IEEE/ASME TRANSACTIONS ON MECHATRONICS, VOL. 23, NO.
3, JUNE 2018 1215
A Master–Slave Integrated Surgical Robot With
Active Motion Transformation Using Wrist Axis
Ryoken Miyazaki , Kohei Hirose, Yoshiya Ishikawa
Abstract—In this paper, a master–slave integrated surgi-
cal robot system for the laparoscopic surgery is proposed.
Instead of commanding the manipulator from the remote
master console, the proposed system integrates the master
controller into the proximal end of the slave manipulator.
The slave has a flexible wrist joint, whose bending angle is
operated by a joystick on the master. Focusing on suturing
of a curved needle, which is a common task in laparoscopic
surgery, we developed an active motion transformation
method that allows the surgeon to insert the needle
easily. When inserting the needle, the proposed system
transforms the surgeon’s wrist rotation into the rotation
about the bent forceps gripper. Positioning performance
of the proposed system is evaluated by an experiment.
Furthermore, we compared the suturing task performance
between the proposed system and conventional forceps.
The experimental results show that the proposed system
reduces the contact force against an organ model.
Index Terms—Medical robotics, pneumatic systems.
I. INTRODUCTION
APAROSCOPIC surgery is one of the minimally invasive
L surgery procedures. An endoscope and several long tools
are inserted into the patient’s abdominal cavity through small
incisions made in his/her skin. Though the postoperative recov-
ery is earlier than the conventional open surgery, superior skills
are required for surgeons, as it is impossible to approach the
target from arbitrary angles since the motion of the surgical tool
is constrained at the insertion hole of the abdomen. In other
words, only 4-degree of freedom (DOF) motions are allowed
for surgical tools in the abdomen [1], [2]. In this paper, we call
the nonarticulating tool as a conventional forceps.
A typical surgical robot for the laparoscopic surgery has 6-
DOF motion, with a 4-DOF arm outside the abdominal cavity
Manuscript received July 10, 2017; revised September 21, 2017 and
January 3, 2018; accepted January 31, 2018. Date of publication March
22, 2018; date of current version June 12, 2018. Recommended by
Technical Editor Prof. D. Stoianovici. (Corresponding author: Ryoken
Miyazaki.)
R. Miyazaki, T. Kanno, and K. Kawashima are with the Department
of Biomechanics, Institute of Biomaterials and Bioengineering, Tokyo
Medical and Dental University, Tokyo 101-0062, Japan (e-mail: ryoken.
miyazaki@gmail.com; kanno.bmc@tmd.ac.jp; kkawa.bmc@tmd.ac.jp).
K. Hirose is with the Faculty of Medicine, Tokyo Medical and Dental
University, Tokyo 113-8510, Japan (e-mail: 130721ms@tmd.ac.jp).
Y. Ishikawa is with the Department of Hepatobiliary and Pancreatic
Surgery, Medical Hospital, Tokyo Medical and Dental University Tokyo
113-8510, Japan (e-mail: ishimsrg@tmd.ac.jp).
Color versions of one or more of the figures in this paper are available
online at http://ieeexplore.ieee.org.
Digital Object Identifier 10.1109/TMECH.2018.2817212
1083-4435 © 2018 IEEE. Personal use is permitted, but republication/redistribution requires IEEE permission.
See http://www.ieee.org/publications standards/publications/rights/index.html for more information.
, Takahiro Kanno, and Kenji Kawashima
and an additional 2-DOF wrist joint. Therefore, the robot allows
the tool tip to approach the target from an arbitrary position and
posture in the abdomen. It is generally a master–slave-type robot
and a surgeon operates the remote slave arms with the wrist joint
via the master console. Since the slave arms in the abdomen re-
produces the surgeon’s 6-DOF hand motion in the console, the
master–slave type enables an intuitive operation. In addition,
master–slave robots enable telesurgery over computer networks
and microsurgery using motion scaling between the master and
the slave. Several robots have been developed [3], [4], [18],
and da Vinci [5] surgical system is a commercially successful
one, already introduced in thousands of hospitals in the world.
However, the robot is not the best choice for all surgical pro-
cedures of all hospitals since it requires a space for the master
console, a operating skill different from the conventional lara-
poscopic procedure, a time-consuming setup procedures, and
high introduction and running costs [6], [7].
On the other hand, hand-held forceps with the wrist joint
have been developed [8]. The wrist joint is manipulated from
the interface mounted on the forceps itself while supporting
the weight of the forceps. The translation operation of it is
the same as the conventional forceps. Its setup time is shorter
than the master–slave type. The system is small because there
is no master console. Several hand-held robotic forceps driven
by actuators have been developed. Matsuhira et al. proposed
the robotic forceps driven by an electric motor [10]. Focacci
et al. and Hassan et al. developed more lightweight forceps
by separating actuators from the main body [13], [15]. Zahraee
et al. and Okken et al. designed an interface of the forceps based
on ergonomics [14], [23]. Bensignor et al. developed the thin-
diameter robotized forceps without pitch axis and evaluated
it [12]. Other mechanically driven tools have been developed
[9]. Unlike the master–slave robot, such hand-held robots are
