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Robotics Technology Urol Clin N Am 31 (2004) 793–800 Robotics technology: a journey into the future Abhilash Pandya, PhD*, Gregory Auner, PhD Department of Electrical and Computer Engineering, Wayne State University, Engineering Building #3160, 5050 Anthony Wayne Drive, Detroit, MI 48201, USA The authors predict that technology-assisted Even with enormous technologic gains, robotic medicine, and robotics in particular, will have surgery is still in its infancy. Some major techno- a significant impact over the next few decades. logic improvements are needed for this technology Robots will augment the surgeon’s motor perfor- to reach its ultimate potential, including better mance, diagnosis capability, and senses with visualization, tactile sensing, diagnostic sensing, haptics (feel), augmented reality (sight), and and miniaturization [27]. This article gives the ultrasound (sound). Robots already boost surgical authors’ vision of the future of robotic technology skills by filtering tremor and scaling motions, but with respect to robotic vision, sensor fusion, and may be able to automate certain routine tasks to nano-/microrobot development and discusses the free the surgeon to focus on higher-level tasks. path to that future from the current state-of-the- With intelligent interfaces, the robotic system art for medical robots. could warn surgeons of incorrect trajectories or restrict the movements of the surgery away from Robotic vision (augmented reality and image dangerous or critical areas. The authors predict guidance) that the impact of robots will parallel that of imaging technology in medicine today. Many studies have compared and improved Robotic devices have been used in cardiac the surgical interface and improved the surgeon’s surgery [1–13], urology [14–16], fetal surgery performance [28–31]. One of the key problems of [17,18], pediatrics [19–22], neurosurgery [23,24], robotic surgery, however, is that surgeries can orthopedics [25,26], and many other medical become more difficult and take longer [32].In disciplines. As with imaging technology, robotics robotic surgery, the magnification and, therefore, will bring patient care and treatment a leap for- the size of the field-of-view changes with the ward. In several cases, it has started to happen proximity of the endoscope to the objects being already. In particular, the Vattikuti Urology In- viewed [33]. Because of the small incisions and stitute at Henry Ford Hospital in Detroit, Mich- camera view, the surgeon can no longer see inside igan is the first facility in the country to perform the patient directly. Visualization is critical for surgery routinely using a robotic system for the systems that use a robotic interface because the treatment of prostate cancer. With this robotic surgeon typically operates from a remote location laparoscopic procedure, the patient’s pain, blood and relies almost entirely on indirect, limited field- loss, and recovery time in the hospital and at of-view video of the surgery [27,33,34]. Direct home are reduced significantly compared with linkage of medical robotic systems to patient data traditional surgery. In addition, the procedure and the optimal visualization of those data for eliminates the need for large incisions [15]. the surgical team are important for successful operations. In their review article on medical robots, Cleary and Nguyen [27] state that if medical * Corresponding author. robots are to reach their full potential, they need E-mail address: [email protected] to be more integrated systems in which the robots (A. Pandya). are linked to the imaging modalities or directly to 0094-0143/04/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.ucl.2004.06.013 794 A. Pandya, G. Auner / Urol Clin N Am 31 (2004) 793–800 the patient anatomy. They state further that robotic arms on the operating table to avoid robotics systems need to be developed in an collisions between arms during the procedure ‘‘Image-Compatible’’ way. Visual information and maximize the range of motion of the instru- from the patient site needs to be augmented to ments. A significant potential exists to affect allow greater situational awareness, accuracy, and medical robotics with the preoperative planning confidence. That is, these systems must operate and intraoperative visualization tools [37]. within the constraints of various image modalities Two types of visualization technology have such as CT and MRI. This link, they conjecture, is been used for real-time visualization in the essential if the potential advantages of robots are medical domain: augmented reality (AR) and to be realized in the medical domain. virtual reality (VR) [38,39]. These visualization In addition, surgical planning and information methods are well suited for robotic surgery. management for these robotic systems is essential Image guidance is an example of VR. In image- for successful operations [27]. Two main problems guidance surgery (IGS), the surgeon views a encountered in robotic surgery are nonoptimal computer-generated world of image data and port (incisions on the patient’s body for the three-dimensional models after registration. The robotic arms) placements and robotic-arm colli- registration ensures a one-to-one correspondence sions. Robotic-arm collisions often require man- to the end-effector of the robot and the image ual repositioning of the robotic arms on the coordinates. In contrast, the AR system gener- operating table that unnecessarily adds to the ates a composite view for the user that includes operative time. Incorrect port placement typically the live video view fused (registered) with either results in robotic-arm collisions, can damage precomputed data (eg, three-dimensional geome- robotic instruments, and also can make the try) or other registered sensed data [40].ARis operative site inaccessible. Improved accessibility a variation and extension of VR and represents to the operative site can enhance patient safety a middle ground between computer graphics in [35]. These problems can be avoided in the a completely synthetically generated world (as in preoperative stages given the appropriate visual- VR) and a normal camera view of the real world ization tools. Therefore, it is important that [41–45]. The current technique of image guidance a robust visualization system be built that is does not allow the surgeon to use real and linked to patient imaging data to offer the surgeon synthetic data simultaneously [46]. The surgeon tools for visualization, robotic system setup, and can detect anomalies using advanced imaging port placement [36]. and sensors and can place his or her tools Computer modeling tools that help visualize accurately within surgical environments with the anatomic structures of the patient would aid robots. Nevertheless, the surgeon also needs his the surgeon greatly in the preoperative stage. or her own vision to detect other features that Visualization tools can help the surgeon determine may not be available from the sensor informa- optimal port-placement sites. In addition, these tion. This, the authors believe, is one advantage tools will help determine the placement of the of AR (Fig. 1) [47]. Fig. 1. Augmented reality and image-guided visualization. A. Pandya, G. Auner / Urol Clin N Am 31 (2004) 793–800 795 Robotic ultrasound volume. If this information is extracted, the physical parameters of each resolvable volume Imagine listening to tissue for abnormalities. element (ie, approximately 1 mm3) in the insoni- New technology using acoustic holography is fied volume then should enable diagnosis of the within reach for early diagnosis of diseases such nature of the material. In principle, it is possible as cancer because of significant advances in to distinguish small tumors from healthy tissues microsystem and signal analysis. Although holog- by this method. Preliminary images and phase raphy technology has existed for over 25 years, its information are shown in Fig. 2. application in the clinical/diagnostic arena did not come to fruition because of a lack of advanced microsystems and signal analysis technology. Robotic touch What has been missing is a conversion element that can record the ultrasound interference pat- Can the sense of hyper-touch and -temperature terns, reconstruct them with a real or synthesized be useful for a surgeon? Development of advanced ultrasound interference pattern, and finally re- force-sensing arrays can advance tactile augmen- construct them with real or synthesized ultra- tation on the robot. For example, new dual-mode sound frequency waves that could be transformed acoustic wave sensors that can switch between directly into a visible image. surface acoustic wave and surface transverse wave This is now possible using micropiezoelectric modes can sense pressure and viscosity in liquid, arrays equipped with chip reconstruction at high distinguish force caused by liquid or solid inter- spatial and temporal resolution. In addition to actions, and further distinguish between normal three-dimensional holography imaging, a vital and transverse forces (pinching pressure or sliding objective of the device is to recover the wave frictional forces). Because new wide-bandgap, envelope emerging from each pixel. Although the semiconductor-based acoustic sensor arrays have hologram requires freezing the waves in time long linear temperature coefficients, they can be superb enough to capture a stable interference pattern temperature sensors as well. Thus, tactile forces with adequate signal-to-noise (typically
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