Robot-Assisted Feeding (RAF) systems are essential for assisting individuals with disabilities or motor impairments in eating tasks. Manipulating granular food items, such as rice and beans, poses significant challenges due to their dynamic physical properties. Learning from human demonstrations offers a promising solution, but acquiring high-quality demonstrations is complex. To address this, we present VERAGMIL, a framework that combines a high-fidelity simulator with an intuitive Virtual Reality (VR) interface for recording demonstrations and supporting different imitation learning methods. VERAGMIL provides a realistic environment for training RAF systems to handle granular materials, including robots, sensors, and various food items with distinct physical characteristics. We evaluate VERAGMIL by training three imitation learning models—BC, BC-RNN, and BCQ—on granular scooping and transporting tasks using both VR interface and 3D space mouse demonstrations, comparing them with a human-expert baseline. The models are assessed on success rate, spillage, generalization to unseen food items, and task completion time. Results show that VR-based demonstrations significantly outperform 3D space mouse data, with BCQ achieving the best overall performance, particularly in reducing spillage and approaching human performance. These findings underscore the effectiveness of our framework for training RAF systems in granular material handling. The code for our framework is publicly available at: https://github.com/AmanuelErgogo/VERAGMIL.git.

Computer-assisted surgical (CAS) systems enhance surgical execution and outcomes by providing advanced support to surgeons. These systems often rely on deep learning models trained on complex, challenging-to-annotate data. While synthetic data generation can address these challenges, enhancing the realism of such data is crucial. This work introduces a multi-stage pipeline for generating realistic synthetic data, featuring a fully-fledged surgical simulator that automatically produces all necessary annotations for modern CAS systems. This simulator generates a wide set of annotations that surpass those available in pub-lic synthetic datasets. Additionally, it offers a more complex and realistic simulation of surgical interactions, including the dynamics between surgical instruments and de-formable anatomical environments, outperforming existing approaches. To further bridge the visual gap between synthetic and real data, we propose a lightweight and flexible image-to-image translation method based on Stable Diffusion (SD) and Low-Rank Adaptation (LoRA). This method leverages a limited amount of annotated data, enables efficient training, and maintains the integrity of annotations generated by our simulator. The proposed pipeline is exper-imentally validated and can translate synthetic images into images with real-world characteristics, which can generalize to real-world context, thereby improving both training and CAS guidance. The code and the dataset are available at https://github.com/SanoScience/SimuScope.

Robotic surgery is a rapidly developing field that can greatly benefit from the automation of surgical tasks. However, training techniques such as Reinforcement Learning (RL) require a high number of task repetitions, which are generally unsafe and impractical to perform on real surgical systems. This stresses the need for simulated surgical environments, which are not only realistic, but also computationally efficient and scalable. We introduce FF-SRL (Fast and Flexible Surgical Reinforcement Learning), a high-performance learning environment for robotic surgery. In FF-SRL both physics simulation and RL policy training reside entirely on a single GPU. This avoids typical bottlenecks associated with data transfer between the CPU and GPU, leading to accelerated learning rates. Our results show that FF-SRL reduces the training time of a complex tissue manipulation task by an order of magnitude, down to a couple of minutes, compared to a common CPU/GPU simulator. Such speed-up may facilitate the experimentation with RL techniques and contribute to the development of new generation of surgical systems. To this end, we make our code publicly available to the community.

Reinforcement Learning (RL) algorithms can learn robotic control tasks from visual observations, but they often require a large amount of data, especially when the visual scene is complex and unstructured. In this paper, we explore how the agent’s knowledge of its shape can improve the sample efficiency of visual RL methods. We propose a novel method, Disentangled Environment and Agent Representations (DEAR), that uses the segmentation mask of the agent as supervision to learn disentangled representations of the environment and the agent through feature separation constraints. Unlike previous approaches, DEAR does not require reconstruction of visual observations. These representations are then used as an auxiliary loss to the RL objective, encouraging the agent to focus on the relevant features of the environment. We evaluate DEAR on two challenging benchmarks: Distracting DeepMind control suite and Franka Kitchen manipulation tasks. Our findings demonstrate that DEAR surpasses state-of-the-art methods in sample efficiency, achieving comparable or superior performance with reduced parameters. Our results indicate that integrating agent knowledge into visual RL methods has the potential to enhance their learning efficiency and robustness.

