A Teleoperated Control for Robot-Aided Percutaneous Surgery: An Application to Needle Insertion in Nephrolithotomy

Minimally Invasive Percutaneous Surgery (MIPS) has revolutionized medical practice by allowing access to internal organs through needle puncture, thus avoiding large incisions. Tele-operated robotic systems address MIPS challenges, but current literature lacks real-time needle path re-planning during surgery, which is crucial due to organ shifts between pre-operative imaging and the intra-operative setting. Moreover, no studies have systematically compared the performance of different control strategies. This letter aims to enhance MIPS effectiveness by improving patient safety while considering efficiency, usability, and acceptability. A new tele-operated control strategy, adaptable to surgeon preferences, is introduced with application to nephrolithotomy. The strategy integrates position control for access point re-planning and two operation modes for needle advancement: OM1 - parallel position/velocity, and OM2 - master-slave position error-based. Experimental validation involved six subjects performing nephrolithotomy on a synthetic anatomical model. Results showed comparable puncture time, usability, and acceptability between modes. OM1 achieved higher needle orientation accuracy (<inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$max \ DNA = 0.006 \pm 0.003 \ [rad]$</tex-math></inline-formula>) and motion smoothness (<inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$SM = 0.13 \pm 0.08$</tex-math></inline-formula>), while OM2 was more responsive in terms of needle displacement accuracy (<inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$CRE = 0. 8 \pm 0.9 \ [mm]$</tex-math></inline-formula>). Six experts further evaluated the system, finding both modes intuitive with moderate mental and physical workload.