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

Volume 16, issue 2

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1118/thumbnail.jp

Designing a robotic port system for laparo-endoscopic single-site surgery

Current research and development in the field of surgical interventions aim to reduce the invasiveness by using few incisions or natural orifices in the body to access the surgical site. Considering surgeries in the abdominal cavity, the Laparo-Endoscopic Single-site Surgery (LESS) can be performed through a single incision in the navel, reducing blood loss, post-operative trauma, and improving the cosmetic outcome. However, LESS results in less intuitive instrument control, impaired ergonomic, loss of depth and haptic perception, and restriction of instrument positioning by a single incision. Robot-assisted surgery addresses these shortcomings, by introducing highly articulated, flexible robotic instruments, ergonomic control consoles with 3D visualization, and intuitive instrument control algorithms. The flexible robotic instruments are usually introduced into the abdomen via a rigid straight port, such that the positioning of the tools and therefore the accessibility of anatomical structures is still constrained by the incision location. To address this limitation, articulated ports for LESS are proposed by recent research works. However, they focus on only a few aspects, which are relevant to the surgery, such that a design considering all requirements for LESS has not been proposed yet. This partially originates in the lack of anatomical data of specific applications. Further, no general design guidelines exist and only a few evaluation metrics are proposed. To target these challenges, this thesis focuses on the design of an articulated robotic port for LESS partial nephrectomy. A novel approach is introduced, acquiring the available abdominal workspace, integrated into the surgical workflow. Based on several generated patient datasets and developed metrics, design parameter optimization is conducted. Analyzing the surgical procedure, a comprehensive requirement list is established and applied to design a robotic system, proposing a tendon-driven continuum robot as the articulated port structure. Especially, the aspects of stiffening and sterile design are addressed. In various experimental evaluations, the reachability, the stiffness, and the overall design are evaluated. The findings identify layer jamming as the superior stiffening method. Further, the articulated port is proven to enhance the accessibility of anatomical structures and offer a patient and incision location independent design

Robotic surgery in management of ovarian cancer. Review of the literature.

Μετά την έγκριση της από τον αμερικανικό οργανισμό τροφίμων και φαρμάκων για γυναικολογική χειρουργική, η χρήση της ρομποτικής χειρουργικής στην γυναικολογική ογκολογία έχει αυξηθεί ραγδαία. Παρά τους αρχικούς ενδοιασμούς για την εφαρμογή της πιο προηγμένης τεχνολογικά, ελάχιστα επεμβατικής χειρουργικής στην γυναικολογική ογκολογία, η χειρουργική αυτή προσέγγιση έχει φανεί ότι είναι τόσο ασφαλής όσο και εφικτή και τουλάχιστον ισοδύναμη με την συμβατική λαπαροσκοπική χειρουργική στην αντιμετώπιση του καρκίνου του τραχήλου και του σώματος της μήτρας. Ωστόσο επικρατεί σκεπτικισμός σχετικά με την ασφάλεια της ρομποτικής χειρουργικής στην αντιμετώπιση του ωοθηκικού καρκίνου όσον αφορά στην εκτίμηση, διάγνωση και σταδιοποίηση του προφανούς ωοθηκικού καρκίνου αρχικού σταδίου, της πρωτογενούς ή μετά από προεγχειριτική χημειοθεραπεία κυτταρομείωσης του ωοθηκικού καρκίνου προχωρημένου σταδίου και την εφαρμογή της στην κυτταρομείωση των υποτροπών της νόσου. Η βιβλιογραφική αυτή ανασκόπηση προσπαθεί να αναδείξει τις κύριες εφαρμογές και τον δυνητικό ρολό της ρομποτικής χειρουργικής στην αντιμετώπιση του ωοθηκικού καρκίνου. Στο μέλλον απαιτούνται τυχαιοποιημένες προοπτικές μελέτες για να στηρίξουν τον ρόλο της ρομποτικής χειρουργικής στην αντιμετώπιση του ωοθηκικού καρκίνου.Since its approval by the FDA in 2005 for gynecological surgery, the use of robotic surgery (RS) in gynecologic oncology has increased dramatically. Despite initial considerations about the application of the most technologically advanced modality of minimally invasive surgery (MIS) in oncogynecology, this surgical approach has been shown to be both safe and feasible and at least equal to conventional laparoscopic surgery in management of cervical and uterine cancer. However there are feasibility and safety concerns regarding the role of RS in management of ovarian cancer (OC) as far as evaluation, diagnosis and staging of apparent early stage OC, primary or postneoadjuvant chemotherapy debulking of advanced OC and its use in cytoreduction of recurrent disease. This review of the literature tries to address the main applications and the potential role of RS in OC management. Future prospective randomized control studies are needed to support the role of RS in management of OC

