Ontology-based surgical subtask automation, automating blunt dissection

May 7, 2018, World Scientific Publishing

In a paper to be published in the Journal of Medical Robotics Research, a team of researchers have discovered a way to automate blunt dissection using the da Vinci surgical robot, which is controlled by the Da Vinci Research Kit (DVRK).

Blunt dissection is the surgical separation of tissue layers by means of a blunt instrument. In most surgical procedures, blunt dissection takes up far more time than sharp dissection, which can be described as the practice of cutting through tissues with a sharp instrument. Due to this, any innovation that can make the process of blunt dissection easier, safer or faster could significantly improve the lives of both surgeons and patients alike.

A good way to make blunt dissection easier, safer, and faster is to automate it. Here's a general overview of how the automation of surgical procedures is done. Surgical operations are first described as a series of tasks known as a Surgical Process (SP). An ontology, or a complex data/knowledge representation system based on the accurate description of agents in surgery, is developed to represent the SP in a way that allows it to be analysed in an automated manner. A Surgical Process Model (SPM) is then created to simplify the SP into a pattern that can be performed with support from a workflow management system.

Recently, a team of researchers comprising Dénes Ákos Nagy, Tamás Dániel Nagy, Renáta Elek, Imre J. Rudas and Tamás Haidegger have discovered a way to automate blunt dissection using the da Vinci surgical robot, which is controlled by the Da Vinci Research Kit (DVRK). The team decided to automate blunt dissection as it is performed during Laparoscopic Cholecystectomy (LC), or the procedure by which the gall bladder is removed by keyhole surgery. First, they read the surgical literature on LC and watched videos depicting the procedure. Based on this information, an SPM was created and the portion of the SPM which involved blunt dissection was selected for further study. An algorithm was written to control and monitor the execution of the process. The algorithim requires the surgeon to select a start and an end point for the dissection on an endoscopic image. The 3D field is then reconstructed and the dissection line between the boundary points identified. The computer vision algorithm selects one point on this line with the least depth and the surgical robot executes blunt dissection at this point. When the dissection is complete, the program checks if the target anatomy is exposed. If not, the algorithm reinitiates the dissection line and starts the process again.

To test the performance of this algorithm, the team created an object consisting of two outer layers of hard silicone and an inner layer of soft, foamy, dissectable silicone which could be penetrated with the laparoscopic tool. In all the test cases, the dissection progressed on the intended dissection line. The team also tested the sensitivity of the method to texture and rotation. In addition, they tested the method on more realistic objects such as chicken breast, pork shoulder, and duck liver. It was found that the method is highly sensitive to texture but not significantly sensitive to rotation, and that the performance of the method on realistic objects depended largely on the texture of the objects and the lighting. The method performed far better on feature-rich objects than on feature-poor ones.

While further trials are necessary to confirm the reliability and robustness of this method under surgical conditions, it seems that blunt dissection can be carried out by the surgical robot with only the visual data from the stereo endoscopic camera image feed. This means that additional sensors are not required, and that the can therefore be easily integrated into the current surgical workflow. In the near future, all blunt dissection could be carried out by surgical robots.

Explore further: Acute aortic dissection should be suspected with pulse or neurologic deficit and hypotension

More information: Dénes Ákos Nagy et al, Ontology-Based Surgical Subtask Automation, Automating Blunt Dissection, Journal of Medical Robotics Research (2018). DOI: 10.1142/S2424905X18410052

Related Stories

Acute aortic dissection should be suspected with pulse or neurologic deficit and hypotension

April 23, 2018
In the appropriate clinical setting, suspicion for acute aortic dissection should be raised when patients present with findings that have a high specificity and high positive likelihood ratio (hypotension, pulse deficit, ...

Genetic mutation linked to aortic dissection in the chest

May 11, 2017
Researchers at Umeå University in Sweden have discovered a genetic mutation that can cause dissection of the thoracic aorta, which is the body's main artery. The mutation leads to an impaired function of the smooth muscle ...

Da vinci robot used in anterior lumbar interbody fusion

March 12, 2013
(HealthDay)—The da Vinci Robotic Surgical System can be used for anterior lumbar interbody fusion, according to a case report published in the Feb. 15 issue of Spine.

Central neck dissection underused in some thyroid CA

September 28, 2017
(HealthDay)—Only about one-third of patients with medullary thyroid carcinoma (MTC) undergo initial central neck dissection, which is associated with a reduced rate of reoperation, according to a study published online ...

New surgical techniques help save patients from life-threatening heart condition

June 6, 2017
Cardiac surgeons are successfully performing more extensive surgical repairs of type A aortic dissection—one of the highest risk operations in cardiothoracic surgery. These new surgical techniques, along with improved postoperative ...

Serious heart problem a family matter

August 25, 2016
(HealthDay)—A potentially deadly heart problem can run in families and occur at similar ages, a new study suggests.

Recommended for you

Surprise finding—for very sick elderly, lighter sedation won't drop risk of postoperative delirium, study suggests

August 13, 2018
Johns Hopkins Medicine researchers say a study designed to see if reducing the amount of anesthesia reduces the risk of postoperative delirium in older patients surprisingly found that lighter sedation failed to do so in ...

Kidney transplant chains more effective in saving lives

August 9, 2018
New research from the UBC Sauder School of the Business has found that transplant societies which prioritize kidney transplant chains over kidney exchanges can increase the total number of transplants, thereby saving more ...

Surgical mesh implants may cause autoimmune disorders

July 31, 2018
Surgical mesh implants, often used for hernia or gynecological repair, may be the reason so many patients report symptoms of an autoimmune disorder, according to a University of Alberta rheumatologist.

Surgeons discuss options when the risks of surgery may be too high

July 27, 2018
In an essay published July 26 in the New England Journal of Medicine, Ira Leeds, M.D., research fellow, and David Efron, M.D., professor of surgery, both of the Johns Hopkins University School of Medicine, along with their ...

Blood plasma during emergency air transport saves lives

July 25, 2018
Two units of plasma given in a medical helicopter on the way to the hospital could increase the odds of survival by 10 percent for traumatically injured patients with severe bleeding, according to the results of a national ...

The dark side of antibiotic ciprofloxacin

July 25, 2018
The use of ciprofloxacin and other antibiotics of the class of fluoroquinolones may be associated with disruption of the normal functions of connective tissue, including tendon rupture, tendonitis and retinal detachment. ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.