Ameya Pore

Increased demand for less invasive procedures has accelerated the adoption of Intraluminal Procedures (IP) and Endovascular Interventions (EI) performed through body lumens and vessels. As navigation through lumens and vessels is quite complex, interest grows to establish autonomous navigation techniques for IP and EI for reaching the target area. Current research efforts are directed toward increasing the Level of Autonomy (LoA) during the navigation phase. One key ingredient for autonomous navigation is Motion Planning (MP) techniques. This paper provides an overview of MP techniques categorizing them based on LoA. Our analysis investigates advances for the different clinical scenarios. Through a systematic literature analysis using the PRISMA method, the study summarizes relevant works and investigates the clinical aim, LoA, adopted MP techniques, and validation types. We identify the limitations of the corresponding MP methods and provide directions to improve the robustness of the algorithms in dynamic intraluminal environments. MP for IP and EI can be classified into four subgroups: node, sampling, optimization, and learning-based techniques, with a notable rise in learning-based approaches in recent years. One of the review’s contributions is the identification of the limiting factors in IP and EI robotic systems hindering higher levels of autonomous navigation. In the future, navigation is bound to become more autonomous, placing the clinician in a supervisory position to improve control precision and reduce workload.

Flexible Endoscopes (FEs) for colonoscopy present several limitations due to their inherent complexity, resulting in patient discomfort and lack of intuitiveness for clinicians. Robotic FEs with autonomous control represent a viable solution to reduce the workload of endoscopists and the training time while improving the procedure outcome. Prior works on autonomous endoscope FE control use heuristic policies that limit their generalisation to the unstructured and highly deformable colon environment and require frequent human intervention. This work proposes an image-based FE control using Deep Reinforcement Learning, called Deep Visuomotor Control (DVC), to exhibit adaptive behaviour in convoluted sections of the colon. DVC learns a mapping between the images and the FE control signal. A first user study of 20 expert gastrointestinal endoscopists was carried out to compare their navigation performance with DVC using a realistic virtual simulator. The results indicate that DVC shows equivalent performance on several assessment parameters, being more safer. Moreover, a second user study with 20 novice users was performed to demonstrate easier human supervision compared to a state-of-the-art heuristic control policy. Seamless supervision of colonoscopy procedures would enable endoscopists to focus on the medical decision rather than on the control of FE.

Deep Reinforcement Learning (DRL) is a viable solution for automating repetitive surgical subtasks due to its ability to learn complex behaviours in a dynamic environment. This task automation could lead to reduced surgeon’s cognitive workload, increased precision in critical aspects of the surgery, and fewer patient-related complications. However, current DRL methods do not guarantee any safety criteria as they maximise cumulative rewards without considering the risks associated with the actions performed. Due to this limitation, the application of DRL in the safety-critical paradigm of robot-assisted Minimally Invasive Surgery (MIS) has been constrained. In this work, we introduce a Safe-DRL framework that incorporates safety constraints for the automation of surgical subtasks via DRL training. We validate our approach in a virtual scene that replicates a tissue retraction task commonly occurring in multiple phases of an MIS. Furthermore, to evaluate the safe behaviour of the robotic arms, we formulate a formal verification tool for DRL methods that provides the probability of unsafe configurations. Our results indicate that a formal analysis guarantees safety with high confidence such that the robotic instruments operate within the safe workspace and avoid hazardous interaction with other anatomical structures.

Reinforcement Learning (RL) methods have demonstrated promising results for the automation of subtasks in surgical robotic systems. Since many trial and error attempts are required to learn the optimal control policy, RL agent training can be performed in simulation and the learned behavior can be then deployed in real environments. In this work, we introduce an open-source simulation environment providing support for position based dynamics soft bodies simulation and state-of-the-art RL methods. We demonstrate the capabilities of the proposed framework by training an RL agent based on Proximal Policy Optimization in fat tissue manipulation for tumor exposure during a nephrectomy procedure. Leveraging on a preliminary optimization of the simulation parameters, we show that our agent is able to learn the task on a virtual replica of the anatomical environment. The learned behavior is robust to changes in the initial end-effector position. Furthermore, we show that the learned policy can be directly deployed on the da Vinci Research Kit, which is able to execute the trajectories generated by the RL agent. The proposed simulation environment represents an essential component for the development of next-generation robotic systems, where the interaction with the deformable anatomical environment is involved.