sCAM: An Untethered Insertable Laparoscopic Surgical Camera Robot

Fully insertable robotic imaging devices represent a promising future of minimally invasive laparoscopic vision. Emerging research efforts in this field have resulted in several proof-of-concept prototypes. One common drawback of these designs derives from their clumsy tethering wires which not only cause operational interference but also reduce camera mobility. Meanwhile, these insertable laparoscopic cameras are manipulated without any pose information or haptic feedback, which results in open loop motion control and raises concerns about surgical safety caused by inappropriate use of force.This dissertation proposes, implements, and validates an untethered insertable laparoscopic surgical camera (sCAM) robot. Contributions presented in this work include: (1) feasibility of an untethered fully insertable laparoscopic surgical camera, (2) camera-tissue interaction characterization and force sensing, (3) pose estimation, visualization, and feedback with sCAM, and (4) robotic-assisted closed-loop laparoscopic camera control. Borrowing the principle of spherical motors, camera anchoring and actuation are achieved through transabdominal magnetic coupling in a stator-rotor manner. To avoid the tethering wires, laparoscopic vision and control communication are realized with dedicated wireless links based on onboard power. A non-invasive indirect approach is proposed to provide real-time camera-tissue interaction force measurement, which, assisted by camera-tissue interaction modeling, predicts stress distribution over the tissue surface. Meanwhile, the camera pose is remotely estimated and visualized using complementary filtering based on onboard motion sensing. Facilitated by the force measurement and pose estimation, robotic-assisted closed-loop control has been realized in a double-loop control scheme with shared autonomy between surgeons and the robotic controller.The sCAM has brought robotic laparoscopic imaging one step further toward less invasiveness and more dexterity. Initial ex vivo test results have verified functions of the implemented sCAM design and the proposed force measurement and pose estimation approaches, demonstrating the technical feasibility of a tetherless insertable laparoscopic camera. Robotic-assisted control has shown its potential to free surgeons from low-level intricate camera manipulation workload and improve precision and intuitiveness in laparoscopic imaging

Microscope Embedded Neurosurgical Training and Intraoperative System

In the recent years, neurosurgery has been strongly influenced by new technologies. Computer Aided Surgery (CAS) offers several benefits for patients\u27 safety but fine techniques targeted to obtain minimally invasive and traumatic treatments are required, since intra-operative false movements can be devastating, resulting in patients deaths. The precision of the surgical gesture is related both to accuracy of the available technological instruments and surgeon\u27s experience. In this frame, medical training is particularly important. From a technological point of view, the use of Virtual Reality (VR) for surgeon training and Augmented Reality (AR) for intra-operative treatments offer the best results. In addition, traditional techniques for training in surgery include the use of animals, phantoms and cadavers. The main limitation of these approaches is that live tissue has different properties from dead tissue and that animal anatomy is significantly different from the human. From the medical point of view, Low-Grade Gliomas (LGGs) are intrinsic brain tumours that typically occur in younger adults. The objective of related treatment is to remove as much of the tumour as possible while minimizing damage to the healthy brain. Pathological tissue may closely resemble normal brain parenchyma when looked at through the neurosurgical microscope. The tactile appreciation of the different consistency of the tumour compared to normal brain requires considerable experience on the part of the neurosurgeon and it is a vital point. The first part of this PhD thesis presents a system for realistic simulation (visual and haptic) of the spatula palpation of the LGG. This is the first prototype of a training system using VR, haptics and a real microscope for neurosurgery. This architecture can be also adapted for intra-operative purposes. In this instance, a surgeon needs the basic setup for the Image Guided Therapy (IGT) interventions: microscope, monitors and navigated surgical instruments. The same virtual environment can be AR rendered onto the microscope optics. The objective is to enhance the surgeon\u27s ability for a better intra-operative orientation by giving him a three-dimensional view and other information necessary for a safe navigation inside the patient. The last considerations have served as motivation for the second part of this work which has been devoted to improving a prototype of an AR stereoscopic microscope for neurosurgical interventions, developed in our institute in a previous work. A completely new software has been developed in order to reuse the microscope hardware, enhancing both rendering performances and usability. Since both AR and VR share the same platform, the system can be referred to as Mixed Reality System for neurosurgery. All the components are open source or at least based on a GPL license

