INSTINCT - INtuitive Soft, stiffness-controllable hapTic INterfaCe for soft Tissue palpation during robot-assisted minimally invasive surgery

In open surgery, surgeons are able to directly access soft tissue/organs and perform manual palpation to understand the texture, size, consistency and location of soft tissue areas. Stiffer areas than the surrounding tissue might suggest the presence of tumours. Through vision and, most importantly, tactile sensation of the surgeons' fingertips, surgeons are able to accurately localise unhealthy tissue areas by distinguishing cancerous soft tissue from healthy tissue, and remove tumours. Open surgery has been increasingly replaced by Minimally Invasive Surgery from the mid-1980s and by Robot-assisted Minimally Invasive Surgery (RMIS) from 2000. Surgical instruments are introduced through small incisions ranging from 3-12 mm into the human body to perform surgery. Though RMIS has many advantages over open surgery, including improved therapeutic outcome, shortened postoperative recovery, less immunological stress response of the tissue, reduced tissue trauma, lower postoperative pain, and less scarring, current robotic systems do not provide any type of sensation (haptic feedback) to the operating surgeon. The lack of direct palpation can lead to insufficient tumour excising resulting in an increased rate of biochemical relapse and influence decisions about future treatments such as additional surgery and radiation.

Just as the definition of 'instinct' , the vision of this project is to intuitively provide surgeons with soft tissue stiffness information when performing soft tissue palpation during RMIS. Based on previous research creating soft, stiffness-controllable robotic structures and haptic feedback interfaces, the aim of this project is to design, model, fabricate and validate a soft, stiffness-controllable haptic feedback actuator which will be integrated into the da Vinci Research Kit. Of key importance for the success of this work is close collaboration with experienced clinical and industrial experts. Prof. Shervanthi Homer-Vanniasinkam (Professor of Surgery (Founding)), University of Warwick Medical School, Prof. Prokar Dasgupta (Professor of Robotic Surgery and Urological Innovation), King's College London, and Prof. Alberto Arezzo (Associate Professor of Surgery), University of Turin, Dr Alastair Barrow (MD), Generic Robotics, Dr Jerome Perret (CEO), Haption GmbH, and Dr Chris Wagner (Senior Consultant), Cambridge Consultants will consult over the duration of the project on clinical and translational aspects. These Project Partners will form the Expert Working Group meeting at least two times a year, providing feedback and critical appraisal of the experimental design, implementation and outcomes from the research project.

The key objectives through which this ambition will be realised are:

1) Creating pneumatically actuated, soft, stiffness-controllable fingertip interfaces made of silicone with integrated fabric meshes.
2) Integration of stiffness sensor and actuators with the da Vinci Research Kit.
3) Benchmarking tests of different haptic actuator designs distinguishing between healthy and tumorous tissue.

POTENTIAL APPLICATIONS AND BENEFITS:

To maximise economic and clinical impact, INSTINCT project partners Generic Robotics, Haption GmbH, and Cambridge Consultants will advise on the design process, exploitation opportunities and certification procedure. These internationally operating companies aim at revolutionising therapy through ground-breaking surgical devices and simulators drawing on deep experience in simulation, haptics, engineering, electronics, control systems, Virtual Reality, medical device regulations, and commercialisation. The expertise of the industrial partner and guidance of clinical partners are of paramount importance to translate the results of the INSTINCT projects into a medical device/training simulator. Beyond the healthcare sector, possible application areas include wearable haptic devices for Virtual Reality environments and E-Learning technologies.

Who will benefit from the project?

The INSTINCT project with its multidisciplinary Expert Working Group is ideally placed to deliver this timely and adventurous research, with the strong potential to address the fundamental issue of how to accurately localise tumorous soft tissue during Robot-assisted Minimally Invasive Surgery (RMIS) and, hence, optimise surgical cancer treatment.
(i) The project will positively affect the UK economy: The outcome of this project will contribute directly to UK competitiveness in developing smart robotic healthcare technologies by developing a platform-agnostic haptic feedback interface for RMIS. (ii) Negative impact will be prevented for cancer patients who currently experience further treatments, such as additional surgery and radiation, as tumorous soft tissue was not accurately localised and entirely removed during current RMIS, leaving traces of cancerous tissue. Hence, this project represents excellent value for money, for relatively modest resources. (iii) Academics will benefit from new understanding of modelling soft tissue stiffness and how to feedback crucial information during surgical interventions.

How will they benefit from the project?

Industries in the surgical robotics and haptics sector: The number of companies entering the market with surgical robotic platform will increase over the next decade. At the same time, the market for haptic interfaces is expected to be valued at $20 billion by 2022, at a compound annual growth rate of 16.20% between 2016 and 2022. One of the key drivers contributing to the growth of the market includes the potential market for haptics in healthcare. The INSTINCT project will develop new devices that will enhance current surgical cancer treatments conducted in a minimally invasive way. The haptic feedback actuator has enormous potential to be applied to medical training simulators and haptic feedback devices for Virtual Reality.

The general public (i.e. patients and clinicians): The INSTINCT project aims at dramatically enhancing the outcome of surgical cancer treatment to decrease the rate of biochemical relapse and need of additional surgery and radiation. The development of a generic novel soft tissue stiffness feedback device will benefit the surgical outcome. Tumorous tissue can be accurately located, separated from surrounding healthy soft tissue without positive margins and entirely removed. Clinicians are offered the required additional information during surgical intervention using the INSTINCT haptic feedback actuator.

Scientific community and academics: The multidisciplinary nature of this project will train participating scientists with wide range of expertise that will enhance the scientific competitiveness of the UK. The project will increase our understanding of modelling soft tissue stiffness and how to feedback crucial information during surgical interventions. This has wider implications for other fields such as human factors and tissue engineering.