Surgical Navigation System for Transsphenoidal Pituitary Surgery Applying U-Net-Based Automatic Segmentation and Bendable Devices

Conventional navigation systems used in transsphenoidal pituitary surgery have limitations that may lead to organ damage, including long image registration time, absence of alarms when approaching vital organs and lack of 3-D model information. To resolve the problems of conventional navigation systems, this study proposes a U-Net-based, automatic segmentation algorithm for optical nerves and internal carotid arteries, by training patient computed tomography angiography images. The authors have also developed a bendable endoscope and surgical tool to eliminate blind regions that occur when using straight, rigid, conventional endoscopes and surgical tools during transsphenoidal pituitary surgery. In this study, the effectiveness of a U-Net-based navigation system integrated with bendable surgical tools and a bendable endoscope has been demonstrated through phantom-based experiments. In order to measure the U-net performance, the Jaccard similarity, recall and precision were calculated. In addition, the fiducial and target registration errors of the navigation system and the accuracy of the alarm warning functions were measured in the phantom-based environment. © 2019 by the authors.1

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

ADVANCED IMAGING AND ROBOTICS TECHNOLOGIES FOR MEDICAL APPLICATIONS

Due to the importance of surgery in the medical field, a large amount of research has been conducted in this area. Imaging and robotics technologies provide surgeons with the advanced eye and hand to perform their surgeries in a safer and more accurate manner. Recently medical images have been utilized in the operating room as well as in the diagnostic stage. If the image to patient registration is done with sufficient accuracy, medical images can be used as "a map" for guidance to the target lesion. However, the accuracy and reliability of the surgical navigation system should be sufficiently verified before applying it to the patient. Along with the development of medical imaging, various medical robots have also been developed. In particular, surgical robots have been researched in order to reach the goal of minimal invasiveness. The most important factors to consider are determining the demand, the strategy for their use in operating procedures, and how it aids patients. In addition to the above considerations, medical doctors and researchers should always think from the patient's point of view. In this article, the latest medical imaging and robotic technologies focusing on surgical applications are reviewed based upon the factors described in the above. © 2011 Copyright Taylor and Francis Group, LLC.1

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

Advanced Endoscopic Navigation:Surgical Big Data,Methodology,and Applications

随着科学技术的飞速发展，健康与环境问题日益成为人类面临的最重大问题之一。信息科学、计算机技术、电子工程与生物医学工程等学科的综合应用交叉前沿课题，研究现代工程技术方法，探索肿瘤癌症等疾病早期诊断、治疗和康复手段。本论文综述了计算机辅助微创外科手术导航、多模态医疗大数据、方法论及其临床应用：从引入微创外科手术导航概念出发，介绍了医疗大数据的术前与术中多模态医学成像方法、阐述了先进微创外科手术导航的核心流程包括计算解剖模型、术中实时导航方案、三维可视化方法及交互式软件技术，归纳了各类微创外科手术方法的临床应用。同时，重点讨论了全球各种手术导航技术在临床应用中的优缺点，分析了目前手术导航领域内的最新技术方法。在此基础上，提出了微创外科手术方法正向数字化、个性化、精准化、诊疗一体化、机器人化以及高度智能化的发展趋势。【Abstract】Interventional endoscopy (e.g., bronchoscopy, colonoscopy, laparoscopy, cystoscopy) is a widely performed procedure that involves either diagnosis of suspicious lesions or guidance for minimally invasive surgery in a variety of organs within the body cavity. Endoscopy may also be used to guide the introduction of certain items (e.g., stents) into the body. Endoscopic navigation systems seek to integrate big data with multimodal information (e.g., computed tomography, magnetic resonance images, endoscopic video sequences, ultrasound images, external trackers) relative to the patient's anatomy, control the movement of medical endoscopes and surgical tools, and guide the surgeon's actions during endoscopic interventions. Nevertheless, it remains challenging to realize the next generation of context-aware navigated endoscopy. This review presents a broad survey of various aspects of endoscopic navigation, particularly with respect to the development of endoscopic navigation techniques. First, we investigate big data with multimodal information involved in endoscopic navigation. Next, we focus on numerous methodologies used for endoscopic navigation. We then review different endoscopic procedures in clinical applications. Finally, we discuss novel techniques and promising directions for the development of endoscopic navigation.X.L. acknowledges funding from the Fundamental Research Funds for the Central Universities. T.M.P. acknowledges funding from the Canadian Foundation for Innovation, the Canadian Institutes for Health Research, the National Sciences and Engineering Research Council of Canada, and a grant from Intuitive Surgical Inc