Development of a Physical Simulation of the Human Defecatory System for the Investigation of Continence Mechanisms

Faecal incontinence is a highly debilitating condition, prevalent across the population worldwide. Coupled with a large unmet need for clinically viable treatment options, a paucity of research into the biomechanics of continence inhibits the development of treatments which address multi-faceted challenges associated with the condition. Consequently, this thesis presents a method to fabricate, measure and control a physical simulation of the human defecatory system to investigate individual and combined effects of anorectal angle and sphincter pressure on continence. To illustrate the capabilities and clinical relevance of the work, the influence of a passive-assistive artificial anal sphincter (FENIX) is evaluated. A model rectum and associated soft tissues, based on geometry from an anonymised computerised tomography dataset, was fabricated from silicone and showed behavioural realism in terms of their morphology to the biological system and ex-vivo tissue. Simulated stool matter with similar rheological properties to human faeces was developed. Instrumentation and control hardware were used to regulate injection of simulated stool into the system, define the anorectal angle and monitor stool flow rate, intra-rectal pressure, anal canal pressure and puborectalis force. Studies were conducted to examine the response of anorectal angles at 80°, 90° and 100° with simulated stool. Tests were then repeated with the inclusion of a FENIX device. Stool leakage was reduced as the anorectal angle became more acute. Conversely, intra-rectal pressure increased. Overall inclusion of the FENIX reduced faecal leakage, while combined effects of the FENIX and an acute anorectal angle showed the greatest resistance to faecal leakage. These data demonstrate that the anorectal angle and sphincter pressure are fundamental in maintaining continence. Furthermore it demonstrates that use of the FENIX can increase resistance to faecal leakage and reduce anorectal angles required to maintain continence. The physical simulation of the defecatory system is an insightful tool to better understand, in a quantitative manner, the effects of the anorectal angle and sphincter pressure on continence. This work is valuable in helping improve our understanding of the physical behaviour of the continence mechanism and facilitating improved technologies to treat severe faecal incontinence

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

Design, characterization and validation of integrated bioelectronics for cellular studies: from inkjet-printed sensors to organic actuators