operated using buttons and dials, and it is difficult for surgeons
to input complex 3-D trajectory. However, since the interface
such as a dial for each motion axis is independent, the surgeon
is not able to operate the 6-DOF and the grasper at the same
time like the master–slave type. Moreover, hand-held robots
are heavier than conventional forceps due to the weight of the
actuators. Wearable type robot forceps, which are mounted on
the operator’s arm, is one of good solutions, though they have
more weight for attachment parts and require time-consuming
equipment procedure [11], [16], [17].
From the aforementioned, our challenge is the development
of a robot that has operability like a master–slave type with a
handheld robot size. Thus, we developed a master–slave inte-
1216
Fig. 1. Developed robotic system. It consists of a 2-DOF robotic forceps and a 4-DOF passive holder. The forceps is composed of a pneumatically
driven manipulator and a master controller. Variables φ 1, 2 and q1, 2, 3, 4 represent the motion axes of a wrist joint of the forceps and passive joints of
the holder. The origin O is a forceps insertion point to the abdominal cavity.
grated surgical robot and an active motion transformation. It
consists of a 2-DOF pneumatically driven robotic forceps and a
4-DOF passive holders to support of its weight. The wrist joint of
the forceps is operated by a built-in master controller, integrated
in the end of forceps. A surgeon operates the wrist joint and
the grasper, like those in a master–slave robot, while operating
the translational motion manually like the conventional forceps.
It achieved smaller footprint than master–slave surgical robots,
omitting a master console. Moreover, to reduce the weight, we
used pneumatic actuators that have high power-to-weight ratio
for driving the forceps.
For the intuitive operation of a curved needle, the active mo-
tion transformation was proposed. It actively transforms the
rotation axis using the precise control of the joint and the op-
erator’s motion. The details are described in Section II-B. The
proposed transformation and the developed robot allowed the
surgeon to operate the tip positions, postures, and grasper at the
same time.
In [19], we reported a prototype of the master–slave integrated
surgical robot. In this paper, in addition to [19], we discuss kine-
matics analysis, position control performances, and evaluation
using suturing tasks by experts and novices.
The rest of this paper is organized as follows. Section II
presents the developed surgical robot system. Section III dis-
cusses kinematic and dynamic model. Section IV presents a
controller and positioning performances. Section V shows the
evaluation of the robot by small target suturing and measure-
ment of the force in suturing. Section V concludes and discuss
this paper.
II. DEVELOPED ROBOTIC SYSTEM
The developed robot shown in Fig. 1 consists of the 2-
DOF robotic forceps, the 4-DOF passive holder, and an iner-
tial measurement unit (IMU) [19]. The forceps and the holder
are separable. The robotic forceps consists of a pneumatically
IEEE/ASME TRANSACTIONS ON MECHATRONICS, VOL. 23, NO. 3, JUNE 2018
driven manipulator and a master controller. Variables φi and qi
represent the joint displacements of a wrist joint of the forceps
and the 4-DOF passive joints of the holder. O indicates the
fixed point, which is the insertion point of the forceps to the ab-
domen. An operator manipulates the wrist joint (φ1 , φ2 ) of the
forceps tip by the master controller and operates the translational
(q1 , q2 , q3 ) and rotational (q4 ) motion of the forceps directly. The
robot allows the operator to manipulate the bending motion of
the forceps tip, like a master–slave type, while operating the
translational motion manually like a conventional surgical tool.
We describe the components of the system in Section II-A. In
addition, we developed the motion transformation control that
assists the insertion of a curved needle using the precise control
of the wrist joint (φ1 , φ2 ) and the rotational motion (q4 ). We
describe its algorithm in Section II-B.
A. Mechanical Design
In this section, we describe the components of the developed
system: the passive holder, the robotic forceps, and the IMU.
The holder has four passive joints, which constructs the re-
mote center of motion (RCM) mechanism allowing the 4-DOF
forceps motion around the fixed insertion point as fixed point.
The RCM and O are identical. Note that, the holder has ac-
tuators, which we use the passive holder by deactivating the
actuators. For further details of the holder, please refer to [27].
The robotic forceps consist of 2-DOF wrist joint and a grasper,
and the master controller. They are shown in right side of Fig. 1.
Desired motion of the joint and the grasper, in the abdominal
cavity, are realized by the control of the manipulator in re-
sponse to the input by the master controller. In the manipulator,
we adopt the pneumatically driven manipulator same as in [20].
The forceps tip consists of the 2-DOF push–pull-driven wrist
joint and the grasper. The diameter of the insertion portion into
the abdominal is 8 mm. The driving unit of the wrist joint con-
sists of four pneumatic cylinders (SMC, Corp., CJ2QB10-15),
MIYAZAKI et al.: MASTER–SLAVE INTEGRATED SURGICAL ROBOT WITH ACTIVE MOTION TRANSFORMATION USING WRIST AXIS
