179 research outputs found
Surgical Subtask Automation for Intraluminal Procedures using Deep Reinforcement Learning
Intraluminal procedures have opened up a new sub-field of minimally invasive surgery that use flexible instruments to navigate through complex luminal structures of the body, resulting in reduced invasiveness and improved patient benefits. One of the major challenges in this field is the accurate and precise control of the instrument inside the human body. Robotics has emerged as a promising solution to this problem. However, to achieve successful robotic intraluminal interventions, the control of the instrument needs to be automated to a large extent. The thesis first examines the state-of-the-art in intraluminal surgical robotics and identifies the key challenges in this field, which include the need for safe and effective tool manipulation, and the ability to adapt to unexpected changes in the luminal environment. To address these challenges, the thesis proposes several levels of autonomy that enable the robotic system to perform individual subtasks autonomously, while still allowing the surgeon to retain overall control of the procedure. The approach facilitates the development of specialized algorithms such as Deep Reinforcement Learning (DRL) for subtasks like navigation and tissue manipulation to produce robust surgical gestures. Additionally, the thesis proposes a safety framework that provides formal guarantees to prevent risky actions. The presented approaches are evaluated through a series of experiments using simulation and robotic platforms. The experiments demonstrate that subtask automation can improve the accuracy and efficiency of tool positioning and tissue manipulation, while also reducing the cognitive load on the surgeon. The results of this research have the potential to improve the reliability and safety of intraluminal surgical interventions, ultimately leading to better outcomes for patients and surgeons
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
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
patientâs 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 fasergefĂŒhrten
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 langjÀhriges chirurgisches Training, um die Funktion der angrenzenden Organe zu
sichern und damit die LebensqualitĂ€t der Patienten zu erhalten. Die Positionierung des mikroskopis chen Laserapplikators auĂerhalb des Patienten kann zudem die direkte Sicht auf das Zielgebiet
durch anatomische VariabilitÀt erschweren und den Arbeitsraum einschrÀnken. Weitere klinische
Herausforderungen betreffen die Positionierung des Laserfokus auf der GewebeoberflÀche, die
Bildgebung, die Planung und AusfĂŒhrung der Laserablation sowie intraoperative Bewegungen
des Zielgebietes. Die vorliegende Dissertation zielt darauf ab, die Limitierungen der TLM durch
robotische AnsÀtze und intraoperative Assistenz zu adressieren. Obwohl ein Trend zur minimal
invasiven Chirurgie besteht, sind bislang keine hochintegrierten Plattformen fĂŒr die endoskopische
Applikation fokussierter Laserstrahlung verfĂŒgbar. Ebenfalls sind keine Systeme bekannt, die
Szeneninformationen aus der endoskopischen Bildgebung in die Ablationsplanung und -ausfĂŒhrung
einbeziehen. FĂŒr eine situsnahe Fokussierung des Laserstrahls wird in dieser Arbeit zunĂ€chst
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
lÀngenverÀnderlichen Kontinuumsmanipulator. Letzterer ermöglicht in Kombination mit einer
mechatronischen Aktuierungseinheit Bewegungen des Endoskopkopfes in fĂŒnf Freiheitsgraden.
Die kinematische Modellierung und Regelung des Systems werden in ein modulares Framework
eingebunden und evaluiert. Die Manipulation fokussierter Laserstrahlung erfordert zudem eine
prĂ€zise Anpassung der Fokuslage auf das Gewebe. DafĂŒr werden visuelle, haptische und visuell haptische Assistenzfunktionen eingefĂŒhrt. Diese unterstĂŒtzen 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 betrÀgt dabei 0,5 mm. Zur Automatisierung der Ablation
werden abschlieĂend Methoden der bildgestĂŒtzten Regelung vorgestellt. Experimente bestĂ€tigen
einen positiven Effekt der Automationskonzepte fĂŒr die kontaktfreie Laserchirurgie
Snake-Like Robots for Minimally Invasive, Single Port, and Intraluminal Surgeries
The surgical paradigm of Minimally Invasive Surgery (MIS) has been a key
driver to the adoption of robotic surgical assistance. Progress in the last
three decades has led to a gradual transition from manual laparoscopic surgery
with rigid instruments to robot-assisted surgery. In the last decade, the
increasing demand for new surgical paradigms to enable access into the anatomy
without skin incision (intraluminal surgery) or with a single skin incision
(Single Port Access surgery - SPA) has led researchers to investigate
snake-like flexible surgical devices. In this chapter, we first present an
overview of the background, motivation, and taxonomy of MIS and its newer
derivatives. Challenges of MIS and its newer derivatives (SPA and intraluminal
surgery) are outlined along with the architectures of new snake-like robots
meeting these challenges. We also examine the commercial and research surgical
platforms developed over the years, to address the specific functional
requirements and constraints imposed by operations in confined spaces. The
chapter concludes with an evaluation of open problems in surgical robotics for
intraluminal and SPA, and a look at future trends in surgical robot design that
could potentially address these unmet needs.Comment: 41 pages, 18 figures. Preprint of article published in the
