Abstract
To close the surgeon in the control loop is able to take advantages of the fertile sensing information and intelligence from human being so that the complex and unpredictable surgical procedure can be better handled properly. However, there is also weakness to be strengthened. For example, the motion control of the human being is not as accurate as required. Assisted equipment for such purpose may be helpful to the procedure. Exerting large forces during the cutting process may exhaust the operator and cause fatigue. The operator may need power assistance during the surgery procedure. The response speed of human being's may not be adequate to take immediate action in certain critical situations. The constraints from the limbs and human's attention usually cause a significant delay to react the critical situations. This may lead to serious damage by failing to response immediately. For example, in knee replacement procedure, the shape of the knee joint has to be prepared by performing bone resection procedure. The surgeon cuts the bone at certain position and orientation with the help of the cutting jig from the surgical planning. The cutter cut the bone by inserting vibration saw through the slot of the cutting block. The surgeon has to stop the cutter right after the bone has been cut through by the saw so that no surrounding soft tissue, blood vessel, and even important nerves, be damaged. Currently the tactile sensing from the hand is heavily relied on by the surgeon. He has also to be experienced and dexterous. If he fails to draw back the cutter after the bone being cut through, damages to the patient may occur. Therefore there is need to develop a cutting tool, which is intelligent, knows where it is, and is able to judge what the cutting situation is, and further assists the operator to stop the cutter in case that the operator fails to do so, or too slow to response. The benefit to the patient as well as the surgeon will be significant. Therefore the purpose of the paper is to develop an algorithm to implement such functionality of auto-detection of bone cutting through for a bone cutting tool when the cutter has cut through the bone. By the developed method, the intelligent cutter can effectively detect the cutting through condition and then adopt an immediate reaction to prevent the cutter from going further and to avoid unexpected damage.
An auto-detection scheme has also been developed for assisting the operator in judging whether the cutter has reached the boundary or not. The auto-detection scheme is based on analyzing the cutting force pattern in conjunction with a bilateral force controller for the hand's on robot. The bilateral force controller consists of two force controllers. The force controller on the master calculates the feedrate of the cutter according to the push force by the operator. Meanwhile, the operator can also feel the cutting force by the force controller on the slave site, which revises the feedrate of the cutter by the measured cutting force. The operator can kinesthetically feel the cutting force from the variation of the feedrate. When the cutter breaks through the boundary of the bone, the cutting force will drop suddenly to almost zero. When this special force pattern occurs, an acknowledge signal of bone been broken through will be activated. The subsequent action will be followed to stop the cutter going further. We implement this concept by defining a “cutting admittance” indicating the resistance encountered by the cutting during bone resection at different cutting feedrate. During the bone resection, the cutting admittance varies from cutting through hard or soft portions of bone. As reaching the cutting boundary, the cutting admittance will suddenly increase. A threshold value will experimentally be determined to indicate cutting through condition. Together with pushing force by the human operator, the criterion for cutting-through detection is defined. Once cutting through is detected, the admittance for cutter movement will be set zero. The cutter stops going further and the operator feel like hitting a virtual wall in front.
In this paper we proposed a human robot cooperative operation method by which the robotic system can intelligently detect where the cutter has cut through the bone. Characterisation of bone cutting procedure was performed. This auto detection scheme was developed by analyzing the information of the motion and cutting force information during the bone cutting process, no medical images are required. The auto-detection bone cut through was able to transfer the experiences of human being to quantitative modeling. The developed model has been tested for its applicability and robustness by saw bones and pig's knee joints. Results have shown the virtual wall generated by the real-time bone detection scheme and active constraint control is very accurate and capable of providing a safety enhance module for computer assisted orthopaedic surgery, in particular, in total knee replacement. By this method the robot system can accomplish a safe and accurate bone cutting with a complement of an imageless navigation system and results in a low cost, but safe and effective surgical robot system.
