A review on tele-manipulators for remote diagnostic procedures and surgery

With modern medicine and healthcare services improving in leaps and bounds, the integration of telemedicine has helped in expanding these specialised healthcare services to remote locations. Healthcare telerobotic systems form a component of telemedicine, which allows medical intervention from a distance. It has been nearly 40 years since a robotic technology, PUMA 560, was introduced to perform a stereotaxic biopsy in the brain. The use of telemanipulators for remote surgical procedures began around 1995, with the Aesop, the Zeus, and the da Vinci robotic surgery systems. Since then, the utilisation of robots has steadily increased in diverse healthcare disciplines, from clinical diagnosis to telesurgery. The telemanipulator system functions in a master–slave protocol mode, with the doctor operating the master system, aided by audio-visual and haptic feedback. Based on the control commands from the master, the slave system, a remote manipulator, interacts directly with the patient. It eliminates the requirement for the doctor to be physically present in the spatial vicinity of the patient by virtually bringing expert-guided medical services to them. Post the Covid-19 pandemic, an exponential surge in the utilisation of telerobotic systems has been observed. This study aims to present an organised review of the state-of-the-art telemanipulators used for remote diagnostic procedures and surgeries, highlighting their challenges and scope for future research and development.

Robotic Manipulation System Design and Control for Non-Contact Remote Diagnosis in Otolaryngology: Digital Twin Approach

The COVID-19 pandemic has emphasized the need for non-contact medical robots to alleviate the heavy workload and emotional stress experienced by healthcare professionals while preventing infection. In response, we propose a non-contact robotic diagnostic system for otolaryngology clinics, utilizing a digital twin model for initial design optimization. The system employs a master-slave robot architecture, with the slave robot comprising a flexible endoscope manipulation robot and a parallel robot arm for controlling additional medical instruments. The novel 4 degrees of freedom (DOF) control mechanism enables the single robotic arm to handle the endoscope, facilitating the process compared to the traditional two-handed approach. Phantom experiments were conducted to evaluate the effectiveness of the proposed flexible endoscope manipulation system in terms of diagnosis completion time, NASA task load index (NASA-TLX), and subjective risk score. The results demonstrate the system's usability and its potential to alternate conventional diagnosis. © 2013 IEEE.

Easy-to-Deploy Combined Nasal/Throat Swab Robot With Sampling Dexterity and Resistance to External Interference

Robots have been used extensively in the battle against the COVID-19 pandemic since its outbreak. One prominent direction is the use of robots for swab sampling, which not only solves the shortage of medical staffs, but also prevents them from being infected during face-to-face sampling. However, a massive deployment of sampling robots is still not achievable due to their high costs, safety concerns, deployment complexity, and so on. In this letter, we propose a flexible, safe, and easy-to-deploy swab robot in a compact bench-top system. The robot can perform nasal/throat swab sampling tasks as dexterous as a human manual operation. The bio-mimetic rigid interior and soft exterior design guarantee the sampling robot with both flexibility and safety. Furthermore, the integration of 3-D fiber Bragg grating (FBG) based shape sensor and multi-axis force sensor may enhance the control performance. A dedicated constrained compliance control (CCC) algorithm was developed to tackle the unexpected interactions during sampling, which ensures the validity and safety of the sampling under disturbance. Various experiments are conducted to validate our system and prove its feasibility, flexibility, high safety, and efficiency for both nasal/throat swab sampling tasks. The proposed system is promising to be massive duplicated for robotic swab sampling.

On the Design of Integrated Tele-Monitoring/Operation System for Therapeutic Devices in Isolation Intensive Care Unit

We design a central controller system (CCS) and a tele-controlled system (TCS) with an aim of developing the integrated tele-monitoring/operation system that can enable the medical staff to tele-monitor the state of therapeutic devices utilized in the isolation intensive care unit (ICU) and to tele-operate its user interfaces. To achieve this aim, we survey the medical staff for medical requirements first and define the design guideline for tele-monitoring/operation functionality and field applicability. In designing the CCS, we focus on realizing the device having intuitive and user-friendly interfaces so that the medical staff can use the device conveniently without pre-training. Further, we attempt to implement the TCS capable of manipulating various types of user interfaces of the therapeutic device (e.g., touch screen, buttons, and knobs) without failure. As two core components of the TCS, the precision XY-positioner having a maximum positioning error of about 0.695 mm and the end-effector having three-degrees-of-freedom motion (i.e., pressing, gripping, and rotating) are applied to the system. In the experiment conducted for assessing functionality, it is investigated that the time taken to complete the tele-operation after logging into the CCS is less than 1 minute. Furthermore, the result of field demonstration for focus group shows that the proposed system could be applied practically to the medical fields when the functional reliability is improved. IEEE

