Robotic-assisted surgical systems have demonstrated significant potential in enhancing surgical precision and minimizing human errors. However, existing systems lack the ability to accommodate the unique preferences and requirements of individual surgeons. Additionally, they primarily focus on general surgeries (e.g., laparoscopy) and are not suitable for highly precise microsurgeries, such as ophthalmic procedures. Thus, we propose a simulation-based image-guided approach for surgeon-centered autonomous agents that can adapt to the individual surgeon's skill level and preferred surgical techniques during ophthalmic cataract surgery. Our approach utilizes a simulated environment to train reinforcement and imitation learning agents guided by image data to perform all tasks of the incision phase of cataract surgery. By integrating the surgeon's actions and preferences into the training process with the surgeon-in-the-loop, our approach enables the robot to implicitly learn and adapt to the individual surgeon's unique approach through demonstrations. This results in a more intuitive and personalized surgical experience for the surgeon. Simultaneously, it ensures consistent performance for the autonomous robotic apprentice. We define and evaluate the effectiveness of our approach using our proposed metrics; and highlight the trade-off between a generic agent and a surgeon-centered adapted agent. Moreover, our approach has the potential to extend to other ophthalmic surgical procedures, opening the door to a new generation of surgeon-in-the-loop autonomous surgical robots. We provide an open-source simulation framework for future development and reproducibility.

翻译：机器人辅助手术系统在提升手术精度和减少人为失误方面展现了显著潜力。然而，现有系统缺乏适应个体外科医生独特偏好与需求的能力。此外，它们主要适用于常规手术（如腹腔镜手术），并不适宜于高度精细的显微手术，例如眼科手术。为此，我们提出一种基于仿真与图像引导的外科医生中心自主代理方法，该方法能够适应个体外科医生在白内障手术中的技能水平和偏好手术技巧。我们的方法利用模拟环境训练强化学习与模仿学习代理，通过图像数据引导其完成白内障手术切口阶段的所有任务。通过将外科医生的动作与偏好融入外科医生在环训练过程，我们的方法使机器人能够通过演示隐式学习并适应个体外科医生的独特操作方式，从而为外科医生带来更直观、更个性化的手术体验，同时确保自主机器人学徒的性能一致性。我们利用所提出的指标对方法有效性进行定义与评估，并揭示了通用代理与外科医生中心自适应代理之间的权衡。此外，该方法具备扩展至其他眼科手术的潜力，为新一代外科医生在环自主手术机器人开辟了道路。我们提供了开源仿真框架以供后续开发与复现。