A continuum robotic platform for endoscopic non-contact laser surgery: design, control, and preclinical evaluation

The application of laser technologies in surgical interventions has been accepted in the clinical domain due to their atraumatic properties. In addition to manual application of fibre-guided lasers with tissue contact, non-contact transoral laser microsurgery (TLM) of laryngeal tumours has been prevailed in ENT surgery. However, TLM requires many years of surgical training for tumour resection in order to preserve the function of adjacent organs and thus preserve the patient’s quality of life. The positioning of the microscopic laser applicator outside the patient can also impede a direct line-of-sight to the target area due to anatomical variability and limit the working space. Further clinical challenges include positioning the laser focus on the tissue surface, imaging, planning and performing laser ablation, and motion of the target area during surgery. This dissertation aims to address the limitations of TLM through robotic approaches and intraoperative assistance. Although a trend towards minimally invasive surgery is apparent, no highly integrated platform for endoscopic delivery of focused laser radiation is available to date. Likewise, there are no known devices that incorporate scene information from endoscopic imaging into ablation planning and execution. For focusing of the laser beam close to the target tissue, this work first presents miniaturised focusing optics that can be integrated into endoscopic systems. Experimental trials characterise the optical properties and the ablation performance. A robotic platform is realised for manipulation of the focusing optics. This is based on a variable-length continuum manipulator. The latter enables movements of the endoscopic end effector in five degrees of freedom with a mechatronic actuation unit. The kinematic modelling and control of the robot are integrated into a modular framework that is evaluated experimentally. The manipulation of focused laser radiation also requires precise adjustment of the focal position on the tissue. For this purpose, visual, haptic and visual-haptic assistance functions are presented. These support the operator during teleoperation to set an optimal working distance. Advantages of visual-haptic assistance are demonstrated in a user study. The system performance and usability of the overall robotic system are assessed in an additional user study. Analogous to a clinical scenario, the subjects follow predefined target patterns with a laser spot. The mean positioning accuracy of the spot is 0.5 mm. Finally, methods of image-guided robot control are introduced to automate laser ablation. Experiments confirm a positive effect of proposed automation concepts on non-contact laser surgery.Die Anwendung von Lasertechnologien in chirurgischen Interventionen hat sich aufgrund der atraumatischen Eigenschaften in der Klinik etabliert. Neben manueller Applikation von fasergeführten Lasern mit Gewebekontakt hat sich die kontaktfreie transorale Lasermikrochirurgie (TLM) von Tumoren des Larynx in der HNO-Chirurgie durchgesetzt. Die TLM erfordert zur Tumorresektion jedoch ein langjähriges chirurgisches Training, um die Funktion der angrenzenden Organe zu sichern und damit die Lebensqualität der Patienten zu erhalten. Die Positionierung des mikroskopis chen Laserapplikators außerhalb des Patienten kann zudem die direkte Sicht auf das Zielgebiet durch anatomische Variabilität erschweren und den Arbeitsraum einschränken. Weitere klinische Herausforderungen betreffen die Positionierung des Laserfokus auf der Gewebeoberfläche, die Bildgebung, die Planung und Ausführung der Laserablation sowie intraoperative Bewegungen des Zielgebietes. Die vorliegende Dissertation zielt darauf ab, die Limitierungen der TLM durch robotische Ansätze und intraoperative Assistenz zu adressieren. Obwohl ein Trend zur minimal invasiven Chirurgie besteht, sind bislang keine hochintegrierten Plattformen für die endoskopische Applikation fokussierter Laserstrahlung verfügbar. Ebenfalls sind keine Systeme bekannt, die Szeneninformationen aus der endoskopischen Bildgebung in die Ablationsplanung und -ausführung einbeziehen. Für eine situsnahe Fokussierung des Laserstrahls wird in dieser Arbeit zunächst eine miniaturisierte Fokussieroptik zur Integration in endoskopische Systeme vorgestellt. Experimentelle Versuche charakterisieren die optischen Eigenschaften und das Ablationsverhalten. Zur Manipulation der Fokussieroptik wird eine robotische Plattform realisiert. Diese basiert auf einem längenveränderlichen Kontinuumsmanipulator. Letzterer ermöglicht in Kombination mit einer mechatronischen Aktuierungseinheit Bewegungen des Endoskopkopfes in fünf Freiheitsgraden. Die kinematische Modellierung und Regelung des Systems werden in ein modulares Framework eingebunden und evaluiert. Die Manipulation fokussierter Laserstrahlung erfordert zudem eine präzise Anpassung der Fokuslage auf das Gewebe. Dafür werden visuelle, haptische und visuell haptische Assistenzfunktionen eingeführt. Diese unterstützen den Anwender bei Teleoperation zur Einstellung eines optimalen Arbeitsabstandes. In einer Anwenderstudie werden Vorteile der visuell-haptischen Assistenz nachgewiesen. Die Systemperformanz und Gebrauchstauglichkeit des robotischen Gesamtsystems werden in einer weiteren Anwenderstudie untersucht. Analog zu einem klinischen Einsatz verfolgen die Probanden mit einem Laserspot vorgegebene Sollpfade. Die mittlere Positioniergenauigkeit des Spots beträgt dabei 0,5 mm. Zur Automatisierung der Ablation werden abschließend Methoden der bildgestützten Regelung vorgestellt. Experimente bestätigen einen positiven Effekt der Automationskonzepte für die kontaktfreie Laserchirurgie

