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Ever since their first introduction in the late 1980s , , surgical robots have played an increasingly prominent role in medical practice ,. For example, a recent study found that over 15% of all general surgery procedures in 2020 were performed robotically, compared to only 1.8% in 2012. The current worldwide robotic surgery market is estimated to be $\$ $ 5.3 billion and is expected to reach $\$ $ 19 billion by 2027, with a compound annual growth rate over 21%. [ABSTRACT FROM AUTHOR]

Continuum robots are not constructed with discrete joints but, instead, change shape and position their tip by flexing along their entire length. Their narrow curvilinear shape makes them well suited to passing through body lumens, natural orifices, or small surgical incisions to perform minimally invasive procedures. Modeling and controlling these robots are, however, substantially more complex than traditional robots comprised of rigid links connected by discrete joints. Furthermore, there are many approaches to achieving robot flexure. Each presents its own design and modeling challenges, and to date, each has been pursued largely independently of the others. This article attempts to provide a unified summary of the state of the art of continuum robot architectures with respect to design for specific clinical applications. It also describes a unifying framework for modeling and controlling these systems while additionally explaining the elements unique to each architecture. The major research accomplishments are described for each topic and directions for the future progress needed to achieve widespread clinical use are identified. [ABSTRACT FROM AUTHOR]

Continuum robots offer the dexterity and obstacle circumvention capabilities necessary to enable surgery in deep surgical sites. They also can enable joint-level ex situ force sensing (JEFS), which provides an estimate of end-effector wrenches given joint-level forces. Prior works on JEFS relied on a restrictive embodiment with minimal actuation line friction and captured model and frictional actuation transmission uncertainties using a configuration space formulation. In this work, we overcome these limitations. First, frictional losses are canceled using a feed-forward term based on support vector regression in joint space. Then, regression maps and their interpolation are used to account for actuation hysteresis. The residual joint-force error is then further minimized using a least-squares model parameter update. An indirect hybrid force/position controller using JEFS is presented with evaluation carried out on a realistic pre-clinically deployable insertable robotic effectors platform (IREP) for single-port access surgery. Automated mock force-controlled ablation, exploration, and knot tightening are evaluated. A user study involving the daVinci Research Kit surgeon console and the IREP as a surgical slave was carried out to compare the performance of users with and without force feedback based on JEFS for force-controlled ablation and knot tightening. Results in automated experiments and a user study of telemanipulated experiments suggest that intrinsic force-sensing can achieve levels of force uncertainty and force regulation errors of the order of 0.2 N. Using JEFS and automated task execution, repeatability, and force regulation accuracy is shown to be comparable to using a commercial force sensor for human-in-the-loop feedback. [ABSTRACT FROM AUTHOR]

Laparoscopic and Single Port Access Surgery (SPAS) present unique dexterity challenges related to dual-arm operations in confined spaces and tele-manipulation of highly dexterous surgical slaves. In an effort to reduce tele-manipulation burden, new paradigms for semi-automating surgical tasks are needed. This paper presents a new minimal constraint suturing and automated choice of handedness for anthropomorphic dual-arm robots. The automated choice of handedness supports surgeons during tele-manipulation of complex robotic slaves where dexterity and workspace constraints are difficult to learn. This criterion is also used to support automated dual-arm rendezvous for quicker suture exchange during dual-arm suturing. The minimal constraint algorithm presented in this paper allows surgeons to operate within a shared-control tele-manipulation framework whereby the surgeon controls the needle insertion speed and the robot controls the needle orientation while respecting a minimalistic set of tissue constraints. This framework is evaluated on a novel insertable robotic end-effectors platform for SPAS. A simulation study demonstrates the effectiveness of the automated choice of handedness criterion through a study of dexterity limitations of each arm. Additional simulations show the proposed algorithm for automated rendezvous and suture exchange. [ABSTRACT FROM AUTHOR]

Introduction: Transurethral resection of bladder tumor (TURBT) and pathological staging are both standard surgical therapies for nonmuscle-invasive bladder cancer and integral parts of the diagnostic evaluation and progression monitoring of all bladder tumors. We developed and tested a dexterous robot that can fit through a standard resectoscope for evaluation for possible en bloc resection of bladder tumors, especially tumors along the dome and anterior wall of the bladder. Materials and Methods: Our dexterous robot uses a continuum (snake-like) mechanical architecture with three working channels through which a fiberscope, biopsy graspers, and a holmium laser were placed. The continuum robot has two segments. Using indigo carmine, injections were performed through the detrusor muscle into the mucosa of the ex vivo bovine bladders at a total of 11 positions throughout all quadrants of the bladder. The snake robot was used in conjunction with the holmium laser to ablate nine of the lesions; two additional lesions were resected en bloc using the grasper and the laser down through the muscle layer. Results: Both experiments showed that the robotic system was able to directly visualize all 11 targets. In both the bladders, we were able to resect en bloc two tumors using the grasper and 200 μm holmium laser fiber down to the muscle layer indicating a good resection. All of the other targets were completely ablated using the holmium laser. Conclusion: The dexterous robot allowed for visualization as well as provided adequate ablation and en bloc resection of bladder lesions throughout the entire bladder. [ABSTRACT FROM AUTHOR]

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