D'Ettorre, Claudia; (2022) Robot Assisted Object Manipulation for Minimally Invasive Surgery. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Robotic systems have an increasingly important role in facilitating minimally invasive surgical treatments. In robot-assisted minimally invasive surgery, surgeons remotely control instruments from a console to perform operations inside the patient. However, despite the advanced technological status of surgical robots, fully autonomous systems, with decision-making capabilities, are not yet available. In 2017, a structure to classify the research efforts toward autonomy achievable with surgical robots was proposed by Yang et al. Six different levels were identified: no autonomy, robot assistance, task autonomy, conditional autonomy, high autonomy, and full autonomy. All the commercially available platforms in robot-assisted surgery is still in level 0 (no autonomy). Despite increasing the level of autonomy remains an open challenge, its adoption could potentially introduce multiple benefits, such as decreasing surgeons’ workload and fatigue and pursuing a consistent quality of procedures. Ultimately, allowing the surgeons to interpret the ample and intelligent information from the system will enhance the surgical outcome and positively reflect both on patients and society. Three main aspects are required to introduce automation into surgery: the surgical robot must move with high precision, have motion planning capabilities and understand the surgical scene. Besides these main factors, depending on the type of surgery, there could be other aspects that might play a fundamental role, to name some compliance, stiffness, etc. This thesis addresses three technological challenges encountered when trying to achieve the aforementioned goals, in the specific case of robot-object interaction. First, how to overcome the inaccuracy of cable-driven systems when executing fine and precise movements. Second, planning different tasks in dynamically changing environments. Lastly, how the understanding of a surgical scene can be used to solve more than one manipulation task. To address the first challenge, a control scheme relying on accurate calibration is implemented to execute the pick-up of a surgical needle. Regarding the planning of surgical tasks, two approaches are explored: one is learning from demonstration to pick and place a surgical object, and the second is using a gradient-based approach to trigger a smoother object repositioning phase during intraoperative procedures. Finally, to improve scene understanding, this thesis focuses on developing a simulation environment where multiple tasks can be learned based on the surgical scene and then transferred to the real robot. Experiments proved that automation of the pick and place task of different surgical objects is possible. The robot was successfully able to autonomously pick up a suturing needle, position a surgical device for intraoperative ultrasound scanning and manipulate soft tissue for intraoperative organ retraction. Despite automation of surgical subtasks has been demonstrated in this work, several challenges remain open, such as the capabilities of the generated algorithm to generalise over different environment conditions and different patients.

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