Micro-motion controller

Micro-motions in surgical applications are small motions in the range of a few millimeters and are common in ophthalmic surgery, neurosurgery, and other surgeries which require precise manipulation over short distances. Robotic surgery is replacing traditional open surgery at a rapid pace due to the obvious health benefits, however, most of the robotic surgical tools use robotic motion controllers that are designed to work over a large portion of the human body, thus involving motion of the entire human arm at shoulder joint. This requirement to move a large inertial mass results in undesirable, unwanted, and imprecise motion. This senior design project has created a 2-axis micro-motion “capable” platform, where the device studies the most common linear, 2-D surgical micro-motion of pinched human fingers in a damped and un-damped state. Through a system of printed and modeled parts in combination with motors and encoders a microsurgical controller was developed which can provide location-based output on a screen. Mechanical damping was introduced to research potential stability of micro-motion in any surgeon’s otherwise unsteady hand. The device is to also serve as a starter set for future biomedical device research projects in Santa Clara University’s bioengineering department. Further developments in the microsurgical controller such as further scaling, addition of a third axis, haptic feedback through the microcontroller, and component encasing to allow productization for use on an industrial robotic surgical device for clinical applications

Haptics in Robot-Assisted Surgery: Challenges and Benefits

Robotic surgery is transforming the current surgical practice, not only by improving the conventional surgical methods but also by introducing innovative robot-enhanced approaches that broaden the capabilities of clinicians. Being mainly of man-machine collaborative type, surgical robots are seen as media that transfer pre- and intra-operative information to the operator and reproduce his/her motion, with appropriate filtering, scaling, or limitation, to physically interact with the patient. The field, however, is far from maturity and, more critically, is still a subject of controversy in medical communities. Limited or absent haptic feedback is reputed to be among reasons that impede further spread of surgical robots. In this paper objectives and challenges of deploying haptic technologies in surgical robotics is discussed and a systematic review is performed on works that have studied the effects of providing haptic information to the users in major branches of robotic surgery. It has been tried to encompass both classical works and the state of the art approaches, aiming at delivering a comprehensive and balanced survey both for researchers starting their work in this field and for the experts

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

Development and preliminary results of bimanual smart micro-surgical system using a ball-lens coupled OCT distance sensor

Bimanual surgery enhances surgical effectiveness and is required to successfully accomplish complex microsurgical tasks. The essential advantage is the ability to simultaneously grasp tissue with one hand to provide counter traction or exposure, while dissecting with the other. Towards enhancing the precision and safety of bimanual microsurgery we present a bimanual SMART micro-surgical system for a preliminary ex-vivo study. To the best of our knowledge, this is the first demonstration of a handheld bimanual microsurgical system. The essential components include a ball-lens coupled common-path swept source optical coherence tomography sensor. This system effectively suppresses asynchronous hand tremor using two PZT motors in feedback control loop and efficiently assists ambidextrous tasks. It allows precise bimanual dissection of biological tissues with a reduction in operating time as compared to the same tasks performed with conventional onehanded approaches. © 2016 Optical Society of America.1

Miniature fiber-optic force sensor based on low-coherence Fabry-Pérot interferometry for vitreoretinal microsurgery

During vitreoretinal surgery, the surgeon manipulates retinal tissue with tool-to-tissue interaction forces below the human sensory threshold. A force sensor (FS) integrated with conventional surgical tools may significantly improve the surgery outcome by providing tactile feedback to the surgeon. We designed and built a surgical tool integrated with a miniature FS with an outer diameter smaller than 1 mm for vitreoretinal surgery based on low-coherence Fabry–Pérot (FP) interferometry. The force sensing elements are located at the tool tip which is in direct contact with tissue during surgery and the FP cavity length is interrogated by a fiber-optic common-path phase-sensitive optical coherence tomography (OCT) system. We have calibrated the FS's response to axial and lateral forces and conducted experiments to verify that our FS can simultaneously measure both axial and lateral force components

State of the art of robotic surgery related to vision: Brain and eye applications of newly available devices

Raffaele Nuzzi, Luca Brusasco Department of Surgical Sciences, Eye Clinic, University of Torino, Turin, Italy Background: Robot-assisted surgery has revolutionized many surgical subspecialties, mainly where procedures have to be performed in confined, difficult to visualize spaces. Despite advances in general surgery and neurosurgery, in vivo application of robotics to ocular surgery is still in its infancy, owing to the particular complexities of microsurgery. The use of robotic assistance and feedback guidance on surgical maneuvers could improve the technical performance of expert surgeons during the initial phase of the learning curve. Evidence acquisition: We analyzed the advantages and disadvantages of surgical robots, as well as the present applications and future outlook of robotics in neurosurgery in brain areas related to vision and ophthalmology. Discussion: Limitations to robotic assistance remain, that need to be overcome before it can be more widely applied in ocular surgery. Conclusion: There is heightened interest in studies documenting computerized systems that filter out hand tremor and optimize speed of movement, control of force, and direction and range of movement. Further research is still needed to validate robot-assisted procedures. Keywords: robotic surgery related to vision, robots, ophthalmological applications of robotics, eye and brain robots, eye robot

