Robotic manipulators for single access surgery

This thesis explores the development of cooperative robotic manipulators for enhancing surgical precision and patient outcomes in single-access surgery and, specifically, Transanal Endoscopic Microsurgery (TEM). During these procedures, surgeons manipulate a heavy set of instruments via a mechanical clamp inserted in the patient’s body through a surgical port, resulting in imprecise movements, increased patient risks, and increased operating time. Therefore, an articulated robotic manipulator with passive joints is initially introduced, featuring built-in position and force sensors in each joint and electronic joint brakes for instant lock/release capability. The articulated manipulator concept is further improved with motorised joints, evolving into an active tool holder. The joints allow the incorporation of advanced robotic capabilities such as ultra-lightweight gravity compensation and hands-on kinematic reconfiguration, which can optimise the placement of the tool holder in the operating theatre. Due to the enhanced sensing capabilities, the application of the active robotic manipulator was further explored in conjunction with advanced image guidance approaches such as endomicroscopy. Recent advances in probe-based optical imaging such as confocal endomicroscopy is making inroads in clinical uses. However, the challenging manipulation of imaging probes hinders their practical adoption. Therefore, a combination of the fully cooperative robotic manipulator with a high-speed scanning endomicroscopy instrument is presented, simplifying the incorporation of optical biopsy techniques in routine surgical workflows. Finally, another embodiment of a cooperative robotic manipulator is presented as an input interface to control a highly-articulated robotic instrument for TEM. This master-slave interface alleviates the drawbacks of traditional master-slave devices, e.g., using clutching mechanics to compensate for the mismatch between slave and master workspaces, and the lack of intuitive manipulation feedback, e.g. joint limits, to the user. To address those drawbacks a joint-space robotic manipulator is proposed emulating the kinematic structure of the flexible robotic instrument under control.Open Acces

Cable-driven parallel mechanisms for minimally invasive robotic surgery

Minimally invasive surgery (MIS) has revolutionised surgery by providing faster recovery times, less post-operative complications, improved cosmesis and reduced pain for the patient. Surgical robotics are used to further decrease the invasiveness of procedures, by using yet smaller and fewer incisions or using natural orifices as entry point. However, many robotic systems still suffer from technical challenges such as sufficient instrument dexterity and payloads, leading to limited adoption in clinical practice. Cable-driven parallel mechanisms (CDPMs) have unique properties, which can be used to overcome existing challenges in surgical robotics. These beneficial properties include high end-effector payloads, efficient force transmission and a large configurable instrument workspace. However, the use of CDPMs in MIS is largely unexplored. This research presents the first structured exploration of CDPMs for MIS and demonstrates the potential of this type of mechanism through the development of multiple prototypes: the ESD CYCLOPS, CDAQS, SIMPLE, neuroCYCLOPS and microCYCLOPS. One key challenge for MIS is the access method used to introduce CDPMs into the body. Three different access methods are presented by the prototypes. By focusing on the minimally invasive access method in which CDPMs are introduced into the body, the thesis provides a framework, which can be used by researchers, engineers and clinicians to identify future opportunities of CDPMs in MIS. Additionally, through user studies and pre-clinical studies, these prototypes demonstrate that this type of mechanism has several key advantages for surgical applications in which haptic feedback, safe automation or a high payload are required. These advantages, combined with the different access methods, demonstrate that CDPMs can have a key role in the advancement of MIS technology.Open Acces

Modeling, Analysis, Force Sensing and Control of Continuum Robots for Minimally Invasive Surgery

