Towards automated visual flexible endoscope navigation

Background:\ud The design of flexible endoscopes has not changed significantly in the past 50 years. A trend is observed towards a wider application of flexible endoscopes with an increasing role in complex intraluminal therapeutic procedures. The nonintuitive and nonergonomical steering mechanism now forms a barrier in the extension of flexible endoscope applications. Automating the navigation of endoscopes could be a solution for this problem. This paper summarizes the current state of the art in image-based navigation algorithms. The objectives are to find the most promising navigation system(s) to date and to indicate fields for further research.\ud Methods:\ud A systematic literature search was performed using three general search terms in two medical–technological literature databases. Papers were included according to the inclusion criteria. A total of 135 papers were analyzed. Ultimately, 26 were included.\ud Results:\ud Navigation often is based on visual information, which means steering the endoscope using the images that the endoscope produces. Two main techniques are described: lumen centralization and visual odometry. Although the research results are promising, no successful, commercially available automated flexible endoscopy system exists to date.\ud Conclusions:\ud Automated systems that employ conventional flexible endoscopes show the most promising prospects in terms of cost and applicability. To produce such a system, the research focus should lie on finding low-cost mechatronics and technologically robust steering algorithms. Additional functionality and increased efficiency can be obtained through software development. The first priority is to find real-time, robust steering algorithms. These algorithms need to handle bubbles, motion blur, and other image artifacts without disrupting the steering process

Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-opera- tive morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilites by observ- ing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted in- struments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This paper reviews the state-of-the-art methods for optical intra-operative 3D reconstruction in laparoscopic surgery and discusses the technical challenges and future perspectives towards clinical translation. With the recent paradigm shift of surgical practice towards MIS and new developments in 3D opti- cal imaging, this is a timely discussion about technologies that could facilitate complex CAS procedures in dynamic and deformable anatomical regions

Apparatus for endoscopic examination

An endoscope is having a propulsion mechanism and at least one transmitter at the distal end transmitting bursts of energy waves (radio frequency or ultrasonic) for tracking the position of the distal end through the use of two or more transducers on the anterior or lateral surfaces of a patient is described. The propulsion mechanism which consists of two radially expandable bladders separated by an axially expandable bellows with only the forward bladder attached to the distal end is discussed. Alternate mechanisms are reported. A sheath on the endoscope which includes material having a sharp melting point slightly above body temperature so that the sheath is made flexible at selected sections by applying current to separate heating wires in the sections of the sheath is described

A compact targeted drug delivery mechanism for a next generation wireless capsule endoscope

This paper reports a novel medication release and delivery mechanism as part of a next generation wireless capsule endoscope (WCE) for targeted drug delivery. This subsystem occupies a volume of only 17.9mm3 for the purpose of delivering a 1 ml payload to a target site of interest in the small intestinal tract. An in-depth analysis of the method employed to release and deliver the medication is described and a series of experiments is presented which validates the drug delivery system. The results show that a variable pitch conical compression spring manufactured from stainless steel can deliver 0.59 N when it is fully compressed and that this would be sufficient force to deliver the onboard medication

Robot Autonomy for Surgery

Autonomous surgery involves having surgical tasks performed by a robot operating under its own will, with partial or no human involvement. There are several important advantages of automation in surgery, which include increasing precision of care due to sub-millimeter robot control, real-time utilization of biosignals for interventional care, improvements to surgical efficiency and execution, and computer-aided guidance under various medical imaging and sensing modalities. While these methods may displace some tasks of surgical teams and individual surgeons, they also present new capabilities in interventions that are too difficult or go beyond the skills of a human. In this chapter, we provide an overview of robot autonomy in commercial use and in research, and present some of the challenges faced in developing autonomous surgical robots

2D Reconstruction of Small Intestine's Interior Wall

Examining and interpreting of a large number of wireless endoscopic images from the gastrointestinal tract is a tiresome task for physicians. A practical solution is to automatically construct a two dimensional representation of the gastrointestinal tract for easy inspection. However, little has been done on wireless endoscopic image stitching, let alone systematic investigation. The proposed new wireless endoscopic image stitching method consists of two main steps to improve the accuracy and efficiency of image registration. First, the keypoints are extracted by Principle Component Analysis and Scale Invariant Feature Transform (PCA-SIFT) algorithm and refined with Maximum Likelihood Estimation SAmple Consensus (MLESAC) outlier removal to find the most reliable keypoints. Second, the optimal transformation parameters obtained from first step are fed to the Normalised Mutual Information (NMI) algorithm as an initial solution. With modified Marquardt-Levenberg search strategy in a multiscale framework, the NMI can find the optimal transformation parameters in the shortest time. The proposed methodology has been tested on two different datasets - one with real wireless endoscopic images and another with images obtained from Micro-Ball (a new wireless cubic endoscopy system with six image sensors). The results have demonstrated the accuracy and robustness of the proposed methodology both visually and quantitatively.Comment: Journal draf

