Purpose

Cooperative surgical systems enable humans and machines to combine their individual strengths and collaborate to improve the surgical outcome. Cooperative telemanipulated systems offer the widest spectrum of cooperative functionalities, because motion scaling is possible. Haptic guidance can be used to assist surgeons and haptic feedback makes acting forces at the slave side transparent to the operator, however, overlapping and masking of forces needs to be avoided. This study evaluates the usability of a cooperative surgical telemanipulator in a laboratory setting.

Methods

Three experiments were designed and conducted for characteristic surgical task scenarios derived from field studies in orthopedics and neurosurgery to address bone tissue differentiation, guided milling and depth sensitive milling. Interaction modes were designed to ensure that no overlapping or masking of haptic guidance and haptic feedback occurs when allocating information to the haptic channel. Twenty participants were recruited to compare teleoperated modes, direct manual execution and an exemplary automated milling with respect to usability.

Results

Participants were able to differentiate compact and cancellous bone, both directly manually and teleoperatively. Both telemanipulated modes increased effectiveness measured by the mean absolute depth and contour error for guided and depth sensitive millings. Efficiency is decreased if solely a boundary constraint is used in hard material, while a trajectory guidance and manual milling perform similarly. With respect to subjective user satisfaction trajectory guidance is rated best for guided millings followed by boundary constraints and the direct manual interaction. Haptic feedback only improved subjective user satisfaction.

Conclusion

A cooperative surgical telemanipulator can improve effectiveness and efficiency close to an automated execution and enhance user satisfaction compared to direct manual interaction. At the same time, the surgeon remains part of the control loop and is able to adjust the surgical plan according to the intraoperative situation and his/her expertise at any time.

中文翻译：

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协作式外科遥控操作在骨铣削任务中的可用性

目的

协作式外科手术系统使人与机器可以结合各自的优势并协作以改善手术效果。协作远程操纵系统提供了最广泛的协作功能范围，因为可以进行运动缩放。触觉引导可用于协助外科医生，并且触觉反馈可使从动侧的作用力对操作员透明，但是，需要避免力的重叠和掩盖。这项研究评估了在实验室环境中协作外科手术远距操纵器的可用性。

方法

针对骨科和神经外科领域的野外研究，针对特征性外科任务方案设计并进行了三个实验，以解决骨组织分化，导向铣削和深度敏感铣削问题。设计交互模式以确保在将信息分配给触觉通道时不会发生触觉指导和触觉反馈的重叠或掩盖。招募了20名参与者，以比较远程操作模式，直接手动执行和关于可用性的示例性自动铣削。

结果

参与者能够直接手动和远程地分辨出致密和松质的骨。两种遥操作模式均通过导向铣削和深度感应铣削的平均绝对深度和轮廓误差来衡量，从而提高了效率。如果仅在硬质材料中使用边界约束，则效率会降低，而轨迹引导和手动铣削的性能类似。关于主观用户满意度，对于引导式铣削，其次是边界约束和直接的手动交互，轨迹引导的评价最高。触觉反馈只会提高主观用户满意度。

结论

与直接手动交互相比，协作式外科手术远程操纵器可提高效率和效率，接近自动化执行，并提高用户满意度。同时，外科医生仍然是控制回路的一部分，并能够根据术中情况和他/她的专业知识随时调整手术计划。