Recent trends, technical concepts and components of computer-assisted orthopedic surgery systems: A comprehensive review

Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.Web of Science1923art. no. 519

Review of robotic technology for keyhole transcranial stereotactic neurosurgery

The research of stereotactic apparatus to guide surgical devices began in 1908, yet a major part of today's stereotactic neurosurgeries still rely on stereotactic frames developed almost half a century ago. Robots excel at handling spatial information, and are, thus, obvious candidates in the guidance of instrumentation along precisely planned trajectories. In this review, we introduce the concept of stereotaxy and describe a standard stereotactic neurosurgery. Neurosurgeons' expectations and demands regarding the role of robots as assistive tools are also addressed. We list the most successful robotic systems developed specifically for or capable of executing stereotactic neurosurgery. A critical review is presented for each robotic system, emphasizing the differences between them and detailing positive features and drawbacks. An analysis of the listed robotic system features is also undertaken, in the context of robotic application in stereotactic neurosurgery. Finally, we discuss the current perspective, and future directions of a robotic technology in this field. All robotic systems follow a very similar and structured workflow despite the technical differences that set them apart. No system unequivocally stands out as an absolute best. The trend of technological progress is pointing toward the development of miniaturized cost-effective solutions with more intuitive interfaces.This work has been partially financed by the NETT Project (FP7-PEOPLE-2011-ITN-289146), ACTIVE Project (FP7-ICT-2009-6-270460), and FCT PhD grant (ref. SFRH/BD/86499/2012)

Da Vinci robot at Hospital Clinic. Manoeuvrability devices and performance in robotic tech

Treballs Finals de Grau d'Enginyeria Biomèdica. Facultat de Medicina i Ciències de la Salut. Universitat de Barcelona. Curs: 2020-2021. Tutor: Manel Puig Vidal.Robot-assisted surgical systems are becoming increasingly common in medical procedures as they embrace many of the benefits of minimally invasive surgery including less trauma, recovery time and financial costs associated to the treatment after surgery. These robotic systems allow the surgeons to navigate within confined spaces where an operator’s human hand would normally be greatly limited. This dexterity is further strengthened through motion scaling, which translates large motions by the operator into diminutive actions of the robotic end effector. An example of this is the Da Vinci System which is coupled to the EndoWrist end effector tool. Nevertheless, these systems also have some drawbacks such as the high cost of the surgery itself and the lack of tactile or haptic feedback. This means that as the surgeon is performing the procedures outside the patient’s body, he/she can not feel the resistance of the human tissue’s when cutting. Therefore, one can risk damaging healthy tissues if force is not controlled or, when sewing, one can exert an exaggerated force and break the thread. In this project, a new system is created based on the UR5 robot (Universal Robots) and an EndoWrist needle to mimic the behaviour of the Da Vinci System and implement some improvements regarding the manoeuvrability and haptic feedback performance

An Underactuated Flexible Instrument for Single Incision Laparoscopic Surgery

More and more patients and surgeons have switched from open surgery to minimally invasive surgery over these years. This exciting advancement has brought massive benefits to patients. Researchers and institutions have proposed robot assisted surgery which combines the advantage of developed robot system and human experience. This thesis reviews state of the art in this area and analyze some advanced surgical instrument for single incision laparoscopic instrument, then propose a design of robotic instrument for single incision laparoscopic surgery which can be integrated with collaborative robot manipulator to construct a surgical robot system.Single-incision laparoscopic surgery (SILS) has its own features and advantages compare to other minimally invasive surgery techniques which also lead to special design requirements for SILS instruments, among which increased flexibility compare to multi-incision surgery instruments is an important part. So we want to design a robotic surgical instrument that has increased flexibility compare to traditional instruments for other MIS techniques. As a laparoscopic robotic instrument compactness and light weight are also our considerations.Single incision laparoscopic surgery (SILS) inserts multiple instruments and laparoscopes through a single trocar which reduces trauma. But this improvement for patients caused difficulty in operation because of instruments triangulation, laparoscope field-of-view, etc. That brings up our challenges in designing a robotic instruments. Designing a highly flexible robotic instrument that provides sufficient workspace and good triangulation in order to relieve the difficulties introduced by narrow instrument trocars.We want to implement a highly recognized surgical instrument with a designed robotic instrument actuation pack. These two parts compose a robotic surgical instrument for single incision laparoscopic surgery. And we want to analyze the performance and viability of our design approach for SILS application

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

CRANE: A Redundant, Multi-Degree-of-Freedom Computed Tomography Robot for Heightened Needle Dexterity within a Medical Imaging Bore

Computed Tomography (CT) image guidance enables accurate and safe minimally invasive treatment of diseases, including cancer and chronic pain, with needle-like tools via a percutaneous approach. The physician incrementally inserts and adjusts the needle with intermediate images due to the accuracy limitation of free-hand adjustment and patient physiological motion. Scanning frequency is limited to minimize ionizing radiation exposure for the patient and physician. Robots can provide high positional accuracy and compensate for physiological motion with fewer scans. To accomplish this, the robots must operate within the confined imaging bore while retaining sufficient dexterity to insert and manipulate the needle. This paper presents CRANE: CT Robotic Arm and Needle Emplacer, a CT-compatible robot with a design focused on system dexterity that enables physicians to manipulate and insert needles within the scanner bore as naturally as they would be able to by hand. We define abstract and measurable clinically motivated metrics for in-bore dexterity applicable to general-purpose intra-bore image-guided needle placement robots, develop an automatic robot planning and control method for intra-bore needle manipulation and device setup, and demonstrate the redundant linkage design provides dexterity across various human morphology and meets the clinical requirements for target accuracy during an in-situ evaluation.Comment: 20 pages, 13 figures, Transactions on Robotic

Bridging the gap between robotic technology and health care

Although technology and computation power have become more and more present in our daily lives, we have yet to see the same tendency in robotics applied to health care. In this work we focused on the study of four distinct applications of robotic technology to health care, named Robotic Assisted Surgery, Robotics in Rehabilitation, Prosthetics and Companion Robotic Systems. We identified the main roadblocks that are limiting the progress of such applications by an extensive examination of recent reports. Based on the limitations of the practical use of current robotic technology for health care we proposed a general modularization approach for the conception and implementation of specific robotic devices. The main conclusions of this review are: (i) there is a clear need of the adaptation of robotic technology (closed loop) to the user, so that robotics can be widely accepted and used in the context of heath care; (ii) for all studied robotic technologies cost is still prohibitive and limits their wide use. The reduction of costs influences technology acceptability; thus innovation by using cheaper computer systems and sensors is relevant and should be taken into account in the implementation of robotic systems