Snake-Like Robots for Minimally Invasive, Single Port, and Intraluminal Surgeries

The surgical paradigm of Minimally Invasive Surgery (MIS) has been a key driver to the adoption of robotic surgical assistance. Progress in the last three decades has led to a gradual transition from manual laparoscopic surgery with rigid instruments to robot-assisted surgery. In the last decade, the increasing demand for new surgical paradigms to enable access into the anatomy without skin incision (intraluminal surgery) or with a single skin incision (Single Port Access surgery - SPA) has led researchers to investigate snake-like flexible surgical devices. In this chapter, we first present an overview of the background, motivation, and taxonomy of MIS and its newer derivatives. Challenges of MIS and its newer derivatives (SPA and intraluminal surgery) are outlined along with the architectures of new snake-like robots meeting these challenges. We also examine the commercial and research surgical platforms developed over the years, to address the specific functional requirements and constraints imposed by operations in confined spaces. The chapter concludes with an evaluation of open problems in surgical robotics for intraluminal and SPA, and a look at future trends in surgical robot design that could potentially address these unmet needs.Comment: 41 pages, 18 figures. Preprint of article published in the Encyclopedia of Medical Robotics 2018, World Scientific Publishing Company www.worldscientific.com/doi/abs/10.1142/9789813232266_000

Optimal dimensional synthesis of force feedback lower arm exoskeletons

This paper presents multi-criteria design optimization of parallel mechanism based force feedback exoskeletons for human forearm and wrist. The optimized devices are aimed to be employed as a high fidelity haptic interfaces. Multiple design objectives are discussed and classified for the devices and the optimization problem to study the trade-offs between these criteria is formulated. Dimensional syntheses are performed for optimal global kinematic and dynamic performance, utilizing a Pareto front based framework, for two spherical parallel mechanisms that satisfy the ergonomic necessities of a human forearm and wrist. Two optimized mechanisms are compared and discussed in the light of multiple design criteria. Finally, kinematic structure and dimensions of an optimal exoskeleton are decided

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 Novel Handheld Device for Active Compensation of Physiological Tremor

In microsurgery, the human hand imposes certain limitations in accurately positioning the tip of a device such as scalpel. Any errors in the motion of the hand make microsurgical procedures difficult and involuntary motions such as hand tremors can make some procedures significantly difficult to perform. This is particularly true in the case of vitreoretinal microsurgery. The most familiar source of involuntary motion is physiological tremor. Real-time compensation of tremor is, therefore, necessary to assist surgeons to precisely position and manipulate the tool-tip to accurately perform a microsurgery. In this thesis, a novel handheld device (AID) is described for compensation of physiological tremor in the hand. MEMS-based accelerometers and gyroscopes have been used for sensing the motion of the hand in six degrees of freedom (DOF). An augmented state complementary Kalman filter is used to calculate 2 DOF orientation. An adaptive filtering algorithm, band-limited Multiple Fourier linear combiner (BMFLC), is used to calculate the tremor component in the hand in real-time. Ionic Polymer Metallic Composites (IPMCs) have been used as actuators for deflecting the tool-tip to compensate for the tremor

Parallel manipulators: practical applications and kinematic design criteria. Towards the modular reconfigurable robots

Post-PrintModern robotic manipulators play an essential role in industry, developing several tasks in an easy way, enhancing the accuracy of the final product and reducing the executing time. Also they can be found in other fields as aerospace industry, several medical applications, gaming industry, and so on. In particular, the parallel manipulators have acquired a great relevance in the last years. Indeed, many research activities and projects deal with the study and develop-ment of this type of robots. Nevertheless, usually, a bilateral communication between industry and research does not exist, even among the different existing research areas. This causes a lack of knowledge regarding works that have been carried out, the ones that are under devel-opment and the possible future investigations. Hence, once a specific field of knowledge has acquired a certain level of maturity, it is convenient to reflect its current state of the art. In this sense, the authors of this paper present a review of the different fields in which parallel ma-nipulators have a significant participation, and also the most active research topics in the anal-ysis and design of these robots. Besides, several contributions of the authors to this field are cited.The authors wish to acknowledge the financial support received from the Spanish Government through the "Ministerio de Economía y Competitividad" (Project DPI2015-67626-P (MINECO/FEDER, UE)), the financial support from the Uni-versity of the Basque Country (UPV/EHU) under the program UFI 11/29 and the support to the research group, through the project with ref. IT949-16, given by the "Departamento de Educación, Política Lingüística y Cultura" of the Regional Government of the Basque Country

