Human-Centred Automation, Robotics and Monitoring

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• Journal article
  Das B, Ledesma F, Naik R, Law S, Soleimani-Nouri P, Khan OA, Mylonas G, Pai M, Ashrafian H, Spalding D, Fehervari Met al., 2024,

  Development and validation of a virtual teaching method for minimally invasive surgery skills: a prospective cohort study

  , INTERNATIONAL JOURNAL OF SURGERY, Vol: 110, Pages: 7414-7420, ISSN: 1743-9191
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• Journal article
  Rodriguez-Luna MR, Keller DS, Guerriero L, Kunda R, Marom G, Rubio-Solis A, Mylonas G, Mintz Y, Perretta Set al., 2024,

  A snapshot audit of global flexible endoscopy practice among European Association of Endoscopic Surgeons (EAES) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) surgeons from the EAES Flexible Endoscopy Subcommittee survey

  , SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 38, Pages: 6312-6323, ISSN: 0930-2794
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• Journal article
  Alian A, Avery J, Mylonas G, 2024,

  Tissue palpation in endoscopy using EIT and soft actuators

  , FRONTIERS IN ROBOTICS AND AI, Vol: 11, ISSN: 2296-9144
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• Journal article
  Sivananthan A, Rubio-Solis A, Darzi A, Mylonas G, Patel Net al., 2024,

  Eye-controlled endoscopy - a benchtop trial of a novel robotic steering platform-iGAZE2

  , JOURNAL OF ROBOTIC SURGERY, Vol: 18, ISSN: 1863-2483
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• Journal article
  Almukhtar A, Caddick V, Naik R, Goble M, Mylonas G, Darzi A, Orihuela-Espina F, Leff Det al., 2024,

  Objective assessment of cognitive workload in surgery: a systematic review

  , Annals of Surgery, ISSN: 0003-4932

  Objective: To systematically review technologies that objectively measure CWL in surgery, assessing their psychometric and methodological characteristics.Summary Background Data: Surgical tasks involving concurrent clinical decision-making and the safe application of technical and non-technical skills require a substantial cognitive demand and resource utilization. Cognitive overload leads to impaired clinical decision-making and performance decline. Assessing cognitive workload (CWL) could enable interventions to alleviate burden and improve patient safety.Methods: Ovid MEDLINE, OVID Embase, the Cochrane Library and IEEE Xplore databases were searched from inception to August 2023. Full-text, peer-reviewed original studies in a population of surgeons, anesthesiologists or interventional radiologists were considered, with no publication date constraints. Study population, task paradigm, stressor, Cognitive Load Theory (CLT) domain, objective and subjective parameters, statistical analysis and results were extracted. Studies were assessed for a) definition of CWL, b) details of the clinical task paradigm, and c) objective CWL assessment tool. Assessment tools were evaluated using psychometric and methodological characteristics.Results: 10790 studies were identified; 9004 were screened; 269 full studies were assessed for eligibility, of which 67 met inclusion criteria. The most widely used assessment modalities were autonomic (32 eye studies and 24 cardiac). Intrinsic workload (e.g. task complexity) and germane workload (effect of training or expertize) were the most prevalent designs investigated. CWL was not defined in 30 of 67 studies (44.8%). Sensitivity was greatest for neurophysiological instruments (100% EEG, 80% fNIRS); and across modalities accuracy increased with multi-sensor recordings. Specificity was limited to cardiac and ocular metrics, and was found to be sub-optimal (50% and 66.67%). Cardiac sensors were the least intrusive, with 54.2% of studies cond

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• Journal article
  Yang J, Runciman M, Avery J, Sun Z, Mylonas Get al., 2024,

  A soft inflatable robot driven by hydraulic folded pouch actuators for minimally invasive surgery

  , IEEE Robotics and Automation Letters, Vol: 9, Pages: 4870-4877, ISSN: 2377-3766

  This paper presents a soft, inflatable, cable-driven parallel robot (CDPR) for Minimally Invasive Surgery. The CDPR has 5 degrees of freedom and is driven by 6 cables and 6 hydraulic folded actuators. The actuator utilizes a folded chamber to pull a cable. The robot comprises a soft hexagonal variable-stiffness scaffold with a welded internal triangular support, which increases the stiffness of the robot when pressurized. The fabrication methodology is demonstrated in detail. A test platform is designed to obtain the characteristics of the folding actuator. The relationship between input liquid volume and actuator displacement can be predicted well by a geometry-based method. The displacement output of the actuator can reach 22 mm, which is nearly twice its length in its zero-volume folded state. Robot repeatability tests show mean and root mean square errors below 0.3 mm. The robot is made from plastic laminate sheets of thickness 120 μm and can deploy from 100 mm in length and 14 mm in diameter when folded, into an inflatable hollow hexagonal prism with 29 mm side length and 78 mm edge length. Deployment in a colon phantom is demonstrated and simulated surgery is conducted to validate the robot performance.

