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 fasergeführten 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 Ausführung 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 für die endoskopische Applikation fokussierter Laserstrahlung verfügbar. Ebenfalls sind keine Systeme bekannt, die Szeneninformationen aus der endoskopischen Bildgebung in die Ablationsplanung und -ausführung 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 fünf 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 für die kontaktfreie Laserchirurgie

Development of a slender continuum robotic system for on-wing inspection/repair of gas turbine engines

The maintenance works (e.g. inspection, repair) of aero-engines while still attached on the airframes requires a desirable approach since this can significantly shorten both the time and cost of such interventions as the aerospace industry commonly operates based on the generic concept “power by the hour”. However, navigating and performing a multi-axis movement of an end-effector in a very constrained environment such as gas turbine engines is a challenging task. This paper reports on the development of a highly flexible slender (i.e. low diameter-to-length ratios) continuum robot of 25 degrees of freedom capable to uncoil from a drum to provide the feeding motion needed to navigate into crammed environments and then perform, with its last 6 DoF, complex trajectories with a camera equipped machining end-effector for allowing in-situ interventions at a low-pressure compressor of a gas turbine engine. This continuum robot is a compact system and presents a set of innovative mechatronics solutions such as: (i) twin commanding cables to minimise the number of actuators; (ii) twin compliant joints to enable large bending angles (±90°) arranged on a tapered structure (start from 40 mm to 13 mm at its end); (iii) feeding motion provided by a rotating drum for coiling/uncoiling the continuum robot; (iv) machining end-effector equipped with vision system. To be able to achieve the in-situ maintenance tasks, a set of innovative control algorithms to enable the navigation and end-effector path generation have been developed and implemented. Finally, the continuum robot has been tested both for navigation and movement of the end-effector against a specified target within a gas turbine engine mock-up proving that: (i) max. deviations in navigation from the desired path (1000 mm length with bends between 45° and 90°) are ±10 mm; (ii) max. errors in positioning the end-effector against a target situated at the end of navigation path is 1 mm. Thus, this paper presents a compact continuum robot that could be considered as a step forward in providing aero-engine manufacturers with a solution to perform complex tasks in an invasive manner

Automated sequence and motion planning for robotic spatial extrusion of 3D trusses

While robotic spatial extrusion has demonstrated a new and efficient means to fabricate 3D truss structures in architectural scale, a major challenge remains in automatically planning extrusion sequence and robotic motion for trusses with unconstrained topologies. This paper presents the first attempt in the field to rigorously formulate the extrusion sequence and motion planning (SAMP) problem, using a CSP encoding. Furthermore, this research proposes a new hierarchical planning framework to solve the extrusion SAMP problems that usually have a long planning horizon and 3D configuration complexity. By decoupling sequence and motion planning, the planning framework is able to efficiently solve the extrusion sequence, end-effector poses, joint configurations, and transition trajectories for spatial trusses with nonstandard topologies. This paper also presents the first detailed computation data to reveal the runtime bottleneck on solving SAMP problems, which provides insight and comparing baseline for future algorithmic development. Together with the algorithmic results, this paper also presents an open-source and modularized software implementation called Choreo that is machine-agnostic. To demonstrate the power of this algorithmic framework, three case studies, including real fabrication and simulation results, are presented.Comment: 24 pages, 16 figure

Multi-objective particle swarm optimization for the structural design of concentric tube continuum robots for medical applications

Concentric tube robots belong to the class of continuum robotic systems whose morphology is described by continuous tangent curvature vectors. They are composed of multiple, interacting tubes nested inside one another and are characterized by their inherent flexibility. Concentric tube continuum robots equipped with tools at their distal end have high potential in minimally invasive surgery. Their morphology enables them to reach sites within the body that are inaccessible with commercial tools or that require large incisions. Further, they can be deployed through a tight lumen or follow a nonlinear path. Fundamental research has been the focus during the last years bringing them closer to the operating room. However, there remain challenges that require attention. The structural synthesis of concentric tube continuum robots is one of these challenges, as these types of robots are characterized by their large parameter space. On the one hand, this is advantageous, as they can be deployed in different patients, anatomies, or medical applications. On the other hand, the composition of the tubes and their design is not a straightforward task but one that requires intensive knowledge of anatomy and structural behavior. Prior to the utilization of such robots, the composition of tubes (i.e. the selection of design parameters and application-specific constraints) must be solved to determine a robotic design that is specifically targeted towards an application or patient. Kinematic models that describe the change in morphology and complex motion increase the complexity of this synthesis, as their mathematical description is highly nonlinear. Thus, the state of the art is concerned with the structural design of these types of robots and proposes optimization algorithms to solve for a composition of tubes for a specific patient case or application. However, existing approaches do not consider the overall parameter space, cannot handle the nonlinearity of the model, or multiple objectives that describe most medical applications and tasks. This work aims to solve these fundamental challenges by solving the parameter optimization problem by utilizing a multi-objective optimization algorithm. The main concern of this thesis is the general methodology to solve for patient- and application-specific design of concentric tube continuum robots and presents key parameters, objectives, and constraints. The proposed optimization method is based on evolutionary concepts that can handle multiple objectives, where the set of parameters is represented by a decision vector that can be of variable dimension in multidimensional space. Global optimization algorithms specifically target the constrained search space of concentric tube continuum robots and nonlinear optimization enables to handle the highly nonlinear elasticity modeling. The proposed methodology is then evaluated based on three examples that include cooperative task deployment of two robotic arms, structural stiffness optimization under the consideration of workspace constraints and external forces, and laser-induced thermal therapy in the brain using a concentric tube continuum robot. In summary, the main contributions are 1) the development of an optimization methodology that describes the key parameters, objectives, and constraints of the parameter optimization problem of concentric tube continuum robots, 2) the selection of an appropriate optimization algorithm that can handle the multidimensional search space and diversity of the optimization problem with multiple objectives, and 3) the evaluation of the proposed optimization methodology and structural synthesis based on three real applications

