Scientists have developed the first-ever surgical system that facilitates four-arm laparoscopic surgery by allowing surgeons to control two supplementary robotic arms using haptic foot interfaces. This remarkable achievement integrates multi-limb manipulation with cutting-edge shared control augmentation, marking a significant milestone in the field of laparoscopic surgery.

A team of researchers at EPFL (Lausanne, Switzerland) has devised a surgical system that lets surgeons control two robotic arms in addition to their own natural arms, using haptic foot interfaces featuring five degrees of freedom. Each hand handles a surgical instrument, while one foot controls an endoscope/camera and the other foot directs an actuated gripper. One of the groundbreaking elements of this system is the shared control between the surgeon and the robotic assistants. The control framework designed by the researchers enables collaborative work between the surgeon and the robots within a concurrent workspace, while satisfying the stringent precision and safety requirements of laparoscopic surgery.

The foot pedals incorporate actuators that provide haptic feedback to the user, steering the foot toward the target and limiting force and movement to prevent patient endangerment due to erroneous foot movements. This system broadens the scope for surgeons to execute four-handed laparoscopic operations, enabling a single surgeon to undertake a task typically requiring two to three individuals. This concept, known as shared control, sometimes allows the robotics to preemptively direct the surgeon's instrument control, anticipating the surgeon's intended movement. For instance, when tying a knot, the endoscope aligns itself in the correct position and the gripper may reposition to avoid obstruction.

The research team conducted a detailed user study involving practicing surgeons to assess the system's user-friendliness and efficacy. The study demonstrated that the system has the potential to lessen the workload of surgeons while enhancing precision and safety. The shared-control strategies integrated into the system were shown to reduce task load, enhance performance, boost fluency, and improve coordination during laparoscopic procedures. Even as the system undergoes further testing and refinements, these results confirm its capability to facilitate four-arm surgical tasks without the need for intensive training. The system has already been successfully employed to train specialists, and clinical trials are currently underway.

“Controlling four arms simultaneously, moreover with one’s feet, is far from routine and can be quite tiring,” said Professor Aude Billard, head of the Learning Algorithms and Systems Laboratory (LASA). “To reduce the complexity of the control, the robots actively assist the surgeon by coordinating their movements with the surgeon’s 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.” 

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