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

Advanced Strategies for Robot Manipulators

Amongst the robotic systems, robot manipulators have proven themselves to be of increasing importance and are widely adopted to substitute for human in repetitive and/or hazardous tasks. Modern manipulators are designed complicatedly and need to do more precise, crucial and critical tasks. So, the simple traditional control methods cannot be efficient, and advanced control strategies with considering special constraints are needed to establish. In spite of the fact that groundbreaking researches have been carried out in this realm until now, there are still many novel aspects which have to be explored

Visual Tracking in Robotic Minimally Invasive Surgery

Intra-operative imaging and robotics are some of the technologies driving forward better and more effective minimally invasive surgical procedures. To advance surgical practice and capabilities further, one of the key requirements for computationally enhanced interventions is to know how instruments and tissues move during the operation. While endoscopic video captures motion, the complex appearance dynamic effects of surgical scenes are challenging for computer vision algorithms to handle with robustness. Tackling both tissue and instrument motion estimation, this thesis proposes a combined non-rigid surface deformation estimation method to track tissue surfaces robustly and in conditions with poor illumination. For instrument tracking, a keypoint based 2D tracker that relies on the Generalized Hough Transform is developed to initialize a 3D tracker in order to robustly track surgical instruments through long sequences that contain complex motions. To handle appearance changes and occlusion a patch-based adaptive weighting with segmentation and scale tracking framework is developed. It takes a tracking-by-detection approach and a segmentation model is used to assigns weights to template patches in order to suppress back- ground information. The performance of the method is thoroughly evaluated showing that without any offline-training, the tracker works well even in complex environments. Finally, the thesis proposes a novel 2D articulated instrument pose estimation framework, which includes detection-regression fully convolutional network and a multiple instrument parsing component. The framework achieves compelling performance and illustrates interesting properties includ- ing transfer between different instrument types and between ex vivo and in vivo data. In summary, the thesis advances the state-of-the art in visual tracking for surgical applications for both tissue and instrument motion estimation. It contributes to developing the technological capability of full surgical scene understanding from endoscopic video

Development of a Surgical Assistance System for Guiding Transcatheter Aortic Valve Implantation

Development of image-guided interventional systems is growing up rapidly in the recent years. These new systems become an essential part of the modern minimally invasive surgical procedures, especially for the cardiac surgery. Transcatheter aortic valve implantation (TAVI) is a recently developed surgical technique to treat severe aortic valve stenosis in elderly and high-risk patients. The placement of stented aortic valve prosthesis is crucial and typically performed under live 2D fluoroscopy guidance. To assist the placement of the prosthesis during the surgical procedure, a new fluoroscopy-based TAVI assistance system has been developed. The developed assistance system integrates a 3D geometrical aortic mesh model and anatomical valve landmarks with live 2D fluoroscopic images. The 3D aortic mesh model and landmarks are reconstructed from interventional angiographic and fluoroscopic C-arm CT system, and a target area of valve implantation is automatically estimated using these aortic mesh models. Based on template-based tracking approach, the overlay of visualized 3D aortic mesh model, landmarks and target area of implantation onto fluoroscopic images is updated by approximating the aortic root motion from a pigtail catheter motion without contrast agent. A rigid intensity-based registration method is also used to track continuously the aortic root motion in the presence of contrast agent. Moreover, the aortic valve prosthesis is tracked in fluoroscopic images to guide the surgeon to perform the appropriate placement of prosthesis into the estimated target area of implantation. An interactive graphical user interface for the surgeon is developed to initialize the system algorithms, control the visualization view of the guidance results, and correct manually overlay errors if needed. Retrospective experiments were carried out on several patient datasets from the clinical routine of the TAVI in a hybrid operating room. The maximum displacement errors were small for both the dynamic overlay of aortic mesh models and tracking the prosthesis, and within the clinically accepted ranges. High success rates of the developed assistance system were obtained for all tested patient datasets. The results show that the developed surgical assistance system provides a helpful tool for the surgeon by automatically defining the desired placement position of the prosthesis during the surgical procedure of the TAVI.Die Entwicklung bildgeführter interventioneller Systeme wächst rasant in den letzten Jahren. Diese neuen Systeme werden zunehmend ein wesentlicher Bestandteil der technischen Ausstattung bei modernen minimal-invasiven chirurgischen Eingriffen. Diese Entwicklung gilt besonders für die Herzchirurgie. Transkatheter Aortenklappen-Implantation (TAKI) ist eine neue entwickelte Operationstechnik zur Behandlung der schweren Aortenklappen-Stenose bei alten und Hochrisiko-Patienten. Die Platzierung der Aortenklappenprothese ist entscheidend und wird in der Regel unter live-2D-fluoroskopischen Bildgebung durchgeführt. Zur Unterstützung der Platzierung der Prothese während des chirurgischen Eingriffs wurde in dieser Arbeit ein neues Fluoroskopie-basiertes TAKI Assistenzsystem entwickelt. Das entwickelte Assistenzsystem überlagert eine 3D-Geometrie des Aorten-Netzmodells und anatomischen Landmarken auf live-2D-fluoroskopische Bilder. Das 3D-Aorten-Netzmodell und die Landmarken werden auf Basis der interventionellen Angiographie und Fluoroskopie mittels eines C-Arm-CT-Systems rekonstruiert. Unter Verwendung dieser Aorten-Netzmodelle wird das Zielgebiet der Klappen-Implantation automatisch geschätzt. Mit Hilfe eines auf Template Matching basierenden Tracking-Ansatzes wird die Überlagerung des visualisierten 3D-Aorten-Netzmodells, der berechneten Landmarken und der Zielbereich der Implantation auf fluoroskopischen Bildern korrekt überlagert. Eine kompensation der Aortenwurzelbewegung erfolgt durch Bewegungsverfolgung eines Pigtail-Katheters in Bildsequenzen ohne Kontrastmittel. Eine starrere Intensitätsbasierte Registrierungsmethode wurde verwendet, um kontinuierlich die Aortenwurzelbewegung in Bildsequenzen mit Kontrastmittelgabe zu detektieren. Die Aortenklappenprothese wird in die fluoroskopischen Bilder eingeblendet und dient dem Chirurg als Leitfaden für die richtige Platzierung der realen Prothese. Eine interaktive Benutzerschnittstelle für den Chirurg wurde zur Initialisierung der Systemsalgorithmen, zur Steuerung der Visualisierung und für manuelle Korrektur eventueller Überlagerungsfehler entwickelt. Retrospektive Experimente wurden an mehreren Patienten-Datensätze aus der klinischen Routine der TAKI in einem Hybrid-OP durchgeführt. Hohe Erfolgsraten des entwickelten Assistenzsystems wurden für alle getesteten Patienten-Datensätze erzielt. Die Ergebnisse zeigen, dass das entwickelte chirurgische Assistenzsystem ein hilfreiches Werkzeug für den Chirurg bei der Platzierung Position der Prothese während des chirurgischen Eingriffs der TAKI bietet