The field of robotic Flexible Endoscopes (FEs) has progressed significantly, offering a promising solution to reduce patient discomfort. However, the limited autonomy of most robotic FEs results in non-intuitive and challenging manoeuvres, constraining their application in clinical settings. While previous studies have employed lumen tracking for autonomous navigation, they fail to adapt to the presence of obstructions and sharp turns when the endoscope faces the colon wall. In this work, we propose a Deep Reinforcement Learning (DRL)-based navigation strategy that eliminates the need for lumen tracking. However, the use of DRL methods poses safety risks as they do not account for potential hazards associated with the actions taken. To ensure safety, we exploit a Constrained Reinforcement Learning (CRL) method to restrict the policy in a predefined safety regime. Moreover, we present a model selection strategy that utilises Formal Verification (FV) to choose a policy that is entirely safe before deployment. We validate our approach in a virtual colonoscopy environment and report that out of the 300 trained policies, we could identify three policies that are entirely safe. Our work demonstrates that CRL, combined with model selection through FV, can improve the robustness and safety of robotic behaviour in surgical applications.

Abstract Natural language annotations and manuals can provide useful procedural information and relations for the highly specialized scenario of autonomous robotic task planning. In this paper, we propose and publicly release AUTOMATE, a pipeline for automatic task knowledge extraction from expert-written domain texts. AUTOMATE integrates semantic sentence classification, semantic role labeling, and identification of procedural connectors, in order to extract templates of Linear Temporal Logic (LTL) relations that can be directly implemented in any sufficiently expressive logic programming formalism for autonomous reasoning, assuming some low-level commonsense and domain-independent knowledge is available. This is the first work that bridges natural language descriptions of complex LTL relations and the automation of full robotic tasks. Unlike most recent similar works that assume strict language constraints in substantially simplified domains, we test our pipeline on texts that reflect the expressiveness of natural language used in available textbooks and manuals. In fact, we test AUTOMATE in the surgical robotic scenario, defining realistic language constraints based on a publicly available dataset. In the context of two benchmark training tasks with texts constrained as above, we show that automatically extracted LTL templates, after translation to a suitable logic programming paradigm, achieve comparable planning success in reduced time, with respect to logic programs written by expert programmers.

Automatic recognition of fine-grained surgical activities, called steps, is a challenging but crucial task for intelligent intra-operative computer assistance. The development of current vision-based activity recognition methods relies heavily on a high volume of manually annotated data. This data is difficult and time-consuming to generate and requires domain-specific knowledge. In this work, we propose to use coarser and easier-to-annotate activity labels, namely phases, as weak supervision to learn step recognition with fewer step annotated videos. We introduce a step-phase dependency loss to exploit the weak supervision signal. We then employ a Single-Stage Temporal Convolutional Network (SS-TCN) with a ResNet-50 backbone, trained in an end-to-end fashion from weakly annotated videos, for temporal activity segmentation and recognition. We extensively evaluate and show the effectiveness of the proposed method on a large video dataset consisting of 40 laparoscopic gastric bypass procedures and the public benchmark CATARACTS containing 50 cataract surgeries.

Increased demand for less invasive procedures has accelerated the adoption of Intraluminal Procedures (IP) and Endovascular Interventions (EI) performed through body lumens and vessels. As navigation through lumens and vessels is quite complex, interest grows to establish autonomous navigation techniques for IP and EI for reaching the target area. Current research efforts are directed toward increasing the Level of Autonomy (LoA) during the navigation phase. One key ingredient for autonomous navigation is Motion Planning (MP) techniques. This paper provides an overview of MP techniques categorizing them based on LoA. Our analysis investigates advances for the different clinical scenarios. Through a systematic literature analysis using the PRISMA method, the study summarizes relevant works and investigates the clinical aim, LoA, adopted MP techniques, and validation types. We identify the limitations of the corresponding MP methods and provide directions to improve the robustness of the algorithms in dynamic intraluminal environments. MP for IP and EI can be classified into four subgroups: node, sampling, optimization, and learning-based techniques, with a notable rise in learning-based approaches in recent years. One of the review's contributions is the identification of the limiting factors in IP and EI robotic systems hindering higher levels of autonomous navigation. In the future, navigation is bound to become more autonomous, placing the clinician in a supervisory position to improve control precision and reduce workload.

