Autofluorescence lifetime augmented reality as a means for real-time robotic surgery guidance in human patients.

Due to loss of tactile feedback the assessment of tumor margins during robotic surgery is based only on visual inspection, which is neither significantly sensitive nor specific. Here we demonstrate time-resolved fluorescence spectroscopy (TRFS) as a novel technique to complement the visual inspection of oral cancers during transoral robotic surgery (TORS) in real-time and without the need for exogenous contrast agents. TRFS enables identification of cancerous tissue by its distinct autofluorescence signature that is associated with the alteration of tissue structure and biochemical profile. A prototype TRFS instrument was integrated synergistically with the da Vinci Surgical robot and the combined system was validated in swine and human patients. Label-free and real-time assessment and visualization of tissue biochemical features during robotic surgery procedure, as demonstrated here, not only has the potential to improve the intraoperative decision making during TORS but also other robotic procedures without modification of conventional clinical protocols

Towards automated visual flexible endoscope navigation

Background:\ud The design of flexible endoscopes has not changed significantly in the past 50 years. A trend is observed towards a wider application of flexible endoscopes with an increasing role in complex intraluminal therapeutic procedures. The nonintuitive and nonergonomical steering mechanism now forms a barrier in the extension of flexible endoscope applications. Automating the navigation of endoscopes could be a solution for this problem. This paper summarizes the current state of the art in image-based navigation algorithms. The objectives are to find the most promising navigation system(s) to date and to indicate fields for further research.\ud Methods:\ud A systematic literature search was performed using three general search terms in two medical–technological literature databases. Papers were included according to the inclusion criteria. A total of 135 papers were analyzed. Ultimately, 26 were included.\ud Results:\ud Navigation often is based on visual information, which means steering the endoscope using the images that the endoscope produces. Two main techniques are described: lumen centralization and visual odometry. Although the research results are promising, no successful, commercially available automated flexible endoscopy system exists to date.\ud Conclusions:\ud Automated systems that employ conventional flexible endoscopes show the most promising prospects in terms of cost and applicability. To produce such a system, the research focus should lie on finding low-cost mechatronics and technologically robust steering algorithms. Additional functionality and increased efficiency can be obtained through software development. The first priority is to find real-time, robust steering algorithms. These algorithms need to handle bubbles, motion blur, and other image artifacts without disrupting the steering process

Alternative Applications of Trans-Oral Robotic Surgery (TORS): A Systematic Review

The role of robotic surgery in the field of oncology has been widely described, in particular for the tumours of the oropharynx and larynx, but its efficacy for benign pathology is inconsistent