Design of a Robotic Instrument Manipulator for Endoscopic Deployment

This thesis describes the initial design process for an application of continuum robotics to endoscopic surgical procedures, specifically dissection of the colon. We first introduce the long-term vision for a benchtop dual-instrument endoscopic system with intuitive haptic controllers and then narrow our focus to the design and testing of the instrument manipulator itself, which must be actuated through the long, winding channel of a standard colonoscope. Based on design requirements for a target procedure, we analyze simulations of two types of continuum robots using recently established kinematic and mechanic modeling approaches: the concentric-tube robot (CTR) and the concentric agonist-antagonist robot (CAAR). In addition, we investigate solutions to the primary engineering challenge to this system, which is accurately transmitting joint motion through exible, hollow shafts. Based on our study of the manipulator simulations and transmission shafts, we select instrument designs for prototyping and testing. We present approaches for controlling the position of the robotic instrument in real-time using an input device, and demonstrate the degree of control we can achieve in various configurations by performing time trial experiments with our prototype robotic instruments. Our observations of the manipulator during testing inform us of sources of error, and we conclude this report with suggestions for future work, including shaft design and alternative continuum manipulator approaches

Recent finding and new technologies in nephrolithiasis: a review of the recent literature

This review summarizes recent literature on advances regarding renal and ureteral calculi, with particular focus in areas of recent advances in the overall field of urolithiasis. Clinical management in everyday practice requires a complete understanding of the issues regarding metabolic evaluation and subgrouping of stone-forming patients, diagnostic procedures, effective treatment regime in acute stone colic, medical expulsive therapy, and active stone removal. In this review we focus on new perspectives in managing nephrolitihiasis and discuss recentadvances, including medical expulsive therapy, new technologies, and refinements of classical therapy such as shock wave lithotripsy, give a fundamental modification of nephrolithiasis management. Overall, this field appears to be the most promising, capable of new developments in ureterorenoscopy and percutaneous approaches. Further improvements are expected from robotic-assisted procedures, such as flexible robotics in ureterorenoscopy

Modeling, Analysis, Force Sensing and Control of Continuum Robots for Minimally Invasive Surgery

This dissertation describes design, modeling and application of continuum robotics for surgical applications, specifically parallel continuum robots (PCRs) and concentric tube manipulators (CTMs). The introduction of robotics into surgical applications has allowed for a greater degree of precision, less invasive access to more remote surgical sites, and user-intuitive interfaces with enhanced vision systems. The most recent developments have been in the space of continuum robots, whose exible structure create an inherent safety factor when in contact with fragile tissues. The design challenges that exist involve balancing size and strength of the manipulators, controlling the manipulators over long transmission pathways, and incorporating force sensing and feedback from the manipulators to the user. Contributions presented in this work include: (1) prototyping, design, force sensing, and force control investigations of PCRs, and (2) prototyping of a concentric tube manipulator for use in a standard colonoscope. A general kinetostatic model is presented for PCRs along with identification of multiple physical constraints encountered in design and construction. Design considerations and manipulator capabilities are examined in the form of matrix metrics and ellipsoid representations. Finally, force sensing and control are explored and experimental results are provided showing the accuracy of force estimates based on actuation force measurements and control capabilities. An overview of the design requirements, manipulator construction, analysis and experimental results are provided for a CTM used as a tool manipulator in a traditional colonoscope. Currently, tools used in colonoscopic procedures are straight and exit the front of the scope with 1 DOF of operation (jaws of a grasper, tightening of a loop, etc.). This research shows that with a CTM deployed, the dexterity of these tools can be increased dramatically, increasing accuracy of tool operation, ease of use and safety of the overall procedure. The prototype investigated in this work allows for multiple tools to be used during a single procedure. Experimental results show the feasibility and advantages of the newly-designed manipulators