The comanipulation paradigm, in which a user and a robot simultaneously hold a tool, allows for gesture guidance. In particular, virtual fixtures, which are geometrical constraints imposed to the tool by the robot, have received great interest in the domain of surgical applications. So far, this concept has been implemented in the context of open surgery. This paper explores the application of virtual fixtures for minimally invasive surgery, in which the tool is inserted in the patient through a fulcrum. Here, a key issue is to return to the surgeon forces that are virtually applied at the instrument distal tip, while the robot is physically attached to the instrument proximal handle. To this aim, two approaches are investigated. A first approach consists of applying a full wrench at the proximal end of the instrument that is equal to the wrench constituted by a pure force applied to the instrument's distal tip. A second approach consists of applying a pure force to the instrument proximal end, thanks to a lever model about the fulcrum. The two approaches are compared through experiments, during which naive subjects blindly perform virtual object palpation and robot-guided movements. During experiments, indicators involving motion and force analysis are computed. The user capacity to distinguish between several virtual objects is evaluated as well. Although drastically different, the two approaches provide assistance with a similar level of efficiency.

A novel robotic device, aimed at assisting a urologist in performing prostate biopsies guided by an endorectal ultrasound probe, is described. The paper describes the robot kinematics and the actuation system. The actuation system combines electromagnetic brakes, balancing springs, and electrical motors with cable transmissions. The robot supports two modes of operation: the free mode, where the entire control of the probe movements is left to the urologist, and the blocked mode, where the robot precisely maintains the probe at a given position and orientation with respect to the prostate. For the blocked mode, the set of specifications is antagonistic: firstly, a security constraint requires a low robot stiffness to allow to compliantly adapt to potential movements from the patient; secondly, a precision constraint requires a high robot stiffness in order to maintain the position and orientation of the probe in the presence of unmodeled external forces, when the robot is switched from the free mode to the blocked mode. A control strategy is developed to obtain this behavior. It combines an inner impedance controller with a relatively low stiffness and an outer intelligent position integrator that operates only during a limited period of time, when switching from the free mode to the blocked mode. Both in vitro and in cadavero experimental results show the efficiency of this approach.