A virtual scalpel system for computer-assisted laser microsurgery

A medical robotic system for teleoperated laser microsurgery based on a concept we have called “virtual scalpel” is presented in this paper. This system allows surgeries to be safely and precisely performed using a graphics pen directly over a live video from the surgical site. This is shown to eliminate hand-eye coordination problems that affect other microsurgery systems and to make full use of the operator's manual dexterity without requiring extra training. The implementation of this system, which is based on a tablet PC and a new motorized laser micromanipulator offering 1μm aiming accuracy within the traditional line-of-sight 2D operative space, is fully described. This includes details on the system's hardware and software structures and on its calibration process, which is essential for guaranteeing precise matching between a point touched on the live video and the laser aiming point at the surgical site. Together, the new hardware and software structures make both the calibration parameters and the laser aiming accuracy (on any plane orthogonal to the imaging axis) independent of the target distance and of its motions. Automatic laser control based on new intraoperative planning software and safety improvements based on virtual features are also described in this paper, which concludes by presenting results from sets of path following evaluation experiments conducted with 10 different subjects. These demonstrate an error reduction of almost 50% when using the virtual scalpel system versus the traditional laser microsurgery setup, and an 80% error reduction when using the automatic laser control routines, evidencing great improvements in terms of precision and controllability, and suggesting that the technological advances presented herein will lead to a significantly enhanced capacity for treating a variety of internal human pathologies.