Fig. 2. Schematic model of the 1-DOF joint push–pull-driven mech-
anism by the cylinder displacement X 1 and X 3 (right). The bending
posture of the 2-DOF wrist joint (upper left). The numbers 1, 2, 3, and
4 correspond to the numbers of the cylinder displacements X 1 , X 2 , X 3 ,
and X 4 , respectively.
four Ni–Ti superelastic wires, and four linear potentiometers
(Alps Electric, Co., Ltd., RDC1010A12), which measure each
displacement of the cylinder. The cylinder is mounted every 90°
to drive the wrist joint. The wires are attached to the wrist joint
of the stainless steel spring. The wires go through the sheath
and are fastened to the pneumatic cylinders. The 2-DOF bend-
ing motion is achieved by driving the joint via the wires by the
cylinders. Fig. 2 shows a schematic model of the push–pull-
driven mechanism. Right side of Fig. 2 shows an 1-DOF joint
mechanism driven by the cylinder displacement X1 and X3 . On
a plane orthogonal to this plane, the other 1-DOF joint, which
is driven by the cylinder displacement X2 and X4 , is installed.
Servo valves (FESTO, Corp., MPYE-5-M5-010-B), air pressure
sensors (SMC, Corp., PSE540-01), and other electric and pneu-
matic components are built in the control box. Fi shows the
cylinder driving force [N], which is computed by multiplying
an air pressure Pij [kPa] by a pressurized area of the cylinder
Aij [mm2 ]. ui is the input voltage [V] to the servo valve.
Upper left of Fig. 2 shows the 2-DOF bending posture. The
numbers 1–4 in Fig. 2 correspond to the numbers of the cylin-
der displacements X1 , X2 , X3 , and X4 , respectively. In this re-
search, we convert the bending posture of the wrist joint (φ1 , φ2 ),
whose motion range is [−π/2, π/2], to a polar coordinate sys-
tem (δ, θ) using (1) for kinematic analysis.
    developed robot, which is necessary for the position control and
δ atan2
 (φ2 , φ1 )
= (1)
θ φ1 2 + φ2 2
atan2 (y, x) is a function that calculates four-quadrant inverse
tangent of φ1 and φ2 [21]. We set δ = 0 when φ1 = φ2 = 0,
where atan2 is indeterminate. δ and θ denote the bending di-
rection (−π ≤ δ ≤ π) and the bending angle (0 ≤ θ ≤ π/2),
respectively. The grasper has a link mechanism and is driven by
a built-in small pneumatic cylinder at the forceps tip [20].
1217
In the master controller, the operator pinches it by his/her
thumb and index finger [22]. The wrist joint of the forceps is
operated by tilting the controller, and the grasper is operated by
opening and closing it. The controller is mounted on a two-DOF
stick controller (Alps Electric Co., Ltd., RKJXK122000D) [23]
and had a slider crank mechanism and a linear potentiometer
(Alps Electric Co., Ltd., RDC1010A12) that transform pinching
motion to linear motion. The IMU (Invensense Inc., MPU-6050)
is mounted on the system to measure the operator’s wrist rota-
tion angle. The measured rotation angle is used for the motion
transformation control.
B. Active Motion Transformation
In the laparoscopic surgery, a needle used for suturing organs
and blood vessels is a curved needle. Therefore, to insert the
needle along the shape of it, a rotation about the Z-axis (lon-
gitudinal axis) of the hand coordinate, which is attached to the
tip of the gripper is essential [10], [14]. In this paper, we call
the rotation as the tip rotation. However, it is difficult to add a
mechanical degree-of-freedom at the distal end of the forceps
to realize such motion since the space inside the sheath to em-
bed some mechanisms is limited. In addition, a user interface
for operating the tip rotation is required. Therefore, we devel-
oped the active motion transformation for an easy suturing of a
needle using the precise control of the wrist joint (δ, θ) and the
rotational motion (q4 ) of the operator.
Fig. 3 shows the rotation with the bending forceps tip with and
without the proposed control. Fig. 3(a) shows the initial posture
of the bending forceps tip and of the wrist rotation angle. O,
Ob , Oe , and Og are the coordinates that are used to discuss
the kinematics analysis in Section III. In Fig. 3(b), usually,
when the operator rotates his/her wrist by the angle q4 rot , the
bending direction of the forceps tip is rotated by q4 rot from
the initial angle δ0 about the forceps sheath. In this case, when
the bending direction is modified to cancel q4 rot by setting the
bending direction as δ0 − q4 rot , the forceps tip rotate by q4 rot
maintaining the tip position [see Fig. 3(c)]. Thus, tip rotation
in response to wrist rotation of the operator, which is similar to
the motion of a flexible screw driver, is virtually achieved. This
control allows the operator to insert the suture needle by the wrist
rotation. In this research, we estimated the wrist rotation angle
q4 rot from the IMU and use it for the control. The kinematics
including the control is explained in detail in Section III-B.
III. KINEMATIC AND DYNAMIC MODEL
This section discusses kinematic and dynamic models of the
the proposed active motion transformation.
A. Forward Kinematics
Before discussing the kinematics, we convert the bending pos-
ture of the wrist joint (φ1,2 ) to a polar coordinate system (δ, θ)
using (1) for kinematic analysis. First, the joint coordinate is de-
fined and the relationship with the cylinder displacement is de-
rived. It is assumed that the flexible joint is a 3-DOF continuum
1218 IEEE/ASME TRANSACTIONS ON MECHATRONICS, VOL. 23, NO. 3, JUNE 2018

