Rolling-joint design optimization for tendon driven snake-like surgical robots

The use of snake-like robots for surgery is a popular choice for intra-luminal procedures. In practice, the requirements for strength, flexibility and accuracy are difficult to be satisfied simultaneously. This paper presents a computational approach for optimizing the design of a snake-like robot using serial rolling-joints and tendons as the base architecture. The method optimizes the design in terms of joint angle range and tendon placement to prevent the tendons and joints from colliding during bending motion. The resulting optimized joints were manufactured using 3D printing. The robot was characterized in terms of workspace, dexterity, precision and manipulation forces. The results show a repeatability as low as 0.9mm and manipulation forces of up to 5.6N

Surgical Applications of Compliant Mechanisms:A Review

Current surgical devices are mostly rigid and are made of stiff materials, even though their predominant use is on soft and wet tissues. With the emergence of compliant mechanisms (CMs), surgical tools can be designed to be flexible and made using soft materials. CMs offer many advantages such as monolithic fabrication, high precision, no wear, no friction, and no need for lubrication. It is therefore beneficial to consolidate the developments in this field and point to challenges ahead. With this objective, in this article, we review the application of CMs to surgical interventions. The scope of the review covers five aspects that are important in the development of surgical devices: (i) conceptual design and synthesis, (ii) analysis, (iii) materials, (iv) maim facturing, and (v) actuation. Furthermore, the surgical applications of CMs are assessed by classification into five major groups, namely, (i) grasping and cutting, (ii) reachability and steerability, (iii) transmission, (iv) sensing, and (v) implants and deployable devices. The scope and prospects of surgical devices using CMs are also discussed

Use of the Olympus endoArm for spinal and skull-based transsphenoidal neurosurgery

ManuscriptMinimally invasive surgical techniques have evolved to reduce soft-tissue injury associated with open surgical techniques. The use of endoscopic visualization allows the exposure of deep structures and provides a mechanism to perform all the components of an open surgical procedure through small portals, thus satisfying a basic requirement of minimally invasive surgical procedures. Surgeons in the field of skull-based and spine surgery are now taking advantage of the benefits of such endoscopes. The pneumatically powered EndoArm endoscopic holder has been used extensively in both cranial and spinal neurosurgical cases at the University of Utah. These cases include minimally invasive cervical and lumbar decompression procedures, as well as more recently for the resection of larger and more extensive pituitary tumors. In this paper, the multiple advantages of the Olympus EndoArm endoscopic holder are described in detail. As more surgeons gain experience with endoscopes in skull-based surgery, the hope is that operative times will be shorter and more extensive surgical resections will be possible with less patient morbidity

A Miniature 3-DoF Flexible Parallel Robotic Wrist Using NiTi Wires for Gastrointestinal Endoscopic Surgery

Gastrointestinal endoscopic surgery (GES) has high requirements for instruments' size and distal dexterity, because of the narrow endoscopic channel and long, tortuous human gastrointestinal tract. This paper utilized Nickel-Titanium (NiTi) wires to develop a miniature 3-DoF (pitch-yaw-translation) flexible parallel robotic wrist (FPRW). Additionally, we assembled an electric knife on the wrist's connection interface and then teleoperated it to perform an endoscopic submucosal dissection (ESD) on porcine stomachs. The effective performance in each ESD workflow proves that the designed FPRW has sufficient workspace, high distal dexterity, and high positioning accuracy.Comment: IEEE International Conference on Robotics and Automation (ICRA) 2022 workshop: Frontiers of Endoluminal Intervention: Clinical opportunities and technical challenge

