Neurosputnik: Left-Handed (LevshAI) Robotic Complex for Endovascular Neurosurgery

The main articles are:

• Robots in medicine
• Robots surgeons
• Endovascular surgery

2023

Development of tactile sensation transfer technology for robotic surgeons

The domestic intelligent robotic motion copying system LevshAI ("Left-handed") for remote neurosurgical endovascular operations was presented by scientists from the company "Neurosputnik." It has tactile feedback and the ability to preoperate personalized 3D modeling. Preclinical expert testing was carried out by the Association of Endovascular Neurosurgeons named after Academician F. A. Serbinenko. This was announced on June 26, 2023 by Zdrav.Expert University of Science and Technology MISIS.

Scientists in Russia have created a technology for transmitting tactile sensations for robotic surgeons

LevshAI ("Left-hander") uses artificial intelligence before and during surgery, simulates the patient's vessels in 3D format, corrects finger tremors, identifies critical situations. Most robotic devices do not use isomorphic tactile feedback and do not adapt the device for the convenience of surgeons. For example, the GRX (Corindus) endovascular robotic system for heart operations uses joysticks without tactile feedback that require surgeons to retrain. Therefore, the system we are developing is special, more convenient for doctors and safe for patients, reported Alexandra Bernadotte, Ph.D., Associate Professor, Department of Engineering Cybernetics, NUST MISIS, General Director of Neurosputnik.

The need to introduce robotization and mechatronics to implement endovascular telesurgery is ripe for a number of reasons. First, it provides access to the operation from anywhere in the world. Since the number of experienced neurosurgeons is limited, it becomes necessary to carry out operations remotely. Secondly, it allows you to protect the doctor from exposure to X-rays, since when performing endovascular operations, surgeons are close to the radiation source, which is used to visually monitor the course of the operation. In addition, the Lefty ecosystem allows you to work out skills on the simulator both in training mode and in personalized simulation mode.

Thanks to the architecture of the motion copy system, it is possible to integrate assistant intelligent modules into the operational process, which will reduce the likelihood of critical operational complications.

The Lefty ecosystem provides the possibility of 3D reconstruction of cerebral vessels and allows you to take into account the features of specific patients, plan surgery, change tactics during surgery, minimizing the risk of complications.

A feature of endovascular surgery is minimal invasiveness. During such an intervention, the microcatheter moves along the inner walls of the vessels. The monitoring unit of the Lefty system is located outside the operating room, protecting doctors from radiation. The doctor remotely sets the operating device in motion using special controllers. The digitized signal from the surgeon's hands provides the intelligent unit with encrypted information commands to move the catheter and other instruments.

The operating unit copies the surgeon's movements and moves catheters and other surgical instruments through the vessels of the brain. The X-ray fluoroscope and optical sensors help to control their movement. The built-in AI processes the information and transmits it to the left-handed visual control unit.

The monitoring and operating units communicate with each other via an Ethernet connection. Communication can be either wired or wireless. The imaging module shows an X-ray image of the patient's brain vessels online, allowing the surgeon to control movement. To detect twisting and vibration, piezoelectric sensors located along the catheter are used. Data from the operating room is subjected to additional artificial intelligence processing (noise filtering, resistance linearization, artifact removal) so that the feedback on the surgeon's side is as accurate as possible.

The "lefty" mimics tactile feedback as accurately as possible to provide a kinesthetic sensation when mechanical resistance occurs in the cerebral vessel or the catheter rests against the wall. Moreover, the surgeon receives information about the strength and direction of mechanical resistance visually - in the form of a diode scale.

Of particular importance in the LevshAI ecosystem is the simulator. The system is equipped with a training program that allows surgeons to practice on a 3D simulator and choose the best tactics.

First, with the help of images of computer or magnetic resonance imaging (MRI) of the patient, before the operation, the three-dimensional architecture of the cerebral vascular system is recreated. On this basis, a 3D reconstruction is created, which is integrated into a simulator, also developed by our team. This is a complex mathematical and algorithmic problem that requires training of artificial intelligence on an extensive dataset, narrated by Alexandra Bernadotte.

In the near future, a stage of clinical research will begin in cooperation with the Association of Endovascular Neurosurgeons named after Academician F. A. Serbinenko. In the future, to speed up the device's perception of information in critical situations, the developers will implement a brain-computer interface that recognizes mental commands 300 times faster than movements.

Method of protecting a robot surgeon from cyber attacks

A team of Russian scientists has proposed an approach to ensuring cybersecurity of intelligent teleoperating surgical systems, taking into account modern requirements. As Zdrav.Expert was reported on April 3, 2023 by representatives of the Neurosputnik company, the approach has already been applied to ensure the safety of the company's development - a domestic intelligent robotic complex for endovascular neurosurgery LevshAI.