Next, we discuss the 6-DOF kinematics of the developed

robot system that consists of the 2-DOF wrist joint of the robotic
forceps and the 4-DOF operator’s direct motion. In Fig. 3(a),
the coordinates are defined as follows.
1) O − xyz: A reference coordinate.
2) Ob − xb yb zb : Base of the wrist joint.
3) Oe − xe ye ze : Tip of the wrist joint and base of the
grasper.
4) Og − xg yg zg : Tip of the forceps and tip of the grasper.
Then, the position p and the rotation matrix R of the forceps
tip are written as follows:
p = E iq 1 E j q 2 E k q 4 (a + f ) (5)
and
R = E iq 1 E j q 2 E k q 4 E k δ E j θ E k (−δ ) (6)
where E n α denote the rotation matrices of the angle α about the
vector n, where i = [1, 0, 0]T , j = [0, 1, 0]T and k = [0, 0, 1]T .
Since we adopted a flexible joint, the kinematics requires three
rotation matrices for the explanation of a 2-DOF bending. The
derivation of (6) is described in [20].
a denotes the vector from the origin O to the wrist joint base
Ob , which is written as follows:
a = [0, 0, Lo + q3 ]T (7)
where Lo = 120 mm denotes the initial distance from the origin
O to the wrist joint base Ob . Vector f denotes the vector from
the wrist joint base Ob to the forceps tip Og . It is written as
follows:
Fig. 3. Rotation with the bent forceps tip. (a) Initial position and posture  
of the forceps tip. (b) Overall rotation, which is the rotation about the
forceps sheath. (c) Developed transformation, which is the rotation about f = E k δ e + E j θ E j (−δ ) g (8)
the bent forceps tip.
where e and g denote the vector from the wrist joint base to
the wrist joint tip and the vector from the gripper base to the
shaping an ideal arc as shown in Fig. 2. In Fig. 2, δ, θ, and r gripper tip, respectively. These are written as follows:
⎡ ⎤
denote the direction of bending, the bending angle, and the dis- 1 − cos θ
tance between the center of the joint and the wire, respectively. Ls ⎢ ⎥
e = ⎣ 0 ⎦ (9)
The generalized coordinate of the robotic forceps is defined as θ
sin θ
 T
q = δ, θ,  (2) where Ls denotes the length of the center line of the wrist joint,
where  denotes the stretch of the joint from the natural length which is 20 mm in length.
Ls . g = [0, 0, Lg ]T (10)
The relationship between q and the cylinder displacement X
is written as follows: where Lg denotes the length of the grasper 30 mm for our
⎡ ⎤ ⎡ ⎤ prototype.
X1 −rθ cos δ + 
⎢ X ⎥ ⎢ −rθ sin δ +  ⎥
⎢ 2⎥ ⎢ ⎥ B. Kinematics of the Active Motion Transformation
X (q) = ⎢ ⎥=⎢ ⎥. (3)
⎣ X3 ⎦ ⎣ rθ cos δ +  ⎦
The motion transformation control transforms the wrist rota-
X4 rθ sin δ +  tion of the operator into the rotation about the bent forceps tip
From the aforementioned equation, the joint position q (X) is by controlling the forceps. In other words, when the operator
written as follows: rotates the wrist, the position of the forceps tip p does not change
⎡ ⎤ and only the posture R is changed. Therefore, in this subsection,
⎡ ⎤ atan2 ((X2 − X4 ), (X1 − X3 )) we discuss the transformation using its position p and posture
δ ⎢ ⎥
⎢ ⎥ ⎢ 1 (X − X )2 + (X − X )2 ⎥ R.
q (X) = ⎣ θ ⎦ = ⎢⎢ 2r 1 3 2 4 ⎥. (4)
⎥ Fig. 3 is a schematic model showing the motion of over-
 ⎣ 1 ⎦ all rotation and tip rotation. In this subsection, we put R2 =
(X1 + X2 + X3 + X4 )
4 E iq 1 E j q 2 . As shown in Fig. 3(a), q4 = 0, δ = δ0 , and θ = θ0
MIYAZAKI et al.: MASTER–SLAVE INTEGRATED SURGICAL ROBOT WITH ACTIVE MOTION TRANSFORMATION USING WRIST AXIS
are set as the initial position and the initial rotation. The posi-
tion and rotation matrix are written as follows:
 
pinit = R2 a + R2 E k δ 0 e + E j θ 0 g (11)
and
Rinit = R2 E k δ 0 E j θ 0 E k (−δ 0 ) .
Next, as shown in Fig. 3(b), we consider the position and pos-
ture when the operator’s wrist is rotated by angle q4 rot without
the transformation control. We call this rotation an overall rota-
tion. Then, q4 = q4 rot , δ = δ0 , and θ = θ0 are set as the rotate
position prot and the rotate posture Rrot , which are written as
follows:
 
prot = R2 a + R2 E k q 4 r o t E k δ 0 e + E j θ 0 g (13)
and
k δ0 j θ0 k (−δ 0 ) k q4r o t
Rrot = R2 E E E E = Rinit E
The aforementioned equation shows that the forceps tip was ro-
tating from R0 by angle q4 rot and (13) represents the tip position
prot is changed by the rotation angle q4 rot as compared with p0 .
Therefore, (13) and (14) show that when the bent forceps are
rotated, the tip position changes.
Finally, we discuss the motion transformation control. In the
robotic system, q4 and δ are coaxial rotations around the Z-axis.
Therefore, as shown in Fig. 3(c), this control changes only the
posture without changing the tip position by controlling δ =
δ0 − q4 rot to cancel the wrist rotation angle q4 = q4 rot . Then,
q4 = q4 rot , δ = δ0 − q4 rot , and θ = θ0 are set as the tip rotate
position pcntl and the tip rotate posture Rcntl , which are written
as follows:
 
