Robotic assistance in minimally invasive surgery can greatly enhance surgical precision and reduce surgeon fatigue. This paper presents a focused investigation on the kinematic and ergonomic design principles for a laparoscopic surgical robotic arm aimed at high-precision tasks. We propose a 7-degree-of-freedom (7-DOF) robotic arm system that incorporates a remote center of motion (RCM) at the instrument insertion point and ergonomic considerations to improve surgeon interaction. The design is implemented on a general-purpose robotic platform, and a series of simulated surgical tasks were performed to evaluate targeting accuracy, task efficiency, and surgeon comfort compared to conventional manual laparoscopy. Experimental results demonstrate that the optimized robotic design achieves significantly improved targeting accuracy (error reduced by over 50%) and shorter task completion times, while substantially lowering operator muscle strain and discomfort. These findings validate the importance of kinematic optimization (such as added articulations and tremor filtering) and human-centered ergonomic design in enhancing the performance of robot-assisted surgery. The insights from this work can guide the development of next-generation surgical robots that improve surgical outcomes and ergonomics for the operating team.

Robot-assisted surgery has revolutionized the healthcare industry by providing surgeons with greater precision, reducing invasiveness, and improving patient outcomes. However, the success of these surgeries depends heavily on the robotic system ability to accurately interpret the intentions of the surgical trainee or even surgeons. One critical factor impacting intent recognition is the cognitive workload experienced during the procedure. In our recent research project, we are building an intelligent adaptive system to monitor cognitive workload and improve learning outcomes in robot-assisted surgery. The project will focus on achieving a semantic understanding of surgeon intents and monitoring their mental state through an intelligent multi-modal assistive framework. This system will utilize brain activity, heart rate, muscle activity, and eye tracking to enhance intent recognition, even in mentally demanding situations. By improving the robotic system ability to interpret the surgeons intentions, we can further enhance the benefits of robot-assisted surgery and improve surgery outcomes.

Holistic surgical scene segmentation in robot-assisted surgery (RAS) enables surgical residents to identify various anatomical tissues, articulated tools, and critical structures, such as veins and vessels. Given the firm intraoperative time constraints, it is challenging for surgeons to provide detailed real-time explanations of the operative field for trainees. This challenge is compounded by the scarcity of expert surgeons relative to trainees, making the unambiguous delineation of go- and no-go zones inconvenient. Therefore, high-performance semantic segmentation models offer a solution by providing clear postoperative analyses of surgical procedures. However, recent advanced segmentation models rely on user-generated prompts, rendering them impractical for lengthy surgical videos that commonly exceed an hour. To address this challenge, we introduce Surg-SegFormer, a novel prompt-free model that outperforms current state-of-the-art techniques. Surg-SegFormer attained a mean Intersection over Union (mIoU) of 0.80 on the EndoVis2018 dataset and 0.54 on the EndoVis2017 dataset. By providing robust and automated surgical scene comprehension, this model significantly reduces the tutoring burden on expert surgeons, empowering residents to independently and effectively understand complex surgical environments.

Background: Robot-assisted surgery has been widely adopted in recent years. However, compared to other health technologies operating in close proximity to patients in a vulnerable state, ethical issues of robot-assisted surgery have received less attention. Against the background of increasing automation that are expected to raise new ethical issues, this systematic review aims to map the state of the ethical debate in this field. Methods: A protocol was registered in the international prospective register of systematic reviews (PROSPERO CRD42023397951). Medline via PubMed, EMBASE, CINHAL, Philosophers' Index, IEEE Xplorer, Web of Science (Core Collection), Scopus and Google Scholar were searched in January 2023. Screening, extraction, and analysis were conducted independently by two authors. A qualitative narrative synthesis was performed. Results: Out of 1,723 records, 66 records were included in the final dataset. Seven major strands of the ethical debate emerged during analysis. These include questions of harms and benefits, responsibility and control, professional-patient relationship, ethical issues in surgical training and learning, justice, translational questions, and economic considerations. Discussion: The identified themes testify to a broad range of different and differing ethical issues requiring careful deliberation and integration into the surgical ethos. Looking forward, we argue that a different perspective in addressing robotic surgical devices might be helpful to consider upcoming challenges of automation.