Dynamic Active Constraints for Surgical Robots using Vector Field Inequalities

Robotic assistance allows surgeons to perform dexterous and tremor-free procedures, but robotic aid is still underrepresented in procedures with constrained workspaces, such as deep brain neurosurgery and endonasal surgery. In these procedures, surgeons have restricted vision to areas near the surgical tooltips, which increases the risk of unexpected collisions between the shafts of the instruments and their surroundings. In this work, our vector-field-inequalities method is extended to provide dynamic active-constraints to any number of robots and moving objects sharing the same workspace. The method is evaluated with experiments and simulations in which robot tools have to avoid collisions autonomously and in real-time, in a constrained endonasal surgical environment. Simulations show that with our method the combined trajectory error of two robotic systems is optimal. Experiments using a real robotic system show that the method can autonomously prevent collisions between the moving robots themselves and between the robots and the environment. Moreover, the framework is also successfully verified under teleoperation with tool-tissue interactions.Comment: Accepted on T-RO 2019, 19 Page

CIDGIKc: Distance-Geometric Inverse Kinematics for Continuum Robots

The small size, high dexterity, and intrinsic compliance of continuum robots (CRs) make them well suited for constrained environments. Solving the inverse kinematics (IK), that is finding robot joint configurations that satisfy desired position or pose queries, is a fundamental challenge in motion planning, control, and calibration for any robot structure. For CRs, the need to avoid obstacles in tightly confined workspaces greatly complicates the search for feasible IK solutions. Without an accurate initialization or multiple re-starts, existing algorithms often fail to find a solution. We present CIDGIKc (Convex Iteration for Distance-Geometric Inverse Kinematics for Continuum Robots), an algorithm that solves these nonconvex feasibility problems with a sequence of semidefinite programs whose objectives are designed to encourage low-rank minimizers. CIDGIKc is enabled by a novel distance-geometric parameterization of constant curvature segment geometry for CRs with extensible segments. The resulting IK formulation involves only quadratic expressions and can efficiently incorporate a large number of collision avoidance constraints. Our experimental results demonstrate >98% solve success rates within complex, highly cluttered environments which existing algorithms cannot account for

Design and Modeling of Multi-Arm Continuum Robots

Continuum robots are snake-like systems able to deliver optimal therapies to pathologies deep inside the human cavity by following 3D complex paths. They show promise when anatomical pathways need to be traversed thanks to their enhanced flexibility and dexterity and show advantages when deployed in the field of single-port surgery. This PhD thesis concerns the development and modelling of multi-arm and hybrid continuum robots for medical interventions. The flexibility and steerability of the robot’s end-effector are achieved through concentric tube technology and push/pull technology. Medical robotic prototypes have been designed as proof of concepts and testbeds of the proposed theoretical works.System design considers the limitations and constraints that occur in the surgical procedures for which the systems were proposed for. Specifically, two surgical applications are considered. Our first prototype was designed to deliver multiple tools to the eye cavity for deep orbital interventions focusing on a currently invasive intervention named Optic Nerve Sheath Fenestration (ONSF). This thesis presents the end-to-end design, engineering and modelling of the prototype. The developed prototype is the first suggested system to tackle the challenges (limited workspace, need for enhanced flexibility and dexterity, danger for harming tissue with rigid instruments, extensive manipulation of the eye) arising in ONSF. It was designed taking into account the clinical requirements and constraints while theoretical works employing the Cosserat rod theory predict the shape of the continuum end-effector. Experimental runs including ex vivo experimental evaluations, mock-up surgical scenarios and tests with and without loading conditions prove the concept of accessing the eye cavity. Moreover, a continuum robot for thoracic interventions employing push/pull technology was designed and manufactured. The developed system can reach deep seated pathologies in the lungs and access regions in the bronchial tree that are inaccessible with rigid and straight instruments either robotically or manually actuated. A geometrically exact model of the robot that considers both the geometry of the robot and mechanical properties of the backbones is presented. It can predict the shape of the bronchoscope without the constant curvature assumption. The proposed model can also predict the robot shape and micro-scale movements accurately in contrast to the classic geometric model which provides an accurate description of the robot’s differential kinematics for large scale movements