pcntl = R2 a + R2 E k δ 0 e + E j θ 0 g = pinit (15)
and
Rcntl = R2 E k δ 0 E j θ 0 E k (−δ 0 ) E k q 4 r o t = Rinit E k q 4 r o t .
The aforementioned equation shows that the forceps tip was
rotating from R0 by angle q4 rot . Equation (15) shows that the
tip rotate position pcntl is not affected by wrist rotate angle q4 rot
and is equal to the initial position p0 . Therefore, we clarified that
the tip rotation can be performed by controlling the tip position
of the forceps.
C. Dynamic Model
In this subsection, dynamic model of the robotic forceps is
discussed in order to compensate for its mechanical impedance
for precise control.
The resisting forces Z = [Z1 , Z2 , Z3 , Z4 ]T that act on the
cylinders are given as follows:
⎡ ⎤
C1 Ẋ1 + D1 sgn(Ẋ1 )eμ 1 θ − K1 φ1 + K 
⎢ ⎥
⎢ C2 Ẋ2 + D2 sgn(Ẋ2 )eμ 2 θ − K2 φ2 + K  ⎥
Z=⎢ ⎢ ⎥ (17)
μ θ ⎥ (21)
⎣ C3 Ẋ3 + D3 sgn(Ẋ3 )e 3 + K3 φ1 + K  ⎦
C4 Ẋ4 + D4 sgn(Ẋ4 )eμ 4 θ + K4 φ2 + K 
where φ is the angle parameter defined as the same as (1). Each
term of the aforementioned force has the following meaning.
1219
1) Viscous friction Cj Ẋj : The force due to the pneumatic
cylinder, where Cj denotes the viscosity coefficient.
2) Coulomb friction Dj sgn(Ẋj )eμ j θ : The main component
of the Coulomb friction is the friction between the supere-
lastic wires and the wire guide on the flexible joint, where
(12) the friction coefficient is denoted by Dj . The friction be-
comes larger according to the bending angle, which is
modeled in this paper as eμ j θ .
3) Elastic force ±Kj φk : Elastic forces are caused by the
bended joints and wires, which are proportional to the
angle parameter φ.
4) Elastic force K : Elastic forces are caused by the elon-
gated and contracted joints, which are proportional to the
stretch of the joint from the natural length .
IV. POSITION CONTROL LAW
k q4r o t
. (14)
A. Design of the Controller
In this subsection, we discuss the control law of the robotic
forceps shown in Fig. 4. The wrist joint is driven by pneumatic
cylinders in response to the reference position qref (δref , θref ),
which is operated by the master controller and the transforma-
tion controller, which is a wrist rotation angle estimator. The
bending direction δ and the bending angle θ represent the pos-
ture of the joint obtained by converting θ1,2 using (1). The
reference position of the joint are written as follows:
   
δref δ0 − q4 rot
qref = = (18)
θref αθ0
where δ0 and θ0 denote a bending direction and an angle that
are inputted by the operator from the master controller. α is a
scaling constant of the angle between the operation and the joint.
q4 rot denotes an estimate of operator’s wrist rotation angle from
the IMU. From (18), to control the tip rotation in response to
(16)
wrist rotation, δref is modified by adding δ0 to the wrist-rotation
angle q4 rot to cancel the rotation about the sheath axis.
δ0 and θ0 are given by following equation:
   atan2 (φ , φ ) 
δ0 s2 s1
= (19)
θ0 φm 1 + φm 2 2
2
where φm 1, 2 [deg] denote the bending angle of the controller.
Since the controller is a 2-DOF variable resistor, we experi-
mentally approximated the angle φm 1, 2 and voltage v, when the
supply voltage to the sensor is 5 V, by the following polynomial:
φm 1, 2 = 2.47v 3 − 18.86v 2 + 19.88v + 28.62. (20)
To estimate the wrist rotation angle x, we applied a Kalman
filter [26] to the signals of a gyroscope and an accelerometer in
the IMU for robust measurement against the sensor noise and
the gyroscopic drift. The filter can be described as follows:
xk = Axk −1 + B ẋk + wk
zk = Hxk + vk . (22)
 T
The system state is defined as xk = x ẋb k . x and ẋb de-
note the filtered angle and the bias, which is the amount of the
1220 IEEE/ASME TRANSACTIONS ON MECHATRONICS, VOL. 23, NO. 3, JUNE 2018

Fig. 4. Block diagram of the controller. It consists of three part: the operator input using the master controller, the transformation controller that
estimate the wrist rotation angle and modify the input, and the wrist joint position controller. The joint position controller is a cascade controller that
includes a minor loop of the pneumatic force controller.

gyroscopic drift. A represents the system transition matrix, TABLE I

PARAMETER OF CONTROL GAINS
which is applied to the previous state xk −1 . B represents the
control input matrix, which calculates the angle by multiply the
angular rate ẋk from the gyroscope by the delta time Δt, which Parameter Gain
is 0.001. wk denote the process noise, which is Gaussian noise K p p [N/mm] 8.60
with covariance to the time k. The measurement zk is the mea- K p d [N·s/mm] 0.45
K a p [V/N] 0.15
surement from the accelerometer. It is given by the current state K a i [V/N·s] 1.00
xk multiplied by the measurement matrix Hk and the measure- K a d [V·s/N] 0.05
ment noise vk , which is Gaussian noise. The matrices A, B, and
H are as follows: TABLE II
    PARAMETER OF DYNAMICS MODEL
1 −Δt Δt  
A= , B= , H= 10 . (23)
0 1 0 Parameter j=1 j=2 j=3 j=4
In our system, the filtered angle x is used as the estimate of the C j [N·s/mm] 0.10 0.10 0.10 0.10
wrist rotation angle q4 rot . D j [N] 0.70 0.70 0.70 0.70
For the wrist joint position, a cascade control, which is a μj 1.10 1.10 1.10 1.10
K j [N/rad] 3.60 3.60 3.60 3.60
proportional-derivative-based position controller with feedfor- K  [N/mm] 0.01 0.01 0.01 0.01
ward compensation that encloses a PID-based pneumatic force
controller, is implemented. The cascade controller compensates
for a nonlinearity of the pneumatic servo system caused by the the model (17) using the heuristically defined parameters in
air compressibility and the pipe line [24], [25]. In the pneumatic Table II and the variables φ1,2 , θ, and length of contraction.
control, the bandwidth of the pneumatic force controller has to The variables φ1,2 and θ, and the length of contraction is kine-
be higher than that of the position controller. In our system, matically calculated from the measured cylinder displacement
since the bandwidth of the servo valve is about 100 Hz and the and geometric models by (1) and (4). The protocol to tune the
desired bandwidth of the robot is about 2 Hz, experimentally parameters are as follows. We gave sinusoidal reference for θ
confirmed using a suturing task by experts [27], the controller and tuned the parameters so that θ tracks the reference angle
has sufficient performance to compensate for the nonlinearity. only by feedforward control (no potentiometer feedback). First,
The reference cylinder positions Xref are calculated from the we tune the elastic coefficients to match the amplitudes of the
reference position qref by solving inverse kinematics given by reference and measured angle. Then, friction parameters are in-
(3). Fref and F represent the cylinder driving force multiplied creased until the deadband in the measured angle disappears.
the air pressure P by the pressurized area A of the cylinder. Finally, we tune the viscous friction to match the phase. The
u denotes the input voltage to the servo valve. q(X) denotes parameters have sufficient reproducibility in position control.
forward kinematics. The subscript i corresponds to each cylin-
der. The experimentally determined control gains are listed in
B. Position Control Performance
Table I.
The feedforward dynamics compensation based on the dy- To evaluate the positioning performance of the wrist joint
namics model is described in Section II-B. We implemented with the control law, we had three position control experiments
MIYAZAKI et al.: MASTER–SLAVE INTEGRATED SURGICAL ROBOT WITH ACTIVE MOTION TRANSFORMATION USING WRIST AXIS 1221