The rise of Large Language Models (LLMs) has impacted research in robotics and automation. While progress has been made in integrating LLMs into general robotics tasks, a noticeable void persists in their adoption in more specific domains such as surgery, where critical factors such as reasoning, explainability, and safety are paramount. Achieving autonomy in robotic surgery, which entails the ability to reason and adapt to changes in the environment, remains a significant challenge. In this work, we propose a multi-modal LLM integration in robot-assisted surgery for autonomous blood suction. The reasoning and prioritization are delegated to the higher-level task-planning LLM, and the motion planning and execution are handled by the lower-level deep reinforcement learning model, creating a distributed agency between the two components. As surgical operations are highly dynamic and may encounter unforeseen circumstances, blood clots and active bleeding were introduced to influence decision-making. Results showed that using a multi-modal LLM as a higher-level reasoning unit can account for these surgical complexities to achieve a level of reasoning previously unattainable in robot-assisted surgeries. These findings demonstrate the potential of multi-modal LLMs to significantly enhance contextual understanding and decision-making in robotic-assisted surgeries, marking a step toward autonomous surgical systems.

The dominant paradigm for end-to-end robot learning focuses on optimizing task-specific objectives that solve a single robotic problem such as picking up an object or reaching a target position. However, recent work on high-capacity models in robotics has shown promise toward being trained on large collections of diverse and task-agnostic datasets of video demonstrations. These models have shown impressive levels of generalization to unseen circumstances, especially as the amount of data and the model complexity scale. Surgical robot systems that learn from data have struggled to advance as quickly as other fields of robot learning for a few reasons: (1) there is a lack of existing large-scale open-source data to train models, (2) it is challenging to model the soft-body deformations that these robots work with during surgery because simulation cannot match the physical and visual complexity of biological tissue, and (3) surgical robots risk harming patients when tested in clinical trials and require more extensive safety measures. This perspective article aims to provide a path toward increasing robot autonomy in robot-assisted surgery through the development of a multi-modal, multi-task, vision-language-action model for surgical robots. Ultimately, we argue that surgical robots are uniquely positioned to benefit from general-purpose models and provide three guiding actions toward increased autonomy in robot-assisted surgery.

Endoscopic video recordings are widely used in minimally invasive robot-assisted surgery, but when the endoscope is outside the patient's body, it can capture irrelevant segments that may contain sensitive information. To address this, we propose a framework that accurately detects out-of-body frames in surgical videos by leveraging self-supervision with minimal data labels. We use a massive amount of unlabeled endoscopic images to learn meaningful representations in a self-supervised manner. Our approach, which involves pre-training on an auxiliary task and fine-tuning with limited supervision, outperforms previous methods for detecting out-of-body frames in surgical videos captured from da Vinci X and Xi surgical systems. The average F1 scores range from 96.00 to 98.02. Remarkably, using only 5% of the training labels, our approach still maintains an average F1 score performance above 97, outperforming fully-supervised methods with 95% fewer labels. These results demonstrate the potential of our framework to facilitate the safe handling of surgical video recordings and enhance data privacy protection in minimally invasive surgery.

While artificial intelligence continues to transform health care, the tech has an Achilles heel: training AI systems to perform specific tasks requires a great deal of annotated data that engineers sometimes just don't have or cannot get. In a perfect world, researchers would be able to digitally generate the exact data they need when they need it, unlocking new capabilities of AI. In reality, however, even digitally generating this data is tricky because real-world data, especially in medicine, is complex and multi-faceted. But solutions are in the pipeline. Researchers in the Whiting School of Engineering's Laboratory for Computational Sensing and Robotics have created software to realistically simulate the data necessary for developing AI algorithms that perform important tasks in surgery, such as X-ray image analysis.

Fueled by advances in computing hardware and software, Artificial intelligence (AI) is rapidly becoming commonplace in healthcare settings. Just a few years ago, it was emerging from the research labs of tech giants like Google and Microsoft. Today, AI is being used in a wide range of industries to improve efficiencies and make better decisions. Healthcare is no exception--it's one of the most promising applications of AI technology today. Here's how artificial intelligence will transform the future of healthcare.

Trust is an important variable in health-related decision-making,