Mención Internacional en el título de doctorAdvances in bioinspired and biomimetic electronics have enabled coupling engineering devices to biological systems with unprecedented integration levels. Major efforts, however, have been devoted to interface malleable electronic devices externally to the organs and tissues. A promising alternative is embedding electronics into living tissues/organs or, turning the concept inside out, lading electronic devices with soft living matters which may accomplish remote monitoring and control of tissue’s functions from within. This endeavor may unleash the ability to engineer “living electronics” for regenerative medicine and biomedical applications. In this context, it remains a challenge to insert electronic devices efficiently with living cells in a way that there are minimal adverse reactions in the biological host while the electronics maintaining the engineered functionalities. In addition, investigating in real-time and with minimal invasion the long-term responses of biological systems that are brought in contact with such bioelectronic devices is desirable. In this work we introduce the development (design, fabrication and characterization) and validation of sensors and actuators mechanically soft and compliant to cells able to properly operate embedded into a cell culture environment, specifically of a cell line of human epithelial keratinocytes. For the development of the sensors we propose moving from conventional microtechnology approaches to techniques compatible with bioprinting in a way to support the eventual fabrication of tissues and electronic sensors in a single hybrid plataform simultaneously. For the actuators we explore the use of electroactive, organic, printing-compatible polymers to induce cellular responses as a drug-free alternative to the classic chemical route in a way to gain eventual control of biological behaviors electronically. In particular, the presented work introduces inkjet-printed interdigitated electrodes to monitor label-freely and non-invasively cellular migration, proliferation and cell-sensor adhesions of epidermal cells (HaCaT cells) using impedance spectroscopy and the effects of (dynamic) mechanical stimulation on proliferation, migration and morphology of keratinocytes by varying the magnitude, frequency and duration of mechanical stimuli exploiting the developed biocompatible actuator. The results of this thesis contribute to the envision of three-dimensional laboratory-growth tissues with built-in electronics, paving exciting avenues towards the idea of living smart cyborg-skin substitutes.En los útimos años los avances en el desarrollo de dispositivos electrónicos diseñados imitando las propiedades de sistemas vivos han logrado acoplar sistemas electrónicos y órganos/tejidos biológicos con un nivel de integración sin precedentes. Convencionalmente, la forma en que estos sistemas bioelectrónicos son integrados con órganos o tejidos ha sido a través del contacto superficial entre ambos sistemas, es decir acoplando la electrónica externamente al tejido. Lamentablemente estas aproximaciones no contemplan escenarios donde ha habido una pérdida o daño del tejido con el cual interactuar, como es el caso de daños en la piel debido a quemaduras, úlceras u otras lesiones genéticas o producidas. Una alternativa prometedora para ingeniería de tejidos y medicina regenerativa, y en particular para implantes de piel, es embeber la electrónica dentro del tejido, o presentado de otra manera, cargar el sistema electrónico con células vivas y tejidos fabricados por ingeniería de tejidos como parte innata del propio dispositivo. Este concepto permitiría no solo una monitorización remota y un control basado en señalizaciones eléctricas (sin químicos) de tejidos biológicos fabricados mediante técnicas de bioingeniería desde dentro del propio tejido, sino también la fabricación de una “electrónica viva”, biológica y eléctricamente funcional. En este contexto, es un desafío insertar de manera eficiente dispositivos electrónicos con células vivas sin desencadenar reacciones adversas en el sistema biológico receptor ni en el sistema electrónico diseñado. Además, es deseable monitorizar en tiempo real y de manera mínimamente invasiva las respuestas de dichos sistemas biológicos que se han añadido a tales dispositivos bioelectrónicos. En este trabajo presentamos el desarrollo (diseño, fabricación y caracterización) y validación de sensores y actuadores mecánicamente suaves y compatibles con células capaces de funcionar correctamente dentro de un entorno de cultivo celular, específicamente de una línea celular de células epiteliales humanas. Para el desarrollo de los sensores hemos propuesto utilizar técnicas compatibles con la bioimpresión, alejándonos de la micro fabricación tradicionalmente usada para la manufactura de sensores electrónicos, con el objetivo a largo plazo de promover la fabricación de los tejidos y los sensores electrónicos simultáneamente en un mismo sistema de impresión híbrido. Para el desarrollo de los actuadores hemos explorado el uso de polímeros electroactivos y compatibles con impresión y hemos investigado el efecto de estímulos mecánicos dinámicos en respuestas celulares con el objetivo a largo plazo de autoinducir comportamientos biológicos controlados de forma electrónica. En concreto, este trabajo presenta sensores basados en electrodos interdigitados impresos por inyección de tinta para monitorear la migración celular, proliferación y adhesiones célula-sustrato de una línea celular de células epiteliales humanas (HaCaT) en tiempo real y de manera no invasiva mediante espectroscopía de impedancia. Por otro lado, este trabajo presenta actuadores biocompatibles basados en el polímero piezoeléctrico fluoruro de poli vinilideno y ha investigado los efectos de estimular mecánicamente células epiteliales en relación con la proliferación, migración y morfología celular mediante variaciones dinámicas de la magnitud, frecuencia y duración de estímulos mecánicos explotando el actuador biocompatible propuesto. Ambos sistemas presentados como resultado de esta tesis doctoral contribuyen al desarrollo de tejidos 3D con electrónica incorporada, promoviendo una investigación hacia la fabricación de sustitutos equivalentes de piel mitad orgánica mitad electrónica como tejidos funcionales biónicos inteligentes.The main works presented in this thesis have been conducted in the facilities of the Universidad Carlos III de Madrid with support from the program Formación del Profesorado Universitario FPU015/06208 granted by Spanish Ministry of Education, Culture and Sports. Some of the work has been also developed in the facilities of the Fraunhofer-Institut für Zuverlässigkeit und Mikrointegration (IZM) and University of Applied Sciences (HTW) in Berlin, under the supervision of Prof. Dr. Ing. H-D. Ngo during a research visit funded by the Mobility Fellows Program by the Spanish Ministry of Education, Culture, and Sports. This work has been developed in the framework of the projects BIOPIELTEC-CM (P2018/BAA-4480), funded by Comunidad de Madrid, and PARAQUA (TEC2017-86271-R) funded by Ministerio de Ciencia e Innovación.Programa de Doctorado en Ingeniería Eléctrica, Electrónica y Automática por la Universidad Carlos III de MadridPresidente: José Antonio García Souto.- Secretario: Carlos Elvira Pujalte.- Vocal: María Dimak

