IEEE Robotics & Automation Magazine - September 2023 - 150

another type of common sense. For
example, knowing the effects of a complex
surgical action on the internal
organs requires surgical knowledge and
experience (and thus surgical common
sense) that may not be required in simpler
and standard cases, when only medical
common sense may be sufficient.
To clarify the proposed classification,
we introduce Figure 1, which describes
the common-sense knowledge required
during the suturing phase of a partial
nephrectomy intervention. This classification
can be adapted to other surgical
phases or procedures. The sentence at the
top is taken from a surgical textbook [7]
and represents the procedural knowledge
of the intervention. However, it does not
describe how to assess the conditions of
a good suture nor how to select the best
surgical approach to connect the tissues,
nor does it list the individual steps and
actions needed to accomplish it (surgical
common sense). Furthermore, it does
not describe the effect that a suture
generally causes on tissue nor how to
pharmacologically treat the patient after
the surgery (medical common sense),
nor does it provide the implicit general
knowledge about the objects involved in
the suture, e.g., a needle is needed and it
must be grasped, inserted, and extracted
(general common sense). Despite these
missing details, surgeons are able to
perform the intervention after reading
a manual. This is possible because they
can leverage their broader background
that glues information together. Surgical
textbooks alone are not sufficient
to fully describe an intervention, and
an ARSS must acquire the same level
of knowledge mentioned previously to
perform the surgical task and properly
handle the situations that occur.
MAPPING COMMON-SENSE SKILLS
TO AUTONOMY LEVELS IN SURGERY
Following the taxonomy first presented
for self-driving cars [8], an ARSS can be
classified into five levels of autonomy, as
proposed by Yang et al. [9]: at autonomy
level 0, the human performs all the tasks
and makes all the decisions; at autonomy
level 1, the robot provides dexterity
and cognitive assistance during the task,
sharing controls and actions with the
human; at level 2, the robot is autonomous
during specific tasks, i.e., trading
control of the system with the human at
discrete times; at level 3, the robot generates
task strategies but the human has
the final decision over the proposed
tasks; at level 4, the robot can make
decisions on the complete surgical strategy
but under the supervision of a qualified
doctor; finally, level 5 introduces
the full autonomy, i.e., a robotic surgeon
that can perform an entire procedure
without supervision. These different levels
of autonomy are obviously associated
with different levels of knowledge, and
we propose the classification schematized
in Figure 2. In particular, the
sophisticated capabilities required to
reach high autonomy levels are implicitly
connected to the breadth of the
required common-sense knowledge.
Current surgical robots are teleoperated
systems with some assistive function
(levels 0 and 1) and have no knowledge
of the steps to be performed but simply
The renorrhaphy
sutures can now be
introduced and temporarily
situated near the
operative field.
Procedural Knowledge:
Suturing is a phase of the intervention.
Partial Nephrectomy:
Surgical Common Sense:
The following steps are required to perform a suture:
* Grasping the needle (a)
* Moving close to the insertion point (b)
* Inserting the needle (c)
* ...
Furthermore:
* What does " near the operative field " mean?
* When and how should the needle be inserted according to
the current anatomical configuration?
(a)
* Which suture technique is preferable in this specific case?
Medical Common Sense:
* How does a suture generally impact tissues?
* How should the patient be treated after surgery?
* What medications are required?
* ...
General Common Sense:
* The needle should be inserted from tip to eye.
* ...
Eye
Tip
p
Suturing
(b)
(c)
FIGURE 1. Procedural knowledge enriched with surgical, medical, and general common sense.
15 IEEE ROBOTICS & AUTOMATION MAGAZINE SEPTEMBER 2023
IEEE Robotics & Automation Magazine - September 2023

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