Autonomous robotic surgery requires deliberation, i.e. the ability to plan and execute a task adapting to uncer-tain and dynamic environments. Uncertainty in the surgical domain is mainly related to the partial pre-operative knowledge about patient-specific anatomical properties. In this paper, we introduce a logic-based framework for surgical tasks with deliberative functions of monitoring and learning. The DE-liberative Framework for Robot-Assisted Surgery (DEFRAS) estimates a pre-operative patient-specific plan, and executes it while continuously measuring the applied force obtained from a biomechanical pre-operative model. Monitoring module compares this model with the actual situation reconstructed from sensors. In case of significant mismatch, the learning module is invoked to update the model, thus improving the estimate of the exerted force. DEFRAS is validated both in simulated and real environment with da Vinci Research Kit executing soft tissue retraction. Compared with state-of-the-art related works, the success rate of the task is improved while minimizing the interaction with the tissue to prevent unintentional damage.

Flexible Endoscopes (FEs) for colonoscopy present several limitations due to their inherent complexity, resulting in patient discomfort and lack of intuitiveness for clinicians. Robotic FEs with autonomous control represent a viable solution to reduce the workload of endoscopists and the training time while improving the procedure outcome. Prior works on autonomous endoscope FE control use heuristic policies that limit their generalisation to the unstructured and highly deformable colon environment and require frequent human intervention. This work proposes an image-based FE control using Deep Reinforcement Learning, called Deep Visuomotor Control (DVC), to exhibit adaptive behaviour in convoluted sections of the colon. DVC learns a mapping between the images and the FE control signal. A first user study of 20 expert gastrointestinal endoscopists was carried out to compare their navigation performance with DVC using a realistic virtual simulator. The results indicate that DVC shows equivalent performance on several assessment parameters, being more safer. Moreover, a second user study with 20 novice users was performed to demonstrate easier human supervision compared to a state-of-the-art heuristic control policy. Seamless supervision of colonoscopy procedures would enable endoscopists to focus on the medical decision rather than on the control of FE.

Optical Coherence Tomography (OCT) is increasingly used in endoluminal procedures since it provides high-speed and high resolution imaging. Distortion and instability of images obtained with a proximal scanning endoscopic OCT system are significant due to the motor rotation irregularity, the friction between the rotating probe and outer sheath and synchronization issues. On-line compensation of artefacts is essential to ensure image quality suitable for real-time assistance during diagnosis or minimally invasive treatment. In this paper, we propose a new online correction method to tackle both B-scan distortion, video stream shaking and drift problem of endoscopic OCT linked to A-line level image shifting. The proposed computational approach for OCT scanning video correction integrates a Convolutional Neural Network (CNN) to improve the estimation of azimuthal shifting of each A-line. To suppress the accumulative error of integral estimation we also introduce another CNN branch to estimate a dynamic overall orientation angle. We train the network with semi-synthetic OCT videos by intentionally adding rotational distortion into real OCT scanning images. The results show that networks trained on this semi-synthetic data generalize to stabilize real OCT videos, and the algorithm efficacy is demonstrated on both ex vivo and in vivo data, where strong scanning artifacts are successfully corrected.

In this paper, we propose a novel bilateral teleoperation architecture that allows to optimally render the remote interaction force at the local side while guaranteeing a robustly stable behaviour. Stability is guaranteed by ensuring a proper energy exchange between the local and the remote sides. Desired performance is obtained by optimizing the way energy is exploited for generating the behaviour at each side. The effectiveness of the proposed architecture is experimentally validated on a torque-controlled manipulator and in a surgical scenario, using the da Vinci®Research Kit (dVRK).

