26 research outputs found
Cable-driven parallel mechanisms for minimally invasive robotic surgery
Minimally invasive surgery (MIS) has revolutionised surgery by providing faster recovery times, less post-operative complications, improved cosmesis and reduced pain for the patient. Surgical robotics are used to further decrease the invasiveness of procedures, by using yet smaller and fewer incisions or using natural orifices as entry point. However, many robotic systems still suffer from technical challenges such as sufficient instrument dexterity and payloads, leading to limited adoption in clinical practice. Cable-driven parallel mechanisms (CDPMs) have unique properties, which can be used to overcome existing challenges in surgical robotics. These beneficial properties include high end-effector payloads, efficient force transmission and a large configurable instrument workspace. However, the use of CDPMs in MIS is largely unexplored. This research presents the first structured exploration of CDPMs for MIS and demonstrates the potential of this type of mechanism through the development of multiple prototypes: the ESD CYCLOPS, CDAQS, SIMPLE, neuroCYCLOPS and microCYCLOPS. One key challenge for MIS is the access method used to introduce CDPMs into the body. Three different access methods are presented by the prototypes. By focusing on the minimally invasive access method in which CDPMs are introduced into the body, the thesis provides a framework, which can be used by researchers, engineers and clinicians to identify future opportunities of CDPMs in MIS. Additionally, through user studies and pre-clinical studies, these prototypes demonstrate that this type of mechanism has several key advantages for surgical applications in which haptic feedback, safe automation or a high payload are required. These advantages, combined with the different access methods, demonstrate that CDPMs can have a key role in the advancement of MIS technology.Open Acces
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
Modeling, Analysis, Force Sensing and Control of Continuum Robots for Minimally Invasive Surgery
This dissertation describes design, modeling and application of continuum robotics for surgical applications, specifically parallel continuum robots (PCRs) and concentric tube manipulators (CTMs). The introduction of robotics into surgical applications has allowed for a greater degree of precision, less invasive access to more remote surgical sites, and user-intuitive interfaces with enhanced vision systems. The most recent developments have been in the space of continuum robots, whose exible structure create an inherent safety factor when in contact with fragile tissues. The design challenges that exist involve balancing size and strength of the manipulators, controlling the manipulators over long transmission pathways, and incorporating force sensing and feedback from the manipulators to the user.
Contributions presented in this work include: (1) prototyping, design, force sensing, and force control investigations of PCRs, and (2) prototyping of a concentric tube manipulator for use in a standard colonoscope. A general kinetostatic model is presented for PCRs along with identification of multiple physical constraints encountered in design and construction. Design considerations and manipulator capabilities are examined in the form of matrix metrics and ellipsoid representations. Finally, force sensing and control are explored and experimental results are provided showing the accuracy of force estimates based on actuation force measurements and control capabilities.
An overview of the design requirements, manipulator construction, analysis and experimental results are provided for a CTM used as a tool manipulator in a traditional colonoscope. Currently, tools used in colonoscopic procedures are straight and exit the front of the scope with 1 DOF of operation (jaws of a grasper, tightening of a loop, etc.). This research shows that with a CTM deployed, the dexterity of these tools can be increased dramatically, increasing accuracy of tool operation, ease of use and safety of the overall procedure. The prototype investigated in this work allows for multiple tools to be used during a single procedure. Experimental results show the feasibility and advantages of the newly-designed manipulators
Snake Robots for Surgical Applications: A Review
Although substantial advancements have been achieved in robot-assisted surgery, the blueprint to existing snake robotics predominantly focuses on the preliminary structural design, control, and human–robot interfaces, with features which have not been particularly explored in the literature. This paper aims to conduct a review of planning and operation concepts of hyper-redundant serpentine robots for surgical use, as well as any future challenges and solutions for better manipulation. Current researchers in the field of the manufacture and navigation of snake robots have faced issues, such as a low dexterity of the end-effectors around delicate organs, state estimation and the lack of depth perception on two-dimensional screens. A wide range of robots have been analysed, such as the i2Snake robot, inspiring the use of force and position feedback, visual servoing and augmented reality (AR). We present the types of actuation methods, robot kinematics, dynamics, sensing, and prospects of AR integration in snake robots, whilst addressing their shortcomings to facilitate the surgeon’s task. For a smoother gait control, validation and optimization algorithms such as deep learning databases are examined to mitigate redundancy in module linkage backlash and accidental self-collision. In essence, we aim to provide an outlook on robot configurations during motion by enhancing their material compositions within anatomical biocompatibility standards
LaryngoTORS: a novel cable-driven parallel robotic system for transoral laser phonosurgery
Transoral laser phonosurgery is a commonly used surgical procedure in which a laser beam is used to perform incision, ablation or photocoagulation of laryngeal tissues. Two techniques are commonly practiced: free beam and fiber delivery. For free beam delivery, a laser scanner is integrated into a surgical microscope to provide an accurate laser scanning pattern. This approach can only be used under direct line of sight, which may cause increased postoperative pain to the patient and injury, is uncomfortable for the surgeon during prolonged operations, the manipulability is poor and extensive training is required. In contrast, in the fiber delivery technique, a flexible fiber is used to transmit the laser beam and therefore does not require direct line of sight. However, this can only achieve manual level accuracy, repeatability and velocity, and does not allow for pattern scanning. Robotic systems have been developed to overcome the limitations of both techniques. However, these systems offer limited workspace and degrees-of-freedom (DoF), limiting their clinical applicability. This work presents the LaryngoTORS, a robotic system that aims at overcoming the limitations of the two techniques, by using a cable-driven parallel mechanism (CDPM) attached at the end of a curved laryngeal blade for controlling the end tip of the laser fiber. The system allows autonomous generation of scanning patterns or user driven freepath scanning. Path scan validation demonstrated errors as low as 0.054±0.028 mm and high repeatability of 0.027±0.020 mm (6×2 mm arc line). Ex vivo tests on chicken tissue have been carried out. The results show the ability of the system to overcome limitations of current methods with high accuracy and repeatability using the superior fiber delivery approach
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
Soft Robot-Assisted Minimally Invasive Surgery and Interventions: Advances and Outlook
Since the emergence of soft robotics around two decades ago, research interest in the field has escalated at a pace. It is fuelled by the industry's appreciation of the wide range of soft materials available that can be used to create highly dexterous robots with adaptability characteristics far beyond that which can be achieved with rigid component devices. The ability, inherent in soft robots, to compliantly adapt to the environment, has significantly sparked interest from the surgical robotics community. This article provides an in-depth overview of recent progress and outlines the remaining challenges in the development of soft robotics for minimally invasive surgery
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