Nowadays Robotic assisted Minimally Invasive Surgeries (R-MIS) are the elective procedures for treating highly accurate and scarcely invasive pathologies, thanks to their ability to empower surgeons' dexterity and skills. The research on new Multi-Robots Surgery (MRS) platform is cardinal to the development of a new SARAS surgical robotic platform, which aims at carrying out autonomously the assistants tasks during R-MIS procedures. In this work, we will present the SARAS MRS platform validation protocol, framed in order to assess: (i) its technical performances in purely dexterity exercises, and (ii) its functional performances. The results obtained show a prototype able to put the users in the condition of accomplishing the tasks Manuscript

This paper presents an accurate and robust tracking vision algorithm for Fetoscopic Laser Photo-coagulation (FLP) surgery for Twin-Twin Transfusion Syndrome (TTTS). The aim of the proposed method is to assist surgeons during anastomosis localization, coagulation and review using a teleoperated robotic system. The algorithm computes the relative position of the fetoscope tool tip with respect to the placenta, via local vascular structure registration. The algorithm uses image features (local superficial vascular structures of the placenta's surface) to automatically match consecutive fetoscopic images. It is composed of three sequential steps: image processing (filtering, binarization and vascular structures segmentation); relevant Points Of Interest (POIs) seletion; and image registration between consecutive images. The algorithm has to deal with the low quality of fetoscopic images, the liquid and dirty environment inside the placenta jointly with the thin diameter of the fetoscope optics and low amount of environment light reduces the image quality. The obtained images are blurred, noisy and with very poor color components. The tracking system has been tested using real video sequences of FLP surgery for TTTS. The computational performance enables real time tracking, locally guiding the robot over the placenta's surface with enough accuracy.

This paper addresses the generation of collisionfree trajectories for the autonomous execution of assistive tasks in Robotic Minimally Invasive Surgery (R-MIS). The proposed approach takes into account geometric constraints related to the desired task, like for example the direction to approach the final target and the presence of moving obstacles. The developed motion planner is structured as a two-layer architecture: a global level computes smooth spline-based trajectories that are continuously updated using virtual potential fields; a local level, exploiting Dynamical Systems based obstacle avoidance, ensures collision free connections among the spline control points. The proposed architecture is validated in a realistic surgical scenario.

Objectives: Evaluating the learning effect of the new Scanbooster ultrasound simulator app and to compare it to conventional learning methods with a focus on assessing the recognition of physiological structures in fetal echocardiography. Methods: 226 medical students participated. A tablet was used to display the sonographic simulation, the control was implemented by a smartphone as a virtual probe. 118 students used the new ultrasound simulator app (app group, n = 118) and 108 students were taught by conventional learning material from a standard textbook (PDF group, n = 108). The knowledge of both groups was checked using short videos in which different structures of the fetal heart were marked and had to be identified correctly by single-choice from 5 possible answers, both before and after the learning phase. Results: There were no significant differences between the two groups with regard to age (p = 0.87), gender (p = 0.28), and the number of previous ultrasound examinations performed by participants (p = 0.45). Students in the app group showed a significantly higher technical experience (scale from 0-100; median 39.5 vs. 26.6; p = 0.008) and affinity to technology (scale from 0-100; median 60.5 vs. 50.0; p = 0.002). The app group showed a significantly higher learning effect in terms of an increase in correct answers (p = 0.005). The students had significantly more fun learning with the ultrasound simulation app (scale from 0-100; median 68.2 vs. 10.2; p < 0.001). In the app group, 78.8% would prefer ultrasound training using the app to the conventional learning method. This rate did not differ significantly by gender, technology affinity, or previous knowledge of the participants (all p > 0.2). Conclusions: The first data indicate that with the new ultrasound simulator app, complex sonographic structures can be understood better compared to conventional learning methods. Contrary to expensive and bulky ultrasound simulators, the new app is inexpensive, yet effective and can be deployed independently of location and time. OC10.09 Face validity evaluation of a fetoscopic laser surgery simulator

Objectives: To evaluate the effects of using robotic assistance in the performance of placental laser surgery (PLS) in the treatment of Twin-twin transfusion syndrome (TTTS). Methods: We developed two platforms to simulate PLS using real tools and integrating a tracking system to record fetoscope trajectories. The manual platform (MP) reproduces current surgical procedure and the robotic platform (RP) incorporates a robotic arm to move the fetoscope, stabilise the trocar and laser movements. The RP allows to mark the anastomoses, can automatically guide the fetoscope to any of them and generates virtual sliding surface to avoid contact with placenta surface. Finally, it generates an interactive navigation map showing located anastomoses and fetoscope trajectories. A total of 16 fetal surgery specialist were recruited. After a period of training in both platforms, they were asked to perform a PLS using several placental images from real monochorionic pregnancies. Trajectory, duration and coagulated area were compared. Results: In general, RP improved surgeons' performance with shorter and more structured trajectories. In addition, coagulated surface decreases in RP, maximising the preserved placenta's surface. The overall execution time has increased on the RP especially because of the velocity limitation provided. Conclusions: The use of a robotic assistance tool improved the performance of PLS reducing trajectory length and coagulated surface but with a slightly increase in duration of procedure. Further studies to evaluate safety and applicability in clinical setting are warranted.