INSTINCT - INtuitive Soft, stiffness-controllable hapTic INterfaCe for soft Tissue palpation during robot-assisted minimally invasive surgery

在开放手术中，外科医生能够直接接触软组织/器官，并进行手动触诊，以了解软组织区域的质地、大小、一致性和位置。比周围组织僵硬的区域可能暗示有肿瘤的存在。通过视觉，最重要的是，通过对外科医生指尖的触觉，外科医生能够通过区分癌症软组织和健康组织来准确地定位不健康的组织区域，并切除肿瘤。自20世纪80年代中期以来，开放手术已越来越多地被微创手术所取代，自2000年以来，机器人辅助微创手术(RMIS)已经越来越多地被取代。手术器械通过3-12毫米的小切口进入人体进行手术。虽然与开放手术相比，RMI具有许多优点，包括改善治疗结果，缩短术后恢复时间，减少组织的免疫应激反应，减少组织创伤，降低术后疼痛，减少疤痕，但目前的机器人系统不能为手术医生提供任何类型的感觉(触觉反馈)。缺乏直接触诊可能会导致肿瘤切除不足，导致生化复发率增加，并影响未来治疗的决定，如额外的手术和放射治疗。正如“本能”的定义，该项目的愿景是在RMI期间进行软组织触诊时，直观地为外科医生提供软组织僵硬信息。该项目的目标是在先前研究开发软的、刚度可控的机器人结构和触觉反馈接口的基础上，设计、建模、制造和验证一种软的、刚度可控的触觉反馈致动器，并将其集成到达芬奇研究工具包中。这项工作成功的关键是与经验丰富的临床和工业专家的密切合作。华威大学医学院的Shervanthi Hmer-Vanniasinkam教授(外科(创始)教授)、伦敦国王学院的Prokar Dasgupta教授(机器人外科与泌尿外科创新)和都灵大学的Alberto Arezzo教授(外科副教授)、Alastair Barrow博士(MD)、仿制机器人技术、Jerome Perret博士(首席执行官)、Haption GmbH博士和Chris Wagner博士(高级顾问)将就项目的持续时间就临床和翻译方面提供咨询。这些项目合作伙伴将组成专家工作组会议，每年至少召开两次会议，对实验设计、实施和研究项目成果提供反馈和批判性评估。实现这一雄心的关键目标是：1)创造由硅胶制成的、柔软的、硬度可控的指尖接口，并集成织物网孔。2)将硬度传感器和执行器与达芬奇研究工具包集成在一起。3)对不同的触觉致动器设计进行基准测试，以区分健康组织和肿瘤组织。潜在的应用和好处：为了最大限度地提高经济和临床影响，本能项目合作伙伴通用机器人公司、Haption GmbH和剑桥咨询公司将就设计过程、开发机会和认证程序提供建议。这些国际运营公司的目标是通过突破性的手术设备和模拟器实现治疗革命，利用模拟、触觉、工程、电子、控制系统、虚拟现实、医疗器械监管和商业化方面的丰富经验。工业合作伙伴的专业知识和临床合作伙伴的指导对于将本能项目的结果转化为医疗设备/培训模拟器至关重要。除了医疗保健领域，可能的应用领域还包括用于虚拟现实环境的可穿戴触觉设备和E-Learning技术。

In open surgery, surgeons are able to directly access soft tissue/organs and perform manual palpation to understand the texture, size, consistency and location of soft tissue areas. Stiffer areas than the surrounding tissue might suggest the presence of tumours. Through vision and, most importantly, tactile sensation of the surgeons' fingertips, surgeons are able to accurately localise unhealthy tissue areas by distinguishing cancerous soft tissue from healthy tissue, and remove tumours. Open surgery has been increasingly replaced by Minimally Invasive Surgery from the mid-1980s and by Robot-assisted Minimally Invasive Surgery (RMIS) from 2000. Surgical instruments are introduced through small incisions ranging from 3-12 mm into the human body to perform surgery. Though RMIS has many advantages over open surgery, including improved therapeutic outcome, shortened postoperative recovery, less immunological stress response of the tissue, reduced tissue trauma, lower postoperative pain, and less scarring, current robotic systems do not provide any type of sensation (haptic feedback) to the operating surgeon. The lack of direct palpation can lead to insufficient tumour excising resulting in an increased rate of biochemical relapse and influence decisions about future treatments such as additional surgery and radiation.Just as the definition of 'instinct' , the vision of this project is to intuitively provide surgeons with soft tissue stiffness information when performing soft tissue palpation during RMIS. Based on previous research creating soft, stiffness-controllable robotic structures and haptic feedback interfaces, the aim of this project is to design, model, fabricate and validate a soft, stiffness-controllable haptic feedback actuator which will be integrated into the da Vinci Research Kit. Of key importance for the success of this work is close collaboration with experienced clinical and industrial experts. Prof. Shervanthi Homer-Vanniasinkam (Professor of Surgery (Founding)), University of Warwick Medical School, Prof. Prokar Dasgupta (Professor of Robotic Surgery and Urological Innovation), King's College London, and Prof. Alberto Arezzo (Associate Professor of Surgery), University of Turin, Dr Alastair Barrow (MD), Generic Robotics, Dr Jerome Perret (CEO), Haption GmbH, and Dr Chris Wagner (Senior Consultant), Cambridge Consultants will consult over the duration of the project on clinical and translational aspects. These Project Partners will form the Expert Working Group meeting at least two times a year, providing feedback and critical appraisal of the experimental design, implementation and outcomes from the research project.The key objectives through which this ambition will be realised are:1) Creating pneumatically actuated, soft, stiffness-controllable fingertip interfaces made of silicone with integrated fabric meshes.2) Integration of stiffness sensor and actuators with the da Vinci Research Kit. 3) Benchmarking tests of different haptic actuator designs distinguishing between healthy and tumorous tissue.POTENTIAL APPLICATIONS AND BENEFITS:To maximise economic and clinical impact, INSTINCT project partners Generic Robotics, Haption GmbH, and Cambridge Consultants will advise on the design process, exploitation opportunities and certification procedure. These internationally operating companies aim at revolutionising therapy through ground-breaking surgical devices and simulators drawing on deep experience in simulation, haptics, engineering, electronics, control systems, Virtual Reality, medical device regulations, and commercialisation. The expertise of the industrial partner and guidance of clinical partners are of paramount importance to translate the results of the INSTINCT projects into a medical device/training simulator. Beyond the healthcare sector, possible application areas include wearable haptic devices for Virtual Reality environments and E-Learning technologies.