This dissertation describes design, modeling and application of continuum robotics for surgical applications, specifically parallel continuum robots (PCRs) and concentric tube manipulators (CTMs). The introduction of robotics into surgical applications has allowed for a greater degree of precision, less invasive access to more remote surgical sites, and user-intuitive interfaces with enhanced vision systems. The most recent developments have been in the space of continuum robots, whose exible structure create an inherent safety factor when in contact with fragile tissues. The design challenges that exist involve balancing size and strength of the manipulators, controlling the manipulators over long transmission pathways, and incorporating force sensing and feedback from the manipulators to the user. Contributions presented in this work include: (1) prototyping, design, force sensing, and force control investigations of PCRs, and (2) prototyping of a concentric tube manipulator for use in a standard colonoscope. A general kinetostatic model is presented for PCRs along with identification of multiple physical constraints encountered in design and construction. Design considerations and manipulator capabilities are examined in the form of matrix metrics and ellipsoid representations. Finally, force sensing and control are explored and experimental results are provided showing the accuracy of force estimates based on actuation force measurements and control capabilities. An overview of the design requirements, manipulator construction, analysis and experimental results are provided for a CTM used as a tool manipulator in a traditional colonoscope. Currently, tools used in colonoscopic procedures are straight and exit the front of the scope with 1 DOF of operation (jaws of a grasper, tightening of a loop, etc.). This research shows that with a CTM deployed, the dexterity of these tools can be increased dramatically, increasing accuracy of tool operation, ease of use and safety of the overall procedure. The prototype investigated in this work allows for multiple tools to be used during a single procedure. Experimental results show the feasibility and advantages of the newly-designed manipulators

Design and Development of a Surgical Robot for Needle-Based Medical Interventions

Lung cancer is the leading cause of cancer related deaths. If diagnosed in a timely manner, the treatment of choice is surgical resection of the cancerous lesions followed by radiotherapy. However, surgical resection may be too invasive for some patients due to old age or weakness. An alternative is minimally invasive needle-based interventions for cancer diagnosis and treatment. This project describes the design, analysis, development and experimental evaluation of a modular, compact, patient-mounted robotic manipulator for lung cancer diagnosis and treatment. In this regard, a novel parallel Remote Centre of Motion (RCM) mechanism is proposed for minimally invasive delivery of needle-based interventions. The proposed robot provides four degrees of freedom (DOFs) to orient and move a surgical needle within a spherical coordinate system. There is an analytical solution for the kinematics of the proposed parallel mechanism and the end-effectors motion is well-conditioned within the required workspace. The RCM is located beneath the skin surface to minimize the invasiveness of the surgical procedure while providing the required workspace to target the cancerous lesions. In addition, the proposed robot benefits from a design capable of measuring the interaction forces between the needle and the tissue. The experimental evaluation of the robot has proved its capability to accurately orient and move a surgical needle within the required workspace. Although this robotic system has been designed for the treatment of lung cancer, it is capable of performing other procedures in the thoracic or abdominal cavity such as liver cancer diagnosis and treatment

A continuum robotic platform for endoscopic non-contact laser surgery: design, control, and preclinical evaluation