Soft manipulators and grippers: A review

Soft robotics is a growing area of research which utilizes the compliance and adaptability of soft structures to develop highly adaptive robotics for soft interactions. One area in which soft robotics has the ability to make significant impact is in the development of soft grippers and manipulators. With an increased requirement for automation, robotics systems are required to perform task in unstructured and not well defined environments; conditions which conventional rigid robotics are not best suited. This requires a paradigm shift in the methods and materials used to develop robots such that they can adapt to and work safely in human environments. One solution to this is soft robotics, which enables soft interactions with the surroundings while maintaining the ability to apply significant force. This review paper assesses the current materials and methods, actuation methods and sensors which are used in the development of soft manipulators. The achievements and shortcomings of recent technology in these key areas are evaluated, and this paper concludes with a discussion on the potential impacts of soft manipulators on industry and society

Adaptive physical human-robot interaction (PHRI) with a robotic nursing assistant.

Recently, more and more robots are being investigated for future applications in health-care. For instance, in nursing assistance, seamless Human-Robot Interaction (HRI) is very important for sharing workspaces and workloads between medical staff, patients, and robots. In this thesis we introduce a novel robot - the Adaptive Robot Nursing Assistant (ARNA) and its underlying components. ARNA has been designed specifically to assist nurses with day-to-day tasks such as walking patients, pick-and-place item retrieval, and routine patient health monitoring. An adaptive HRI in nursing applications creates a positive user experience, increase nurse productivity and task completion rates, as reported by experimentation with human subjects. ARNA has been designed to include interface devices such as tablets, force sensors, pressure-sensitive robot skins, LIDAR and RGBD camera. These interfaces are combined with adaptive controllers and estimators within a proposed framework that contains multiple innovations. A research study was conducted on methods of deploying an ideal HumanMachine Interface (HMI), in this case a tablet-based interface. Initial study points to the fact that a traded control level of autonomy is ideal for tele-operating ARNA by a patient. The proposed method of using the HMI devices makes the performance of a robot similar for both skilled and un-skilled workers. A neuro-adaptive controller (NAC), which contains several neural-networks to estimate and compensate for system non-linearities, was implemented on the ARNA robot. By linearizing the system, a cross-over usability condition is met through which humans find it more intuitive to learn to use the robot in any location of its workspace, A novel Base-Sensor Assisted Physical Interaction (BAPI) controller is introduced in this thesis, which utilizes a force-torque sensor at the base of the ARNA robot manipulator to detect full body collisions, and make interaction safer. Finally, a human-intent estimator (HIE) is proposed to estimate human intent while the robot and user are physically collaborating during certain tasks such as adaptive walking. A NAC with HIE module was validated on a PR2 robot through user studies. Its implementation on the ARNA robot platform can be easily accomplished as the controller is model-free and can learn robot dynamics online. A new framework, Directive Observer and Lead Assistant (DOLA), is proposed for ARNA which enables the user to interact with the robot in two modes: physically, by direct push-guiding, and remotely, through a tablet interface. In both cases, the human is being “observed” by the robot, then guided and/or advised during interaction. If the user has trouble completing the given tasks, the robot adapts their repertoire to lead users toward completing goals. The proposed framework incorporates interface devices as well as adaptive control systems in order to facilitate a higher performance interaction between the user and the robot than was previously possible. The ARNA robot was deployed and tested in a hospital environment at the School of Nursing of the University of Louisville. The user-experience tests were conducted with the help of healthcare professionals where several metrics including completion time, rate and level of user satisfaction were collected to shed light on the performance of various components of the proposed framework. The results indicate an overall positive response towards the use of such assistive robot in the healthcare environment. The analysis of these gathered data is included in this document. To summarize, this research study makes the following contributions: Conducting user experience studies with the ARNA robot in patient sitter and walker scenarios to evaluate both physical and non-physical human-machine interfaces. Evaluation and Validation of Human Intent Estimator (HIE) and Neuro-Adaptive Controller (NAC). Proposing the novel Base-Sensor Assisted Physical Interaction (BAPI) controller. Building simulation models for packaged tactile sensors and validating the models with experimental data. Description of Directive Observer and Lead Assistance (DOLA) framework for ARNA using adaptive interfaces