ADVANCED TECHNIQUES IN ROBOTIC TELESURGERY USING MEMS TECHNOLOGY

Authors: Prardhana B(B-Tech, Electronics Engineering) School of Biosciences and Technology, Vivekananda College of Engineering

I.ABSTRACT
Tele surgery or surgery at a distance has revolutionized the healthcare field today. This is achieved with the help of robots which is programmed to mimic the surgeons work. This eliminates the need of the surgeon to be present in the surgical area. Other benefits of remote robotassisted surgery are multiple. Geographic constraints will no longer determine the type of treatment the patient receives because of lack of surgical expertise. Emergency operations in small rural hospitals are sometimes challenging for young surgeons on call. The availability of a network connecting the hospital to a major centre would allow expert surgeons to assist or carry out the procedure themselves. The availability of expert surgeons might very well help in remote areas where military or scientific missions are being performed or in remote islands, especially in the case of emergency operations. But though tele surgery has all these advantages, it hasnt been able to meet up to the efficiency offered by normal surgery. Some of the major problems faced are less degrees of freedom for the robotic arms, inaccuracy and precision, bulky structure etc... in this paper, advancements in the current telesurgical procedures are discussed and how the use of MEMS technology is able to eliminate the above problems. KEYWORDS: Telesurgery, AESOP, MEMS. Davinci surgery,
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II.INTRODUCTION
Laparoscopic surgery technique has been very famous since the last decade. In this process incisions are very small and hence the disadvantages of postoperative trauma and pain are overcome and it paves a path to a faster recovery. It also has other advantages like significantly less pain, less blood loss, less scarring and a shorter hospital stay. It is minimally invasive that the surgery is performed with instruments and viewing equipment inserted through small incisions rather than by making a large incision to expose and provide access to the operation site. Yet there are certain disadvantages of MIS. The instruments are not big enough and are majorly controlled by human beings. Human tremors or fatigue may affect the positioning of the instrument inside the body making them risky and dangerous. Since the maximum degree of freedom it can achieve is four it becomes difficult to arbitrarily orient the instruments tip. This greatly reduces its efficiency. Force feedback is reduced due to the friction at the air tight trocars and the stiffness of the inflated abdominal wall. These are some of the issues discussed in this paper and improvements in the current technology have been brought about to increase the overall efficiency and reduce the errors. In recent times a lot of mishaps have been reported due to human error during surgery. Hence a few years ago Robotic surgery had been introduced to aid the surgeon in his task. It involves a human machine interface and the surgeon uses this to interact with the robot which works directly in

contact with the patient. Many new discoveries have been made on applications relating to robotic surgery which includes robotic telesurgery. Telerobotic surgery is the next step in the evolution of robotic surgery in which it is not necessary for the surgeon to be in the immediate vicinity of the patient. This is quite helpful in serving emergency situations en route to the hospital. It also helps surgeon to perform surgeries in rural areas where doctors cannot arrive in time to treat the patient. Tele surgery is used very commonly in western countries to make use of the expertise of various surgeons in different places.

Telesurgery (surgery at a distance) is a technique which allows surgeons to robotically operate on a patient while being at a considerable distance from the operating table. Telesurgery has been made possible by extraordinary advances in the fields of robotics and telecommunications and has the potential to revolutionize healthcare delivery in the near future. There is increasing realization that some tasks can be performed significantly better by humans than robots but, due to associated hazards, distance, etc., only a robot can be employed. Telemedicine is one area where remotely controlled robots can have a major impact by providing urgent care at remote sites.

III.ROBOTIC TELE SURGERY

The robots which are used in surgery are not autonomous machines that carry out simple, preprogrammed instructions. Operating theatre robots are designed to supplement a surgeon's abilities, translating human movements into incredibly steady and accurate robotic movements, which, in turn, manipulate instruments to aid delicate operations. In robotic telesurgery, the goal is to develop robotic tools to replace hand instruments used in surgery. In robotic telesurgery, the robotic tools are not automated robots but teleoperated systems under direct control of the surgeon, therefore giving the name telesurgery. With the telesurgical workstation, the goal is to restore the manipulation and sensation capabilities of the surgeon which were lost due to minimally invasive surgery.

the console. They move with seven degrees of freedom and two degrees of axial rotation.

V.DISADVANTAGES OF DA VINCI SURGERY

Da Vinci is still in its first generation of production. Because it was designed specifically for cardiac surgery, the engineers did not consider the requirements of abdominal surgery. As a result, the use of da Vinci for abdominal surgery presents a variety of challenges. Instrumentation is limited. The robotic arms are bulky. The arms are not attached to the operating room table. Large excursion arcs of the arms lead to frequent collisions. The strong robotic arms lack tensile feedback. Use of the tele robot in standard operating rooms is cumbersome and frustrating. The da Vinci system fills a large operating room, so its use in smaller rooms is impractical. It weighs a great deal. It is difficult to move around the room and even more difficult to push down the hall to another operating room. These disadvantages calls for a better robotic system which is to an extent realized through AESOP or automated endoscope system for optimal positioning.