The application of laser technologies in surgical interventions has been accepted in the clinical domain due to their atraumatic properties. In addition to manual application of fibre-guided lasers with tissue contact, non-contact transoral laser microsurgery (TLM) of laryngeal tumours has been prevailed in ENT surgery. However, TLM requires many years of surgical training for tumour resection in order to preserve the function of adjacent organs and thus preserve the patient’s quality of life. The positioning of the microscopic laser applicator outside the patient can also impede a direct line-of-sight to the target area due to anatomical variability and limit the working space. Further clinical challenges include positioning the laser focus on the tissue surface, imaging, planning and performing laser ablation, and motion of the target area during surgery. This dissertation aims to address the limitations of TLM through robotic approaches and intraoperative assistance. Although a trend towards minimally invasive surgery is apparent, no highly integrated platform for endoscopic delivery of focused laser radiation is available to date. Likewise, there are no known devices that incorporate scene information from endoscopic imaging into ablation planning and execution. For focusing of the laser beam close to the target tissue, this work first presents miniaturised focusing optics that can be integrated into endoscopic systems. Experimental trials characterise the optical properties and the ablation performance. A robotic platform is realised for manipulation of the focusing optics. This is based on a variable-length continuum manipulator. The latter enables movements of the endoscopic end effector in five degrees of freedom with a mechatronic actuation unit. The kinematic modelling and control of the robot are integrated into a modular framework that is evaluated experimentally. The manipulation of focused laser radiation also requires precise adjustment of the focal position on the tissue. For this purpose, visual, haptic and visual-haptic assistance functions are presented. These support the operator during teleoperation to set an optimal working distance. Advantages of visual-haptic assistance are demonstrated in a user study. The system performance and usability of the overall robotic system are assessed in an additional user study. Analogous to a clinical scenario, the subjects follow predefined target patterns with a laser spot. The mean positioning accuracy of the spot is 0.5 mm. Finally, methods of image-guided robot control are introduced to automate laser ablation. Experiments confirm a positive effect of proposed automation concepts on non-contact laser surgery.Die Anwendung von Lasertechnologien in chirurgischen Interventionen hat sich aufgrund der atraumatischen Eigenschaften in der Klinik etabliert. Neben manueller Applikation von fasergeführten Lasern mit Gewebekontakt hat sich die kontaktfreie transorale Lasermikrochirurgie (TLM) von Tumoren des Larynx in der HNO-Chirurgie durchgesetzt. Die TLM erfordert zur Tumorresektion jedoch ein langjähriges chirurgisches Training, um die Funktion der angrenzenden Organe zu sichern und damit die Lebensqualität der Patienten zu erhalten. Die Positionierung des mikroskopis chen Laserapplikators außerhalb des Patienten kann zudem die direkte Sicht auf das Zielgebiet durch anatomische Variabilität erschweren und den Arbeitsraum einschränken. Weitere klinische Herausforderungen betreffen die Positionierung des Laserfokus auf der Gewebeoberfläche, die Bildgebung, die Planung und Ausführung der Laserablation sowie intraoperative Bewegungen des Zielgebietes. Die vorliegende Dissertation zielt darauf ab, die Limitierungen der TLM durch robotische Ansätze und intraoperative Assistenz zu adressieren. Obwohl ein Trend zur minimal invasiven Chirurgie besteht, sind bislang keine hochintegrierten Plattformen für die endoskopische Applikation fokussierter Laserstrahlung verfügbar. Ebenfalls sind keine Systeme bekannt, die Szeneninformationen aus der endoskopischen Bildgebung in die Ablationsplanung und -ausführung einbeziehen. Für eine situsnahe Fokussierung des Laserstrahls wird in dieser Arbeit zunächst eine miniaturisierte Fokussieroptik zur Integration in endoskopische Systeme vorgestellt. Experimentelle Versuche charakterisieren die optischen Eigenschaften und das Ablationsverhalten. Zur Manipulation der Fokussieroptik wird eine robotische Plattform realisiert. Diese basiert auf einem längenveränderlichen Kontinuumsmanipulator. Letzterer ermöglicht in Kombination mit einer mechatronischen Aktuierungseinheit Bewegungen des Endoskopkopfes in fünf Freiheitsgraden. Die kinematische Modellierung und Regelung des Systems werden in ein modulares Framework eingebunden und evaluiert. Die Manipulation fokussierter Laserstrahlung erfordert zudem eine präzise Anpassung der Fokuslage auf das Gewebe. Dafür werden visuelle, haptische und visuell haptische Assistenzfunktionen eingeführt. Diese unterstützen den Anwender bei Teleoperation zur Einstellung eines optimalen Arbeitsabstandes. In einer Anwenderstudie werden Vorteile der visuell-haptischen Assistenz nachgewiesen. Die Systemperformanz und Gebrauchstauglichkeit des robotischen Gesamtsystems werden in einer weiteren Anwenderstudie untersucht. Analog zu einem klinischen Einsatz verfolgen die Probanden mit einem Laserspot vorgegebene Sollpfade. Die mittlere Positioniergenauigkeit des Spots beträgt dabei 0,5 mm. Zur Automatisierung der Ablation werden abschließend Methoden der bildgestützten Regelung vorgestellt. Experimente bestätigen einen positiven Effekt der Automationskonzepte für die kontaktfreie Laserchirurgie

Development of A Soft Robotic Approach for An Intra-abdominal Wireless Laparoscopic Camera

