DESIGN, DEVELOPMENT, AND EVALUATION OF A MRI-GUIDED NEUROSURGICAL INTRACRANIAL ROBOT

Brain tumors are among the most feared complications of cancer. Their treatment is challenging because of the lack of good imaging modality and the inability to remove the complete tumor. To overcome this limitation, we propose to develop a Magnetic Resonance Imaging (MRI)-compatible neurosurgical robot. The robot can be operated under continuous MRI, and the Magnetic Resonance (MR) images can be used to supplement physicians' visual capabilities, resulting in precise tumor removal. We have developed two prototypes of the Minimally Invasive Neurosurgical Intracranial Robot (MINIR) using MRI compatible materials and shape memory alloy (SMA) actuators. The major difference between the two robots is that one uses SMA wire actuators and the other uses SMA spring actuators combined with the tendon-sheath mechanism. Due to space limitation inside the robot body and the strong magnetic field in the MRI scanner, most sensors cannot be used inside the robot body. Hence, one possible approach is to rely on image feedback to control the motion of the robot. In this research, as a preliminary approach, we have relied on image feedback from a camera to control the motion of the robot. Since the image tracking algorithm may fail in some situations, we also developed a temperature feedback control scheme which served as a backup controller for the robot. Experimental results demonstrated that both image feedback and temperature feedback can be used reliably to control the joint motion of the robots. A series of MRI compatibility tests were performed to evaluate the MRI compatibility of the robots and to assess the degradation in image quality. The experimental results demonstrated that the robots are MRI compatible and created no significant image distortion in the MR images during actuation. The accomplishments presented in this dissertation represent a significant development of using SMA actuators to actuate MRI-compatible robots. It is anticipated that, in the future, continuous MR imaging would be used reliably to control the motion of the robot. It is aspired that the robot design and the control methods of SMA actuators developed in this research can be utilized in practical applications

Smart actuation and sensing for meso-scale surgical robotic systems

This dissertation presents the development of meso-scale surgical robotics based on smart actuation and sensing for minimally invasive surgery (MIS). By replacing conventional straight tools by steerable surgical robots, surgical outcomes can potentially be improved due to more precise, stable, and flexible manipulation. Since bending and torsion are the two fundamental motion forms required by surgical tools to complete general surgical procedures, compact torsion and bending modules, both integrated with intrinsic sensors for motion feedback, have been developed based on shape memory alloy (SMA). The developed actuation and sensing techniques have been applied on a robot for neurosurgical intracerebral hemorrhage evacuation (NICHE) and a steerable catheter for atrial fibrillation (AFib) treatment. The NICHE robot consists of a straight stem, an SMA torsion module, and an SMA bending module as a distal bending tip. By synchronizing the motion of the stem, the bending module, and the torsion module, the robot is capable of tip articulation within the brain to remove hemorrhage effectively through suction and electrocauterization. In addition, a skull-mounted robotic headframe has been developed based on a Stewart platform to manipulate the NICHE robot. The robotic catheter is developed by integrating multiple SMA bending modules with flexible braid reinforced tubing. Polymer 3D-printing is used to fabricate all the structural components due to its relatively low cost, short fabrication period, and capability of fabricating complicated structures with high accuracy. The developed surgical robotic systems have been thoroughly evaluated using phantom or cadaver models under computed tomography (CT) and/or magnetic resonance imaging (MRI) guidance. The imaging-guided experimental studies showed that the developed robotic systems consisting of smart actuation and sensing were compatible with CT and MR imaging.Ph.D

Shape Memory Alloy Actuators and Sensors for Applications in Minimally Invasive Interventions

Reduced access size in minimally invasive surgery and therapy (MIST) poses several restriction on the design of the dexterous robotic instruments. The instruments should be developed that are slender enough to pass through the small sized incisions and able to effectively operate in a compact workspace. Most existing robotic instruments are operated by big actuators, located outside the patient’s body, that transfer forces to the end effector via cables or magnetically controlled actuation mechanism. These instruments are certainly far from optimal in terms of their cost and the space they require in operating room. The lack of adequate sensing technologies make it very challenging to measure bending of the flexible instruments, and to measure tool-tissue contact forces of the both flexible and rigid instruments during MIST. Therefore, it requires the development of the cost effective miniature actuators and strain/force sensors. Having several unique features such as bio-compatibility, low cost, light weight, large actuation forces and electrical resistivity variations, the shape memory alloys (SMAs) show promising applications both as the actuators and strain sensors in MIST. However, highly nonlinear hysteretic behavior of the SMAs hinders their use as actuators. To overcome this problem, an adaptive artificial neural network (ANN) based Preisach model and a model predictive controller have been developed in this thesis to precisely control the output of the SMA actuators. A novel ultra thin strain sensor is also designed using a superelastic SMA wire, which can be used to measure strain and forces for many surgical and intervention instruments. A da Vinci surgical instrument is sensorized with these sensors in order to validate their force sensing capability