IV.DAVINCI SURGERY

V. AUTOMATED ENDOSCOPE SYSTEM FOR OPTIMAL POSITIONING

AESOP was the first robot to be cleared by the FDA for assisting surgery in the operating room. They are voice controlled and they work more efficiently compared to older robots. They are attached to the sides of the surgical table and they are not cumbersome. AESOP facilitate solosurgeon laparoscopic surgery. Numerous research is being conducted on AESOP and one of the modification is that the robot automatically follows a color marker attached to one of the laparoscopic instruments inserted into the operative field.

Da Vinci surgery is the first type of robot assistedminimally invasive surgical technique. The system consists of a surgical console which is normally situated in the same room as the patient. Here, the surgeon is seated in an ergonomically comfortable and position at a console or work station. The system is designed with four robotic arms. Three of the arms are for tools that hold objects, such as a scalpel, scissors, electrocautery instruments. The fourth arm is for an endoscopic camera with two lenses that gives the surgeon full stereoscopic vision from
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VI.MEMS
MEMS is Micro Electro Mechanical Systems which has micro scale dimensions (1mm = 1000 microns) and has both electrical and mechanical features. It is the integration of mechanical elements, sensors, actuators, and electronics on a common silicon substrate through the utilization of micro fabrication technology. MEMS fabrication techniques originally used IC (computer chip) fabrication techniques but more MEMS-specific fabrication techniques and materials are now in use. MEMS is an enabling technology for smaller device size and batch processing for low cost, uniform production, distributed device placement with more precise sensing.

Micro electro mechanical systems (MEMS) (also written as micro-electro-mechanical, Micro Electro Mechanical or microelectronic and micro electromechanical systems) are small devices driven by electricity; it merges at the nano-scale into Nano electromechanical systems (NEMS). It is believed that MEMS devices will be in the forefront of next generation technological developments. MEMS promises to revolutionize nearly every product category by bringing together silicon-based microelectronics with micromachining technology, thereby, making possible the realization of complete systems-on-achip. MEMS is truly an enabling technology allowing the development of smart products by augmenting the computational ability of microelectronics with the perception and control capabilities of microsensors and microactuators. MEMS is also an extremely diverse and fertile technology, both in the applications it is expected to be used, as well as in how the devices are designed and manufactured. MEMS technology makes possible the integration of microelectronics with active perception and control functions, thereby, greatly expanding the design and application space.

VII. MEMS DEVISES FOR ROBOTICS :SENSORS AND ACTUATORS.

The MEMS field is an outgrowth of the well developed field of sensors and actuators and especially the outgrowth from the long-term emphasis in that field on the concept of miniaturization. Sensor and actuator devices are essential components in robotics. The new twist, and one that gives enormous possibilities for miniaturization, is the ability to replace the old, hand-crafted devices with lithographic, mass produced MEMS devices that can operate in systems. MEMS-based sensors are very small and perform a sensing task properly on robots of all dimensions. In fact, sensor sensitivity usually increases as the size is reduced. Small sensors are of vital importance in robotics, both to miniaturize existing functions, and to enable new functions.

Barkelay Sensor

Microactuators are used for moving or controlling the mechanism of a system. While research and development of microactuators has been rapidly expanding in the last few years, there are mainly four classes of microactuators which are widely used in various applications. They are micro valves, micro pumps, micro motors and lateral resonant devices.

robotic arm, it is possible to control it more precisely, and also to speed up the actions of the arm. This improves automation and allows a more repeatable response. Image stabilization is another important aspect which is mandatory during surgery. Feedback from motion sensors allows a camera or camera platform to be stabilised, and can also be used in software to improve the captured images. The research problems in the development of a telesurgical system are manipulator design and achieving high fidelity teleoperation. Telesurgical manipulators need to be small, 10 mm or smaller for laparoscopy, and 5 mm or smaller for cardiac and fetal surgery, yet have significant workspace and apply forces in the range of several Newtons to be able to manipulate the tissue. Miniature Electrically Controlled Stiffness (ECS) elements and Electrically Controlled Force and Stiffness (ECFS) actuators that mirror the stiffness and forces at remote/virtual sites are available and they can be integrated into MEMS which can solve the above problem. Lab-on-a-chip devices are a subset of MEMS devices which help us to integrate a large number of analog devices into a single chip. It has higher analysis and control speed and better efficiency, better process control because of a faster response of the system and lower fabrication costs, allowing cost- effective chips.