Fig. 6. Joint position control with the sinusoidal input references of

δre f = [deg], θre f = −50 ∼ 50° at 0.5 Hz (upper) and 2.0 Hz (lower).

Fig. 5. Joint position control with the step input reference of 1°/s. Upper,
middle, and lower figures represent the bending angle of the joint, the
cylinder positions, and the cylinder forces.

that are a step wise input, a sinusoidal input, and the developed
transformation control.
First, we evaluated the performance when the reference bend-
ing angle θref stepwisely changes from 0° to 60° with a step
input of 1°/s and the reference bending direction δref = 0°.
Fig. 5 shows the bending angle θ (upper), the cylinder positions
X1,3 (middle), and the cylinder forces F1,3 (lower). The dotted
and solid lines show the reference and measured signals. We
confirmed a tracking error of 1° or less in a steady state.
Next, a sine wave with an amplitude 50°and a frequency 0.5
or 2.0 Hz was input to the reference bending angle θref . In
Fig. 6, the dotted and solid lines show the reference and mea-
sured signals. Tracking error is 2.0° or less at the frequency of
2.0 Hz, showing that the control bandwidth is sufficient for
surgical operations [27]. Fig. 7. Joint position control with the developed transformation control.
Finally, we evaluate the developed transformation control per- The initial input of δ0 = 0°, θ0 = 50°. The figures showed the bending
formance when the operator rotates the wrist while inputting the direction (upper), the wrist rotation angle (middle), and the bending angle
(lower).
constant bending angle θref = 50°. We compared the estimation
of the rotation angle using the IMU with the measurement of
that using a rotary encoder (MTL Inc., MEH-12-2000PTS16).
Fig. 7 shows the performance of the transformation control, We computed the mean absolute error and mean absolute
where the upper, middle, and lower figures represent the bend- deviation between the reference and the measured position in
ing direction, the wrist rotation angle, and the bending angle. In each experiment and summarized the results in Table III.
the upper and lower figures, the dotted and solid lines show the
reference and measured signals. In the middle figure, the dotted V. SUTURING TASK
and solid lines represent the measured rotation angle using the
A. φ 1-mm Target Suturing
rotary encoder and the estimation of the rotation angle using the
IMU. The estimation showed good performance and the amount In this subsection, we tried to a φ 1-mm target for evaluating
of the drift and the noise from the IMU were negligibly small. the interface of the robot and the position control performance.
1222
TABLE III
SUMMARY OF POSITIONING ERROR AND DEVIATION
MAE∗ MAD†
Fig. 5
θ [deg] 0.24 0.01
X 1 [mm] 0.03 0.02
Fig. 6
θ [deg] at 0.5 Hz 0.99 0.05
θ [deg] at 2.0 Hz 1.25 0.08
Fig. 7
δ [deg] 1.18 0.05
q 4 [deg] 1.84 0.03
θ [deg] 0.28 0.01
∗
Mean absolute error. † Mean absolute deviation.
Fig. 8. Suturing sheet with 1-mm diameter targets. In right figure, the
arrows and numbers show a trajectory of a needle in the task. A surgeon
inserts and withdraws the needle along the trajectory.
The developed robot requires the surgeon to control four differ-
ent motion (i.e., a tip position, a bending angle of a two-DOF
stick controller, a rotation of forceps shaft, and a master gripper)
at the same time. Therefore, we examined whether the operation
interface does not reduce the performance of surgeons. We com-
pared the robot with the conventional forceps by the completion
time in a simple suturing task [28]. Since the task was short,
the number of mistakes increase and the completion time of the
task becomes long, if the operation interface of the developed
robot is poor. In addition, we experimentally confirm the needle
insertion performance by using 1-mm diameter suturing target
and 0.45-mm diameter suture needle in the task.
1) Methods: Fig. 8 shows a suture sheet (Tmedix Co. Ltd.)
with tears used in this task. Participants are required to insert a
suture needle into a 1-mm diameter target on the sheet and to
withdraw it from the target opposite the tear. In this figure, the
arrows and numbers indicate the trajectory of the suture needle,
the first suture direction is transverse and the second is longitu-
dinal. The diameter of the needle used for the task is 0.45 mm
(ETHICON Co. Ltd. 2771D). Three right-handed participants
performed the task in two methods; one is the robotic method
using the developed system with their right hand and a straight
forceps (ETHICON Co. Ltd. E705R) with their left hand, and
the other is the conventional method using two straight forceps
(ETHICON Co. Ltd. E705R). To compare the developed robot
to the conventional forceps using the suturing tasks by right-
handed participants, we unified both conditions except for the
IEEE/ASME TRANSACTIONS ON MECHATRONICS, VOL. 23, NO. 3, JUNE 2018
TABLE IV
TIME RESULT FOR THE SUTURING TASK
Robot Conventional p-Value†
Time [s] 35.22 ± 9.44 36.39 ± 11.14 NS
†
Wilcoxon signed-rank test. NS: Not significant.
Fig. 9. Developed suturing object. It is used for the tasks to measure
the maximum contact force and the completion time in the suturing task.
It consists of a force sensor and a biosheet with separate marks. Lower
left and right figure shows a longitudinal suturing task and a transverse
suturing task. In the figures, the arrows and numbers show a trajectory of
a needle in the task. A surgeon inserts and withdraws the needle along
the trajectory.
TABLE V
FORCE RESULT FOR WITH/WITHOUT THE TRANSFORMATION CONTROL
w/ Control w/o Control p-Value†
Maximum force [N] 1.94 ± 0.31 3.47 ± 0.34 0.04
†
Wilcoxon signed-rank test.
right-hand tool. The sheet was put in a training box for the la-
paroscopic surgery and the participants watched inside the box
through a 3-D laparoscope. The participants were instrumented
and well trained about both methods beforehand and performed
the task six times for each method. We measured the completion
time and statistically tested them.
2) Result: Table IV shows the mean (and its standard devi-
ation) of the completion time of each method and the p-value
test of the Wilcoxon signed-rank test [31]. In both methods, the
needle was inserted into the 1-mm diameter target. In addition,
there was no significant difference in completion time between
two methods.
From the result, since the completion time of the robotic
method was about the same as that of the conventional method,
we confirmed that the interface of the developed robot does not
interfere with the operation. In addition, we confirmed that the
needle threading accuracy of the robot is 1 mm or less.
MIYAZAKI et al.: MASTER–SLAVE INTEGRATED SURGICAL ROBOT WITH ACTIVE MOTION TRANSFORMATION USING WRIST AXIS 1223

