A Biomimetic steering robot for Minimally invasive surgery application

International audienceMinimally Invasive Surgery represents the future of many types of medical inter- ventions such as keyhole neurosurgey or transluminal endoscopic surgery. These procedures involve insertion of surgical instruments such as needles and endoscopes into human body through small incision/ body cavity for biopsy and drug delivery. However, nearly all surgical instruments for these procedures are inserted manually and there is a long learning curve for surgeons to use them properly. Many research efforts have been made to design active instruments (endoscope, needles) to improve this procedure during last decades. New robot mechanisms have been designed and used to improve the dexterity of current endoscope. Usually these robots are flexible and can pass the constrained space for fine manipulations. In recent years, a con- tinuum robotic mechanism has been investigated and designed for medical surgery. Those robots are characterized by the fact that their mechanical components do not have rigid links and discrete joints in contrast with traditional robot manipula- tors. The design of these robots is inspired by movements of natural animals such as tongues, elephant trunks and tentacles. The unusual compliance and redundant degrees of freedom of these robots provide strong potential to achieve delicate tasks successfully even in cluttered and unstructured environments. This chapter will present a complete application of a continuum robot for Mini- mally Invasive Surgery of colonoscopy. This system is composed of a micro-robotic tip, a set of position sensors and a real-time control system for guiding the explo- ration of colon. Details will be described on the modeling of the used pneumatic actuators, the design of the mechanical component, the kinematic model analysis and the control strategy for automatically guiding the progression of the device inside the human colon. Experimental results will be presented to check the perfor- mances of the whole system within a transparent tube

Wireless capsule endoscope for targeted drug delivery

The diagnosis and treatment of pathologies of the gastrointestinal (GI) tract are performed routinely by gastroenterologists using endoscopes and colonoscopes, however the small intestinal tract is beyond the reach of these conventional systems. Attempts have been made to access the small intestines with wireless capsule endoscopes (WCE). These pill-sized cameras take pictures of the intestinal wall and then relay them back for evaluation. This practice enables the detection and diagnosis of pathologies of the GI tract such as Crohn's disease, small intestinal tumours such as lymphoma and small intestinal cancer. The problems with these systems are that they have limited diagnostic capabilities and they do not offer the ability to perform therapy to the affected areas leaving only the options of administering large quantities of drugs or surgical intervention. To address the issue of administering therapy in the small intestinal tract this thesis presents an active swallowable microrobotic platform which has novel functionality enabling the microrobot to treat pathologies through a targeted drug delivery system. This thesis first reviews the state-of-the-art in WCE through the evaluation of current and past literature. A review of current practises such as flexible sigmoidoscopy, virtual colonoscopy and wireless capsule endoscopy are presented. The following sections review the state-of-the-art in methods of resisting peristalsis, drug targeting systems and drug delivery. A review of actuators is presented, in the context of WCE, with a view to evaluate their acceptability in adding functionality to current WCEs. The thesis presents a novel biologically-inspired holding mechanism which overcomes the issue of resisting natural peristalsis in the GI tract. An analysis of the two components of peristaltic force, circumferential and longitudinal peristaltic contractions, are presented to ensure correct functionality of the holding mechanism. A detailed analysis of the motorised method employed to deploy the expanding mechanism is described and a 5:1 scale prototype is presented which characterises the gearbox and validates the holding mechanism. The functionality of WCE is further extended by the inclusion of a novel targeting mechanism capable of delivering a metered dose of medication to a target site of interest in the GI tract. A solution to the problem of positioning a needle within a 360 degree envelope, operating the needle and safely retracting the needle in the GI tract is discussed. A comprehensive analysis of the mechanism to manoeuvre the needle is presented and validation of the mechanism is demonstrated through the evaluation of scale prototypes. Finally a drug delivery system is presented which can expel a 1 ml dose of medication, stored onboard the capsule, into the subcutaneous tissue of the GI tract wall. An analysis of the force required to expel the medication in a set period of time is presented and the design and analysis of a variable pitch conical compression spring which will be used to deliver the medication is discussed. A thermo mechanical trigger mechanism is presented which will be employed to release the compressed conical spring. Experimental results using 1:1 scale prototype parts validate the performance of the mechanisms.Open Acces

