38 research outputs found
Influence of the localization strategy on the accuracy of a neurosurgical robot system
Precise navigation of surgical instruments is one of the most important features of autonomous surgical robots. In this paper, we introduce a concept of robot localization strategy and analyse its influence on the overall application error of a robot system for frameless stereotactic neurosurgery named RONNA. Localization strategies utilize specific angles at which the robot can approach a target point, orientations, and types of movement during the procedure of physical space fiducial marker localization and positioning to the target points. The localization strategies developed in this study are a neutral orientation strategy (NOS), an orientation correction strategy (OCS) and a joint displacement minimization strategy (JDMS). To evaluate the robot positioning performance with the localization strategies applied, we performed laboratory phantom measurements using a different number of fiducial markers in the registration procedure. When three, four, and five fiducial markers were used, the application error for the NOS was 1.571±0.256 mm, 1.397±0.283 mm, and 1.327±0.274 mm, and for the OCS, it was 0.429±0.133 mm, 0.284±0.068mm, and 0.260±0.076 mm, respectively. The application error for the JDMS was 0.493±0.176 mm with four and 0.369±0.160 mm with five fiducial markers used
Patient-Specific Implants in Musculoskeletal (Orthopedic) Surgery
Most of the treatments in medicine are patient specific, aren’t they? So why should we bother with individualizing implants if we adapt our therapy to patients anyway? Looking at the neighboring field of oncologic treatment, you would not question the fact that individualization of tumor therapy with personalized antibodies has led to the thriving of this field in terms of success in patient survival and positive responses to alternatives for conventional treatments. Regarding the latest cutting-edge developments in orthopedic surgery and biotechnology, including new imaging techniques and 3D-printing of bone substitutes as well as implants, we do have an armamentarium available to stimulate the race for innovation in medicine. This Special Issue of Journal of Personalized Medicine will gather all relevant new and developed techniques already in clinical practice. Examples include the developments in revision arthroplasty and tumor (pelvic replacement) surgery to recreate individual defects, individualized implants for primary arthroplasty to establish physiological joint kinematics, and personalized implants in fracture treatment, to name but a few
Virtual and Augmented Reality Techniques for Minimally Invasive Cardiac Interventions: Concept, Design, Evaluation and Pre-clinical Implementation
While less invasive techniques have been employed for some procedures, most intracardiac interventions are still performed under cardiopulmonary bypass, on the drained, arrested heart. The progress toward off-pump intracardiac interventions has been hampered by the lack of adequate visualization inside the beating heart.
This thesis describes the development, assessment, and pre-clinical implementation of a mixed reality environment that integrates pre-operative imaging and modeling with surgical tracking technologies and real-time ultrasound imaging. The intra-operative echo images are augmented with pre-operative representations of the cardiac anatomy and virtual models of the delivery instruments tracked in real time using magnetic tracking technologies. As a result, the otherwise context-less images can now be interpreted within the anatomical context provided by the anatomical models. The virtual models assist the user with the tool-to-target navigation, while real-time ultrasound ensures accurate positioning of the tool on target, providing the surgeon with sufficient information to ``see\u27\u27 and manipulate instruments in absence of direct vision.
Several pre-clinical acute evaluation studies have been conducted in vivo on swine models to assess the feasibility of the proposed environment in a clinical context. Following direct access inside the beating heart using the UCI, the proposed mixed reality environment was used to provide the necessary visualization and navigation to position a prosthetic mitral valve on the the native annulus, or to place a repair patch on a created septal defect in vivo in porcine models.
Following further development and seamless integration into the clinical workflow, we hope that the proposed mixed reality guidance environment may become a significant milestone toward enabling minimally invasive therapy on the beating heart
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
Latent Disentanglement for the Analysis and Generation of Digital Human Shapes
Analysing and generating digital human shapes is crucial for a wide variety of applications ranging from movie production to healthcare. The most common approaches for the analysis and generation of digital human shapes involve the creation of statistical shape models. At the heart of these techniques is the definition of a mapping between shapes and a low-dimensional representation. However, making these representations interpretable is still an open challenge. This thesis explores latent disentanglement as a powerful technique to make the latent space of geometric deep learning based statistical shape models more structured and interpretable. In particular, it introduces two novel techniques to disentangle the latent representation of variational autoencoders and generative adversarial networks with respect to the local shape attributes characterising the identity of the generated body and head meshes. This work was inspired by a shape completion framework that was proposed as a viable alternative to intraoperative registration in minimally invasive surgery of the liver. In addition, one of these methods for latent disentanglement was also applied to plastic surgery, where it was shown to improve the diagnosis of craniofacial syndromes and aid surgical planning
Image-Based Scene Analysis for Computer-Assisted Laparoscopic Surgery
This thesis is concerned on image-based scene analysis for computer-assisted laparoscopic surgery. The focus lies on how to extract different types of information from laparoscopic video data. Methods for semantic analysis can be used to determine what instruments and organs are currently visible and where they are located. Quantitative analysis provides numerical information on the size and distances of structures. Workflow analysis uses information from previously seen images to estimate the progression of surgery. To demonstrate that the proposed methods function in real-world scenarios, multiple evaluations on actual laparoscopic image data recorded from surgeries were performed. The proposed methods for semantic and quantitative analysis were successfully evaluated in live phantom and animal studies and also used during a live gastric bypass on a human patient
Personalized Hip and Knee Joint Replacement
This open access book describes and illustrates the surgical techniques, implants, and technologies used for the purpose of personalized implantation of hip and knee components. This new and flourishing treatment philosophy offers important benefits over conventional systematic techniques, including component positioning appropriate to individual anatomy, improved surgical reproducibility and prosthetic performance, and a reduction in complications. The techniques described in the book aim to reproduce patients’ native anatomy and physiological joint laxity, thereby improving the prosthetic hip/knee kinematics and functional outcomes in the quest of the forgotten joint. They include kinematically aligned total knee/total hip arthroplasty, partial knee replacement, and hip resurfacing. The relevance of available and emerging technological tools for these personalized approaches is also explained, with coverage of, for example, robotics, computer-assisted surgery, and augmented reality. Contributions from surgeons who are considered world leaders in diverse fields of this novel surgical philosophy make this open access book will invaluable to a wide readership, from trainees at all levels to consultants practicing lower limb surger
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 fasergefĂĽhrten
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 AusfĂĽhrung 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 fĂĽr die endoskopische
Applikation fokussierter Laserstrahlung verfĂĽgbar. Ebenfalls sind keine Systeme bekannt, die
Szeneninformationen aus der endoskopischen Bildgebung in die Ablationsplanung und -ausfĂĽhrung
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 fĂĽnf 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 fĂĽr die kontaktfreie Laserchirurgie