Advances of Italian Machine Design

This 2028 Special Issue presents recent developments and achievements in the field of Mechanism and Machine Science coming from the Italian community with international collaborations and ranging from theoretical contributions to experimental and practical applications. It contains selected contributions that were accepted for presentation at the Second International Conference of IFToMM Italy, IFIT2018, that has been held in Cassino on 29 and 30 November 2018. This IFIT conference is the second event of a series that was established in 2016 by IFToMM Italy in Vicenza. IFIT was established to bring together researchers, industry professionals and students, from the Italian and the international community in an intimate, collegial and stimulating environment

Design of a 2D MRI compatible robot for performing prostate cancer treatment using therapeutic ultrasound

Therapeutic ultrasound is a promising treatment method for many common cancers, including prostate cancer. Magnetic resonance image (MRI) guidance of therapeutic ultrasound permits targeting and monitoring of therapy. In this thesis a prototype MRI compatible positioning device for the treatment of prostate cancer using therapeutic ultrasound is presented. The accuracy, MRI compatibility and functionality of the positioning device was evaluated in in vitro experiments (using gel phantoms and in vitro). The MRI was used as the imaging guidance technique. The proposed device incorporates a portable electronic system and operates in two PC controlled stages, linear and angular (X - Θ) and one manual driven stage Z (height of the probe). The device is small and portable and can be placed on the patient’s table to any commercial MRI scanner. The proposed device was tested on two clinical MRI scanners of different manufacturers. Additionally, in this thesis a software that controls an MRI guided focus ultrasound system is presented. The software was written in C sharp and consists of the following options: a) connection with DAQ device, b) tab that controls 2D device, c) tab that controls 3D device, d) tab that controls ultrasound protocol and e) operation command history list, g) MRI compatible camera, h) open and control the DICOM images captured from the MRI scanner during the therapy, i) temperature reading of the HIFU focal point. The proposed positioning device offers approximately 20μm accuracy on linear and angular stages. It incorporates MRI compatible optical encoders as mechanical motion feedback. The accuracy measurements were taken using a digital calibre. The positioning device has range of 111mm in linear stage, ±90o on angular stage and 50mm on Z stage. The design was based on measurements that were taken by a 100 patients. The MRI compatibility and motion accuracy images were taken by scanning gel phantoms using T2W FSE on 1.5T and 3T MRI scanner

Optical Methods in Sensing and Imaging for Medical and Biological Applications

The recent advances in optical sources and detectors have opened up new opportunities for sensing and imaging techniques which can be successfully used in biomedical and healthcare applications. This book, entitled ‘Optical Methods in Sensing and Imaging for Medical and Biological Applications’, focuses on various aspects of the research and development related to these areas. The book will be a valuable source of information presenting the recent advances in optical methods and novel techniques, as well as their applications in the fields of biomedicine and healthcare, to anyone interested in this subject

Actas de las XXXIV Jornadas de Automática

Postprint (published version