Mixed-Reality-Enhanced Human–Robot Interaction with an Imitation-Based Mapping Approach for Intuitive Teleoperation of a Robotic Arm-Hand System

This paper presents an integrated mapping of motion and visualization scheme based on a Mixed Reality (MR) subspace approach for the intuitive and immersive telemanipulation of robotic arm-hand systems. The effectiveness of different control-feedback methods for the teleoperation system is validated and compared. The robotic arm-hand system consists of a 6 Degrees-of-Freedom (DOF) industrial manipulator and a low-cost 2-finger gripper, which can be manipulated in a natural manner by novice users physically distant from the working site. By incorporating MR technology, the user is fully immersed in a virtual operating space augmented by real-time 3D visual feedback from the robot working site. Imitation-based velocity-centric motion mapping is implemented via the MR subspace to accurately track operator hand movements for robot motion control and enables spatial velocity-based control of the robot Tool Center Point (TCP). The user control space and robot working space are overlaid through the MR subspace, and the local user and a digital twin of the remote robot share the same environment in the MR subspace. The MR-based motion and visualization mapping scheme for telerobotics is compared to conventional 2D Baseline and MR tele-control paradigms over two tabletop object manipulation experiments. A user survey of 24 participants was conducted to demonstrate the effectiveness and performance enhancements enabled by the proposed system. The MR-subspace-integrated 3D mapping of motion and visualization scheme reduced the aggregate task completion time by 48% compared to the 2D Baseline module and 29%, compared to the MR SpaceMouse module. The perceived workload decreased by 32% and 22%, compared to the 2D Baseline and MR SpaceMouse approaches.

Telerehabilitation with Exoskeletons using Adaptive Robust Integral RBF-Neural-Network Impedance Control under Variable Time Delays

With an unprecedented increase in the global aging population and with it, the age-related neuromuscular dysfunction diseases, there is an exorbitant and escalating need for physical rehabilitation. Delivering these services - especially to those that are most vulnerable - under the current COVID-19 pandemic restriction for physical-distancing, is an even greater challenge. Interest in telerehabilitation is spiking, and robotic telerehabilitation could drastically improve patients' access to Some of the major challenges in developing the control methods for these robots are identifying, estimating, and overcoming the effects of dynamic modeling uncertainties, nonlinearities, and disturbances. Having humans in the loop creates the additional need for safety and compliance. Telerehabilitation control methods have the added requirement of delivering telepresence and addressing communication delays which, if not managed, could result in ineffective therapy, destabilize the system, and even cause injury. In this paper, we present a novel adaptive robust integral Radial Basis Function Neural Network Impedance model (RBFNN-I) control method for telerehabilitation with robotic exoskeletons which compensates for dynamic modeling uncertainties in the presence of external human torques and time delays. One of the salient features of the proposed control system is the implementation of a new human torque regulator which improves telepresence. Stability proof using Lyapunov stability theory is shown for the proposed control method. An exoskeleton was designed and used for unilateral and bilateral telerehabilitation simulations. Excellent tracking performance, telepresence and stability was achieved in the presence of large, variable and asymmetric time delays and human torques.

An Investigation into the Feasibility of Remote Object Manipulation Using Consumer Virtual Reality Hardware and Decoupled Mapping Control

With the occurrence of the COVID-19 pandemic, many health workers in hospitals, nursing homes and quarantine facilities were put at increased health risk in their workplace. One effective solution to reduce this risk is to use Telerobotics which enables health workers to carry out their tasks remotely. Such a system must be able to perform a wide range of tasks in an unpredictable environment. This research paper will focus on the pick and place of small objects, which is one of the most common tasks in health care settings. This research designs a prototype telerobotic system using an innovative and new control method to remotely pick and place small objects and will perform the following test: An operator will use a virtual reality headset to remotely control a robot arm located more than 44 kilometres away from the operator and pick several common everyday objects and place them into a container. By developing this proof of concept prototype, this research will help to accelerate the adoption of telerobotic technologies in health care and other industries. © 2021 Australasian Robotics and Automation Association. All rights reserved.

Telerobotic Operation of Intensive Care Unit Ventilators.

