A Teleoperated Control for Robot-Aided Percutaneous Surgery: An Application to Needle Insertion in Nephrolithotomy
Clemente Lauretti, Rosaura Morfino, Francesco Cocco, Francesco Prata, Rocco Papalia and Loredana Zollo
AI summary
Problem
Current teleoperated robotic systems lack real-time needle path re-planning to compensate for intra-operative anatomical shifts, and no studies systematically compare the performance of different teleoperation control modes for percutaneous needle insertion.
Approach
The authors designed a teleoperated control architecture that safely re-plans the needle access point in real-time using cylindrical workspace constraints, followed by needle advancement via two selectable control modes: parallel position/velocity and master-slave position error-based.
Key results
- Real-time access point re-planning maintains safe skin distance while preserving needle orientation
- Parallel position/velocity mode achieved higher needle orientation accuracy and motion smoothness
- Master-slave position error mode demonstrated superior needle displacement responsiveness
- Both modes were rated intuitive and acceptable by experts with moderate mental and physical workload
Why it matters
This adaptable teleoperation framework enhances patient safety and surgical precision in percutaneous procedures, offering clinicians a reliable tool for real-time trajectory adjustments and robotic surgery developers a validated control comparison.
Abstract
Minimally Invasive Percutaneous Surgery (MIPS) has revolutionized medical practice by allowing access to internal organs through needle puncture, thus avoiding large incisions. Tele-operated robotic systems address MIPS challenges, but current literature lacks real-time needle path re-planning during surgery, which is crucial due to organ shifts between pre- operative imaging and the intra-operative setting. Moreover, no studies have systematically compared the performance of different control strategies. This letter aims to enhance MIPS effectiveness by improving patient safety while considering effi- ciency, usability, and acceptability. A new tele-operated control strategy, adaptable to surgeon preferences, is introduced with application to nephrolithotomy. The strategy integrates position control for access point re-planning and two operation modes for needle advancement: OM1 – parallel position/velocity, and OM2 – master-slave position error-based. Experimental validation involved six subjects performing nephrolithotomy on a synthetic anatomical model. Results showed comparable puncture time, usability, and acceptability between modes. OM1 achieved higher needle orientation accuracy (max DNA = 0.006 ± 0.003 [rad]) and motion smoothness (SM = 0.13 ± 0.08), while OM2 was more responsive in terms of needle displacement accuracy (CRE = 0.8 ± 0.9 [mm]). Six experts further evaluated the system, finding both modes intuitive with moderate mental and physical workload.