Frontiers of robotic endoscopic capsules: a review

Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd., is an example of disruptive technology and represents an attractive alternative to traditional diagnostic techniques. WCE overcomes conventional endoscopy enabling inspection of the digestive system without discomfort or the need for sedation. Thus, it has the advantage of encouraging patients to undergo gastrointestinal (GI) tract examinations and of facilitating mass screening programmes. With the integration of further capabilities based on microrobotics, e.g. active locomotion and embedded therapeutic modules, WCE could become the key-technology for GI diagnosis and treatment. This review presents a research update on WCE and describes the state-of-the-art of current endoscopic devices with a focus on research-oriented robotic capsule endoscopes enabled by microsystem technologies. The article also presents a visionary perspective on WCE potential for screening, diagnostic and therapeutic endoscopic procedures

Advanced Endoscopic Navigation:Surgical Big Data,Methodology,and Applications

随着科学技术的飞速发展，健康与环境问题日益成为人类面临的最重大问题之一。信息科学、计算机技术、电子工程与生物医学工程等学科的综合应用交叉前沿课题，研究现代工程技术方法，探索肿瘤癌症等疾病早期诊断、治疗和康复手段。本论文综述了计算机辅助微创外科手术导航、多模态医疗大数据、方法论及其临床应用：从引入微创外科手术导航概念出发，介绍了医疗大数据的术前与术中多模态医学成像方法、阐述了先进微创外科手术导航的核心流程包括计算解剖模型、术中实时导航方案、三维可视化方法及交互式软件技术，归纳了各类微创外科手术方法的临床应用。同时，重点讨论了全球各种手术导航技术在临床应用中的优缺点，分析了目前手术导航领域内的最新技术方法。在此基础上，提出了微创外科手术方法正向数字化、个性化、精准化、诊疗一体化、机器人化以及高度智能化的发展趋势。【Abstract】Interventional endoscopy (e.g., bronchoscopy, colonoscopy, laparoscopy, cystoscopy) is a widely performed procedure that involves either diagnosis of suspicious lesions or guidance for minimally invasive surgery in a variety of organs within the body cavity. Endoscopy may also be used to guide the introduction of certain items (e.g., stents) into the body. Endoscopic navigation systems seek to integrate big data with multimodal information (e.g., computed tomography, magnetic resonance images, endoscopic video sequences, ultrasound images, external trackers) relative to the patient's anatomy, control the movement of medical endoscopes and surgical tools, and guide the surgeon's actions during endoscopic interventions. Nevertheless, it remains challenging to realize the next generation of context-aware navigated endoscopy. This review presents a broad survey of various aspects of endoscopic navigation, particularly with respect to the development of endoscopic navigation techniques. First, we investigate big data with multimodal information involved in endoscopic navigation. Next, we focus on numerous methodologies used for endoscopic navigation. We then review different endoscopic procedures in clinical applications. Finally, we discuss novel techniques and promising directions for the development of endoscopic navigation.X.L. acknowledges funding from the Fundamental Research Funds for the Central Universities. T.M.P. acknowledges funding from the Canadian Foundation for Innovation, the Canadian Institutes for Health Research, the National Sciences and Engineering Research Council of Canada, and a grant from Intuitive Surgical Inc

ENDOSCOPE GEOMETRICAL ANALYSIS AND KINEMATIC CONTROL

ABSTRACT Endoscopes are used in medical practice to effect minimally invasive diagnostics and treatments through a natural or surgical orifice. The endoscope is a snakelike device with a two degree-offreedom articulated tip that bends in any direction using internal cables actuated by knobs. In this paper we use a serial robot model of the tip to show that the tip motions are not decoupled with respect to the knob inputs nor do they have constant gains. Further in a geometrical analysis it is shown that the articulated tip always lies along a circle. A tip kinematic control strategy is developed based on small motions that is able to decouple the output motions from the input motions and provide a constant gain functions. This allows the surgeon to control the endoscope in an intuitive and efficient manner

Design, Actuation, and Functionalization of Untethered Soft Magnetic Robots with Life-Like Motions: A Review

Soft robots have demonstrated superior flexibility and functionality than conventional rigid robots. These versatile devices can respond to a wide range of external stimuli (including light, magnetic field, heat, electric field, etc.), and can perform sophisticated tasks. Notably, soft magnetic robots exhibit unparalleled advantages among numerous soft robots (such as untethered control, rapid response, and high safety), and have made remarkable progress in small-scale manipulation tasks and biomedical applications. Despite the promising potential, soft magnetic robots are still in their infancy and require significant advancements in terms of fabrication, design principles, and functional development to be viable for real-world applications. Recent progress shows that bionics can serve as an effective tool for developing soft robots. In light of this, the review is presented with two main goals: (i) exploring how innovative bioinspired strategies can revolutionize the design and actuation of soft magnetic robots to realize various life-like motions; (ii) examining how these bionic systems could benefit practical applications in small-scale solid/liquid manipulation and therapeutic/diagnostic-related biomedical fields

