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In context of the Corona pandemic, telemedicine acquired a new significance. Whereas previously the aim was to override given barriers, now, in the case of a pandemic, the main idea is to create an intentional distance between patients and healthcare professionals in order to avoid cross-infection. To meet the needs of a fully diagnostic examination, a robotic based system was designed. However, collaborative robotic systems bear new risks, that have to be dealt with. To prepare future physicians for telediagnostics, we developed a training curriculum for the telemedical examinations. It is based upon multiple stages including a skill trainer, healthy volunteers, supervised examinations of real patients and an exam. In a first proof of concept, we demonstrated the existence of a learning curve and significant better performance after the passed curriculum compared to an untrained collective.

PurposeIn the era of patient-centered medicine, clinical procedures, tools and instruments should be individually adapted to the patient. In this context, the presented 3D-printed Single-Port Overtube Manipulator System follows the aims to provide patient- and task-specific disposable manipulators for minimally invasive surgery. In a first experiment, the robustness of the monolithic flexure hinge structures in use as robotic manipulators will be investigated.MethodsCustomizable monolithic manipulator structures designed by means of an automated design process and manufactured with selective laser sintering were investigated with regard to long-term stability in an endurance test. Therefore, a bare manipulator arm, an arm equipped with a standard instrument and finally loaded with an additional load of 0.5 N were evaluated by continuously following a trajectory within the workspace of the manipulator arms over a period of 90 min.ResultsThe unloaded manipulator as well as the manipulator arm equipped with a standard instrument showed a sufficient reproducibility (deviation of 1.5 mm and 2.5 mm, respectively, on average) with regard to an application as telemanipulated master–slave surgical robotic system. The 3D-printed manipulators showed no damage and maintained integrity after the experiment.ConclusionIt has been shown that 3D-printed manipulators in principle are suitable for use as disposable surgical manipulator systems and offer a long-term stability over at least 90 min. The developed manipulator design shows great potential for the production of patient-, task- and user-specific robot systems. However, the manipulator geometries as well as the control strategies still show room for improvements.

Purpose Autonomously self-navigating clinical assistance systems (ASCAS) seem highly promising for improving clinical workflows. There is great potential for easing staff workload and improving overall efficiency by reducing monotonous and physically demanding tasks. However, a seamless integration of such systems into complex human-supervised clinical workflows is challenging. As of yet, guiding principles and specific approaches for solving this problem are lacking. Methods We propose to treat ASCAS orchestration as a scheduling problem. However, underlying objectives and constraints for this scheduling problem differ considerably from those found in other domains (e.g., manufacturing, logistics). We analyze the clinical environment to deduce unique needs and conclude that existing scheduling approaches are not sufficient to overcome these challenges. Results We present four guiding principles, namely human precedence, command structure, emergency context and immediacy, that govern the integration of self-navigating assistance systems into clinical workflows. Based on these results, we propose our approach, namely Auto-Navigation Task Scheduling for Operating Rooms (ANTS-OR), for solving the ASCAS orchestration problem in a surgical application scenario, employing a score-based scheduling strategy. Conclusion The proposed approach is a first step toward addressing the ASCAS orchestration problem for the OR wing. We are currently advancing and validating our concept using a simulation environment and aim at realizing a dynamic end-to-end ASCAS orchestration platform in the future.

Purpose Minimally invasive surgery (MIS) has become the standard for many surgical procedures as it minimizes trauma, reduces infection rates and shortens hospitalization. However, the manipulation of objects in the surgical workspace can be difficult due to the unintuitive handling of instruments and limited range of motion. Apart from the advantages of robot-assisted systems such as augmented view or improved dexterity, both robotic and MIS techniques introduce drawbacks such as limited haptic perception and their major reliance on visual perception. Methods In order to address the above-mentioned limitations, a perception study was conducted to investigate whether the transmission of intra-abdominal acoustic signals can potentially improve the perception during MIS. To investigate whether these acoustic signals can be used as a basis for further automated analysis, a large audio data set capturing the application of electrosurgery on different types of porcine tissue was acquired. A sliding window technique was applied to compute log-mel-spectrograms, which were fed to a pre-trained convolutional neural network for feature extraction. A fully connected layer was trained on the intermediate feature representation to classify instrument–tissue interaction. Results The perception study revealed that acoustic feedback has potential to improve the perception during MIS and to serve as a basis for further automated analysis. The proposed classification pipeline yielded excellent performance for four types of instrument–tissue interaction (muscle, fascia, liver and fatty tissue) and achieved top-1 accuracies of up to 89.9%. Moreover, our model is able to distinguish electrosurgical operation modes with an overall classification accuracy of 86.40%. Conclusion Our proof-of-principle indicates great application potential for guidance systems in MIS, such as controlled tissue resection. Supported by a pilot perception study with surgeons, we believe that utilizing audio signals as an additional information channel has great potential to improve the surgical performance and to partly compensate the loss of haptic feedback.

We propose a novel method to tackle the visual-inertial localization problem for constrained camera movements. We use residuals from the different modalities to jointly optimize a global cost function. The residuals emerge from IMU measurements, stereoscopic feature points, and constraints on possible solutions in SE(3). In settings where dynamic disturbances are frequent, the residuals reduce the complexity of the problem and make localization feasible. We verify the advantages of our method in a suitable medical use case and produce a dataset capturing a minimally invasive surgery in the abdomen. Our novel clinical dataset MITI is comparable to state-of-the-art evaluation datasets, contains calibration and synchronization and is available at https://mediatum.ub.tum.de/1621941.

A common treatment for malignant hepatic tumors is radiofrequency thermal ablation (RFA); however this procedure is often exhausting and error-prone, when performed only with hand held devices. In this work, we present a new concept for a computer- and mechatronic-arm-assisted treatment of hepatic tumor with RFA. Challenging factors of state-of-the-art RFA procedures are tackled by utilizing a prototype, which combines state-of-the-art ultrasound image guidance with a mechatronic support arm system. Physicians can image and examine the human abdomen using an ultrasound capturing device which is guided by the mechatronic support arm. The mechatronic arm allows to track the ultrasound transducer via joint position encoders, so that the recorded images’ exact positions are acquired and the patient is automatically registered during imaging. Consequently, physicians can use the acquired ultrasound images to navigate in the imaged abdomen area. The established prototype enables preplanning and semi-automatic alignment of trajectories with sufficient accuracy. In addition, the arm system supports the usually lengthy, exhausting and error-prone holding of the needle during the ablation process. Based on the results of accuracy examination and expert assessments by surgeons, the established concept could be proven to be advantageous for the considered use case.