Discriminating tissue stiffness with a haptic catheter: Feeling the inside of the beating heart

Catheter devices allow physicians to access the inside of the human body easily and painlessly through natural orifices and vessels. Although catheters allow for the delivery of fluids and drugs, the deployment of devices, and the acquisition of the measurements, they do not allow clinicians to assess the physical properties of tissue inside the body due to the tissue motion and transmission limitations of the catheter devices, including compliance, friction, and backlash. The goal of this research is to increase the tactile information available to physicians during catheter procedures by providing haptic feedback during palpation procedures. To accomplish this goal, we have developed the first motion compensated actuated catheter system that enables haptic perception of fast moving tissue structures. The actuated catheter is instrumented with a distal tip force sensor and a force feedback interface that allows users to adjust the position of the catheter while experiencing the forces on the catheter tip. The efficacy of this device and interface is evaluated through a psychophyisical study comparing how accurately users can differentiate various materials attached to a cardiac motion simulator using the haptic device and a conventional manual catheter. The results demonstrate that haptics improves a user's ability to differentiate material properties and decreases the total number of errors by 50% over the manual catheter system.Engineering and Applied Science

Context-aware learning for robot-assisted endovascular catheterization

Endovascular intervention has become a mainstream treatment of cardiovascular diseases. However, multiple challenges remain such as unwanted radiation exposures, limited two-dimensional image guidance, insufficient force perception and haptic cues. Fast evolving robot-assisted platforms improve the stability and accuracy of instrument manipulation. The master-slave system also removes radiation to the operator. However, the integration of robotic systems into the current surgical workflow is still debatable since repetitive, easy tasks have little value to be executed by the robotic teleoperation. Current systems offer very low autonomy, potential autonomous features could bring more benefits such as reduced cognitive workloads and human error, safer and more consistent instrument manipulation, ability to incorporate various medical imaging and sensing modalities. This research proposes frameworks for automated catheterisation with different machine learning-based algorithms, includes Learning-from-Demonstration, Reinforcement Learning, and Imitation Learning. Those frameworks focused on integrating context for tasks in the process of skill learning, hence achieving better adaptation to different situations and safer tool-tissue interactions. Furthermore, the autonomous feature was applied to next-generation, MR-safe robotic catheterisation platform. The results provide important insights into improving catheter navigation in the form of autonomous task planning, self-optimization with clinical relevant factors, and motivate the design of intelligent, intuitive, and collaborative robots under non-ionizing image modalities.Open Acces

Image-Based Force Estimation and Haptic Rendering For Robot-Assisted Cardiovascular Intervention

Clinical studies have indicated that the loss of haptic perception is the prime limitation of robot-assisted cardiovascular intervention technology, hindering its global adoption. It causes compromised situational awareness for the surgeon during the intervention and may lead to health risks for the patients. This doctoral research was aimed at developing technology for addressing the limitation of the robot-assisted intervention technology in the provision of haptic feedback. The literature review showed that sensor-free force estimation (haptic cue) on endovascular devices, intuitive surgeon interface design, and haptic rendering within the surgeon interface were the major knowledge gaps. For sensor-free force estimation, first, an image-based force estimation methods based on inverse finite-element methods (iFEM) was developed and validated. Next, to address the limitation of the iFEM method in real-time performance, an inverse Cosserat rod model (iCORD) with a computationally efficient solution for endovascular devices was developed and validated. Afterward, the iCORD was adopted for analytical tip force estimation on steerable catheters. The experimental studies confirmed the accuracy and real-time performance of the iCORD for sensor-free force estimation. Afterward, a wearable drift-free rotation measurement device (MiCarp) was developed to facilitate the design of an intuitive surgeon interface by decoupling the rotation measurement from the insertion measurement. The validation studies showed that MiCarp had a superior performance for spatial rotation measurement compared to other modalities. In the end, a novel haptic feedback system based on smart magnetoelastic elastomers was developed, analytically modeled, and experimentally validated. The proposed haptics-enabled surgeon module had an unbounded workspace for interventional tasks and provided an intuitive interface. Experimental validation, at component and system levels, confirmed the usability of the proposed methods for robot-assisted intervention systems

Robotic Catheters for Beating Heart Surgery

Compliant and flexible cardiac catheters provide direct access to the inside of the heart via the vascular system without requiring clinicians to stop the heart or open the chest. However, the fast motion of the intracardiac structures makes it difficult to modify and repair the cardiac tissue in a controlled and safe manner. In addition, rigid robotic tools for beating heart surgery require the chest to be opened and the heart exposed, making the procedures highly invasive. The novel robotic catheter system presented here enables minimally invasive repair on the fast-moving structures inside the heart, like the mitral valve annulus, without the invasiveness or risks of stopped heart procedures. In this thesis, I investigate the development of 3D ultrasound-guided robotic catheters for beating heart surgery. First, the force and stiffness values of tissue structures in the left atrium are measured to develop design requirements for the system. This research shows that a catheter will experience contractile forces of 0.5 – 1.0 N and a mean tissue structure stiffness of approximately 0.1 N/mm while interacting with the mitral valve annulus. Next, this thesis presents the catheter system design, including force sensing, tissue resection, and ablation end effectors. In order to operate inside the beating heart, position and force control systems were developed to compensate for the catheter performance limitations of friction and deadzone backlash and evaluated with ex vivo and in vivo experiments. Through the addition of friction and deadzone compensation terms, the system is able to achieve position tracking with less than 1 mm RMS error and force tracking with 0.08 N RMS error under ultrasound image guidance. Finally, this thesis examines how the robotic catheter system enhances beating heart clinical procedures. Specifically, this system improves resection quality while reducing the forces experienced by the tissue by almost 80% and improves ablation performance by reducing contact resistance variations by 97% while applying a constant force on the moving tissue.Engineering and Applied Science