Monolithic self-supportive bi-directional bending pneumatic bellows catheter

The minimally invasive surgery has proven to be advantageous over conventional open surgery in terms of reduction in recovery time, patient trauma, and overall cost of treatment. To perform a minimally invasive procedure, preliminary insertion of a flexible tube or catheter is crucial without sacrificing its ability to manoeuvre. Nevertheless, despite the vast amount of research reported on catheters, the ability to implement active catheters in the minimally invasive application is still limited. To date, active catheters are made of rigid structures constricted to the use of wires or on-board power supplies for actuation, which increases the risk of damaging the internal organs and tissues. To address this issue, an active catheter made of soft, flexible and biocompatible structure, driven via nonelectric stimulus is of utmost importance. This thesis presents the development of a novel monolithic self-supportive bi-directional bending pneumatic bellows catheter using a sacrificial molding technique. As a proof of concept, in order to understand the effects of structural parameters on the bending performance of a bellows-structured actuator, a single channel circular bellows pneumatic actuator was designed. The finite element analysis was performed in order to analyze the unidirectional bending performance, while the most optimal model was fabricated for experimental validation. Moreover, to attain biocompatibility and bidirectional bending, the novel monolithic polydimethylsiloxane (PDMS)-based dual-channel square bellows pneumatic actuator was proposed. The actuator was designed with an overall cross-sectional area of 5 x 5 mm2, while the input sequence and the number of bellows were characterized to identify their effects on the bending performance. A novel sacrificial molding technique was adopted for developing the monolithic-structured actuator, which enabled simple fabrication for complex designs. The experimental validation revealed that the actuator model with a size of5 x 5 x 68.4 mm3 i.e. having the highest number of bellows, attained optimal bi-directional bending with maximum angles of -65° and 75°, and force of 0.166 and 0.221 N under left and right channel actuation, respectively, at 100 kPa pressure. The bending performance characterization and thermal insusceptibility achieved by the developed pneumatic catheter presents a promising implementation of flexibility and thermal stability for various biomedical applications, such as dialysis and cardiac catheterization

Continuum Robots for Space Applications Based on Layer-Jamming Scales with Stiffness Capability

Continuum robots, which have continuous mechanical structures comparable to the flexibility in elephant trunks and octopus arms, have been primarily geared toward the medical and defense communities. In space, however, NASA projects these robots to have a place in irregular inspection routines. The inherent compliance and bending of these continuum arms are especially suitable for inspection in obstructed spaces to ensure proper equipment functionality. In this paper, we propose a new solution that improves on the functionality of previous continuum robots, via a novel mechanical scaly layer-jamming design. Layer-jamming assisted continuum arms have previously required pneumatic sources for actuation, which limit their portability and usage in aerospace applications. This paper combines the compliance of continuum arms and stiffness modulation of the layer jamming mechanism to design new hybrid layer jamming continuum arms. The novel designs use an electromechanical actuation which eliminates the previous need for pneumatic actuation therefore making the hardware compact and portable

Image-guided surgery and medical robotics in the cranial area

Surgery in the cranial area includes complex anatomic situations with high-risk structures and high demands for functional and aesthetic results. Conventional surgery requires that the surgeon transfers complex anatomic and surgical planning information, using spatial sense and experience. The surgical procedure depends entirely on the manual skills of the operator. The development of image-guided surgery provides new revolutionary opportunities by integrating presurgical 3D imaging and intraoperative manipulation. Augmented reality, mechatronic surgical tools, and medical robotics may continue to progress in surgical instrumentation, and ultimately, surgical care. The aim of this article is to review and discuss state-of-the-art surgical navigation and medical robotics, image-to-patient registration, aspects of accuracy, and clinical applications for surgery in the cranial area

Design of a wireless ureteropyeloscope

Ureteroscopy is a form of endoscopy that concerns itself with the urinary system. Flexible ureteropyeloscopes are instruments used to access the urinary system for diagnostic and therapeutic procedures. An average ureteropyeloscope requires a repair for every 3 to 13 hours of use, or alternatively 6 to 15 procedures. Therefore, there is a need to increase the durability of the ureteropyeloscope to lower the frequency of repairs required. In addition, the number of cables in the workspace needs to be reduced for improved handling by the clinician. The present study details the design of an ureteropyeloscope, which is modelled after currently existing instruments. Current endoscopes use fibre-optics for lighting area of interest as well as image acquisition. However, the ureteropyeloscope discussed was developed with a camera at the distal end of the insertion tube as its image acquisition system. The images captured were transmitted to a monitor for viewing via a wireless transmission module. The ureteropyeloscope discussed in the study was aimed at increasing the durability of the deflection unit of the ureteropyeloscope, with primary component made of nitinol, and reducing the number of cables around the workstation by using wireless means to transmit images from image acquisition system to monitor