VIII. Application of MEMS in Telesurgery.

MEMS tactile sensor for minimal invasive surgery (MIS)medical device. MEMS has large bandwidth operational range, high linearity, low insertion loss, reduced size, high shock resistance, wide temperature operational range, low power consumption, good isolation and low cost. These features make it a promising revolutionary component in the area of robotic telesurgery. Robotic telesurgery is one field in which motion sensing is quite invaluable. For instance, by gaining an accurate reading for the position and motion of a
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IX.CHALLENGES OF ROBOTIC TELE SURGERY AND THE SOLUTION

Although the surgeons were able to successfully suture and tie knots without any force feedback, there were more cases when the needle snapped from the suture, or the suture itself was damaged. This was mainly because of the lack of force feedback, since it is very difficult to judge the amount of force applied to the suture, just with visual feedback.
Also, in the absence of force feedback, the forces felt by the operator on the handle are purely function of the master characteristics, completely independent of the what is happening on the slave side. Therefore, it is necessary to have some form of force feedback to the master from the slave side. Miniature Electrically Controlled Stiffness (ECS) elements and Electrically Controlled Force and Stiffness (ECFS) actuators that mirror the stiffness and forces at remote/virtual sites are available and they can be integrated into MEMS which can solve the above problem. Robotic arms demand specific modifications to accommodate the style of the surgeon. The robotic arms are bulky and hence cannot move around unlike the bones of a human being. The degree of freedom of a robotic arm is limited .Large extensions of the arm can lead to frequent collisions. All these problems can be resolved by

using a MEMS design .MEMS has been used till date as a sensor but in this field its electrical and mechanical properties are tested. A MEMS element is fitted into the joint areas of the robot. This addition of MEMS increases the degree of freedom of the robot joint. Hence the robot can now make minute changes in the patients body.

X. CONCLUSION DIRECTIONS.

AND

FUTURE

As the biomedical arena and research moves increasingly toward intelligent, distributed, as well as wireless monitoring and control, MEMS technology will definitely play an increasingly vital role in this sector. The trend toward MEMS-enabled miniaturization and micro mechatronics is bolstering the development of components, devices, systems, and subsystems for numerous applications. MEMS is used in low or medium volume applications. Its because of lack of fabrication knowledge. If these problems are overcome then miniaturization will be at its highest level. Applications of MEMS Design and technologies have very high future prospects. All fields of electronics are now shifting to MEMS and NEMS. Biomedicine and Telemedicine are on the verge of new breakthroughs thus helping to spread knowledge and expertise in surgical environments. Major healthcare giants and industries will see a bright future in the field of MEMS applied with Robotics.

XI. REFERENCES. 1) Robotic surgery and tele surgery: basic principles and description of a novel concept. A. Lobontiu, D. Loisance, Department of Cardio-Thoracic Surgery Henri Mondor Hospital, University Paris 12, France 2) Robotics for Telesurgery: Second Generation Berkeley/UCSF Laparoscopic Telesurgical Workstation and Looking towards the Future Applications M. Cenk C avuoglu, Dept. of Electrical Eng. And Computer Sci., s University of California, Berkeley, CA 94720 mcenk@eecs.berkeley.edu Winthrop Williams Dept. of Electrical Eng. and Computer Sci., University winthrop@robotics.eecs.berkeley.edu Frank Tendick Department of Surgery, tendick@eecs.berkeley.edu S. Shankar Sastry Dept. of Electrical Eng. and Computer Sci., University of California, Berkeley, CA sastry@eecs.berkeley.edu 3) Low-Cost MEMs Robotics for Space Exploration: A Probabilistic Trade Space for Biomorphic Exploration Devices. Jeffrey H Smith, Jet Proportion Laboratory, California Institute Of Technology Pasadena, CA 91109-8009 jeffrev.h.smith(iiJ.jp1.nasa.2:ov 4) Applications of MEMS in Robotics and BioMEMS Manisha P.Khorgade, Lecturer, manishakhorgade@hotmail.com awanigaidhane@yahoo.co.in 5) Computer-enhanced robotic telesurgery W. S. Melvin, B. J. Needleman, K. R. Krause, C. Schneider, R. K. Wolf, R. E. Michler, E. C. Ellison Department of Surgery and Center for Minimally Invasive Surgery, Ohio State University School of Medicine and Public Health, Columbus, OH, USA. 6) Integrated MEMS Sensors for Industrial Control by Bob Scannell, Analog Devices First published by EPN Magazine, January 2007 7) Technology Review Telesurgery: Advances and Trends David Holt, B.Sc (OT7), Ali Zaidi*, B.Sc (OT7), Joy Abramson, B.Sc (OT8)
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of California,

Berkeley, CA 94720

University

of California,

San Francisco,

CA 94143

ETC

Department

,NYSSCOER,

Nagpur,India.

Awani Gaidhane, Lecturer, ETC Department ,NYSSCOER, Nagpur,India.