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

Surgical Instruments based on flexible micro-electronics

This dissertation explores strategies to create micro-scale tools with integrated electronic and mechanical functionalities. Recently developed approaches to control the shape of flexible micro-structures are employed to fabricate micro-electronic instruments that embed components for sensing and actuation, aiming to expand the toolkit of minimally invasive surgery. This thesis proposes two distinct types of devices that might expand the boundaries of modern surgical interventions and enable new bio-medical applications. First, an electronically integrated micro-catheter is developed. Electronic components for sensing and actuation are embedded into the catheter wall through an alternative fabrication paradigm that takes advantage of a self-rolling polymeric thin-film system. With a diameter of only 0.1 mm, the catheter is capable of delivering fluids in a highly targeted fashion, comprises actuated opposing digits for the efficient manipulation of microscopic objects, and a magnetic sensor for navigation. Employing a specially conceived approach for position tracking, navigation with a high resolution below 0.1 mm is achieved. The fundamental functionalities and mechanical properties of this instrument are evaluated in artificial model environments and ex vivo tissues. The second development explores reshapeable micro-electronic devices. These systems integrate conductive polymer actuators and strain or magnetic sensors to adjust their shape through feedback-driven closed loop control and mechanically interact with their environment. Due to their inherent flexibility and integrated sensory capabilities, these devices are well suited to interface with and manipulate sensitive biological tissues, as demonstrated with an ex vivo nerve bundle, and may facilitate new interventions in neural surgery.:List of Abbreviations 1 Introduction 1.1 Motivation 1.2 Objectives and structure of this dissertation 2 Background 2.1 Tools for minimally invasive surgery 2.1.1 Catheters 2.1.2 Tools for robotic micro-surgery 2.1.3 Flexible electronics for smart surgical tools 2.2 Platforms for shapeable electronics 2.2.1 Shapeable polymer composites 2.2.2 Shapeable electronics 2.2.3 Soft actuators and manipulators 2.3 Sensors for position and shape feedback 2.3.1 Magnetic sensors for position and orientation measurements 2.3.2 Strain gauge sensors 3 Materials and Methods 3.1 Materials for shapeable electronics 3.1.1 Metal-organic sacrificial layer 3.1.2 Polyimide as reinforcing material 3.1.3 Swelling hydrogel for self assembly 3.1.4 Polypyrrole for flexible micro actuators 3.2 Device fabrication techniques 3.2.1 Photolithography 3.2.2 Electron beam deposition 3.2.3 Sputter deposition 3.2.4 Atomic layer deposition 3.2.5 Electro-polymerization of polypyrrole 3.3 Device characterization techniques 3.3.1 Kerr magnetometry 3.3.2 Electro-magnetic characterization of sensors 3.3.3 Electro-chemical analysis of polypyrrole 3.3.4 Preparation of model environments and materials 3.4 Sensor signal evaluation and processing 3.4.1 Signal processing 3.4.2 Cross correlation for phase analysis 3.4.3 PID feedback control 4 Electronically Integrated Self Assembled Micro Catheters 4.1 Design and Fabrication 4.1.1 Fabrication and self assembly 4.1.2 Features and design considerations 4.1.3 Electronic and fluidic connections 4.2 Integrated features and functionalities 4.2.1 Fluidic transport 4.2.2 Bending stability 4.2.3 Actuated micro manipulator 4.3 Magnetic position tracking 4.3.1 Integrated magnetic sensor 4.3.2 Position control with sensor feedback 4.3.3 Introduction of magnetic phase encoded tracking 4.3.4 Experimental realization 4.3.5 Simultaneous magnetic and ultrasound tracking 4.3.6 Discussion, limitations, and perspectives 5 Reshapeable Micro Electronic Devices 5.1 Design and fabrication 5.1.1 Estimation of optimal fabrication parameters 5.1.2 Device Fabrication 5.1.3 Control electronics and software 5.2 Performance of Actuators 5.2.1 Blocking force, speed, and durability 5.2.2 Curvature 5.3 Orientation control with magnetic sensors 5.3.1 Magnetic sensors on actuated device 5.3.2 Reference magnetic field 5.3.3 Feedback control 5.4 Shape control with integrated strain sensors 5.4.1 Strain gauge curvature sensors 5.4.2 Feedback control 5.4.3 Obstacle detection 5.5 Heterogenous integration with active electronics 5.5.1 Fabrication and properties of active matrices 5.5.2 Fabrication and operation of PPy actuators 5.5.3 Site selective actuation 6 Discussion and Outlook 6.1 Integrated self assembled catheters 6.1.1 Outlook 6.2 Reshapeable micro electronic devices 6.2.1 Outlook 7 Conclusion Appendix A1 Processing parameters for polymer stack layers A2 Derivation of magnetic phase profile in 3D Bibliography List of Figures and Tables Acknowledgements Theses List of Publication

Design of Novel Sensors and Instruments for Minimally Invasive Lung Tumour Localization via Palpation

Minimally Invasive Thoracoscopic Surgery (MITS) has become the treatment of choice for lung cancer. However, MITS prevents the surgeons from using manual palpation, thereby often making it challenging to reliably locate the tumours for resection. This thesis presents the design, analysis and validation of novel tactile sensors, a novel miniature force sensor, a robotic instrument, and a wireless hand-held instrument to address this limitation. The low-cost, disposable tactile sensors have been shown to easily detect a 5 mm tumour located 10 mm deep in soft tissue. The force sensor can measure six degrees of freedom forces and torques with temperature compensation using a single optical fiber. The robotic instrument is compatible with the da Vinci surgical robot and allows the use of tactile sensing, force sensing and ultrasound to localize the tumours. The wireless hand-held instrument allows the use of tactile sensing in procedures where a robot is not available