Cataract is the leading cause of blindness worldwide with an increasing number of patients due to changing demographics, making automation an important part in future surgical treatment. In this work, we focus on a substep of cataract surgery, the Continuous Curvilinear Capsulorhexis (CCC). With a high complexity, this task is an ideal candidate for Reinforcement Learning (RL) in simulation. First, we present an interactive and physically realistic simulation based on the Finite Element Method (FEM) that mimics the tearing behavior of soft tissue during CCC. Then, we train and evaluate RL models in simulation, demonstrating that the trained policies can complete the CCC in 85% of cases. We also show that applying domain randomization techniques make the policy more robust against changes in geometrical and biomechanical boundary conditions.

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.

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.