In Single-Incision Laparoscopic Surgery (SILS), the Magnetic Anchoring and Guidance System (MAGS) arises as a promising technique to provide larger workspaces and field of vision for the laparoscopes, relief space for other instruments, and require fewer incisions. Inspired by MAGS, many concept designs related to fully insertable magnetically driven laparoscopes are developed and tested on the transabdominal operation. However, ignoring the tissue interaction and insertion procedure, most of the designs adopt rigid structures, which not only damage the patients\u27 tissue with excess stress concentration and sliding motion but also require complicated operation for the insertion. Meanwhile, lacking state tracking of the insertable camera including pose and contact force, the camera systems operate in open-loop control. This provides mediocre locomotion precision and limited robustness to uncertainties in the environment. This dissertation proposes, develops, and validates a soft robotic approach for an intra-abdominal wireless laparoscopic camera. Contributions presented in this work include (1) feasibility of a soft intra-abdominal laparoscopic camera with friendly tissue interaction and convenient insertion, (2) six degrees of freedom (DOF) real-time localization, (3) Closed-loop control for a robotic-assisted laparoscopic system and (4) untethering solution for wireless communication and high-quality video transmission. Embedding magnet pairs into the camera and external actuator, the camera can be steered and anchored along the abdominal wall through transabdominal magnetic coupling. To avoid the tissue rapture by the sliding motion and dry friction, a wheel structure is applied to achieve rolling motion. Borrowing the ideas from soft robotic research, the main body of the camera implements silicone material, which grants it the bendability to passively attach along the curved abdominal wall and the deformability for easier insertion. The six-DOF pose is estimated in real-time with internal multi-sensor fusion and Newton-Raphson iteration. Combining the pose tracking and force-torque sensor measurement, an interaction model between the deformable camera and tissue is established to evaluate the interaction force over the tissue surface. Moreover, the proposed laparoscopic system is integrated with a multi-DOF manipulator into a robotic-assisted surgical system, where a closed-loop control is realized based on a feedback controller and online optimization. Finally, the wireless control and video streaming are accomplished with Bluetooth Low Energy (BLE) and Analog Video (AV) transmission. Experimental assessments have been implemented to evaluate the performance of the laparoscopic system

Realization of a demonstrator slave for robotic minimally invasive surgery

Robots for Minimally Invasive Surgery (MIS) can improve the surgeon’s work conditions with respect to conventional MIS and to enable MIS with more complex procedures. This requires to provide the surgeon with tactile feedback to feel forces executed on e.g. tissue and sutures, which is partially lost in conventional MIS. Additionally use of a robot should improve the approach possibilities of a target organ by means of instrument degrees of freedom (DoFs) and of the entry points with a compact set-up. These requirements add to the requirements set by the most common commercially available system, the da Vinci which are: (i) dexterity, (ii) natural hand-eye coordination, (iii) a comfortable body posture, (iv) intuitive utilization, and (v) a stereoscopic ’3D’ view of the operation site. The purpose of Sofie (Surgeon’s operating force-feedback interface Eindhoven) is to evaluate the possible benefit of force-feedback and the approach of both patient and target organ. Sofie integrates master, slave, electronic hardware and control. This thesis focusses on the design and realization of a technology demonstrator of the Slave. To provide good accuracy and valuable force-feedback, good dynamic behavior and limited hysteresis are required. To this end the Slave includes (i) a relatively short force-path between its instrument-tips and between tip and patient, and (ii) a passive instrument-support by means of a remote kinematically fixed point of rotation. The incision tissue does not support the instrument. The Slave is connected directly to the table. It provides a 20 DoF highly adaptable stiff frame (pre-surgical set-up) with a short force-path between the instrumenttips and between instrument-tip and patient. During surgery this frame supports three 4 DoF manipulators, two for exchangeable 4 DoF instruments and one for an endoscope. The pre-surgical set-up of the Slave consists of a 5 DoF platform-adjustment with a platform. This platform can hold three 5 DoF manipulator-adjustments in line-up. The set-up is compact to avoid interference with the team, entirely mechanical and allows fast manual adjustment and fixation of the joints. It provides a stiff frame during surgery. A weight-compensation mechanism for the platformadjustment has been proposed. Measurements indicate all natural frequencies are above 25 Hz. The manipulator moves the instrument in 4 DoFs (??, , ?? and Z). Each manipulator passively supports its instrument with a parallelogram mechanism, providing a kinematically fixed point of rotation. Two manipulators have been designed in consecutive order. The first manipulator drives with a worm-wormwheel, the second design uses a ball-screw drive. This ball-screw drive reduces friction, which is preferred for next generations of the manipulator, since the worm-wormwheel drive shows a relatively low coherence at low frequencies. The compact ??Zmanipulator moves the instrument in ?? by rotating a drum. Friction wheels in the drum provide Z. Eventually, the drum will be removable from the manipulator for sterilization. This layout of the manipulator results in a small motion-envelope and least obstructs the team at the table. Force sensors measuring forces executed with the instrument, are integrated in the manipulator instead of at the instrument tip, to avoid all risks of electrical signals being introduced into the patient. Measurements indicate the separate sensors function properly. Integrated in the manipulator the sensors provide a good indication of the force but do suffer from some hysteresis which might be caused by moving wires. The instrument as realized consists of a drive-box, an instrument-tube and a 4 DoF tip. It provides the surgeon with three DoFs additional to the gripper of conventional MIS instruments. These DoFs include two lateral rotations (pitch and pivot) to improve the approach possibilities and the roll DoF will contribute in stitching. Pitch and roll are driven by means of bevelgears, driven with concentric tubes. Cables drive the pivot and close DoFs of the gripper. The transmissions are backdriveable for safety. Theoretical torques that can be achieved with this instrument approximate the requirements closely. Further research needs to reveal the torques achieved in practice and whether the requirements obtained from literature actually are required for these 4 DoF instruments. Force-sensors are proposed and can be integrated. Sofie currently consists of a master prototype with two 5 DoF haptic interfaces, the Slave and an electronic hardware cabinet. The surgeon uses the haptic interfaces of the Master to manipulate the manipulators and instruments of the Slave, while the actuated DoFs of the Master provide the surgeon with force-feedback. This project resulted in a demonstrator of the slave with force sensors incorporated, compact for easy approach of the patient and additional DoFs to increase approach possibilities of the target organ. This slave and master provide a good starting point to implement haptic controllers. These additional features may ultimately benefit both surgeon and patient

