Surgical Applications of Compliant Mechanisms:A Review

Current surgical devices are mostly rigid and are made of stiff materials, even though their predominant use is on soft and wet tissues. With the emergence of compliant mechanisms (CMs), surgical tools can be designed to be flexible and made using soft materials. CMs offer many advantages such as monolithic fabrication, high precision, no wear, no friction, and no need for lubrication. It is therefore beneficial to consolidate the developments in this field and point to challenges ahead. With this objective, in this article, we review the application of CMs to surgical interventions. The scope of the review covers five aspects that are important in the development of surgical devices: (i) conceptual design and synthesis, (ii) analysis, (iii) materials, (iv) maim facturing, and (v) actuation. Furthermore, the surgical applications of CMs are assessed by classification into five major groups, namely, (i) grasping and cutting, (ii) reachability and steerability, (iii) transmission, (iv) sensing, and (v) implants and deployable devices. The scope and prospects of surgical devices using CMs are also discussed

Design and control of a parallel linkage wrist for robotic microsurgery

This paper presents the design and control of a teleoperated robotic system for dexterous micromanipulation tasks at the meso-scale, specifically open microsurgery. Robotic open microsurgery is an unexplored yet potentially a high impact area of surgical robotics. Microsurgical operations, such as microanastomosis of blood vessels and reattachment of nerve fibers, require high levels of manual dexterity and accuracy that surpass human capabilities. A 3-DoF robotic wrist is designed and built based on a spherical five-bar mechanism. The wrist is attached to a 3-axis commercial off-the-shelf linear stage, achieving a fully dexterous system. Design requirements are determined using motion data collected during a simulated microanastomosis operation. The wrist design is optimized to maximize workspace and manipulability. The system is teleoperated using a haptic device, and has the required bandwidth to replicate microsurgical motions. The system was successfully used in a micromanipulation task to stack 1 mm-diameter metal spheres. The micromanipulation system presented here may improve surgical outcomes during open microsurgery by offering better accuracy and dexterity to surgeons.Engineering and Applied Science

METHODS, SYSTEMS, AND DEVICES FOR SURGICAL ACCESS AND PROCEDURES

The embodiments disclosed herein relate to various medical device components, including components that can be incorporated into robotic and/or in vivo medical devices. Certain embodiments include various actuation system embodiments, including fluid actuation systems, drive train actuation systems, and motorless actuation systems. Additional embodiments include a reversibly lockable tube that can provide access for a medical device to a patient\u27s cavity and further provides a reversible rigidity or stability during operation of the device. Further embodiments include various operational components for medical devices, including medical device arm mechanisms that have both axial and rotational movement while maintaining a relatively compact structure. medical device winch components, medical device biopsy/stapler/clamp mechanisms, and medical device adjustable focus mechanisms

Cable-driven parallel robot for transoral laser phonosurgery

Transoral laser phonosurgery (TLP) is a common surgical procedure in otolaryngology. Currently, two techniques are commonly used: free beam and fibre delivery. For free beam delivery, in combination with laser scanning techniques, accurate laser pattern scanning can be achieved. However, a line-of-sight to the target is required. A suspension laryngoscope is adopted to create a straight working channel for the scanning laser beam, which could introduce lesions to the patient, and the manipulability and ergonomics are poor. For the fibre delivery approach, a flexible fibre is used to transmit the laser beam, and the distal tip of the laser fibre can be manipulated by a flexible robotic tool. The issues related to the limitation of the line-of-sight can be avoided. However, the laser scanning function is currently lost in this approach, and the performance is inferior to that of the laser scanning technique in the free beam approach. A novel cable-driven parallel robot (CDPR), LaryngoTORS, has been developed for TLP. By using a curved laryngeal blade, a straight suspension laryngoscope will not be necessary to use, which is expected to be less traumatic to the patient. Semi-autonomous free path scanning can be executed, and high precision and high repeatability of the free path can be achieved. The performance has been verified in various bench and ex vivo tests. The technical feasibility of the LaryngoTORS robot for TLP was considered and evaluated in this thesis. The LaryngoTORS robot has demonstrated the potential to offer an acceptable and feasible solution to be used in real-world clinical applications of TLP. Furthermore, the LaryngoTORS robot can combine with fibre-based optical biopsy techniques. Experiments of probe-based confocal laser endomicroscopy (pCLE) and hyperspectral fibre-optic sensing were performed. The LaryngoTORS robot demonstrates the potential to be utilised to apply the fibre-based optical biopsy of the larynx.Open Acces