The Russian Scientists have proposed a method for protecting robotic surgeons from cyber attacks
Demonstration of the LevshAI complex

According to them, the proposed cybersecurity model allows you to ensure the proper operation of the complex during various attacks on the device. It combines intelligent autonomous controllers to calculate abnormal and suspicious actions, and analyzes network traffic for signs of cyber attacks.

As of April 2023, Lefty is the only special ecosystem in the world that provides a personalized and safe approach to patients, advanced neurosurgery training for novice surgeons and the possibility of remote surgery of vascular pathologies, brain specified in Neurosputnik.

As the head of the Neurosputnik company, associate professor of the Department of Engineering Cybernetics of NUST MISIS, Ph.D. Alexandra Bernadotte explained, intelligent robotic systems in surgery are a new field that does not yet have established solutions. Approaches to ensuring the safety of an intelligent teleoperative surgical system are hardly covered in the literature. At the same time, according to her, there are purely specific problems that are associated with the need to ensure the safety of patients and surgeons when using such systems when communication breaks, equipment fails, cyber attacks.

Alexandra Bernadotte, Head of Neurosputnik, Associate Professor, Department of Engineering Cybernetics, NUST MISIS

"Network security must be considered in addition to the cryptographic security of the transport protocol. There is a need for an isolated loop to ensure double control during the operation, "added Alexandra Bernadotte.

The security of the left-handed telesurgical system is conceptually provided by two main parts, the control unit and the actuator unit, which are connected by, VPN but can be far from each other. One part of the cybersecurity system is the session manager, connected to a VPN, providing security services for the network connection of the main units. In addition, the IP MAC addresses of the interacting devices are pre-recorded in the distributed registry. To protect servers authentications against uncontrolled generation of a large number of false sessions and subsequent denial of service, filtering rules have been created, told in Neurosputnik.

"The right strategy is to prevent cyber attacks at all stages. Both in preparation for the operation, during it, and subsequently to preserve the patient's health, "the researcher emphasized. - We have proposed robust methods to extend security protocols using intelligent agents and redundant autonomous circuits. This security model allows the surgeon to control the operation process during various attacks. The communication unit is separated from the operational unit and disconnected until the threat is eliminated. If necessary, a surgeon having physical access to the autonomous part could operate the actuator unit from the local ward. This security approach is implemented in the Lefty system. "

According to some experts, robotic surgery is cheaper than classical methods. It also saves doctors from radioactive radiation, since operations on the vessels of the brain and heart are carried out in X-ray monitoring mode. In addition, the system actively uses artificial intelligence, which informs about critical conditions, prompts the optimal solution and expands the possibilities for joint complex operations, while increasing the level of patient safety.

Despite the urgent need to develop simulators, telesurgery and personalized surgery, there are a number of strict requirements for the architecture and components of such equipment. The main deterrent to such a system entering the market are guarantees of reliability and safety for patients. Telesurgical robotic complexes are difficult to implement and protect, since any malfunction or cyber attack can cause significant harm to health, told in "Neurosputnik."

LevshAI Intelligent Robotic Complex

The Lefty ecosystem actively uses artificial intelligence for different tasks and consists of three products that work independently of each other: a simulator with a special input device with tactile feedback and a brain vessel simulator (allows surgeons and medical students to work out skills), an operating device and a server application with artificial intelligence to simulate brain vessels of a particular patient.

In turn, each product of the system is equipped with a variety of deep learning models and mathematical modeling algorithms. Thus, the Lefty project creates an individual 3D model of the patient's brain vessels, allowing you to practice before surgery and choose the optimal strategy, which can reduce the risks of complications from 30% to 0. The Lefty simulator recreates conditions almost identical to those in the operating room, has tactile feedback, allowing surgeons to interact with the pathology field in a familiar manner. Assisted artificial intelligence automatically adjusts the work of surgeons, helps to assess the anatomy of patients, gives recommendations for preoperative and postoperative management of patients with a personalized selection of recommendations based on patient data. "Lefty" also has its own extensive database, which allows you to run 3D simulations, identify individual features of patients, recognize critical conditions, errors of surgeons, etc. The operating unit as of early April 2023 is still in development, and the simulator and personalized simulator are already at the pilot training stage.

The process of developing the Lefty system takes place with the consultation of the Russian Society of Endovascular Neurosurgeons (RENS) at the FMBA of Russia. The participation of practicing surgeons allows you to adapt the device to work in a real operation.