Dynamics for variable length multisection continuum arms

Variable length multisection continuum arms are a class of continuum robotic manipulators that generate motion by structural mechanical deformation. Unlike most continuum robots, the sections of these arms do not have (central) supporting flexible backbone, and are actuated by multiple variable length actuators. Because of the constraining nature of actuators, the continuum sections can bend and/or elongate (compress) depending on the elongation/contraction characteristics of the actuators being used. Continuum arms have a number of distinctive differences with respect to traditional rigid arms namely: smooth bending, high inherent compliance, and adaptive whole arm grasping. However, due to numerical instability and the complexity of curve parametric models, there are no spatial dynamic models for multisection continuum arms. This paper introduces novel spatial dynamics and applies these to variable length multisection continuum arms with any number of sections. An efficient recursive computational scheme for deriving the equations of motion is presented. This is applied in a general form based on structurally accurate and numerically well-posed modal kinematics that assumes circular arc deformation of continuum sections without torsion. It is shown that the proposed modal dynamics are highly scalable, producing efficient and accurate numerical results. The spatial dynamic simulation results are experimentally validated using a pneumatic muscle actuated multisection prototype continuum arm. For the first time this enables investigation of spatial dynamic effects in this class of continuum arms

Design of a pneumatic muscle based continuum robot with embedded tendons

© 1996-2012 IEEE. Continuum robots have attracted increasing focus in recent years due to their intrinsic compliance that allows for dexterous and safe movements. However, the inherent compliance in such systems reduces the structural stiffness, and therefore leads to the issue of reduced positioning accuracy. This paper presents the design of a continuum robot employing tendon embedded pneumatic muscles. The pneumatic muscles are used to achieve large-scale movements for preliminary positioning, while the tendons are used for fine adjustment of position. Such hybrid actuation offers the potential to improve the accuracy of the robotic system, while maintaining large displacement capabilities. A three-dimensional dynamic model of the robot is presented using a mass-damper-spring-based network, in which elastic deformation, actuating forces, and external forces are taken into account. The design and dynamic model of the robot are then validated experimentally with the help of an electromagnetic tracking system

Model Based Control of Soft Robots: A Survey of the State of the Art and Open Challenges

Continuum soft robots are mechanical systems entirely made of continuously deformable elements. This design solution aims to bring robots closer to invertebrate animals and soft appendices of vertebrate animals (e.g., an elephant's trunk, a monkey's tail). This work aims to introduce the control theorist perspective to this novel development in robotics. We aim to remove the barriers to entry into this field by presenting existing results and future challenges using a unified language and within a coherent framework. Indeed, the main difficulty in entering this field is the wide variability of terminology and scientific backgrounds, making it quite hard to acquire a comprehensive view on the topic. Another limiting factor is that it is not obvious where to draw a clear line between the limitations imposed by the technology not being mature yet and the challenges intrinsic to this class of robots. In this work, we argue that the intrinsic effects are the continuum or multi-body dynamics, the presence of a non-negligible elastic potential field, and the variability in sensing and actuation strategies.Comment: 69 pages, 13 figure

Challenges of continuum robots in clinical context: a review

With the maturity of surgical robotic systems based on traditional rigid-link principles, the rate of progress slowed as limits of size and controllable degrees of freedom were reached. Continuum robots came with the potential to deliver a step change in the next generation of medical devices, by providing better access, safer interactions and making new procedures possible. Over the last few years, several continuum robotic systems have been launched commercially and have been increasingly adopted in hospitals. Despite the clear progress achieved, continuum robots still suffer from design complexity hindering their dexterity and scalability. Recent advances in actuation methods have looked to address this issue, offering alternatives to commonly employed approaches. Additionally, continuum structures introduce significant complexity in modelling, sensing, control and fabrication; topics which are of particular focus in the robotics community. It is, therefore, the aim of the presented work to highlight the pertinent areas of active research and to discuss the challenges to be addressed before the potential of continuum robots as medical devices may be fully realised

Calibration of Concentric Tube Continuum Robots: Automatic Alignment of Precurved Elastic Tubes

Joint level calibration is an integral part of robotics as it directly influences the achievable accuracy. As opposed to serial robotic arms, continuum robots are not composed of any rigid links or joints, but of elastic materials that undergo bending and torsion. The jointless composition requires dedicated calibration procedures. In this letter, we introduce an automatic method for aligning precurved elastic tubes for joint level calibration of concentric tube continuum robots. The robot tip is equipped with a sensor in order to track its position during calibration such that subsequent data processing can extract the rotational zero position automatically. While we present a general framework independent of the utilized sensor technology, we evaluate our approach using three different sensing methodologies, i.e. magnetic, inductive, and electromagnetic. Furthermore, we advise on properties for appropriate sensors. Our experimental results show, that the rotational home position can be found reproducibly with a minimal dispersion of 0.011°

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

A Soft Continuum Robot with Self-Controllable Variable Curvature

This paper introduces a new type of soft continuum robot, called SCoReS, which is capable of self-controlling continuously its curvature at the segment level; in contrast to previous designs which either require external forces or machine elements, or whose variable curvature capabilities are discrete -- depending on the number of locking mechanisms and segments. The ability to have a variable curvature, whose control is continuous and independent from external factors, makes a soft continuum robot more adaptive in constrained environments, similar to what is observed in nature in the elephant's trunk or ostrich's neck for instance which exhibit multiple curvatures. To this end, our soft continuum robot enables reconfigurable variable curvatures utilizing a variable stiffness growing spine based on micro-particle granular jamming for the first time. We detail the design of the proposed robot, presenting its modeling through beam theory and FEA simulation -- which is validated through experiments. The robot's versatile bending profiles are then explored in experiments and an application to grasp fruits at different configurations is demonstrated.Comment: Accpeted for IEEE Robotics and Automation letters in January 2024, Imperial's open access research REF 2029 open access polic