Intelligent robotic systems in surgery.
Covo, Petar ; Grzan, Marijan ; Covo, Ana 等
Abstract: Modern medicine is one of the prime movers initiating the
development of new technologies within which the application of robots
is of quite new and special significance. The robotic system--ROKI was
designed and developed to assist at operations in surgery. It can be
controlled by preprogrammed routines, by joystick located in the control
console or by voice control. By designing and manufacture of the robotic
system for assistance in surgery the following objectives have been
achieved: 1) designing, developing and manufacture of a robot for the
assistance in surgery; 2) designing and development of SW support for
the control and integration of the robot in the operation room
environment; 3) applying HW and SW modular assembly a few robot variants
were worked out; 4) all phases were integrated; 5) testing and finishing
of the prototype fabricated and the optimization of work and control
parameters. The system simulated behavior and probable control
algorithms were tested on the prototype (Fig. 1.). The tests were based
on the measurements and analysis of the signals of control and check
elements. The accuracy positioning depends mostly on the flexible
deformations of the robot arm and results repeatability within [+ or -]
mm tolerance range, at the maximum acceleration. The tests made on the
robot prototype confirmed the adequacy of the methods applied and tools
used The development of control system, together with the development of
safety, should undergo further research in order to set the conditions
for greater influence of a man in the joint work with these structure
robots types.
Key words: robotic system, surgery
1. INTRODUCTION
The robotic system--ROKI was designed and developed to assist at
operations in surgery within the project financed by the Croatian
Institute of Technology covered by TEST program. The project was managed
by the University of Zadar that formed a project team of 11 researches
who defined and make a conceptual design. The conceptual design
development, designing and manufacture, as well as the control and final
tests of this robotic system were carried out in HSTEC Zadar.
This robot prototype was developed for the first level of
application, and in this way the necessary conditions have been
fulfilled to use a robot in surgery and other medical fields, especially
in laboratories, patient rehabilitation and education, as well as in
related pharmaceutical industry where adequately "equipped"
robots can successfully replace a man in adverse and dangerous
situations for him. Modern HW and SW were applied at the designing of
the robot, where the application of simulation and generally digital and
virtual production adequately reduced the time necessary to develop and
fabricate the robot. Knowledge and experiences gained during the project
execution will set the conditions necessary for the second level of the
robot application in surgery. Sosa, T. at. all. (2007)
Highly sophisticated robotic equipment assists a surgeon in
operations by producing an image of an operative section through a
special camera, and by holding, in a specially designed robot arm,
surgical instruments or even the heart being operated. ROKI may be
controlled by preprogrammed routines, and by joystick located in the
control console. Touch-panel on the console enables easy handling where
the control is carried out easily with four rotary and one linear robot
axes. Voice control is also possible and this facilitates the work of a
surgeon during the operation to a great extent. During the operation,
the robotic system makes a video recording of a complete operation and
files it in its own database. Udiljak, T. at all., (2007),
2. MANUFACTURE PROCEDURE
By designing and manufacture of the robotic system for assistance
in surgery the following objectives have been achieved: 1) designing,
developing and manufacture of a robot for the assistance in surgery; 2)
designing and development of SW support for the control and integration
of the robot in the operation room environment; 3) applying HW and SW
modular assembly a few robot variants were worked out; 4) all phases
were integrated; 5) testing and finishing of the prototype fabricated
and the optimization of work and control parameters.
Defined operations at the prototype manufacture are: 1) system
conceptual design project; 2) control system designing; 3) virtual
robotic system model designing and simulation; 4) preparation of
technical documentation; 5) purchase of standard components; 6)
fabrication of structural elements; 7) necessary control software
engineering; 8) prototype assembling; 9) prototype testing; 10) work and
control parametres adjusting and optimization; 11) preparation of
documentation to initiate the procedure for the obtaining of a
preliminary permit for clinical testing in Croatia.
The result measurableness is divided in four phases: 1st phase: a)
system conceptual design project, b) control system designing, c)
virtual robotic system model and operation simulation; 2nd phase: a)
preparation of technical documentation, b) purchase of standard
components and eleboration of the system variants; 3rd phase: a)
fabrication of structural elements, b) necessary control software
(program support) engineering for the system control and integration and
prototype assembling; 4th phase: a) prototype testing under laboratory
and clinical conditions, b) system finishing-up and optimization.
The project innovativeness and originality are based on the
adoption of new knowledge in the fields of: 1) designing and application
of robotic systems; 2) application of voice control in the control of
robots; 3) human-robot interaction in surgery.
Contribution to the Croatian technological developments is based on
the successful development of a new, export-oriented product made after
innovative actions and strategic planning. The project contributes to
the productivity rise in general, export competitiveness based on the
investments in knowledge. The prototype of a robotic module for the
assistance in surgery may become a competitive export product, while the
innovative components for new technologies may become the basis for the
rise in the competitiveness of Croatian companies that want to automate
and improve their production.
Potential users of the robotic module for the assistance in surgery
are hospitals and other health institutions in the country, as well as
faculties and educational institutions of medicine. Some project results
may generally be used in the robot application and development.
The project validation is based on the establishment of new,
interdisciplinary knowledge and teams for the implementation of robotics
in medicine and other fields of human activity. According to the
analyses made, there exists a strong interest in this project in the
country, as well as abroad. The project usefulness is in the development
and the realization of an innovative market and export-oriented
high-tech product.
After the prototype of the robotic system for the assistance and
auxiliary operations in surgery has been completed, it is necessary to
complete the documentation in compliance with ISO 13 485 and prepare
documentation to initiate the procedure to obtain the preliminary permit
for clinical tests in Croatia in accordance with the Law on Medicines
and Medical Devices (Official Journal No. 121/03 and No. 177/04) and the
Rules on Clinical Tests and Good Clinical Practice (Official Journal No.
