The innovative system, developed through a collaboration between the REHAssist research group and the Learning Algorithms and Systems Laboratory (LASA), allows surgeons to manipulate two additional robotic arms using five-degree-of-freedom haptic foot interfaces. This way, alongside their natural arms, surgeons are able to control an endoscope/camera with one foot and an actuated gripper with the other.
A significant breakthrough of this system is the shared control between the surgeon and the robotic assistants, which ensures precise and safe collaborative work within a concurrent workspace. According to Mohamed Bouri, head of the REHAssist group, actuators in the foot pedals provide haptic feedback to the user, guiding their foot towards the target and limiting force and movement to prevent patient endangerment due to erroneous foot movements.
Bouri emphasized the potential of the new system, stating, “Our system opens up new possibilities for surgeons to perform 4-handed laparoscopic procedures, allowing a single person to do a task that is usually performed by two, sometimes three people.”
The researchers have incorporated a shared control approach known as ‘active prediction’ to minimize fatigue. The robotics sometimes lead the surgeon’s control of the instrument, anticipating where the surgeon intends to move.
Innovation towards improved surgical outcomes
Aude Billard, head of LASA, noted that controlling four arms with one’s feet can be challenging and tiring. She said, “By incorporating foot-controlled robotic assistants and shared control strategies, we reduce the mental and physical load on surgeons and we hypothesize to improve surgical outcomes.”
A comprehensive study with practicing surgeons evaluated the system’s usability and effectiveness. Dr. Enrico Broennimann, who participated in the trials in collaboration with the Swiss Foundation for Innovation and Training in Surgery, attested to the practicality and learnability of the skill.
While further testing and improvements of the system are ongoing, the current results confirm the feasibility of performing four-arm surgical tasks without intensive training. The shared-control strategies implemented were found to reduce task load, improve performance, increase fluency, and enhance coordination during laparoscopic tasks.
