Non linear force feedback enhancement for cooperative robotic neurosurgery enforces virtual boundaries on cortex surface

Surgeons can benefit from the cooperation with a robotic assistant during the repetitive execution of precise targeting tasks on soft tissues, such as brain cortex stimulation procedures in open-skull neurosurgery. Position-based force-to-motion control schemes may not be satisfactory solution to provide the manipulator with the high compliance desirable during guidance along wide trajectories. A new torque controller with non-linear force feedback enhancement (FFE) is presented to provide augmented haptic perception to the operator from instrument-tissue interaction. Simulation tests were performed to evaluate the system stability according to different non-linear force modulation functions (power, sigmoidal and arc tangent). The FFE controller with power modulation was experimentally validated with a pool of non-expert users using brain-mimicking gelatin phantoms (8%-16% concentration). Besides providing hand tremor rejection for a stable holding of the tool, the FFE controller was proven to allow for a safer tissue contact with respect to both robotic assistance without force feedback and freehand executions (50% and 75% reduction of the indentation depth, respectively). Future work will address the evaluation of the safety features of the FFE controller with expert surgeons on a realistic brain phantom, also accounting for unpredictable tissue's motions as during seizures due to cortex stimulation

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

From Concept to Market: Surgical Robot Development

Surgical robotics and supporting technologies have really become a prime example of modern applied information technology infiltrating our everyday lives. The development of these systems spans across four decades, and only the last few years brought the market value and saw the rising customer base imagined already by the early developers. This chapter guides through the historical development of the most important systems, and provide references and lessons learnt for current engineers facing similar challenges. A special emphasis is put on system validation, assessment and clearance, as the most commonly cited barrier hindering the wider deployment of a system

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

Review on Image Guided Surgery Systems

Nowadays modern imaging techniques can grant an excellent quality 3D images that clearly show the anatomy, vascularity, pathology and active functions of the tissues. The ability to register these preoperative images to each other, to offer a comprehensive information, and later the ability to register the image space to the patient space intraoperatively is the core for the image guided surgery systems (IGS). Other main elements of the system include the process of tracking the surgical tools intraoperatively by reflecting their positions within the 3D image model. In some occasions an intraoperative image may be acquired and registered to the preoperative images to make sure the 3D model used to guide the operation describes the actual situation at surgery time. This survey overviews the history of IGS and discusses the modern system components for a reliable application and gives information about the different applications in medical specialties that benefited from the use of IGS

A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery

Design Of Robust Feedback Controllers For A Laser Beam Stabilizer

This work addresses this challenge by employing two different control strategies, namely, Proportional Integral Derivative (PID) and State Feedback with an observer for control

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

Development of an augmented reality guided computer assisted orthopaedic surgery system

Previously held under moratorium from 1st December 2016 until 1st December 2021.This body of work documents the developed of a proof of concept augmented reality guided computer assisted orthopaedic surgery system – ARgCAOS. After initial investigation a visible-spectrum single camera tool-mounted tracking system based upon fiducial planar markers was implemented. The use of visible-spectrum cameras, as opposed to the infra-red cameras typically used by surgical tracking systems, allowed the captured image to be streamed to a display in an intelligible fashion. The tracking information defined the location of physical objects relative to the camera. Therefore, this information allowed virtual models to be overlaid onto the camera image. This produced a convincing augmented experience, whereby the virtual objects appeared to be within the physical world, moving with both the camera and markers as expected of physical objects. Analysis of the first generation system identified both accuracy and graphical inadequacies, prompting the development of a second generation system. This too was based upon a tool-mounted fiducial marker system, and improved performance to near-millimetre probing accuracy. A resection system was incorporated into the system, and utilising the tracking information controlled resection was performed, producing sub-millimetre accuracies. Several complications resulted from the tool-mounted approach. Therefore, a third generation system was developed. This final generation deployed a stereoscopic visible-spectrum camera system affixed to a head-mounted display worn by the user. The system allowed the augmentation of the natural view of the user, providing convincing and immersive three dimensional augmented guidance, with probing and resection accuracies of 0.55±0.04 and 0.34±0.04 mm, respectively.This body of work documents the developed of a proof of concept augmented reality guided computer assisted orthopaedic surgery system – ARgCAOS. After initial investigation a visible-spectrum single camera tool-mounted tracking system based upon fiducial planar markers was implemented. The use of visible-spectrum cameras, as opposed to the infra-red cameras typically used by surgical tracking systems, allowed the captured image to be streamed to a display in an intelligible fashion. The tracking information defined the location of physical objects relative to the camera. Therefore, this information allowed virtual models to be overlaid onto the camera image. This produced a convincing augmented experience, whereby the virtual objects appeared to be within the physical world, moving with both the camera and markers as expected of physical objects. Analysis of the first generation system identified both accuracy and graphical inadequacies, prompting the development of a second generation system. This too was based upon a tool-mounted fiducial marker system, and improved performance to near-millimetre probing accuracy. A resection system was incorporated into the system, and utilising the tracking information controlled resection was performed, producing sub-millimetre accuracies. Several complications resulted from the tool-mounted approach. Therefore, a third generation system was developed. This final generation deployed a stereoscopic visible-spectrum camera system affixed to a head-mounted display worn by the user. The system allowed the augmentation of the natural view of the user, providing convincing and immersive three dimensional augmented guidance, with probing and resection accuracies of 0.55±0.04 and 0.34±0.04 mm, respectively

Development and Validation of a Hybrid Virtual/Physical Nuss Procedure Surgical Trainer

With continuous advancements and adoption of minimally invasive surgery, proficiency with nontrivial surgical skills involved is becoming a greater concern. Consequently, the use of surgical simulation has been increasingly embraced by many for training and skill transfer purposes. Some systems utilize haptic feedback within a high-fidelity anatomically-correct virtual environment whereas others use manikins, synthetic components, or box trainers to mimic primary components of a corresponding procedure. Surgical simulation development for some minimally invasive procedures is still, however, suboptimal or otherwise embryonic. This is true for the Nuss procedure, which is a minimally invasive surgery for correcting pectus excavatum (PE) – a congenital chest wall deformity. This work aims to address this gap by exploring the challenges of developing both a purely virtual and a purely physical simulation platform of the Nuss procedure and their implications in a training context. This work then describes the development of a hybrid mixed-reality system that integrates virtual and physical constituents as well as an augmentation of the haptic interface, to carry out a reproduction of the primary steps of the Nuss procedure and satisfy clinically relevant prerequisites for its training platform. Furthermore, this work carries out a user study to investigate the system’s face, content, and construct validity to establish its faithfulness as a training platform