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• Journal article
  Zhou Z, Yang J, Runciman M, Avery J, Sun Z, Mylonas Get al., 2024,

  A tension sensor array for cable-driven surgical robots

  , Sensors, Vol: 24, ISSN: 1424-8220

  Tendon–sheath structures are commonly utilized to drive surgical robots due to their compact size, flexibility, and straightforward controllability. However, long-distance cable tension estimation poses a significant challenge due to its frictional characteristics affected by complicated factors. This paper proposes a miniature tension sensor array for an endoscopic cable-driven parallel robot, aiming to integrate sensors into the distal end of long and flexible surgical instruments to sense cable tension and alleviate friction between the tendon and sheath. The sensor array, mounted at the distal end of the robot, boasts the advantages of a small size (16 mm outer diameter) and reduced frictional impact. A force compensation strategy was presented and verified on a platform with a single cable and subsequently implemented on the robot. The robot demonstrated good performance in a series of palpation tests, exhibiting a 0.173 N average error in force estimation and a 0.213 N root-mean-square error. In blind tests, all ten participants were able to differentiate between silicone pads with varying hardness through force feedback provided by a haptic device.

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• Journal article
  Yang J, Li X, Runciman M, Avery J, Zhou Z, Sun Z, Mylonas Get al., 2024,

  A novel, soft, cable-driven parallel robot for minimally invasive surgeries based on folded pouch actuators

  , Applied Sciences, Vol: 14, ISSN: 2076-3417

  This paper introduces a soft, cable-driven parallel robot for minimally invasive surgeries. The robot comprises a pneumatic inflatable scaffold, six hydraulic, folded pouch actuators, and a hollow, cylindrical end-effector offering five degrees of freedom. A key development is the design of the pouch actuators, which are small, low-profile, simple structures, capable of a high stroke of 180° angular displacement. The scaffold, actuators, and plastic cables are economically and rapidly fabricated using laser cutting and welding techniques. Constructed primarily from soft plastic materials, the robot can be compactly folded into a cylinder measuring 110 mm in length and 14 mm in diameter. Upon inflation, the scaffold transforms into a hexagonal prism structure with side lengths of 34 mm and edge lengths of 100 mm. The kinematic model of the robot has been developed for workspace calculation and control purposes. A series of tests have been conducted to evaluate the performance of the actuator and the robot. Repeatability tests demonstrate the robot’s high repeatability, with mean and root mean square errors of 0.3645 mm and 0.4186 mm, respectively. The direct connection between the end-effector and the actuators theoretically eliminates cable friction, resulting in a hysteresis angle of less than 2°, as confirmed by the tracking results. In addition, simulated surgical tasks have been performed to further demonstrate the robot’s performance.

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• Conference paper
  Dong B, Chen J, Wang Z, Deng K, Li Y, Lo B, Mylonas Get al., 2024,

  An Intelligent Robotic Endoscope Control System Based on Fusing Natural Language Processing and Vision Models

  , Pages: 8180-8186, ISSN: 1050-4729

  In recent years, the area of Robot-Assisted Minimally Invasive Surgery (RAMIS) is standing on the the verge of a new wave of innovations. However, autonomy in RAMIS is still in a primitive stage. Therefore, most surgeries still require manual control of the endoscope and the robotic instruments, resulting in surgeons needing to switch attention between performing surgical procedures and moving endoscope camera. Automation may reduce the complexity of surgical operations and consequently reduce the cognitive load on the surgeon while speeding up the surgical process. In this paper, a hybrid robotic endoscope control system based on fusion model of natural language processing (NLP) and modified YOLO-V8 vision model is proposed. This proposed system can analyze the current surgical workflow and generate logs to summarize the procedure for teaching and providing feedback to junior surgeons. The user study of this system indicated a significant reduction of the number of clutching actions and mean task time, which effectively enhanced the surgical training.

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• Journal article
  Robertson D, Sterke F, van Weteringen W, Arezzo A, Mintz Y, Horeman Tet al., 2023,

  Escape of surgical smoke particles, comparing conventional and valveless trocar systems

  , SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 37, Pages: 8552-8561, ISSN: 0930-2794
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