Advanced Strategies for Robot Manipulators

Amongst the robotic systems, robot manipulators have proven themselves to be of increasing importance and are widely adopted to substitute for human in repetitive and/or hazardous tasks. Modern manipulators are designed complicatedly and need to do more precise, crucial and critical tasks. So, the simple traditional control methods cannot be efficient, and advanced control strategies with considering special constraints are needed to establish. In spite of the fact that groundbreaking researches have been carried out in this realm until now, there are still many novel aspects which have to be explored

Designing a robotic port system for laparo-endoscopic single-site surgery

Current research and development in the field of surgical interventions aim to reduce the invasiveness by using few incisions or natural orifices in the body to access the surgical site. Considering surgeries in the abdominal cavity, the Laparo-Endoscopic Single-site Surgery (LESS) can be performed through a single incision in the navel, reducing blood loss, post-operative trauma, and improving the cosmetic outcome. However, LESS results in less intuitive instrument control, impaired ergonomic, loss of depth and haptic perception, and restriction of instrument positioning by a single incision. Robot-assisted surgery addresses these shortcomings, by introducing highly articulated, flexible robotic instruments, ergonomic control consoles with 3D visualization, and intuitive instrument control algorithms. The flexible robotic instruments are usually introduced into the abdomen via a rigid straight port, such that the positioning of the tools and therefore the accessibility of anatomical structures is still constrained by the incision location. To address this limitation, articulated ports for LESS are proposed by recent research works. However, they focus on only a few aspects, which are relevant to the surgery, such that a design considering all requirements for LESS has not been proposed yet. This partially originates in the lack of anatomical data of specific applications. Further, no general design guidelines exist and only a few evaluation metrics are proposed. To target these challenges, this thesis focuses on the design of an articulated robotic port for LESS partial nephrectomy. A novel approach is introduced, acquiring the available abdominal workspace, integrated into the surgical workflow. Based on several generated patient datasets and developed metrics, design parameter optimization is conducted. Analyzing the surgical procedure, a comprehensive requirement list is established and applied to design a robotic system, proposing a tendon-driven continuum robot as the articulated port structure. Especially, the aspects of stiffening and sterile design are addressed. In various experimental evaluations, the reachability, the stiffness, and the overall design are evaluated. The findings identify layer jamming as the superior stiffening method. Further, the articulated port is proven to enhance the accessibility of anatomical structures and offer a patient and incision location independent design