**4.2 MRI compatible robot**

Anatomy identification is sometimes difficult during laparoscopic surgery. If surgeon can see vessel, nerve, and lesion under the organ surface, it will be strong merit for safety and quality of the operation. For this purpose, we used intraoperative open bore type MRI for real-time image acquisition and developed a laparoscopic surgical robot which can be placed inside the MRI gantry (**Figure 13**) [53]. As MRI has strong magnetic field, no magnetic metal such as stainless steel cannot be used. Our robot was made of mainly engineering plastic and titanium alloy. Also, we chose ultrasonic motors instead of magnetic motors. The system consists of two forceps and a camera. Additionally, needle insertion device can be attached. The surgeon console display shows the camera view, pre-operative MR image, and intraoperative real-time MR image. We have successfully demonstrated animal experiment by live porcine model.

**Figure 12.** *(Left) Master console (right) patient site of the teleoperation robot.*

**Figure 13.** *MRI image-guided surgical system, reprinted by permission from Springer Nature: Springer Nature [53].*

**103**

scores before and after training was observed [57].

*Intelligent Information-Guided Robotic Surgery DOI: http://dx.doi.org/10.5772/intechopen.82191*

Navigation in surgery includes various techniques. In brain and ENT surgery where the organ deformation are relatively small, the navigation system which detects the real-time position of the instrument in the preoperative three-

dimensional image by using optical position sensors is often used. In laparoscopic surgery, as the organ movement is large, such precise position detection is not required. But sometimes surgeon requires to refer to the segmented preoperative image during the procedure in order to confirm anatomical structure. The problem was that it is very difficult to compare current two-dimensional camera image and preoperative three-dimensional image. In order to solve this problem, we have developed real-time viewer software and sensor system especially for da Vinci partial nephrectomy (**Figure 14**) [54, 55]. This system detects the robot camera angle by position sensor mounted to the da Vinci arm by our own attachment (because da Vinci does not allow to output such data). According to the camera angle, the system computes corresponding view in the three-dimensional preoperative image and displays at the small sub-display under the main display. By this navigation system, the surgeon can see the preoperative image in the same angle of current camera image. We found it very useful, and it is clinically used every time

Training in laparoscopic surgery is important for surgeons. Also, studies about effective training method are important for better learning curve. There are many surgical simulators using computer graphics, rubber phantom, and harvested animal organ. However, measuring surgical skill quantitatively was very difficult. Quantification of skill is important not only for qualifying each surgeon but also for evaluating the effectiveness of training method. We have developed a suture simulator and evaluation software (**Figure 15**) [56, 57]. The phantom mimicking small intestine, made of four layers and string braided rubber, is used for the task. The task is anastomosis of the defect on the intestine by three interrupted sutures. The result is evaluated by five category including completion time, air leakage test, etc. The trainees can be fed back each time by score. Scoring system was developed using data previously obtained from skilled surgeons performing suture on this phantom. By using this simulator, significant difference between the trainees'

**5. Navigation**

in our hospital.

**6. Training**

*Navigation system for da Vinci surgery.*

**Figure 14.**

*Intelligent Information-Guided Robotic Surgery DOI: http://dx.doi.org/10.5772/intechopen.82191*
