199 52.Medical Robotics and Computer-Integrated Surgery Russell H.Taylor,Arianna Menciassi,Gabor Fichtinger,Paolo Dario The growth of medical robotics since the mid- 52.1 Core concepts....1200 1980s has been striking.From a few initial efforts 52.1.1 Medical Robotics, in stereotactic brain surgery,orthopaedics,endo- Computer-Integrated Surgery, and Closed-Loop Interventions......1200 scopic surgery,microsurgery,and other areas,the 52.1.2 Factors Affecting the Acceptance field has expanded to include commercially mar- of Medical Robots.......... ..1200 keted,clinically deployed systems,and a robust 52.1.3 Medical Robotics System m and exponentially expanding research community. Paradigms:Surgical CAD/CAM u This chapter will discuss some major themes and and Surgical Assistance...............1202 illustrate them with examples from current and past research.Further reading providing a more 52.2 Technology.............. .1204 comprehensive review of this rapidly expanding 52.2.1 Mechanical Design Considerations..1204 field is suggested in Sect.52.4. 52.2.2 Control Paradigms 1205 Medical robots may be classified in many ways: 52.2.3 Virtual Fixtures by manipulator design (e.g.,kinematics,actua- and Human-Machine tion);by level of autonomy (e.g.,preprogrammed Cooperative Systems................1206 52.2.4 Safety and Sterility........ ....1207 versus teleoperation versus constrained cooper- 52.2.5 Imaging and Modeling ative control),by targeted anatomy or technique of Patients...... .1208 (e.g.,cardiac,intravascular,percutaneous,la- 52.2.6 Registration. 1208 paroscopic,microsurgical);or intended operating environment(e.g.,in-scanner,conventional op- 52.3 Systems,Research Areas, erating room).In this chapter,we have chosen to and Applications............ .1209 focus on the role of medical robots within the con- 52.3.1 Nonrobotic Computer-Assisted text of larger computer-integrated systems includ- Surgery:Navigation ing presurgical planning,intraoperative execution, and Image Overlay Devices .1209 and postoperative assessment and follow-up. 52.3.2 Orthopaedic Systems .1209 First,we introduce basic concepts of computer- 52.3.3 Percutaneous Needle integrated surgery,discuss critical factors affecting Placement Systems...... ..1210 the eventual deployment and acceptance of 52.3.4Telesurgical Systems .1212 medical robots,and introduce the basic system 52.3.5 Microsurgery Systems.113 52.3.6 Endoluminal Robots. paradigms of surgical computer-assisted plan- .1213 52.3.7 Sensorized Instruments ning,registration,execution,monitoring,and and Haptic Feedback 1214 assessment(CAD/CAM)and surgical assistance.In 52.3.8 Surgical Simulators subsequent sections,we provide an overview of and Telerobotic Systems the technology of medical robot systems and dis- for Training..... 1215 cuss examples of our basic system paradigms, 52.3.9 0ther Applications with brief additional discussion topics of remote and Research Areas 1216 telesurgery and robotic surgical simulators.We conclude with some thoughts on future research 52.4 Conclusion and Future Directions...........1217 directions and provide suggested further reading. Reference5.… 12181199 Medical Robo 52. Medical Robotics and Computer-Integrated Surgery Russell H. Taylor, Arianna Menciassi, Gabor Fichtinger, Paolo Dario The growth of medical robotics since the mid- 1980s has been striking. From a few initial efforts in stereotactic brain surgery, orthopaedics, endo￾scopic surgery, microsurgery, and other areas, the field has expanded to include commercially mar￾keted, clinically deployed systems, and a robust and exponentially expanding research community. This chapter will discuss some major themes and illustrate them with examples from current and past research. Further reading providing a more comprehensive review of this rapidly expanding field is suggested in Sect. 52.4. Medical robots may be classified in many ways: by manipulator design (e.g., kinematics, actua￾tion); by level of autonomy (e.g., preprogrammed versus teleoperation versus constrained cooper￾ative control), by targeted anatomy or technique (e.g., cardiac, intravascular, percutaneous, la￾paroscopic, microsurgical); or intended operating environment (e.g., in-scanner, conventional op￾erating room). In this chapter, we have chosen to focus on the role of medical robots within the con￾text of larger computer-integrated systems includ￾ing presurgical planning, intraoperative execution, and postoperative assessment and follow-up. First, we introduce basic concepts of computer￾integrated surgery, discuss critical factors affecting the eventual deployment and acceptance of medical robots, and introduce the basic system paradigms of surgical computer-assisted plan￾ning, registration, execution, monitoring, and assessment (CAD/CAM) and surgical assistance. In subsequent sections, we provide an overview of the technology of medical robot systems and dis￾cuss examples of our basic system paradigms, with brief additional discussion topics of remote telesurgery and robotic surgical simulators. We conclude with some thoughts on future research directions and provide suggested further reading. 52.1 Core Concepts ....................................... 1200 52.1.1 Medical Robotics, Computer-Integrated Surgery, and Closed-Loop Interventions ...... 1200 52.1.2 Factors Affecting the Acceptance of Medical Robots......................... 1200 52.1.3 Medical Robotics System Paradigms: Surgical CAD/CAM and Surgical Assistance ................. 1202 52.2 Technology .......................................... 1204 52.2.1 Mechanical Design Considerations .. 1204 52.2.2 Control Paradigms ........................ 1205 52.2.3 Virtual Fixtures and Human–Machine Cooperative Systems ..................... 1206 52.2.4 Safety and Sterility ....................... 1207 52.2.5 Imaging and Modeling of Patients .................................. 1208 52.2.6 Registration................................. 1208 52.3 Systems, Research Areas, and Applications .................................. 1209 52.3.1 Nonrobotic Computer-Assisted Surgery: Navigation and Image Overlay Devices ............ 1209 52.3.2 Orthopaedic Systems .................... 1209 52.3.3 Percutaneous Needle Placement Systems ....................... 1210 52.3.4 Telesurgical Systems ..................... 1212 52.3.5 Microsurgery Systems.................... 1213 52.3.6 Endoluminal Robots ..................... 1213 52.3.7 Sensorized Instruments and Haptic Feedback .................... 1214 52.3.8Surgical Simulators and Telerobotic Systems for Training ................................. 1215 52.3.9Other Applications and Research Areas ...................... 1216 52.4 Conclusion and Future Directions ........... 1217 References .................................................. 1218 Part F 52