Enabling the future of colonoscopy with intelligent and autonomous magnetic manipulation

Early diagnosis of colorectal cancer substantially improves survival. However, over half of cases are diagnosed late due to the demand for colonoscopy—the ‘gold standard’ for screening—exceeding capacity. Colonoscopy is limited by the outdated design of conventional endoscopes, which are associated with high complexity of use, cost and pain. Magnetic endoscopes are a promising alternative and overcome the drawbacks of pain and cost, but they struggle to reach the translational stage as magnetic manipulation is complex and unintuitive. In this work, we use machine vision to develop intelligent and autonomous control of a magnetic endoscope, enabling non-expert users to effectively perform magnetic colonoscopy in vivo. We combine the use of robotics, computer vision and advanced control to offer an intuitive and effective endoscopic system. Moreover, we define the characteristics required to achieve autonomy in robotic endoscopy. The paradigm described here can be adopted in a variety of applications where navigation in unstructured environments is required, such as catheters, pancreatic endoscopy, bronchoscopy and gastroscopy. This work brings alternative endoscopic technologies closer to the translational stage, increasing the availability of early-stage cancer treatments

Control of Magnetic Continuum Robots for Endoscopy

The present thesis discusses the problem of magnetic actuation and control applied to millimetre-scale robots for endoluminal procedures. Magnetic actuation, given its remote manipulation capabilities, has the potential to overcome several limitations of current endoluminal procedures, such as the relatively large size, high sti�ness and limited dexterity of existing tools. The application of functional forces remotely facilitates the development of softer and more dexterous endoscopes, which can navigate with reduced discomfort for the patient. However, the solutions presented in literature are not always able to guarantee smooth navigation in complex and convoluted anatomical structures. This thesis aims at improving the navigational capabilities of magnetic endoluminal robots, towards achieving full autonomy. This is realized by introducing novel design, sensing and control approaches for magnetically actuated soft endoscopes and catheters. First, the application of accurate closed-loop control to a 1 Internal Permanent Magnet (IPM) endoscope was analysed. The proposed approach can guarantee better navigation capabilities, thanks to the manipulation of every mechanical Degree of Freedom (DOF) - 5 DOFs. Speci�cally, it was demonstrated that gravity can be balanced with su�cient accuracy to guarantee tip levitation. In this way contact is minimized and obstacle avoidance improved. Consequently, the overall navigation capabilities of the endoscope were enhanced for given application. To improve exploration of convoluted anatomical pathways, the design of magnetic endoscopes with multiple magnetic elements along their length was introduced. This approach to endoluminal device design can ideally allow manipulation along the full length; facilitating full shape manipulation, as compared to tip-only control. To facilitate the control of multiple magneto-mechanical DOFs along the catheters' length, a magnetic actuation method was developed based on the collaborative robotic manipulation of 2 External Permanent Magnets (EPMs). This method, compared to the state-of-the-art, facilitates large workspace and applied �eld, while guaranteeing dexterous actuation. Using this approach, it was demonstrated that it is possible to actuate up to 8 independent magnetic DOFs. In the present thesis, two di�erent applications are discussed and evaluated, namely: colonoscopy and navigational bronchoscopy. In the former, a single-IPM endoscopic approach is utilized. In this case, the anatomy is large enough to permit equipping the endoscope with a camera; allowing navigation by direct vision. Navigational bronchoscopy, on-the-other-hand, is performed in very narrow peripheral lumina, and navigation is informed via pre-operative imaging. The presented work demonstrates how the design of the magnetic catheters, informed by a pre-operative Computed Tomography (CT) scan, can mitigate the need for intra-operative imaging and, consequently, reduce radiation exposure for patients and healthcare workers. Speci�cally, an optimization routine to design the catheters is presented, with the aim of achieving follow-the-leader navigation without supervision. In both scenarios, analysis of how magnetic endoluminal devices can improve the current practice and revolutionize the future of medical diagnostics and treatment is presented and discussed