Evaluating the Dexterity of Surgical Instruments and Performance of the Feedbacks Titolo presentazione Supervisor : Prof. Elena De Momi sottotitolo Co-supervisor : Prof. Sanja Dogramadzi Master Thesis of: Milano, XX mese 20XX Yavuz Gülfem Ceren, 892619 Academic Year 2019-2020
Index Introduction Aim of the Work Methods Results Conclusion & Future Developments Gülfem Ceren YAVUZ, 892619
Introduction: Application Scenario SMARTsurg Project an advanced system for performing Robot Assisted MIS Objectives: • dexterous anthropomorphic surgical instruments • wearable hand exoskeleton to control the surgical instruments • wearable smart glasses for augmented reality and 3D reconstruction of the surgical field. Gülfem Ceren YAVUZ, 892619
Introduction: Problems Limited Dexterity of Surgical Instruments • Da Vinci tool which is used for robot-assisted minimally invasive surgery has disadvantages: • Limited number of degree of freedom • No complex movements • Not satisfied about the ergonomics of the current instruments • Manipulation of the instruments is not intuitive and requires extensive training To Guide to the Surgeon • In the RAMIS, the surgeons are looking inside the body with a camera and generally, they cannot see what is happening above. • To inform them about the borders of tissues or organs, the feedback should be given to the surgeon. • There is not much work on which type of feedback would be more usable and effective choice . Gülfem Ceren YAVUZ, 892619
Introduction: State of Art 3 Fingers Tool Da Vinci Tool (designed by BRL) Gülfem Ceren YAVUZ, 892619
Aim of the Work Compare usability and performances of different surgical instruments Compare usability and performances of different feedback types Haptic Feedback Visual Feedback Gülfem Ceren YAVUZ, 892619
Methods: Build Virtual Reality Virtual Tasks Buzz Wire Task • Aim is to compare performanceof feedbacks Peg Transfer Task • Aim is to compare usability of surgical instruments Gülfem Ceren YAVUZ, 892619
Methods: Peg Transfer Main steps of this task: 1. Track movements of the fingers and hand 2. Design virtual environment 3. Control the surgical instruments in VR 4. Perform experiments 5. Collect results from experiments Gülfem Ceren YAVUZ, 892619
Methods: Peg Transfer Components • HTC Vive System was installed. • Calibrations of data glove and HTC Vive System were done. • In Unity, the virtual environment was developed and game objects were designed. Virtual Environment • The mapping between data glove and instruments in Unity was done. • Picking up and dropping functions were developed in Unity. Gülfem Ceren YAVUZ, 892619
Methods: Experimental Protocols For peg transfer task, Read,fill and sign the forms 14 people are recruited: • 2 surgeons Wear the data Glove and HTC Headset • 12 people who do not have medical skills Practice with the system Perform peg trasnfer task with Da Vinci tool Perform same task with 3 Fingers Fill the surveys Gülfem Ceren YAVUZ, 892619
Methods: Buzz Wire Main steps of this task: 1. Design haptic device 2. Create virtual environment 3. Integrate the device into environment 4. Implement visual feedback 5. Perform experiments 6. Collect results Gülfem Ceren YAVUZ, 892619
Methods: Buzz Wire Components • HTC Vive System was installed. • Calibration of HTC Vive System were done. • In Unity, the virtual environment was developed and game objects were designed. • Haptic device was designed and Virtual Environment tested. • The interaction between device and virtual environment was done. • Virtual feedback was added into environment. Gülfem Ceren YAVUZ, 892619
Methods: Buzz Wire a. The first message sent gives information about the frequency of vibration such as low or high 1. If the tool does not touch the wire which means that it is in the safe region, the message is “0” and nothing happens . If the tool approaches the wire, the message is “1” and the 2. piezo vibrate at 140Hz with frequently delays. (0.5 sec vibration + 0.5 sec no vibration) If the tool touches the wire, the message is “2” and the piezo 3. vibrate at 140Hz continuously. b. The second message sent gives information about the position. In order to develop visual feedback, three spheres are added to the virtual environment around the tool: When the tool is in a safe region, the spheres are green When the tool approaches the wire (distance between the tool and wire is less than approaching limit) that they become yellow The spheres finally turn red when the tool touches the wire which means that the distance between the tool and wire is less than touching limit Gülfem Ceren YAVUZ, 892619