TABLE VI
FORCE AND TIME RESULTS OF SUTURE TASKS FOR ROBOT VERSUS CONVENTIONAL, p-VALUE

Longitudinal Suturing Transverse Suturing

Robot Conventional p-Value† Robot Conventional p-Value†

Experts
Time [s] 46.08 ± 15.70 38.10 ± 6.30 NS 39.00 ± 12.68 32.43 ± 8.63 NS
Maximum force [N] 1.50 ± 0.32 2.90 ± 0.77 <0.001 1.89 ± 0.66 2.84 ± 0.62 <0.001
Novices
Time [s] 45.82 ± 13.79 43.13 ± 24.39 NS 33.61 ± 9.46 29.51 ± 10.81 NS
Maximum force [N] 2.05 ± 0.70 3.87 ± 0.88 <0.001 1.97 ± 0.48 3.19 ± 0.60 <0.001

These score shows the mean ± standard deviation. † Wilcoxon signed-rank test. NS: Not significant.

From [29] and [30], there is no significant difference in the TABLE VII
EXPERTS VERSUS NOVICES ABOUT THE FORCE IN TABLE VI, p-VALUE∗
completion time between a surgical robot and the conventional
forceps in a simple suture task. From the aforementioned, the
results of this experiment are consistent with the trends of these Longitudinal Transverse
Experts Experts
previous studies. In order to more clarify the characteristics of
the developed robot, we have to evaluate it using other evaluation Method Rob. Con. Rob. Con.
index.
Novices Rob. 0.01 <0.01 NS 0.01
Con. <0.01 <0.01 <0.01 NS

