Surgical Applications of Compliant Mechanisms:A Review

Current surgical devices are mostly rigid and are made of stiff materials, even though their predominant use is on soft and wet tissues. With the emergence of compliant mechanisms (CMs), surgical tools can be designed to be flexible and made using soft materials. CMs offer many advantages such as monolithic fabrication, high precision, no wear, no friction, and no need for lubrication. It is therefore beneficial to consolidate the developments in this field and point to challenges ahead. With this objective, in this article, we review the application of CMs to surgical interventions. The scope of the review covers five aspects that are important in the development of surgical devices: (i) conceptual design and synthesis, (ii) analysis, (iii) materials, (iv) maim facturing, and (v) actuation. Furthermore, the surgical applications of CMs are assessed by classification into five major groups, namely, (i) grasping and cutting, (ii) reachability and steerability, (iii) transmission, (iv) sensing, and (v) implants and deployable devices. The scope and prospects of surgical devices using CMs are also discussed

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

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

Robotic manipulators for single access surgery

This thesis explores the development of cooperative robotic manipulators for enhancing surgical precision and patient outcomes in single-access surgery and, specifically, Transanal Endoscopic Microsurgery (TEM). During these procedures, surgeons manipulate a heavy set of instruments via a mechanical clamp inserted in the patient’s body through a surgical port, resulting in imprecise movements, increased patient risks, and increased operating time. Therefore, an articulated robotic manipulator with passive joints is initially introduced, featuring built-in position and force sensors in each joint and electronic joint brakes for instant lock/release capability. The articulated manipulator concept is further improved with motorised joints, evolving into an active tool holder. The joints allow the incorporation of advanced robotic capabilities such as ultra-lightweight gravity compensation and hands-on kinematic reconfiguration, which can optimise the placement of the tool holder in the operating theatre. Due to the enhanced sensing capabilities, the application of the active robotic manipulator was further explored in conjunction with advanced image guidance approaches such as endomicroscopy. Recent advances in probe-based optical imaging such as confocal endomicroscopy is making inroads in clinical uses. However, the challenging manipulation of imaging probes hinders their practical adoption. Therefore, a combination of the fully cooperative robotic manipulator with a high-speed scanning endomicroscopy instrument is presented, simplifying the incorporation of optical biopsy techniques in routine surgical workflows. Finally, another embodiment of a cooperative robotic manipulator is presented as an input interface to control a highly-articulated robotic instrument for TEM. This master-slave interface alleviates the drawbacks of traditional master-slave devices, e.g., using clutching mechanics to compensate for the mismatch between slave and master workspaces, and the lack of intuitive manipulation feedback, e.g. joint limits, to the user. To address those drawbacks a joint-space robotic manipulator is proposed emulating the kinematic structure of the flexible robotic instrument under control.Open Acces

Design of a Surgical Manipulator System for Lumbar Discectomy Procedures

A 3D printed surgical master-slave manipulator system for minimally invasive lumbar discectomy procedure is proposed. Discectomy is the surgery to remove the herniated disc material that is pressing on a nerve root or spinal cord. This surgery is performed to relieve pain or numbness caused by the pressure on the nerve. The workspace is limited (\u3c 27 cm3) and the manipulator has to go through a 3.175mm (0.125”) diameter channel. The proposed system is comprised of a family of manipulators that can work alone or co-operatively to perform tasks required in the surgery. In the proposed system, the manipulator is 3D printed with multiple materials, with flexible links acting as joints of the mechanism. These flexible links are actuated by cables which provide sufficient forces for actuation in the surgical workspace. In this thesis, existing surgical techniques are investigated and a new surgical system is proposed. Various design ideas are presented and evaluated for manufacturing and assembly. Finally, the proposed mechanisms are modeled and tested for their capability to assist the surgeon to perform tasks required for the surgery

Soft Robot-Assisted Minimally Invasive Surgery and Interventions: Advances and Outlook

Since the emergence of soft robotics around two decades ago, research interest in the field has escalated at a pace. It is fuelled by the industry's appreciation of the wide range of soft materials available that can be used to create highly dexterous robots with adaptability characteristics far beyond that which can be achieved with rigid component devices. The ability, inherent in soft robots, to compliantly adapt to the environment, has significantly sparked interest from the surgical robotics community. This article provides an in-depth overview of recent progress and outlines the remaining challenges in the development of soft robotics for minimally invasive surgery

A Miniature 3-DoF Flexible Parallel Robotic Wrist Using NiTi Wires for Gastrointestinal Endoscopic Surgery

Gastrointestinal endoscopic surgery (GES) has high requirements for instruments' size and distal dexterity, because of the narrow endoscopic channel and long, tortuous human gastrointestinal tract. This paper utilized Nickel-Titanium (NiTi) wires to develop a miniature 3-DoF (pitch-yaw-translation) flexible parallel robotic wrist (FPRW). Additionally, we assembled an electric knife on the wrist's connection interface and then teleoperated it to perform an endoscopic submucosal dissection (ESD) on porcine stomachs. The effective performance in each ESD workflow proves that the designed FPRW has sufficient workspace, high distal dexterity, and high positioning accuracy.Comment: IEEE International Conference on Robotics and Automation (ICRA) 2022 workshop: Frontiers of Endoluminal Intervention: Clinical opportunities and technical challenge