The goal of this research is to develop the multidisciplinary science and technology of telepresence and demonstrate its applicability to closed intra-abdominal surgery, endoscopic surgery, and microsurgery. In these fields, the range of functions that can be performed with currently available instruments is restricted, owing to limitations in both visualization and manipulation. Even with video displays, the surgeon's view is detached from his physical relationship to his instruments and to the patient. The selection of instruments is limited and the hand motions required to maneuver them are frequently quite unlike the desired instrument-tip motion. Moreover, it is often impossible to sense the force of contact of the instrument tip with the tissue, which is important, for example, in controlling the tearing force in blunt dissection or the depth of a cut. Compared to the ease and dexterity with which we perform complex tasks with our hands and tools every day, the surgeon's task can be very difficult. Telepresence promises to bring to these surgical specialties the opportunity to expand the range of procedures, to improve the speed and surety of existing procedures, and to reduce the size of the surgical team. Teleoperation is the human control of remote operations, using operator-controlled manipulators, usually under direct or televised observation. Telepresence greatly expands the potential for teleoperation by providing the operator with the complex sensory feedback and motor control he would have were he actually at the worksite, carrying out the operation with his own hands. Telepresence has the potential to make it possible to project one's full motor and sensory capabilities into remote and microscopic environments to perform operations that demand fine dexterity and hand-eye coordination. To develop this capability, it is necessary to better understand how our senses interact with our motor functions and to apply this knowledge to the development of instrumentation specifically configured for convenient use in each surgical environment. SRI has already begun work on the development of a variety of telepresence system components and on understanding the dynamics of the interaction of motor, sensory, and system factors. Initial efforts under the proposed research will concentrate on effectively integrating stereoscopic vision and remote manipulation. The investigators will begin this work using their existing telepresence research system. They will devise psycho physical tests for the evaluation of a sense of presence and objective tests to measure overall system and operator performance. They will develop a stereo laparoscopic video camera and fabricate a pair of dexterous hand controllers and servo-controlled surgical actuators with seven degrees of freedom and force feedback to the operator. These will be integrated into a telepresence operator console designed for surgical use and an intra-abdominal surgery simulator; various surgical procedures will be simulated. To determine the potential for telepresence in endoscopy, the investigators will develop an endoscope-tip experimental module with stereographic video and a pair of actuators that pass through two forceps channels. This instrumentation will be coupled to the SRI operator console and tests will be made of simulated endoscopic procedures.