Development of A Soft Robotic Approach for An Intra-abdominal Wireless Laparoscopic Camera

In Single-Incision Laparoscopic Surgery (SILS), the Magnetic Anchoring and Guidance System (MAGS) arises as a promising technique to provide larger workspaces and field of vision for the laparoscopes, relief space for other instruments, and require fewer incisions. Inspired by MAGS, many concept designs related to fully insertable magnetically driven laparoscopes are developed and tested on the transabdominal operation. However, ignoring the tissue interaction and insertion procedure, most of the designs adopt rigid structures, which not only damage the patients\u27 tissue with excess stress concentration and sliding motion but also require complicated operation for the insertion. Meanwhile, lacking state tracking of the insertable camera including pose and contact force, the camera systems operate in open-loop control. This provides mediocre locomotion precision and limited robustness to uncertainties in the environment. This dissertation proposes, develops, and validates a soft robotic approach for an intra-abdominal wireless laparoscopic camera. Contributions presented in this work include (1) feasibility of a soft intra-abdominal laparoscopic camera with friendly tissue interaction and convenient insertion, (2) six degrees of freedom (DOF) real-time localization, (3) Closed-loop control for a robotic-assisted laparoscopic system and (4) untethering solution for wireless communication and high-quality video transmission. Embedding magnet pairs into the camera and external actuator, the camera can be steered and anchored along the abdominal wall through transabdominal magnetic coupling. To avoid the tissue rapture by the sliding motion and dry friction, a wheel structure is applied to achieve rolling motion. Borrowing the ideas from soft robotic research, the main body of the camera implements silicone material, which grants it the bendability to passively attach along the curved abdominal wall and the deformability for easier insertion. The six-DOF pose is estimated in real-time with internal multi-sensor fusion and Newton-Raphson iteration. Combining the pose tracking and force-torque sensor measurement, an interaction model between the deformable camera and tissue is established to evaluate the interaction force over the tissue surface. Moreover, the proposed laparoscopic system is integrated with a multi-DOF manipulator into a robotic-assisted surgical system, where a closed-loop control is realized based on a feedback controller and online optimization. Finally, the wireless control and video streaming are accomplished with Bluetooth Low Energy (BLE) and Analog Video (AV) transmission. Experimental assessments have been implemented to evaluate the performance of the laparoscopic system

Laboratory Project to Demonstrate the Hall Effect

Tato bakalářská práce se zabývá tvorbou laboratorní úlohy pro demonstraci Hallova jevu. V práci je sepsán teoretický úvod do dané problematiky, který se především zabývá stavbou a fungováním Hallových senzorů. V rešeršní části je představeno nejběžnější využití senzorů a příklady jejich možného využití v medicíně. Pro laboratorní úlohu byla vytvořena aplikace v programu LabVIEW, která uživatele provádí dílčími úlohami, při kterých jsou data měřena pomocí výukové platformy NI ELVIS II. Cílem těchto úloh je objasnit fungovaní Hallových senzorů a představit jejich praktické využití pro měření polohy, vzdálenosti, otáček za minutu a průtoku.This bachelor thesis deals with the making of a laboratory project to demonstrate the Hall effect. A theoretical introduction into the given assignment is written in the thesis, which primarily deals with the building and functioning of Hall effect sensors. In the research section, the closes usage for sensors and examples for its possible utilization in medicine is introduced. For the laboratory project, an application was created in the LabVIEW program. The function of this app is to guide the users through its partial tasks during which educational platform NI ELVIS II is used to measure data. The aim of these tasks is to clarify the function of four Hall effect sensors and to introduce their practical usage for position, distance, revolutions per minute, and flow measurement.450 - Katedra kybernetiky a biomedicínského inženýrstvívýborn

Research on real-time physics-based deformation for haptic-enabled medical simulation

This study developed a multiple effective visuo-haptic surgical engine to handle a variety of surgical manipulations in real-time. Soft tissue models are based on biomechanical experiment and continuum mechanics for greater accuracy. Such models will increase the realism of future training systems and the VR/AR/MR implementations for the operating room