B. Measurement of the Contact Force in Suturing Rob.: Robot. Con.: Conventional.

In this subsection, we measured the contact force in suturing.
From [32]–[34], the maximum force exerted by the experts on
the object during suturing was statistically smaller than those
by novices. With the aforementioned discussion in mind, we
compared the contact force during suturing with the robotic
method and the conventional method. Our hypothesis that if
the motion transformation control assisted the insertion and the
pulling of the suture needle, the maximum contact force during
suturing will be smaller than the conventional method. We also
compared the experts and the novices in the experiment.
1) Methods: Fig. 9 shows a suturing object and the trajec-
tory of the suture needle in the task. The object consists of
a phantom (WetLab, Corp., Sheet Model) and a force sensor
(Bl. Autotec, Ltd., NANO 1.2/1-A-R-RMD-PS). It measured
the force applied to the phantom in the suturing task. In this
experiment, the maximum contact force is defined as the max-
imum absolute force in each direction measured by the sensor
in the task. The object was put in the center of a training box
for the laparoscopic surgery. Participants suture the object with
the curved surgical needle (ETHICON, Co., Ltd., 2771D) while
watching 3-D laparoscopic images.
Participants performed four cases, which combined two types
of suturing tasks and two methods. The tasks were a longitudinal
and a transverse suturing tasks. Each task includes insertion and
withdraw of the suture needle as indicated by the arrows and
numbers in Fig. 9. The two methods were the robotic method
and the conventional method, the same as in Section V-A. Six
people participated in the experiment, three right-handed experts
and three right-handed novices. They tried each case five times.
We measured the maximum contact force and statistically tested
these results. The participants were instructed and trained about
all cases beforehand. In this experiment, we set the scaling con-
stant between the master controller and the wrist joint α as 1.0.
∗
MannWhitney U test. NS: Not significant.
Before the experiments, we had a preliminary experiment
comparing the robot with/without the transformation control.
Since the developed robot has the wrist joint made of the ma-
chined spring, the tip of the robot has more elasticity than the
conventional forceps. Therefore, we experimentally confirm that
the joint does not significantly affect the contact force much
more than the developed transformation control. In the experi-
ment, a right-handed expert tried the longitudinal suturing five
times in each condition.
2) Result: Table V shows a result of the preliminary experi-
ment, which shows the mean of the maximum force and p-value
of the Wilcoxon signed-rank test [31]. To insert the needle to
the target without control, participant required to push the nee-
dle into the target regardless of the curved shape. As a result,
we considered that the target was deformed and the measured
contact force increased when the rotation control is not used.
From the result of the preliminary experiment, the transforma-
tion control affected the contact force more than the only wrist
joint.
Table VI shows the maximum contact force, the completion
time, and p-values of the Wilcoxon signed-rank tested between
the robotic method and the conventional one. In all cases, the
contact force is significantly smaller using the robotic method
than using the conventional one.Table VII shows a p-value tested
between experts and novices about the force in each condition
with MannWhitney U tests [29]. Especially, novices with the
robot applied smaller forces than experts with the conventional
forceps. There are no significant difference in completion times.
The reason of the force reduction by the robotic method can
be explained as follows. Fig. 10 shows the time series of the
forces measured in each direction, in one longitudinal suture.
1224
Fig. 10. Time-series data of the forces measured with one longitudinal
suture. Fx , y , z represents each direction of the force.
Right and left figures represent the results of the robotic method
and the conventional one. The largest difference between the
methods is the force of Fy -direction, which is parallel to the
insertion direction. By using the proposed robot, the needle
can be inserted from arbitrary direction. On the other hand, the
direction of the needle is different from the ideal one using the
conventional forceps only with 4-DOF motion, which results in
undesired deformation of the sheet.
VI. CONCLUSION
In this paper, a master–slave integrated surgical robot that
consists of a 2-DOF robotic forceps and a 4-DOF passive holder
was developed. For easy insertion of a curved needle, the ac-
tive motion transformation was proposed and implemented. It
actively transforms the rotation about the forceps sheath into
the rotation about the forceps tip using the precise control of
the joint and the estimation of the operator’s wrist rotation. We
showed the motion transformation algorithm and the kinematics
including it. We designed the controller of the robot and eval-
uated position control performance. As a result, tracking error
is 1.5° or less at the frequency of 2.0 Hz, which is the typical
bandwidth required for surgical operations.
To evaluate the developed robot, we had two experiments.
One is the small target insertion using the suture needle. The
result shows the needle handling accuracy of the robot is 1 mm
or less. The other is the measurement of the contact force in su-
turing. The result shows the developed robot allows experts and
novices to insert the needle with significantly smaller contact
force than the conventional forceps.
Future work is an experiment by an advanced surgical task like
Roux-en-Y Choledochojejunostomy [35], which requires a long
completion time and advanced skills, to evaluate the developed
robot by a completion time, a contact force, and an economy-of-
movement. In addition, we compare the developed robot with
the master–slave-type surgical robot using surgical tasks [36].
Furthermore, to reduce the system footprint, we will design a
passive holder for supporting the weight of robotic forceps.
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Ryoken Miyazaki is currently working toward
the doctoral degree with the Institute of Bioma-
terials and Bioengineering, Tokyo Medical and
Dental University, Tokyo, Japan.
His recent work is on pneumatically driven
surgical robots.
Kohei Hirose is currently working toward the
Medical degree with the Tokyo Medical and Den-
tal University, Tokyo, Japan.
1225
Yoshiya Ishikawa received the medical degree
from the Tokyo Medical and Dental University,
Tokyo, Japan, in 2010, where from May 2015 to
March 2018, he was working toward the doc-
toral degree with Medical and Dental Science
Track, Graduate School of Medical and Dental
Sciences.
After the medical residency program, he
worked as a Digestive Surgeon. Since 2014, he
has been a Clinical Fellow with the Department
of Hepatobiliary and Pancreatic Surgery, Medi-
cal Hospitals, Tokyo Medical and Dental University. He currently works
with Saitama Cancer Center, Ina, Japan. He is a specialist of Endoscopic
Surgery and Hepatobiliary and Pancreatic Surgery.
Takahiro Kanno received the B.S., M.S., and Dr.
Eng. degrees in mechanical engineering from
Kyoto University, Kyoto, Japan, in 2007, 2009,
and 2013, respectively.
He worked as a Postdoctoral Researcher with
the Tokyo Institute of Technology, Tokyo, Japan.
He is currently an Assistant Professor with the
Tokyo Medical and Dental University, Tokyo. His
research interests include robotics, teleopera-
tion, and haptics.
Kenji Kawashima received the B.S., M.S., and
Dr. Eng. degrees in control engineering from the
Tokyo Institute of Technology, Tokyo, Japan, in
1992, 1994, and 1997, respectively.
From 1997 to 2000, he worked as a Research
Assistant with the Tokyo Metropolitan College of
Technology, Tokyo. Then, he worked as an As-
sociate Professor with the Precision and Intelli-
gence Laboratory, Tokyo Institute of Technology.
Since April 2013, he has been a Professor with
the Institute of Biomaterials and Bioengineering,
Tokyo Medical and Dental University, Tokyo. His research interests in-
clude robotics and UID measurement and control. His recent work is on
surgical robots with force display, power-assist robots, and teleoperation
of robotics.