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

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

로봇을 이용한 자율적 하악골채취 골절단술의 기초방법 개발과 그 정확도 평가

학위논문 (박사)-- 서울대학교 대학원 : 치의학대학원 치의과학과, 2019. 2. 김성민.Objectives: An autonomous robot osteotomy system using direct coordinate determination was developed in our study. The registration accuracy was evaluated by measuring the fiducial localization error (FLE) and target registration error (TRE) and the accuracy of the designed osteotomy method along a preprogrammed plan was evaluated. Furthermore, the accuracy of the robotic osteotomy and a manual osteotomy was compared in regard to cut position, length, angle and depth. Methods: A light-weight-robot was used in this study, with an electric gripper. A direct coordinate determination method, using three points on the teeth, was developed for registration and determination of FLE and TRE, as measured on a mandible model. Sixteen landmarks on the mandible were prepared with holes and zirconia beads and the TRE was computed in ten repeated measurements using the robot. A direct coordinate determination via three points was used for registering and a twenty stone model (7 cm x 7 cm x 3 cm). The osteotomy line was designed similar to the ramal bone graft (2 cm x 1 cm x 0.5 cm). To evaluate accuracy, we measured a position (how accurate the robot arm is located), length (how accurate the robot arm is moving while cutting), angle (the angle at which the robot arm is located), and depth (the depth of the disc cutting) error. Sixteen mandible phantoms were used to simulate the osteotomy for the ramus bone graft. An image of the phantom was obtained by three-dimensional camera scanning and a virtual ramal bone graft was designed with computer software. To evaluate an accuracy and precision, the mandible phantoms were scanned with cone beam computer tomography (CBCT). Cut position, length, angle and depth errors were measured and the results of the robotic surgery were compared with that of manual surgery. Results: The mean value of the FLE was 0.84 ± 0.38 mm and the third reference point which detected the lingual fossa of the right second molar had a larger error than the other reference points. The mean value of the TRE was 1.69 ± 0.82 mm and there were significant differences between the anterior body, posterior body, and coronoid/condyle groups. Landmarks at the anterior body had the lowest TRE (0.96 ± 0.47 mm) and landmarks on the coronoid and condyle had the highest TRE (2.12 ± 0.99 mm). An autonomous robot osteotomy with a direct coordinate determination using three points was successfully achieved. On the model RBG osteotomy, the posterior cut had 0.77±0.32 absolute mean value, the anterior cut had 0.82±0.43, the inferior cut had 0.76 ± 0.38 and the superior cut had 1.37 ± 0.83, respectively. The absolute mean values for osteotomy errors for position, length, angle, and depth were 0.93 ± 0.45 mm, 0.81 ± 0.34 mm, 1.26 ± 1.35°, and 1.19 ± 0.73 mm, respectively. The position and length errors were significantly lower than angle and depth errors. In the comparison between robotic surgery and manual surgery, there were significant differences of absolute mean value and variance in all categories. For the robotic surgery, the cut position, length, angle and depth errors were 0.70 ± 0.34 mm, 0.35 ± 0.19 mm, 1.32 ± 0.96° and 0.59 ± 0.46 mm, respectively. For the manual surgery, the cut position, length, angle and depth errors were 1.83 ± 0.65 mm, 0.62 ± 0.37 mm, 5.96 ± 3.47° and 0.40 ± 0.31 mm, respectively. The robotic surgery had significantly higher accuracy and lower variance for cut position, length and angle errors. On the other hand, the depth error had a significantly higher absolute mean value and variance than the robotic surgery. Conclusions: An autonomous robot osteotomy scheme was developed, using the direct coordinate determination by three points on the teeth, and proved an accurate method for registration. The incisal edge or buccal pit of the teeth were more proper reference points than the fossa of the teeth. The measured RMS of the TRE increased when the target moved away from the reference points. Robotic surgery showed high accuracy and precision in positioning and reduced accuracy in controlling the depth of disc sawing. The robotic surgery showed high accuracy and precision in positioning and somewhat low accuracy in controlling the depth of the disc sawing. Comparing robotic and manual surgeries, the robotic surgery was superior in accuracy and precision in position, length and angle. However, the manual surgery had higher accuracy and precision in depth.1. 