Scalability study for robotic hand platform

The goal of this thesis project was to determine the lower limit of scale for the RIT robotic grasping hand. This was accomplished using a combination of computer simulation and experimental studies. A force analysis was conducted to determine the size of air muscles required to achieve appropriate contact forces at a smaller scale. Input variables, such as the actuation force and tendon return force, were determined experimentally. A dynamic computer model of the hand system was then created using Recurdyn. This was used to predict the contact (grasping) force of the fingers at full-scale, half-scale, and quarter-scale. Correlation between the computer model and physical testing was achieved for both a life-size and half-scale finger assembly. To further demonstrate the scalability of the hand design, both half and quarter-scale robotic hand rapid prototype assemblies were built using 3D printing techniques. This thesis work identified the point where further miniaturization would require a change in the manufacturing process to micro-fabrication. Several techniques were compared as potential methods for making a production intent quarter-scale robotic hand. Investment casting, Swiss machining, and Selective Laser Sintering were the manufacturing techniques considered. A quarter-scale robotic hand tested the limits of each technology. Below this scale, micro-machining would be required. The break point for the current actuation method, air muscles, was also explored. Below the quarter-scale, an alternative actuation method would also be required. Electroactive Polymers were discussed as an option for the micro-scale. In summary, a dynamic model of the RIT robotic grasping hand was created and validated as scalable at full and half-scales. The model was then used to predict finger contact forces at the quarter-scale. The quarter-scale was identified as the break point in terms of the current RIT robotic grasping hand based on both manufacturing and actuation. A novel, prototype quarter-scale robotic hand assembly was successfully built by an additive manufacturing process, a high resolution 3D printer. However, further miniaturization would require alternate manufacturing techniques and actuation mechanisms

Platforms for prototyping minimally invasive instruments

The introduction of new technologies in medicine is often an issue because there are many stages to go through, from the idea to the approval by ethical committees and mass production. This work covers the first steps of the development of a medical device, dealing with the tools that can help to reduce the time for producing the laboratory prototype. These tools can involve electronics and software for the creation of a “universal”' hardware platform that can be used for many robotic applications, adapting only few components for the specific scenario. The platform is created by setting up a traditional computer with operating system and acquisition channels aimed at opening the system toward the real environment. On this platform algorithms can be implemented rapidly, allowing to assess the feasibility of an idea. This approach lets the designer concentrate on the application rather than on the selection of the appropriate hardware electronics every time that a new project starts. In the first part an overview of the existing instruments for minimally invasive interventions that can be found as commercial or research products is given. An introduction related to hardware electronics is presented with the requirements and the specific characteristics needed for a robotic application. The second part focuses on specific projects in MIS. The first project concerns the study and the development of a lightweight hand-held robotic instrument for laparoscopy. Motivations are related to the lack of dexterous hand-held laparoscopic instruments. The second project concerns the study and the presentation of a prototype of a robotic endoscope with enhanced resolution. The third project concerns the development of a system able to detect the inspiration and the expiration phases. The aim is to evaluate the weariness of the surgeon, since breathing can be related to fatigue

A flexible access platform for robot-assisted minimally invasive surgery

Advances in Minimally Invasive Surgery (MIS) are driven by the clinical demand to reduce the invasiveness of surgical procedures so patients undergo less trauma and experience faster recoveries. These well documented benefits of MIS have been achieved through parallel advances in the technology and instrumentation used during procedures. The new and evolving field of Flexible Access Surgery (FAS), where surgeons access the operative site through a single incision or a natural orifice incision, is being promoted as the next potential step in the evolution of surgery. In order to achieve similar levels of success and adoption as MIS, technology again has its role to play in developing new instruments to solve the unmet clinical challenges of FAS. As procedures become less invasive, these instruments should not just address the challenges presented by the complex access routes of FAS, but should also build on the recent advances in pre- and intraoperative imaging techniques to provide surgeons with new diagnostic and interventional decision making capabilities. The main focus of this thesis is the development and applications of a flexible robotic device that is capable of providing controlled flexibility along curved pathways inside the body. The principal component of the device is its modular mechatronic joint design which utilises an embedded micromotor-tendon actuation scheme to provide independently addressable degrees of freedom and three internal working channels. Connecting multiple modules together allows a seven degree-of-freedom (DoF) flexible access platform to be constructed. The platform is intended for use as a research test-bed to explore engineering and surgical challenges of FAS. Navigation of the platform is realised using a handheld controller optimised for functionality and ergonomics, or in a "hands-free" manner via a gaze contingent control framework. Under this framework, the operator's gaze fixation point is used as feedback to close the servo control loop. The feasibility and potential of integrating multi-spectral imaging capabilities into flexible robotic devices is also demonstrated. A force adaptive servoing mechanism is developed to simplify the deployment, and improve the consistency of probe-based optical imaging techniques by automatically controlling the contact force between the probe tip and target tissue. The thesis concludes with the description of two FAS case studies performed with the platform during in-vivo porcine experiments. These studies demonstrate the ability of the platform to perform large area explorations within the peritoneal cavity and to provide a stable base for the deployment of interventional instruments and imaging probes