175/03 and No. 55/04).
3. TEST RESULTS
When the system was being planned and designed, special attention
was paid to the flexibility of a modular concept that offers a wide
variety of applications. The Z-axis shift creates the space ready to
accommodate medical instruments, units for a device handling and
mounting. Altintas,. at all. (2005)
The system simulated behavior and probable control algorithms were
tested on the prototype (Fig. 1.). The tests were based on the
measurements and analysis of the signals of control and check elements.
[FIGURE 1 OMITTED]
The accuracy positioning depends mostly on the flexible
deformations of the robot arm and results repeatability within [+ or -]
0.02 mm tolerance range, at the maximum acceleration. In the next step
it is planned that the quality of a variety of processing procedures by
motorspindle in both variants (motorspindle in motion and fixed) for the
operation processing is tested. Watanabe, A. at all. (2005)
An application functional limit in medicine should be minimized
when the robotic systems of this kind are developed, although the costs
of implementation, a set of applications for non-structured and often
varying composed programs (educational staff), modifications and limited
productions are high. On the other hand, conventional equipment handling
is considerably limited as regards efficiency, accuracy and safety
issues.
4. OPERATING ROOM
An operating room is a room specially designed for surgery. To meet
the requirements this room should: 1) be separated from patient ward and
outside world, 2) be technically and infrastructurally equipped for
surgery, 3) meet standardized room and sanitary conditions, 4) have
available all necessary anterooms enabling free and safe taking patients
in and out, anesthesiological preparation and wakening after an
operation, washing and sterilization of instruments, and storing of
surgical supplies and medicines. Brunicardi, F. C. at all. (2009)
Success in treating of any illness requiring surgery depends on
adequate use of elementary knowledge at diagnostic assessment, adequate
pre-surgery preparation and continuing care of patients prior and after
the surgery. A true care and understanding of the patient's
problems make a surgeon a doctor. Taking into consideration invaluable
importance of the psychosomatic component, a surgeon: 1) should clearly
inform the patient on the nature of his illness, 2) should clarify basic
principles of the operation, 3) should document his decision to perform
the operation, 4) should provide an explanation that has to be in
compliance with Evidence Based Medicine (EBM), 5) when explaining an
indication, it is useful to call, with the permission of the patient, a
family conference to make jointly the best decision to the benefit of
the patient when the immediate family is present, 6) should make
psychological preparation in the atmosphere of mutual trust, which
considerably effects the patient's will to live, as well as the
whole body protective-immunological system during operation. By adopting
a robotic system for assistance in surgery, a new form of education will
be adopted, too.
The above-mentioned duties are primarily parts of medical ethics and vocation, and today they are additionally regulated by law (written
consent by patient or guardian).
Modern operating room design has been developing since the time
when the operations were performed at the patient's home, then in
the surgery clinic or in the tent near battlefield, and to present day
when special rooms are designed in such a way that offer optimum
conditions enabling the operation performance at the minimum risk. The
appropriate room design is necessary not only for immediate medical
treatment of the patient and the provision of adequate environment for
the staff included in the treatment, but also that all the supplies
necessary for the operation are put into it. The staff that should be
present in the operating room consists of a surgeon, assistants,
anesthesiologist, instrument nurses, anesthesia technicians and
perfusionists. In addition to the above there are attendants who do the
cleaning of the operating room and surgical ward, then attendants
maintaining and cleaning the instruments, biomedical engineers, officers
in charge for orders and administrative officers, who are very important
in providing normal functioning of the ward and operating room. To
perform a standard operation there should be at least eight persons in
one operating room. In case of complex specialized operations, the
number of persons present increases to seventeen.
5. CONCLUSION
ROKI, as the first Croatian robotic system for the assistance in
surgery, has created preconditions for further innovations in the
robotic surgery (in cardiac surgery, bone surgery, neurosurgery) and has
made exceptionally positive technological breakthrough in medicine. The
robotic system of a designed structure with a vertical movement located
in the structure column can successfully support a variety of tasks in
the medicine. The tests made on the robot prototype confirmed the
adequacy of the methods applied and tools used. The development of
control system, together with the development of safety, should undergo
further research in order to set the conditions for greater influence of
a man in the joint work with these structure robots types.
At the 38th International Showroom of Innovations, New Technologies
and Products "GENEVE 2010" in April 2010, the work "The
Prototype of a Robotic System for Assistance in
Surgery--"ROKI" Z20091863" received 1) Golden Medallion
and a Special Acknowledgement of the Jury, 2) Special Award of the
National Agency for Scientific Researches of the Romanian Ministry of
Education, Research, Youth and Sport.
The results have been obtained within the TEST--Technologically
research-development projects--program with the support of Croatian
Institute of Technology.
6. REFERENCES:
Altintas, Y., Brecher, C., Weck, M., Witt, S., (2005), Virtual
Machine Tool, Annals of the CIRP.
Sosa, T. at. all. (2007) Surgery, Naklada Ljevak, Zagreb
Udiljak, T. at all., (2007), Intelligent Robot Systems for Flexible
Attendance of Machine Tools, 11th International Scientific Conference on
Production Engineering--CIM2007
Watanabe, A., Sakakibara, S., Ban, K., Yamada, M., Shen, G.,
(2005), Autonomous Visual Measurement for Accurate Setting of Workpieces
in Robotic Cells, Annals CIP
Watanabe, A. at all. (2005), Autonomous Visual Measurement ...
Brunicardi, F.C. at all. (2009), Schwartz's Principles of
Surgery, 9 Edition, McGraw--Hill professional