Encyclopedia of Medical Robotics 2018, World Scientific Publishing Company
www.worldscientific.com/doi/abs/10.1142/9789813232266_000
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
Robot Autonomy for Surgery
Autonomous surgery involves having surgical tasks performed by a robot
operating under its own will, with partial or no human involvement. There are
several important advantages of automation in surgery, which include increasing
precision of care due to sub-millimeter robot control, real-time utilization of
biosignals for interventional care, improvements to surgical efficiency and
execution, and computer-aided guidance under various medical imaging and
sensing modalities. While these methods may displace some tasks of surgical
teams and individual surgeons, they also present new capabilities in
interventions that are too difficult or go beyond the skills of a human. In
this chapter, we provide an overview of robot autonomy in commercial use and in
research, and present some of the challenges faced in developing autonomous
surgical robots
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Mobility, Navigation and Localization Towards Robotic Endoscopy
With significant progress being made towards improving endoscope technology such as capsule endoscopy and robotic endoscopy, the development of advanced strategies for manipulating, controlling and more generally, easing the accessibility of these devices for physicians is an important next step. This work presents the development of several robotic platforms for experimentally testing navigation and localization strategies in robotic endoscopy followed by the development and testing of navigation strategies using these devices. Finally, visual and visual inertial localization and mapping is explored on two of these robotic systems. We first present a detailed description on the state-of-the-art with regard to minimally invasive robotic surgery and then follow this with in-depth description of our design and validation of two important systems, the Robotic Endoscope Platform (REP) and the Modular Endoscopy Simulation Apparatus (MESA), for exploring some of the challenges in robotic endoscopy. Following these descriptions we present a technique for autonomous navigation of the REP within the MESA as well as an attempt at applying Simultaneous Localization and Mapping (SLAM) to allow for the real-time localization of this system. Finally, we transition these techniques to the Endoculus, a complete robotic endoscope suitable for in vivo testing, and demonstrate both autonomous navigation for this device, and the implementation of three different SLAM systems for localization and mapping of the Endoculus system in real-time. Throughout these experiments we demonstrate the potential for advanced methods in computer vision along with other sensory techniques to substantially benefit endoscopy, enabling greater and greater autonomy of these systems and furthering the case for robotic endoscopy as a whole.</p
Challenges of continuum robots in clinical context: a review
With the maturity of surgical robotic systems based on traditional rigid-link principles, the rate of progress slowed as limits of size and controllable degrees of freedom were reached. Continuum robots came with the potential to deliver a step change in the next generation of medical devices, by providing better access, safer interactions and making new procedures possible. Over the last few years, several continuum robotic systems have been launched commercially and have been increasingly adopted in hospitals. Despite the clear progress achieved, continuum robots still suffer from design complexity hindering their dexterity and scalability. Recent advances in actuation methods have looked to address this issue, offering alternatives to commonly employed approaches. Additionally, continuum structures introduce significant complexity in modelling, sensing, control and fabrication; topics which are of particular focus in the robotics community. It is, therefore, the aim of the presented work to highlight the pertinent areas of active research and to discuss the challenges to be addressed before the potential of continuum robots as medical devices may be fully realised
Surgical Navigation System for Transsphenoidal Pituitary Surgery Applying U-Net-Based Automatic Segmentation and Bendable Devices
Conventional navigation systems used in transsphenoidal pituitary surgery have limitations that may lead to organ damage, including long image registration time, absence of alarms when approaching vital organs and lack of 3-D model information. To resolve the problems of conventional navigation systems, this study proposes a U-Net-based, automatic segmentation algorithm for optical nerves and internal carotid arteries, by training patient computed tomography angiography images. The authors have also developed a bendable endoscope and surgical tool to eliminate blind regions that occur when using straight, rigid, conventional endoscopes and surgical tools during transsphenoidal pituitary surgery. In this study, the effectiveness of a U-Net-based navigation system integrated with bendable surgical tools and a bendable endoscope has been demonstrated through phantom-based experiments. In order to measure the U-net performance, the Jaccard similarity, recall and precision were calculated. In addition, the fiducial and target registration errors of the navigation system and the accuracy of the alarm warning functions were measured in the phantom-based environment. © 2019 by the authors.1
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