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A photo showing a surgical robot with four arms, two controlled by a surgeons hands and the other two controlled by their feet.

A surgeon can control two of this four-armed surgical robotics system’s arms with their hands and the other two with their feet. [Photo courtesy of EPFL]

Researchers at EPFL, a public research university in Lausanne, Switzerland, have developed a four-armed surgical robotics system that allows surgeons to perform laparoscopic surgeries by controlling two of the robotic arms using haptic foot interfaces. The results were published in The International Journal of Robotics Research.

The research was a collaboration between the research group REHAssist and the Learning Algorithms and Systems Laboratory (LASA). It was led by EPFL Ph.D. students Jacob Hernandez and Walid Amanhoud, who developed a system that allows surgeons to control two robotic arms using haptic foot interfaces with five degrees of freedom. In this setup, each of the surgeon’s hands controls a manipulative instrument, while one foot controls an actuated gripper while the other controls an endoscope or camera.

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“Actuators in the foot pedals give haptic feedback to the user, guiding the foot towards the target as if following an invisible field-of-forces, and also limit force and movement to ensure that erroneous feet movements do not endanger the patient,” Mohamed Bouri, head of REHAssist, said. “Our system opens up new possibilities for surgeons to perform 4-handed laparoscopic procedures, allowing a single person to do a task that is usually performed by two, sometimes three people.”

One key aspect of the system is that control is shared between the surgeon and robotic assistants. The researchers designed a control framework that ensures the surgeon and robots can work collaboratively within a concurrent workspace while still meeting the precision and demands of laparoscopic surgery.

This feature helps to minimize fatigue for surgeons, as the robots can sometimes lead the surgeon’s control of an instrument as it predicts where the surgeon wants to move.

“Controlling four arms simultaneously, moreover with one’s feet, is far from routine and can be quite tiring. To reduce the complexity of the control, the robots actively assist the surgeon by coordinating their movements with the surgeons through active prediction of the surgeon’s intent and adaptive visual tracking of laparoscopic instruments with the camera. Additionally, assistance is offered for more accurate grasping of the tissues,” Professor Aude Billard, head of LASA, said.

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Specialists have already been trained on the system and clinical trials are currently ongoing in Geneva. The research team conducted a comprehensive user study with practicing surgeons.

According to Dr. Enrico Broennimann, who has participated in the trials in collaboration with the Swiss Foundation for Innovation and Training in Surgery (SFITS), “The idea to actively use one’s feet to perform robotic-assisted surgery is a good idea, and it’s definitely a learnable skill. I’d like to see it implemented in the operating room, perhaps as a cockpit well away from the patient to increase ergonomics.”