Smart surgical tools and augmenting devices

In this survey paper, the authors analyze the general structure of robotic systems for computer-assisted surgery, present a classification of such systems based on the degree of "intelligence" of the tools, and discuss some examples of different classes of devices. Computer-assisted surgery accelerated progress is related, on the one hand, to the improvement of medical imaging techniques and, on the other hand, to the evolution of surgical instrumentation. The integration of these two factors has determined an extraordinary progress that is not just a "linear" temporal development, but it is a "discontinuity" as regards traditional surgical procedures. Specifically, the authors consider the following classes of robotic-derived surgical devices/systems: a) handheld tools augmenting the capabilities of the surgeon; b) teleoperated surgical tools; and c) autonomous surgical robots. The paper will focus essentially on the analysis of systems and components of robots and tools designed for minimally invasive surgery. Although different classification methods exist on the basis of the clinical needs and/or on the design approach, the devices which will be illustrated in this paper are classified on the basis of their scale, degrees of freedom, autonomy, embedded intelligence, and features of the interface between the surgeon and the patient.