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

Surgical Subtask Automation for Intraluminal Procedures using Deep Reinforcement Learning

Intraluminal procedures have opened up a new sub-field of minimally invasive surgery that use flexible instruments to navigate through complex luminal structures of the body, resulting in reduced invasiveness and improved patient benefits. One of the major challenges in this field is the accurate and precise control of the instrument inside the human body. Robotics has emerged as a promising solution to this problem. However, to achieve successful robotic intraluminal interventions, the control of the instrument needs to be automated to a large extent. The thesis first examines the state-of-the-art in intraluminal surgical robotics and identifies the key challenges in this field, which include the need for safe and effective tool manipulation, and the ability to adapt to unexpected changes in the luminal environment. To address these challenges, the thesis proposes several levels of autonomy that enable the robotic system to perform individual subtasks autonomously, while still allowing the surgeon to retain overall control of the procedure. The approach facilitates the development of specialized algorithms such as Deep Reinforcement Learning (DRL) for subtasks like navigation and tissue manipulation to produce robust surgical gestures. Additionally, the thesis proposes a safety framework that provides formal guarantees to prevent risky actions. The presented approaches are evaluated through a series of experiments using simulation and robotic platforms. The experiments demonstrate that subtask automation can improve the accuracy and efficiency of tool positioning and tissue manipulation, while also reducing the cognitive load on the surgeon. The results of this research have the potential to improve the reliability and safety of intraluminal surgical interventions, ultimately leading to better outcomes for patients and surgeons

Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer

PMID: 23127367 [PubMed - indexed for MEDLINE] Free full text Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research.Peer reviewedPublisher PD

Flexible robotic device for spinal surgery

Surgical robots have proliferated in recent years, with well-established benefits including: reduced patient trauma, shortened hospitalisation, and improved diagnostic accuracy and therapeutic outcome. Despite these benefits, many challenges in their development remain, including improved instrument control and ergonomics caused by rigid instrumentation and its associated fulcrum effect. Consequently, it is still extremely challenging to utilise such devices in cases that involve complex anatomical pathways such as the spinal column. The focus of this thesis is the development of a flexible robotic surgical cutting device capable of manoeuvring around the spinal column. The target application of the flexible surgical tool is the removal of cancerous tumours surrounding the spinal column, which cannot be excised completely using the straight surgical tools in use today; anterior and posterior sections of the spine must be accessible for complete tissue removal. A parallel robot platform with six degrees of freedom (6 DoFs) has been designed and fabricated to direct a flexible cutting tool to produce the necessary range of movements to reach anterior and posterior sections of the spinal column. A flexible water jet cutting system and a flexible mechanical drill, which may be assembled interchangeably with the flexible probe, have been developed and successfully tested experimentally. A model predicting the depth of cut by the water jet was developed and experimentally validated. A flexion probe that is able to guide the surgical cutting device around the spinal column has been fabricated and tested with human lumber model. Modelling and simulations show the capacity for the flexible surgical system to enable entering the posterior side of the human lumber model and bend around the vertebral body to reach the anterior side of the spinal column. A computer simulation with a full Graphical User Interface (GUI) was created and used to validate the system of inverse kinematic equations for the robot platform. The constraint controller and the inverse kinematics relations are both incorporated into the overall positional control structure of the robot, and have successfully established a haptic feedback controller for the 6 DoFs surgical probe, and effectively tested in vitro on spinal mock surgery. The flexible surgical system approached the surgery from the posterior side of the human lumber model and bend around the vertebral body to reach the anterior side of the spinal column. The flexible surgical robot removed 82% of mock cancerous tissue compared to 16% of tissue removed by the rigid tool.Open Acces