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

Impact of Ear Occlusion on In-Ear Sounds Generated by Intra-oral Behaviors

We conducted a case study with one volunteer and a recording setup to detect sounds induced by the actions: jaw clenching, tooth grinding, reading, eating, and drinking. The setup consisted of two in-ear microphones, where the left ear was semi-occluded with a commercially available earpiece and the right ear was occluded with a mouldable silicon ear piece. Investigations in the time and frequency domains demonstrated that for behaviors such as eating, tooth grinding, and reading, sounds could be recorded with both sensors. For jaw clenching, however, occluding the ear with a mouldable piece was necessary to enable its detection. This can be attributed to the fact that the mouldable ear piece sealed the ear canal and isolated it from the environment, resulting in a detectable change in pressure. In conclusion, our work suggests that detecting behaviors such as eating, grinding, reading with a semi-occluded ear is possible, whereas, behaviors such as clenching require the complete occlusion of the ear if the activity should be easily detectable. Nevertheless, the latter approach may limit real-world applicability because it hinders the hearing capabilities.</p

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

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

Vision-based methods for state estimation and control of robotic systems with application to mobile and surgical robots

For autonomous systems that need to perceive the surrounding environment for the accomplishment of a given task, vision is a highly informative exteroceptive sensory source. When gathering information from the available sensors, in fact, the richness of visual data allows to provide a complete description of the environment, collecting geometrical and semantic information (e.g., object pose, distances, shapes, colors, lights). The huge amount of collected data allows to consider both methods exploiting the totality of the data (dense approaches), or a reduced set obtained from feature extraction procedures (sparse approaches). This manuscript presents dense and sparse vision-based methods for control and sensing of robotic systems. First, a safe navigation scheme for mobile robots, moving in unknown environments populated by obstacles, is presented. For this task, dense visual information is used to perceive the environment (i.e., detect ground plane and obstacles) and, in combination with other sensory sources, provide an estimation of the robot motion with a linear observer. On the other hand, sparse visual data are extrapolated in terms of geometric primitives, in order to implement a visual servoing control scheme satisfying proper navigation behaviours. This controller relies on visual estimated information and is designed in order to guarantee safety during navigation. In addition, redundant structures are taken into account to re-arrange the internal configuration of the robot and reduce its encumbrance when the workspace is highly cluttered. Vision-based estimation methods are relevant also in other contexts. In the field of surgical robotics, having reliable data about unmeasurable quantities is of great importance and critical at the same time. In this manuscript, we present a Kalman-based observer to estimate the 3D pose of a suturing needle held by a surgical manipulator for robot-assisted suturing. The method exploits images acquired by the endoscope of the robot platform to extrapolate relevant geometrical information and get projected measurements of the tool pose. This method has also been validated with a novel simulator designed for the da Vinci robotic platform, with the purpose to ease interfacing and employment in ideal conditions for testing and validation. The Kalman-based observers mentioned above are classical passive estimators, whose system inputs used to produce the proper estimation are theoretically arbitrary. This does not provide any possibility to actively adapt input trajectories in order to optimize specific requirements on the performance of the estimation. For this purpose, active estimation paradigm is introduced and some related strategies are presented. More specifically, a novel active sensing algorithm employing visual dense information is described for a typical Structure-from-Motion (SfM) problem. The algorithm generates an optimal estimation of a scene observed by a moving camera, while minimizing the maximum uncertainty of the estimation. This approach can be applied to any robotic platforms and has been validated with a manipulator arm equipped with a monocular camera

Capsule endoscopy of the future: What's on the horizon?

Capsule endoscopes have evolved from passively moving diagnostic devices to actively moving systems with potential therapeutic capability. In this review, we will discuss the state of the art, define the current shortcomings of capsule endoscopy, and address research areas that aim to overcome said shortcomings. Developments in capsule mobility schemes are emphasized in this text, with magnetic actuation being the most promising endeavor. Research groups are working to integrate sensor data and fuse it with robotic control to outperform today's standard invasive procedures, but in a less intrusive manner. With recent advances in areas such as mobility, drug delivery, and therapeutics, we foresee a translation of interventional capsule technology from the bench-top to the clinical setting within the next 10 years

Mechatronic Systems

Mechatronics, the synergistic blend of mechanics, electronics, and computer science, has evolved over the past twenty five years, leading to a novel stage of engineering design. By integrating the best design practices with the most advanced technologies, mechatronics aims at realizing high-quality products, guaranteeing at the same time a substantial reduction of time and costs of manufacturing. Mechatronic systems are manifold and range from machine components, motion generators, and power producing machines to more complex devices, such as robotic systems and transportation vehicles. With its twenty chapters, which collect contributions from many researchers worldwide, this book provides an excellent survey of recent work in the field of mechatronics with applications in various fields, like robotics, medical and assistive technology, human-machine interaction, unmanned vehicles, manufacturing, and education. We would like to thank all the authors who have invested a great deal of time to write such interesting chapters, which we are sure will be valuable to the readers. Chapters 1 to 6 deal with applications of mechatronics for the development of robotic systems. Medical and assistive technologies and human-machine interaction systems are the topic of chapters 7 to 13.Chapters 14 and 15 concern mechatronic systems for autonomous vehicles. Chapters 16-19 deal with mechatronics in manufacturing contexts. Chapter 20 concludes the book, describing a method for the installation of mechatronics education in schools