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Microsurgery robots: addressing the needs of high-precision surgical interventions

Robots can help surgeons perform better quality operations, leading to reductions in the hospitalisation time of patients and in the impact of surgery on their postoperative quality of life

From teleoperation to autonomous robot-assisted microsurgery: A survey

Robot-assisted microsurgery (RAMS) has many benefits compared to traditional microsurgery. Microsurgical platforms with advanced control strategies, high-quality micro-imaging modalities and micro-sensing systems are worth developing to further enhance the clinical outcomes of RAMS. Within only a few decades, microsurgical robotics has evolved into a rapidly developing research field with increasing attention all over the world. Despite the appreciated benefits, significant challenges remain to be solved. In this review paper, the emerging concepts and achievements of RAMS will be presented. We introduce the development tendency of RAMS from teleoperation to autonomous systems. We highlight the upcoming new research opportunities that require joint efforts from both clinicians and engineers to pursue further outcomes for RAMS in years to come

Vitreo-retinal eye surgery robot : sustainable precision

Vitreo-retinal eye surgery encompasses the surgical procedures performed on the vitreous humor and the retina. A procedure typically consists of the removal of the vitreous humor, the peeling of a membrane and/or the repair of a retinal detachment. Vitreo-retinal surgery is performed minimal invasively. Small needle shaped instruments are inserted into the eye. Instruments are manipulated by hand in four degrees of freedom about the insertion point. Two rotations move the instrument tip laterally, in addition to a translation in axial instrument direction and a rotation about its longitudinal axis. The manipulation of the instrument tip, e.g. a gripping motion can be considered as a fifth degree of freedom. While performing vitreo-retinal surgery manually, the surgeon faces various challenges. Typically, delicate micrometer range thick tissue is operated, for which steady hand movements and high accuracy instrument manipulation are required. Lateral instrument movements are inverted by the pivoting insertion point and scaled depending on the instrument insertion depth. A maximum of two instruments can be used simultaneously. There is nearly no perception of surgical forces, since most forces are below the human detection limit. Therefore, the surgeon relies only on visual feedback, obtained via a microscope or endoscope. Both vision systems force the surgeon to work in a static and non ergonomic body posture. Although the surgeon’s proficiency improves throughout his career, hand tremor will become a problem at higher age. Robotically assisted surgery with a master-slave system can assist the surgeon in these challenges. The slave system performs the actual surgery, by means of instrument manipulators which handle the instruments. The surgeon remains in control of the instruments by operating haptic interfaces via a master. Using electronic hardware and control software, the master and slave are connected. Amongst others, advantages as tremor filtering, up-scaled force feedback, down-scaled motions and stabilized instrument positioning will enhance dexterity on surgical tasks. Furthermore, providing the surgeon an ergonomic body posture will prolong the surgeon’s career. This thesis focuses on the design and realization of a high precision slave system for eye surgery. The master-slave system uses a table mounted design, where the system is compact, lightweight, easy to setup and equipped to perform a complete intervention. The slave system consists of two main parts: the instrument manipulators and their passive support system. Requirements are derived from manual eye surgery, conversations with medical specialists and analysis of the human anatomy and vitreo-retinal interventions. The passive support system provides a stiff connection between the instrument manipulator, patient and surgical table. Given the human anatomical diversity, presurgical adjustments can be made to allow the instrument manipulators to be positioned over each eye. Most of the support system is integrated within the patient’s headrest. On either the left or right side, two exchangeable manipulator-support arms can be installed onto the support system, depending on the eye being operated upon. The compact, lightweight and easy to install design, allows for a short setup time and quick removal in case of a complication. The slave system’s surgical reach is optimized to emulate manually performed surgery. For bimanual instrument operation, two instrument manipulators are used. Additional instrument manipulators can be used for non-active tools e.g. an illumination probe or an endoscope. An instrument manipulator allows the same degrees of freedom and a similar reach as manually performed surgery. Instrument forces are measured to supply force feedback to the surgeon via haptic interfaces. The instrument manipulator is designed for high stiffness, is play free and has low friction to allow tissue manipulation with high accuracy. Each instrument manipulator is equipped with an on board instrument change system, by which instruments can be changed in a fast and secure way. A compact design near the instrument allows easy access to the surgical area, leaving room for the microscope and peripheral equipment. The acceptance of a surgical robot for eye surgery mostly relies on equipment safety and reliability. The design of the slave system features various safety measures, e.g. a quick release mechanism for the instrument manipulator and additional locks on the pre-surgical adjustment fixation clamp. Additional safety measures are proposed, like a hard cover over the instrument manipulator and redundant control loops in the controlling FPGA. A method to fixate the patient’s head to the headrest by use of a custom shaped polymer mask is proposed. Two instrument manipulators and their passive support system have been realized so far, and the first experimental results confirm the designed low actuation torque and high precision performance