Since the first reports of a novel coronavirus (SARS-CoV-2) in December 2019, over 33 million people have been infected worldwide and approximately 1 million people worldwide have died from the disease caused by this virus, COVID-19. In the United States alone, there have been approximately 7 million cases and over 200,000 deaths. This outbreak has placed an enormous strain on healthcare systems and workers. Severe cases require hospital care, and 8.5% of patients require mechanical ventilation in an intensive care unit (ICU). One major challenge is the necessity for clinical care personnel to don and doff cumbersome personal protective equipment (PPE) in order to enter an ICU unit to make simple adjustments to ventilator settings. Although future ventilators and other ICU equipment may be controllable remotely through computer networks, the enormous installed base of existing ventilators do not have this capability. This paper reports the development of a simple, low cost telerobotic system that permits adjustment of ventilator settings from outside the ICU. The system consists of a small Cartesian robot capable of operating a ventilator touch screen with camera vision control via a wirelessly connected tablet master device located outside the room. Engineering system tests demonstrated that the open-loop mechanical repeatability of the device was 7.5 mm, and that the average positioning error of the robotic finger under visual servoing control was 5.94 mm. Successful usability tests in a simulated ICU environment were carried out and are reported. In addition to enabling a significant reduction in PPE consumption, the prototype system has been shown in a preliminary evaluation to significantly reduce the total time required for a respiratory therapist to perform typical setting adjustments on a commercial ventilator, including donning and doffing PPE, from 271 to 109 s.

Perceived Usefulness of a Social Robot Augmented Telehealth Platform by Therapists in the United States.

With the shortage of rehabilitation clinicians in rural areas and the ongoing COVID-19 pandemic, remote rehabilitation (telerehab) fills an important gap in access to rehabilitation, especially for the treatment of adults and children experiencing upper arm disability due to stroke and cerebral palsy. We propose the use of a socially assistive robot with arms, a torso, and a face to play games with and guide patients, coupled with a telepresence platform, to maintain the patient-clinician interaction, and a computer vision system, to aid in automated objective assessments, as a tool for achieving more effective telerehab. In this paper, we outline the design of such a system, Lil'Flo, and present a uniquely large perceived usefulness evaluation of the Lil'Flo platform with 351 practicing therapists in the United States. We analyzed responses to the question of general interest and 5 questions on Lil'Flo's perceived usefulness. Therapists believe that Lil'Flo would significantly improve communication, motivation, and compliance during telerehab interactions when compared to traditional telepresence. 27% of therapists reported that they were interested in using Lil'Flo. Therapists interested in using Lil'Flo perceived it as having significantly higher usefulness across all measured dimensions than those who were not interested in using it.

[Telerehabilitation: from the virtual world to reality-Medicine in the twenty-first century : Video-assisted treatment in times of COVID-19]. / Telerehabilitation: von der virtuellen Welt zur Realität ­ Medizin im 21. Jahrhundert : Videogestützte Therapie in Zeiten von COVID-19.

Neurological diseases are the most common cause of disability worldwide. In addition to physical limitations, they often lead to cognitive deficits that make active participation in professional and social life difficult. Due to physical and cognitive deficits, it is often difficult for neurological patients to gain access to specialized knowledge or to receive specialized treatment and is associated with greatly increased effort. Neurological diseases account for 11.6% of global disability-adjusted life years (DALYs, a measure for quantifying disease burden) and 16.5% of deaths, and remain the leading cause of DALYs and the second leading cause of death worldwide. Neurorehabilitation encompasses the goal of reintegrating patients with neurological dysfunctions into everyday life. The ongoing situation in the context of the COVID-19 pandemic poses new challenges for the healthcare system. Social distancing and quarantine have deprived many people with neurological disorders of access to routine medical care. The corona pandemic is a catalyst for the widespread use of telemedicine in the field of neurology and neurorehabilitation. Projects such as the Brunei project of the Nordwest Krankenhaus Frankfurt as well as an MS clinic in Canada show that highly specialized medicine and neurorehabilitation can be delivered to remote areas or in the living room of patients or any doctor's office. Telemedical, telerehabilitative and teletherapeutic applications offer the opportunity to supplement and optimize existing care structures and with modern technology to make a new and contemporary interpretation of old-fashioned medical and therapeutic home visits.

COVID-19 Pandemic Spurs Medical Telerobotic Systems: A Survey of Applications Requiring Physiological Organ Motion Compensation.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in public health interventions such as physical distancing restrictions to limit the spread and transmission of the novel coronavirus, causing significant effects on the delivery of physical healthcare procedures worldwide. The unprecedented pandemic spurs strong demand for intelligent robotic systems in healthcare. In particular, medical telerobotic systems can play a positive role in the provision of telemedicine to both COVID-19 and non-COVID-19 patients. Different from typical studies on medical teleoperation that consider problems such as time delay and information loss in long-distance communication, this survey addresses the consequences of physiological organ motion when using teleoperation systems to create physical distancing between clinicians and patients in the COVID-19 era. We focus on the control-theoretic approaches that have been developed to address inherent robot control issues associated with organ motion. The state-of-the-art telerobotic systems and their applications in COVID-19 healthcare delivery are reviewed, and possible future directions are outlined.