Methods: Experimental Protocols Read,fill and sign the forms For buzz wire task, 10 people were recruited: Wear HTC headset and hold the HTC Vive Controller • 2 surgeons • 8 people who do not have medical skills Practice with the system Perform buzz wire game with visual feedback Haptic device is placed to the user’s arm Perform same task with the haptic feedback Fill the surveys Gülfem Ceren YAVUZ, 892619
Methods: Success Measure Compare Usability Score Surgical Instruments Task Load Score Time on Task Compare Usability Score Feedback Types Task Load Score Number of touching (number of errors) Time on Task Gülfem Ceren YAVUZ, 892619
Methods: Data Analysis Quantitative Qualitative Data Data SUS is a standardized metric for measuring the usability of the system and consists of a 10 item questionnaire with five response options for respondents; from strongly agree to System Duration of strongly disagree. Usability task A SUS score above a 68 would be considered above average Scale and anything below 68 is below average. NASA- Task Speed of task NASA-Task Load Index is a multidimensional scale designed Load Index to obtain workload estimates from the participant while he is performing a task. The NASA TLX consists of two parts evaluation procedure: Number of • The first requirement is for each participant to evaluate Touching the contribution of each subscale to the workload of the task. This value is called as its weight. The distance • The second requirement is to obtain numerical ratings for between wire each scale that reflect the magnitude of that subscale in and loop the task. Gülfem Ceren YAVUZ, 892619
Results: Surgical Instruments • According to Wilcoxon Signed-Rank test, there is a significant difference between Da Vinci tool and 3 Fingers tool. Mean SUS Scores of Peg Transfer Mean NASA TLX Scores of Peg Mean Duration of Peg Transfer Transfer Task Task Task [sec] With 12 subjects With 12 subjects With 12 subjects 88.0 76.0 3.4 32.8 2.6 25.2 Da Vinci Tool 3 Fingers Da Vinci 3 Fingers Da Vinci 3 Fingers Tool Tool Tool Tool Tool Mean SUS Scores of Peg Transfer Mean NASA TLX Scores of Peg Mean Duration of Peg Transfer Task Transfer Task Task [sec] With 2 surgeons With 2 surgeons With 2 surgeons 85.0 3.5 73.8 2.7 22.3 10.6 Da Vinci Tool 3 Fingers Da Vinci 3 Fingers Da Vinci 3 Fingers Tool Tool Tool Tool Tool Gülfem Ceren YAVUZ, 892619
Results: Feedbacks • In the results obtained, according to Wilcoxon signed-rank test, there is important difference between visual and haptic feedback usability scores. Mean Duration of Buzz Wire Task Mean SUS Scores of Buzz Wire Mean NASA- TLX Scores of Buzz [sec] Task Wire Task With 8 subjects With 8 subjects With 8 subjects 75.0 99.1 61.8 55.3 45.9 51.6 Visual Haptic Visual Haptic Visual Haptic Feedback Feedback Feedback Feedback Feedback Feedback Mean SUS Scores of Buzz Wire Mean Duration of Buzz Wire Task Mean NASA- TLX Scores of Buzz Task [sec] Wire Task With 2 surgeons With 2 surgeons With 2 surgeons 113.4 71.3 60.0 57.6 58.5 38.4 Visual Haptic Visual Haptic Visual Haptic Feedback Feedback Feedback Feedback Feedback Feedback Gülfem Ceren YAVUZ, 892619
Conclusion & Future Developments Achievements Da Vinci tool has better usability than 3 Fingers tool and its performance is better than the performance of 3 fingers Visual feedback is more effective and usable aid than haptic feedback and it has better performance than haptic Future Developments Comparison with the combination of both feedback types Improvement of the haptic device or new design Implement another task for more complex movements of instruments Gülfem Ceren YAVUZ, 892619
Gülfem Ceren YAVUZ, 892619
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