Patient-specific simulation for autonomous surgery

An Autonomous Robotic Surgical System (ARSS) has to interact with the complex anatomical environment, which is deforming and whose properties are often uncertain. Within this context, an ARSS can benefit from the availability of patient-specific simulation of the anatomy. For example, simulation can provide a safe and controlled environment for the design, test and validation of the autonomous capabilities. Moreover, it can be used to generate large amounts of patient-specific data that can be exploited to learn models and/or tasks. The aim of this Thesis is to investigate the different ways in which simulation can support an ARSS and to propose solutions to favor its employability in robotic surgery. We first address all the phases needed to create such a simulation, from model choice in the pre-operative phase based on the available knowledge to its intra-operative update to compensate for inaccurate parametrization. We propose to rely on deep neural networks trained with synthetic data both to generate a patient-specific model and to design a strategy to update model parametrization starting directly from intra-operative sensor data. Afterwards, we test how simulation can assist the ARSS, both for task learning and during task execution. We show that simulation can be used to efficiently train approaches that require multiple interactions with the environment, compensating for the riskiness to acquire data from real surgical robotic systems. Finally, we propose a modular framework for autonomous surgery that includes deliberative functions to handle real anatomical environments with uncertain parameters. The integration of a personalized simulation proves fundamental both for optimal task planning and to enhance and monitor real execution. The contributions presented in this Thesis have the potential to introduce significant step changes in the development and actual performance of autonomous robotic surgical systems, making them closer to applicability to real clinical conditions.