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

A flexible access platform for robot-assisted minimally invasive surgery

Advances in Minimally Invasive Surgery (MIS) are driven by the clinical demand to reduce the invasiveness of surgical procedures so patients undergo less trauma and experience faster recoveries. These well documented benefits of MIS have been achieved through parallel advances in the technology and instrumentation used during procedures. The new and evolving field of Flexible Access Surgery (FAS), where surgeons access the operative site through a single incision or a natural orifice incision, is being promoted as the next potential step in the evolution of surgery. In order to achieve similar levels of success and adoption as MIS, technology again has its role to play in developing new instruments to solve the unmet clinical challenges of FAS. As procedures become less invasive, these instruments should not just address the challenges presented by the complex access routes of FAS, but should also build on the recent advances in pre- and intraoperative imaging techniques to provide surgeons with new diagnostic and interventional decision making capabilities. The main focus of this thesis is the development and applications of a flexible robotic device that is capable of providing controlled flexibility along curved pathways inside the body. The principal component of the device is its modular mechatronic joint design which utilises an embedded micromotor-tendon actuation scheme to provide independently addressable degrees of freedom and three internal working channels. Connecting multiple modules together allows a seven degree-of-freedom (DoF) flexible access platform to be constructed. The platform is intended for use as a research test-bed to explore engineering and surgical challenges of FAS. Navigation of the platform is realised using a handheld controller optimised for functionality and ergonomics, or in a "hands-free" manner via a gaze contingent control framework. Under this framework, the operator's gaze fixation point is used as feedback to close the servo control loop. The feasibility and potential of integrating multi-spectral imaging capabilities into flexible robotic devices is also demonstrated. A force adaptive servoing mechanism is developed to simplify the deployment, and improve the consistency of probe-based optical imaging techniques by automatically controlling the contact force between the probe tip and target tissue. The thesis concludes with the description of two FAS case studies performed with the platform during in-vivo porcine experiments. These studies demonstrate the ability of the platform to perform large area explorations within the peritoneal cavity and to provide a stable base for the deployment of interventional instruments and imaging probes

Safe Human-Robot Interaction Using Variable Stiffness, Hyper-Redundancy, and Smart Robotic Skins

In service robotics, safe human-robot interaction (HRI) is still an open research topic, requiring developments both in hardware and in software as well as their integration. In UMAY1 and MEDICARE-C2projects, we addressed both mechanism design and perception aspects of a framework for safe HRI. Our first focus was to design variable stiffness joints for the robotic neck and arm to enable inherent compliance to protect a human collaborator. We demonstrate the advantages of variable stiffness actuators (VSA) in compliancy, safety, and energy efficiency with applications in exoskeleton and rehabilitation robotics. The variable-stiffness robotic neck mechanism was later scaled down and adopted in the robotic endoscope featuring hyper-redundancy. The hyper-redundant structures are more controllable, having efficient actuation and better feedback. Lastly, a smart robotic skin is introduced to explain the safety support via enhancement of tactile perception. Although it is developed for a hyper-redundant endoscopic robotic platform, the artificial skin can also be integrated in service robotics to provide multimodal tactile feedback. This chapter gives an overview of systems and their integration to attain a safer HRI. We follow a holistic approach for inherent compliancy via mechanism design (i.e., variable stiffness), precise control (i.e., hyper-redundancy), and multimodal tactile perception (i.e., smart robotic-skins)

Methodology for Validating Mechatronic Digital Twin

The market place is changing rapidly along with the increasing requirements of the clients. To meet up these challenges, there is need for new and efficient methods for the identification and visualization of the problem. Additionally, these methods should allow users in designing and finding alternative solutions to achieve the desired working. In this thesis, studies related to mechatronic model was performed and an approach was presented for the validation of mechatronic digital twin. The concept of digital twin is one of the core concepts of modern industrial revolution. Digital twin can be defined as the digital representation of a physical system, which behaves exactly as actual hardware. A mechatronic digital twin of Festo MPS 500 system was modeled using Siemens NX Mechatronics Concept Designer. The methodology was implemented which involved storing the process parameters of the operation of actual hardware. The stored information was passed to the mechatronic model for verification and validation purpose. Several engineering tools were used for the implementation of the system. These tools were integrated with each other to provide the proof of concept of the methodology. The developed approach can be used with the mechatronic models of existing systems. This enables the user to test and observe different scenarios and alternative solutions in the mechatronic model before implementing it to actual hardware. The proposed methodology can be used for the troubleshooting purpose by re-playing the stored data of the operation of actual hardware in the mechatronic model. By this way, user can visualize the whole operation and identify the problem easily