Deep Reinforcement Learning (DRL) is a viable solution for automating repetitive surgical subtasks due to its ability to learn complex behaviours in a dynamic environment. This task automation could lead to reduced surgeon’s cognitive workload, increased precision in critical aspects of the surgery, and fewer patient-related complications. However, current DRL methods do not guarantee any safety criteria as they maximise cumulative rewards without considering the risks associated with the actions performed. Due to this limitation, the application of DRL in the safety-critical paradigm of robot-assisted Minimally Invasive Surgery (MIS) has been constrained. In this work, we introduce a Safe-DRL framework that incorporates safety constraints for the automation of surgical subtasks via DRL training. We validate our approach in a virtual scene that replicates a tissue retraction task commonly occurring in multiple phases of an MIS. Furthermore, to evaluate the safe behaviour of the robotic arms, we formulate a formal verification tool for DRL methods that provides the probability of unsafe configurations. Our results indicate that a formal analysis guarantees safety with high confidence such that the robotic instruments operate within the safe workspace and avoid hazardous interaction with other anatomical structures.

Automated surgical gestures classification and recognition are important precursors for achieving the goal of objective evaluation of surgical skills. Many works have been done to discover and validate metrics based on the motion of instruments that can be used as features for automatic classification of surgical gestures. In this work, we present a series of angular metrics that can be used together with Cartesian-based metrics to better describe different surgical gestures. These metrics can be calculated both in Cartesian and joint space, and they are used in this work as features for automatic classification of surgical gestures. To evaluate the proposed metrics, we introduce a novel surgical dataset that contains both Cartesian and joint spaces data acquired with da Vinci Research Kit (dVRK) while a single expert operator is performing 40 subsequent suturing exercises. The obtained results confirm that the application of metrics in the joint space improves the accuracy of automatic gesture classification.

Reinforcement Learning (RL) methods have demonstrated promising results for the automation of subtasks in surgical robotic systems. Since many trial and error attempts are required to learn the optimal control policy, RL agent training can be performed in simulation and the learned behavior can be then deployed in real environments. In this work, we introduce an open-source simulation environment providing support for position based dynamics soft bodies simulation and state-of-the-art RL methods. We demonstrate the capabilities of the proposed framework by training an RL agent based on Proximal Policy Optimization in fat tissue manipulation for tumor exposure during a nephrectomy procedure. Leveraging on a preliminary optimization of the simulation parameters, we show that our agent is able to learn the task on a virtual replica of the anatomical environment. The learned behavior is robust to changes in the initial end-effector position. Furthermore, we show that the learned policy can be directly deployed on the da Vinci Research Kit, which is able to execute the trajectories generated by the RL agent. The proposed simulation environment represents an essential component for the development of next-generation robotic systems, where the interaction with the deformable anatomical environment is involved.

Ultrasound (US) guided biopsy is a medical procedure routinely performed in clinical practice. This task could be performed by robotic systems to improve the precision in the execution and then the safety for the patient. Both robotic and human procedures could greatly benefit from real-time localization of the needle in US images. This information could guide the robot or the specialists to the correct target point avoiding critical structures. Unfortunately US data provide very low quality images of the needle making this task quite complex, even more if you want to perform the localization on-line during the image acquisition. In this work we present a needle localization method able to extract the needle orientation and the tip position in real time from B-mode US images. To evaluate the performance of the algorithm in a precise way we use an optical tracking system to measure the position and the orientation of the needle and the US probe. In such a way the comparison is not human dependent (i.e. there are no radiologists manually selecting the needle tip) and fully repeatable. The results show an improvement in term of localization accuracy compared to previous works in literature.

In this work we have designed and developed a new navigation system for interventional radiology, implemented in a light and compact device. The system attached to the needle is composed by a small screen that gives hints about the position and the orientation, a controller that commands the screen and interfaces with the computer, and a marker that communicates with a tracking system. By using a real time software the user is guided to move the needle along the desired position and orientation. To the best of our knowledges, this is the first system to have the navigation display integrated directly on the tool. The in-vitro tests we have performed, show how such a system yields a higher precision in the execution of the task and a reduction of the time required to complete the procedure.