Recent advances in medical robotics: Projects MARGIN, GABIE and IRAS

pa10_reduitResearch in medical robotics have intensified in recent years, supported by several national incentives (Robea program, ACI and RNTS * *) and European. The areas most promising short-term tele-ultrasound robot (OTELO projects [1] and B [2]), and interventional radiology (IRAS project [3] Robea). In the longer term, the minimally invasive endoscopically should benefit from the most recent advances in robotics in terms of perception, decision and action. Nationally, one can mention the project EndoXiroB [4] which aims to develop a robot for minimally invasive surgery and appropriate tools and projects MARGIN [5] and GABIE [6] program Robea.

In the context of minimally invasive surgery, the forced passage of instruments through trocars (guides across the chest or abdominal wall to facilitate introduction of instruments) reduces their mobility. This problem is especially critical in cardiac surgery that the presence of the ribs of the rib cage prohibits any movement of these trocars (very limited, as in surgery). Moreover, surgical techniques are minimally invasive hampered by their conduct in a confined environment compared to traditional surgery “open.” Finally, the friction of the instruments within the trocar obscure real interactions between instruments and tissue, which normally allow the surgeon to control his movements through the sensation ( “haptic”). To overcome these limitations, robotics offers potentially interesting solutions and that the project aims to assess MARGIN.

Tools and methodologies, validated by demonstrators have been proposed: 1) to provide instruments of additional intra-mobility assets to compensate for those lost to the passage of the trocar, 2) to improve the dexterity of the surgeon in achieving precise and delicate movements through cooperative control modes, including some repetitive actions such as sutures, 3) to equip the trocar so that the surgeon had the impression of working directly on the body of the patient channel transmission-manipulator-trocar instrument behaves in a completely transparent to the user. Many other interventions minimally invasive surgery involves inserting, through a small incision instrument inside an organ to carry out a simple operation like a puncture or injection of a product. The use of vision is usually not possible when using external imaging devices, often a scanner (localized radiation therapy) or an ultrasound probe. This very advantageous in terms of cost, is difficult to handle, requiring perfect coordination of the surgeon’s hands. The IRAS project aims to design and control of a robotic system for needle insertion for work under an X-ray scanner for the destruction of small liver tumors by radiofrequency. This system, driven by a haptic interface, allows the radiologist to avoid exposure to radiation. The difficulties of the project are many, including the limited space of the scanner and the need for the robot to track real-time movements of the tumor due to breathing of the patient.
In the draft GABIE it comes to designing a system incorporating an ultrasound imaging coupled to a tool for minimally invasive surgery and a guidance system in real time. The beating-heart repair of a lesion of the mitral valve is the archetype of interventions covered by this project and includes all the difficulties that researchers want to address in particular the possibility of reaching an instrument with a moving target localized by ultrasound. Different experiments will validate a clinical point of view the proposed methodologies.

The effective implementation of robots in the surgical block through miniaturization of devices, operating procedures easier and safer associated with more reasonable costs, conditions far from satisfied by the few systems currently on the market . Surgical robots of tomorrow will be rather robotic tools, specialized for a given task. The operating protocols, even if they change accordingly, remain predominantly performed by surgeons, robotic instruments, accounting for only some specific actions requiring high precision or impossible to achieve manually.