Learning-based Position and Stiffness Feedforward Control of Antagonistic Soft Pneumatic Actuators using Gaussian Processes

Variable stiffness actuator (VSA) designs are manifold. Conventional model-based control of these nonlinear systems is associated with high effort and design-dependent assumptions. In contrast, machine learning offers a promising alternative as models are trained on real measured data and nonlinearities are inherently taken into account. Our work presents a universal, learning-based approach for position and stiffness control of soft actuators. After introducing a soft pneumatic VSA, the model is learned with input-output data. For this purpose, a test bench was set up which enables automated measurement of the variable joint stiffness. During control, Gaussian processes are used to predict pressures for achieving desired position and stiffness. The feedforward error is on average 11.5% of the total pressure range and is compensated by feedback control. Experiments with the soft actuator show that the learning-based approach allows continuous adjustment of position and stiffness without model knowledge.© 2023 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works

Three-Axis Fiber-Optic Body Force Sensor for Flexible Manipulators

This paper proposes a force/torque sensor structure that can be easily integrated with a flexible manipulator structure. The sensor’s ring-like structure with its hollow inner section provides ample space for auxiliary components, such as cables and tubes, to be passed through and, hence, is very suitable for integration with tendon-driven and fluid-actuated manipulators. The sensor structure can also accommodate the wiring for a distributed sensor system as well as for diagnostic instruments that may be incorporated in the manipulator. Employing a sensing approach based on optical fibers as done here allows for the creation of sensors that are free of electrical currents at the point of sensing and immune to magnetic fields. These sensors are inherently safe when used in the close vicinity of humans and their measuring performance is not impaired when they are operated in or nearby machines such as magnetic resonance imaging (MRI) scanners. This type of sensor concept is particularly suitable for inclusion in instruments and robotic tools for minimally invasive surgery (MIS). The paper summarizes the design, integration challenges and calibration of the proposed optical three-axis force sensor. The experimental results confirm the effectiveness of our optical sensing approach and show that after calibrating its stiffness matrix, force and momentum components can be determined accurately

Three-Axis Fiber-Optic Body Force Sensor for Flexible Manipulators

This paper proposes a force/torque sensor structure that can be easily integrated into a flexible manipulator structure. The sensor's ring-like structure with its hollow inner section provides ample space for auxiliary components, such as cables and tubes, to be passed through and, hence, is very suitable for integration with tendon-driven and fluid-actuated manipulators. The sensor structure can also accommodate the wiring for a distributed sensor system as well as for diagnostic instruments that may be incorporated in the manipulator. Employing a sensing approach based on optical fibers as done here allows for the creation of sensors that are free of electrical currents at the point of sensing and immune to magnetic fields. These sensors are inherently safe when used in the close vicinity of humans and their measuring performance is not impaired when they are operated in or nearby machines, such as magnetic resonance imaging scanners. This type of sensor concept is particularly suitable for inclusion in instruments and robotic tools for minimally invasive surgery. This paper summarizes the design, integration challenges, and calibration of the proposed optical three-axis force sensor. The experimental results confirm the effectiveness of our optical sensing approach and show that after calibrating its stiffness matrix, force and momentum components can be determined accurately

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

From Concept to Market: Surgical Robot Development

Surgical robotics and supporting technologies have really become a prime example of modern applied information technology infiltrating our everyday lives. The development of these systems spans across four decades, and only the last few years brought the market value and saw the rising customer base imagined already by the early developers. This chapter guides through the historical development of the most important systems, and provide references and lessons learnt for current engineers facing similar challenges. A special emphasis is put on system validation, assessment and clearance, as the most commonly cited barrier hindering the wider deployment of a system