉通道时，触觉引导和触觉反馈不会发生重叠或掩盖。招募了 20 名参与者，以比较远程操作模式、直接手动执行和示例自动化铣削在可用性方面的差异。
参与者能够直接手动和远程操作两种方式区分致密骨和松质骨。两种远程操纵模式都提高了引导铣削和深度敏感铣削的平均绝对深度和轮廓误差的有效性。如果仅在硬材料中使用边界约束，则效率会降低，而轨迹引导和手动铣削的性能相似。在主观用户满意度方面，轨迹引导在引导铣削中得分最高，其次是边界约束和直接手动交互。触觉反馈仅提高了主观用户满意度。
与直接手动交互相比，协作式手术远程操纵器可以提高有效性和效率，接近自动化执行，并提高用户满意度。同时，外科医生仍然是控制回路的一部分，并且可以根据手术中的情况和他/她的专业知识随时调整手术计划。
