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We explore whether surgical manipulation tasks can be learned on the da Vinci robot via imitation learning. However, the da Vinci system presents unique challenges which hinder straight-forward implementation of imitation learning. Notably, its forward kinematics is inconsistent due to imprecise joint measurements, and naively training a policy using such approximate kinematics data often leads to task failure. To overcome this limitation, we introduce a relative action formulation which enables successful policy training and deployment using its approximate kinematics data. A promising outcome of this approach is that the large repository of clinical data, which contains approximate kinematics, may be directly utilized for robot learning without further corrections. We demonstrate our findings through successful execution of three fundamental surgical tasks, including tissue manipulation, needle handling, and knot-tying., Comment: 8 pages

The absence of openly accessible data and specialized foundation models is a major barrier for computational research in surgery. Toward this, (i) we open-source the largest dataset of general surgery videos to-date, consisting of 680 hours of surgical videos, including data from robotic and laparoscopic techniques across 28 procedures; (ii) we propose a technique for video pre-training a general surgery vision transformer (GSViT) on surgical videos based on forward video prediction that can run in real-time for surgical applications, toward which we open-source the code and weights of GSViT; (iii) we also release code and weights for procedure-specific fine-tuned versions of GSViT across 10 procedures; (iv) we demonstrate the performance of GSViT on the Cholec80 phase annotation task, displaying improved performance over state-of-the-art single frame predictors.

Prostate cancer diagnosis continues to encounter challenges, often due to imprecise needle placement in standard biopsies. Several control strategies have been developed to compensate for needle tip prediction inaccuracies, however none were compared against each other, and it is unclear whether any of them can be safely and universally applied in clinical settings. This paper compares the performance of two resolved-rate controllers, derived from a mechanics-based and a data-driven approach, for bevel-tip needle control using needle shape manipulation through a template. We demonstrate for a simulated 12-core biopsy procedure under model parameter uncertainty that the mechanics-based controller can better reach desired targets when only the final goal configuration is presented even with uncertainty on model parameters estimation, and that providing a feasible needle path is crucial in ensuring safe surgical outcomes when either controller is used for needle shape manipulation.

The dominant paradigm for end-to-end robot learning focuses on optimizing task-specific objectives that solve a single robotic problem such as picking up an object or reaching a target position. However, recent work on high-capacity models in robotics has shown promise toward being trained on large collections of diverse and task-agnostic datasets of video demonstrations. These models have shown impressive levels of generalization to unseen circumstances, especially as the amount of data and the model complexity scale. Surgical robot systems that learn from data have struggled to advance as quickly as other fields of robot learning for a few reasons: (1) there is a lack of existing large-scale open-source data to train models, (2) it is challenging to model the soft-body deformations that these robots work with during surgery because simulation cannot match the physical and visual complexity of biological tissue, and (3) surgical robots risk harming patients when tested in clinical trials and require more extensive safety measures. This perspective article aims to provide a path toward increasing robot autonomy in robot-assisted surgery through the development of a multi-modal, multi-task, vision-language-action model for surgical robots. Ultimately, we argue that surgical robots are uniquely positioned to benefit from general-purpose models and provide three guiding actions toward increased autonomy in robot-assisted surgery.

Recent advances in robot-assisted surgery have resulted in progressively more precise, efficient, and minimally invasive procedures, sparking a new era of robotic surgical intervention. This enables doctors, in collaborative interaction with robots, to perform traditional or minimally invasive surgeries with improved outcomes through smaller incisions. Recent efforts are working toward making robotic surgery more autonomous which has the potential to reduce variability of surgical outcomes and reduce complication rates. Deep reinforcement learning methodologies offer scalable solutions for surgical automation, but their effectiveness relies on extensive data acquisition due to the absence of prior knowledge in successfully accomplishing tasks. Due to the intensive nature of simulated data collection, previous works have focused on making existing algorithms more efficient. In this work, we focus on making the simulator more efficient, making training data much more accessible than previously possible. We introduce Surgical Gym, an open-source high performance platform for surgical robot learning where both the physics simulation and reinforcement learning occur directly on the GPU. We demonstrate between 100-5000x faster training times compared with previous surgical learning platforms. The code is available at: https://github.com/SamuelSchmidgall/SurgicalGym.

Magnetic robotics obviate the physical connections between the actuators and end effectors resulting in ultra-minimally invasive surgeries. Even though such a wireless actuation method is highly advantageous in medical applications, the trade-off between the applied force and miniature magnetic end effector dimensions has been one of the main challenges in practical applications in clinically relevant conditions. This trade-off is crucial for applications where in-tissue penetration is required (e.g., needle access, biopsy, and suturing). To increase the forces of such magnetic miniature end effectors to practically useful levels, we propose an impact-force-based suturing needle that is capable of penetrating into in-vitro and ex-vivo samples with 3-DoF planar freedom (planar positioning and in-plane orienting). The proposed optimized design is a custom-built 12 G needle that can generate 1.16 N penetration force which is 56 times stronger than its magnetic counterparts with the same size without such an impact force. By containing the fast-moving permanent magnet within the needle in a confined tubular structure, the movement of the overall needle remains slow and easily controllable. The achieved force is in the range of tissue penetration limits allowing the needle to be able to penetrate through tissues to follow a suturing method in a teleoperated fashion. We demonstrated in-vitro needle penetration into a bacon strip and successful suturing of a gauze mesh onto an agar gel mimicking a hernia repair procedure., Comment: Journal, 5 figures