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

Design, Development, and Evaluation of a Teleoperated Master-Slave Surgical System for Breast Biopsy under Continuous MRI Guidance

The goal of this project is to design and develop a teleoperated master-slave surgical system that can potentially assist the physician in performing breast biopsy with a magnetic resonance imaging (MRI) compatible robotic system. MRI provides superior soft-tissue contrast compared to other imaging modalities such as computed tomography or ultrasound and is used for both diagnostic and therapeutic procedures. The strong magnetic field and the limited space inside the MRI bore, however, restrict direct means of breast biopsy while performing real-time imaging. Therefore, current breast biopsy procedures employ a blind targeting approach based on magnetic resonance (MR) images obtained a priori. Due to possible patient involuntary motion or inaccurate insertion through the registration grid, such approach could lead to tool tip positioning errors thereby affecting diagnostic accuracy and leading to a long and painful process, if repeated procedures are required. Hence, it is desired to develop the aforementioned teleoperation system to take advantages of real-time MR imaging and avoid multiple biopsy needle insertions, improving the procedure accuracy as well as reducing the sampling errors. The design, implementation, and evaluation of the teleoperation system is presented in this dissertation. A MRI-compatible slave robot is implemented, which consists of a 1 degree of freedom (DOF) needle driver, a 3-DOF parallel mechanism, and a 2-DOF X-Y stage. This slave robot is actuated with pneumatic cylinders through long transmission lines except the 1-DOF needle driver is actuated with a piezo motor. Pneumatic actuation through long transmission lines is then investigated using proportional pressure valves and controllers based on sliding mode control are presented. A dedicated master robot is also developed, and the kinematic map between the master and the slave robot is established. The two robots are integrated into a teleoperation system and a graphical user interface is developed to provide visual feedback to the physician. MRI experiment shows that the slave robot is MRI-compatible, and the ex vivo test shows over 85%success rate in targeting with the MRI-compatible robotic system. The success in performing in vivo animal experiments further confirm the potential of further developing the proposed robotic system for clinical applications

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

A Novel Flexible and Steerable Probe for Minimally Invasive Soft Tissue Intervention

Current trends in surgical intervention favour a minimally invasive (MI) approach, in which complex procedures are performed through increasingly small incisions. Specifically, in neurosurgery, there is a need for minimally invasive keyhole access, which conflicts with the lack of maneuverability of conventional rigid instruments. In an attempt to address this fundamental shortcoming, this thesis describes the concept design, implementation and experimental validation of a novel flexible and steerable probe, named “STING” (Soft Tissue Intervention and Neurosurgical Guide), which is able to steer along curvilinear trajectories within a compliant medium. The underlying mechanism of motion of the flexible probe, based on the reciprocal movement of interlocked probe segments, is biologically inspired and was designed around the unique features of the ovipositor of certain parasitic wasps. Such insects are able to lay eggs by penetrating different kinds of “host” (e.g. wood, larva) with a very thin and flexible multi-part channel, thanks to a micro-toothed surface topography, coupled with a reciprocating “push and pull” motion of each segment. This thesis starts by exploring these foundations, where the “microtexturing” of the surface of a rigid probe prototype is shown to facilitate probe insertion into soft tissue (porcine brain), while gaining tissue purchase when the probe is tensioned outwards. Based on these findings, forward motion into soft tissue via a reciprocating mechanism is then demonstrated through a focused set of experimental trials in gelatine and agar gel. A flexible probe prototype (10 mm diameter), composed of four interconnected segments, is then presented and shown to be able to steer in a brain-like material along multiple curvilinear trajectories on a plane. The geometry and certain key features of the probe are optimised through finite element models, and a suitable actuation strategy is proposed, where the approach vector of the tip is found to be a function of the offset between interlocked segments. This concept of a “programmable bevel”, which enables the steering angle to be chosen with virtually infinite resolution, represents a world-first in percutaneous soft tissue surgery. The thesis concludes with a description of the integration and validation of a fully functional prototype within a larger neurosurgical robotic suite (EU FP7 ROBOCAST), which is followed by a summary of the corresponding implications for future work