목 적 본 연구에서는 세 점 접촉을 통한 좌표 결정 방식을 통해 실제 모델의 좌표와 로봇이 가지고 있는 좌표를 정합하는 방식을 이용하여 자율 로봇을 이용한 하악골채취 골절단술의 기초방법을 개발하고자 한다. 개발된 정합 방법의 위치 추적 오류 (fiducial localization error)와 목표 정합 오류 (target registration error)를 측정하여 정합의 정확성을 평가하고자 한다. 또한 사전에 프로그래밍된 골절단을 직육면체 모델에 시행하고 위치, 길이, 각도, 깊이의 오류를 측정하여 정확성을 알아보고자 한다. 추가적으로 3차원 가상수술을 통해 하악 상행지 골이식술(ramal bone graft)을 설계하고 하악 팬텀 모형에서 이에 맞게 자율 로봇이 골절단술을 수행하여 악골에서 있어서 로봇을 이용한 골절단술의 정확성을 평가해 보고 반대측은 대조군으로 외과의가 기존의 전통적인 방식으로 골절단술을 수행함으로써 양측을 비교하고자 한다. 2. 방 법 본 연구에서는 경량 로봇의 최종 작용체(end effector)에 전자 그리퍼(gripper)를 연결하고 이 그리퍼가 수술용 절삭기구나 디스크가 연결된 치과용 핸드피스를 잡고 골절단을 수행하도록 하였다. 실제 모델의 좌표와 로봇이 가지고 있는 좌표를 중첩하기 위해 세 점을 찍어 첫번째 점을 원점으로 하고, 두번째 점의 방향을 x축으로, 그리고 세 번째 점이 결정하는 평면을 xy 평면으로 인식하도록 하였다. 첫번째 실험에서는 위치 추적 오류와 목표 정합 오류의 평가를 위해 하악골 모델에 치아의 기준 세 점과 하악골의 총 16개의 목표 위치에 1mm 구멍을 뚫고 1mm 지름의 지르코니아 구를 적용하여 CBCT 상에서 잘 보일 수 있도록 하였다. 각 목표 위치에 10번씩 반복하여 위치를 인식하여 오류를 계산하고 목표 정합 오류의 위치별 차이를 분석하였다. 두번째 실험에서는 총 20 개의 직육면체 석고 모델 (7cm x 7cm x 3cm)을 제작하였고 석고의 절단 크기는 하악 상행지 골채취을 위한 골절단 크기 (2cm x 1cm x 0.5cm)와 동일하게 설계하였다. 로봇팔을 이용하여 3점 접촉을 하면 좌표값을 계산하여 미리 프로그래밍된 위치에서 골절단을 수행하였다. 로봇에 의해 수행된 석고 절단선은 위치, 길이 각도 및 깊이로 나누어 오류를 측정하였다. 세번째 실험에서는 하악 상행지 골채취를 위한 골절단 실험을 위해 총 16개의 하악 팬텀 모형을 사용하였다. 팬텀 모형을 삼차원 스캐닝으로 삼차원 영상을 얻고 가상 수술을 시행하여 골절단 크기와 형태 그리고 그 위치에 대한 계획을 세웠다. 이 가상 수술 계획에 따라 로봇이 팬텀 모델에 골절단 수술을 하였다. 반대 측은 대조군으로 기존의 전통적인 방식으로 외과의가 수행하여 양측의 오차를 비교하였다. 절단선의 위치, 길이, 각도 및 깊이를 측정하여 각각의 정확도를 비교하였다. 위치 오류는 x축으로는 로봇이 표면 접촉을 인식하고 골절단을 시행하기에 0의 값으로 측정되었고 y 축과 z 축으로 나누어 측정되었으며 평균값과 제곱평균제곱근를 계산하였다. 3. 결 과 위치 추적 오류와 목표 정합 오류는 각각 0.49±0.22 mm 와 0.98±0.47 mm로 측정되었으며 기준접에서 멀어질수록 목표 정합 오류는 더 큰 값을 보였다. 석고 모델 실험에서 절단선의 위치, 길이, 각도 및 깊이의 평균과 표준오차는 각각 0.93 ± 0.45 mm, 0.81 ± 0.34 mm, 1.26 ± 1.35°, 1.19 ± 0.73 mm 이었다. 위치가 가장 정확한 값을 보였으며 길이 그리고 깊이 순으로 오차가 증가하였으며, 각도와 절단 깊이 제어가 가장 오차가 많은 술식이었다. 하악 팬텀 수술에서 로봇을 이용한 골절단의 위치, 길이, 각도 및 깊이 오차 값은 각각 0.70 ± 0.34 mm, 0.35 ± 0.19 mm, 1.32 ± 0.96°, 0.59 ± 0.46 mm 였으며 외과의의 골절단에서는 값이 각각 1.83 ± 0.65 mm, 0.62 ± 0.37 mm, 5.96 ± 3.47°, 0.40 ± 0.31 mm 였다. 위치, 길이, 각도 오차는 로봇이 더 작은 값을 보였고 깊이 오차는 외과의의 수술에서 더 작은 값을 보였다. 4. 결 론 본 연구에서는 하악 상행지 골채취를 위한 자율 로봇을 이용한 골절단 시스템을 개발하였고 위치추적오류와 목표정합오류 모두 우수한 값을 보였다. 석고 모형과 하악 팬텀 모향을 이용한 두가지 실험 모두에서 유용성과 향상된 정확성을 확인할 수 있었다. 세점 접촉 좌표 결정 시스템은 실제 모델의 좌표를 로봇의 좌표로 등록하는 데 유용한 시스템이었으며, 하악 상행지 골절단술에 대한 자율로봇 시스템의 정확도는 기존의 외과의가 직접 수행하는 방식보다 우수하였다.Abstract (in English) 1. Introduction 1 2. Materials and Methods. 12 3. Results 26 4. Discussion 32 5. Conclusions 40 6. References 41 Tables and Figures 48 Abstract (in Korean) 74Docto

Robotics in Dentistry : A Narrative Review

Background: Robotics is progressing rapidly. The aim of this study was to provide a comprehensive overview of the basic and applied research status of robotics in dentistry and discusses its development and application prospects in several major professional fields of dentistry. Methods: A literature search was conducted on databases: MEDLINE, IEEE and Cochrane Library, using MeSH terms: [“robotics” and “dentistry”]. Result: Forty-nine articles were eventually selected according to certain inclusion criteria. There were 12 studies on prosthodontics, reaching 24%; 11 studies were on dental implantology, accounting for 23%. Scholars from China published the most articles, followed by Japan and the United States. The number of articles published between 2011 and 2015 was the largest. Conclusions: With the advancement of science and technology, the applications of robots in dental medicine has promoted the development of intelligent, precise, and minimally invasive dental treatments. Currently, robots are used in basic and applied research in various specialized fields of dentistry. Automatic tooth-crown-preparation robots, tooth-arrangement robots, drilling robots, and orthodontic archwire-bending robots that meet clinical requirements have been developed. We believe that in the near future, robots will change the existing dental treatment model and guide new directions for further development