Real-time visual localization of needles is necessary for various surgical applications, including surgical automation and visual feedback. In this study we investigate localization and autonomous robotic control of needles in the context of our magneto-suturing system. Our system holds the potential for surgical manipulation with the benefit of minimal invasiveness and reduced patient side effects. However, the non-linear magnetic fields produce unintuitive forces and demand delicate position-based control that exceeds the capabilities of direct human manipulation. This makes automatic needle localization a necessity. Our localization method combines neural network-based segmentation and classical techniques, and we are able to consistently locate our needle with 0.73 mm RMS error in clean environments and 2.72 mm RMS error in challenging environments with blood and occlusion. The average localization RMS error is 2.16 mm for all environments we used in the experiments. We combine this localization method with our closed-loop feedback control system to demonstrate the further applicability of localization to autonomous control. Our needle is able to follow a running suture path in (1) no blood, no tissue; (2) heavy blood, no tissue; (3) no blood, with tissue; and (4) heavy blood, with tissue environments. The tip position tracking error ranges from 2.6 mm to 3.7 mm RMS, opening the door towards autonomous suturing tasks.

The COVID-19 pandemic left an unprecedented impact on the general public health, resulting in thousands of deaths in the US alone. Nationwide testing plans were initiated to control the spread, with drive-through being the currently dominant testing approach, which, however, exhausts personal protective equipment supplies, and is unfriendly to individuals not owning a vehicle. Walk-up testing booths are a safe alternative, but are too prohibitively priced on the market to allow for nationwide deployment. In this paper, we present an accessible, mobile, affordable, and safe version of a positive-pressure COVID-19 testing booth. The booths are manufactured using primarily off-the-shelf components from US vendors with minimized customization. The booths' mobility allows them to be easily transported within local communities to test a larger subset of the population with fewer transportation options. Moreover, the final bill of materials does not surpass USD 3,900, which is about half of the market price. The booths are air conditioned and HEPA filtered to offer healthcare providers a safe and comfortable working environment. The prototype passed required pressure and air exchange tests, and was positively reviewed by two healthcare professionals. Currently, five booths are deployed and used at the Johns Hopkins University School of Nursing, Baltimore City Health Department, and two community health centers in Baltimore. Our design facilitates walk-up testing in the US, as it decreases PPE consumption; reduces the risk of infection; and is accessible to lower-income communities and non-drivers.

Medical robots can play an important role in mitigating the spread of infectious diseases and delivering quality care to patients during the COVID-19 pandemic. Methods and procedures involving medical robots in the continuum of care, ranging from disease prevention, screening, diagnosis, treatment, and homecare have been extensively deployed and also present incredible opportunities for future development. This paper provides an overview of the current state-of-the-art, highlighting the enabling technologies and unmet needs for prospective technological advances within the next 5-10 years. We also identify key research and knowledge barriers that need to be addressed in developing effective and flexible solutions to ensure preparedness for rapid and scalable deployment to combat infectious diseases., Comment: 8 pages, 9 figures, publish in RA-magazine

Since the first reports of a novel coronavirus (SARS-CoV-2) in December 2019, over 33 million people have been infected worldwide and approximately 1 million people worldwide have died from the disease caused by this virus, COVID-19. In the US alone, there have been approximately 7 million cases and over 200,000 deaths. This outbreak has placed an enormous strain on healthcare systems and workers. Severe cases require hospital care, and 8.5\% of patients require mechanical ventilation in an intensive care unit (ICU). One major challenge is the necessity for clinical care personnel to don and doff cumbersome personal protective equipment (PPE) in order to enter an ICU unit to make simple adjustments to ventilator settings. Although future ventilators and other ICU equipment may be controllable remotely through computer networks, the enormous installed base of existing ventilators do not have this capability. This paper reports the development of a simple, low cost telerobotic system that permits adjustment of ventilator settings from outside the ICU. The system consists of a small Cartesian robot capable of operating a ventilator touch screen with camera vision control via a wirelessly connected tablet master device located outside the room. Engineering system tests demonstrated that the open-loop mechanical repeatability of the device was 7.5\,mm, and that the average positioning error of the robotic finger under visual servoing control was 5.94\,mm. Successful usability tests in a simulated ICU environment were carried out and are reported. In addition to enabling a significant reduction in PPE consumption, the prototype system has been shown in a preliminary evaluation to significantly reduce the total time required for a respiratory therapist to perform typical setting adjustments on a commercial ventilator, including donning and doffing PPE, from 271 seconds to 109 seconds., Comment: 22 pages, 9 figures, 1 table; submitted to Frontiers in Robotics; in review