OPTICAL-BASED TACTILE SENSORS FOR MINIMALLY INVASIVE SURGERIES: DESIGN, MODELING, FABRICATION AND VALIDATION

Loss of tactile perception is the most challenging limitation of state-of-the-art technology for minimally invasive surgery. In conventional open surgery, surgeons rely on their tactile sensation to perceive the tissue type, anatomical landmarks, and instrument-tissue interaction in the patient’s body. To compensate for the loss of tactile feedback in minimally invasive surgery, researchers have proposed various tactile sensors based on electrical and optical sensing principles. Optical-based sensors have shown the most compatibility with the functional and physical requirements of minimally invasive surgery applications. However, the proposed tactile sensors in the literature are typically bulky, expensive, cumbersome to integrate with surgical instruments and show nonlinearity in interaction with biological tissues. In this doctoral study, different optical tactile sensing principles were proposed, modeled, validated and various tactile sensors were fabricated, and experimentally studied to address the limitations of the state-of-the-art. The present thesis first provides a critical review of the proposed tactile sensors in the literature with a comparison of their advantages and limitations for surgical applications. Afterward, it compiles the results of the design, modeling, and validation of a hybrid optical-piezoresistive sensor, a distributed Bragg reflecting sensor, and two sensors based on the variable bending radius light intensity modulation principle. The performance of each sensor was verified experimentally for the required criteria of accuracy, resolution, range, repeatability, and hysteresis. Also, a novel image-based intensity estimation technique was proposed and its applicability for being used in surgical applications was verified experimentally. In the end, concluding remarks and recommendations for future studies are provided

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

Haptische Darstellung von Interaktionskräften in einem Assistenzsystem für Herzkatheterisierungen

In den letzten Jahren haben minimalinvasive Operationstechniken die Medizin durch die Ermöglichung komplexer Eingriffe beispielsweise im Bauchraum oder am Herzen durch das für Patienten gegenüber herkömmlichen Operationen geringere Risiko revolutioniert. Einer der Nachteile minimalinvasiver Techniken ist jedoch der Verlust der haptischen Wahrnehmung des Chirurgen. In dieser Arbeit wird daher eine Aktorik für ein Assistenzsystem zur Darstellung haptischer Interaktionskräfte für Herzkatheterisierungen entwickelt. Auf Basis der physiologischen Grundlagen der haptischen Wahrnehmung des Menschen und des Stands der Technik erfolgt im ersten Teil dieser Arbeit eine umfassende Analyse geeigneter Aktorprinzipien. Davon ausgehend wird ein bimodales piezoelektrisches Antriebskonzept entwickelt und aufgebaut. Ein spezieller, bimodal schwingender piezoelektrischer Stapelaktor erzeugt bei einem stabförmigen mechanischen Resonator eine longitudinale und eine transversale Schwingung. Bei einem Resonator mit gebogen Spitze ist eine zweidimensionale Schwingung auch mit einem üblichen symmetrischen Stapelaktoraufbau möglich. Die Überlagerung beider Schwingungen erzeugt an der Spitze des Resonators eine geschlossene Bewegung, die zur Kraftkopplung auf den Führungsdraht genutzt wird. Der Entwurf des Resonators erfolgt zunächst durch analytische Berechnungen. Im Anschluss werden die Ergebnisse mit Hilfe numerischer Lösungsverfahren präzisiert. Im zweiten Teil dieser Arbeit wird der Entwurf und Aufbau eines Verstärkers zur Ansteuerung des piezoelektrischen Aktors dargestellt. Der Verstärker, der ein Ansteuersignal auf eine Spannungsamplitude von 300 V erhöht, zeichnet sich dadurch aus, dass er im Gegensatz zu am Markt erhältlichen Verstärkern trotz der kapazitiven Last des Aktors die Amplitude des hochfrequenten Ansteuersignals nahezu verzerrungsfrei und ohne Dämpfung verstärkt. Die Charakterisierung des piezoelektrischen Ultraschallaktors, die den dritten Themenkomplex dieser Arbeit darstellt, macht die Entwicklung und den Aufbau eines Versuchsumgebung notwendig. In diesem treibt der piezoelektrische Ultraschallaktor eine luftgelagerte Kugel an, deren Rotationsbewegung über zwei optische Sensoren erfasst wird. In verschiedenen Versuchsreihen wird der Einfluss der Amplitude des Ansteuersignals, der Kontaktkraft, der Ansteuerfrequenz sowie der Einfluss von Verschmutzung und der Rauigkeit der Rotoroberfläche auf die gekoppelte Kraft untersucht. Der Erfolg eines neuartigen Assistenzsystems für die Medizintechnik hängt wesentlich von der Gestaltung und der Gebrauchstauglichkeit der Bedieneinheit ab, mit der die Ärzte interagieren. Auf Basis zahlreicher Gespräche mit Kardiologen sowie aus den Ergebnissen einer Designstudie wird abschließend eine Bedieneinheit für das Assistenzsystem entworfe