Spherical wrist dimensional synthesis adapted for tool-guidance medical robots

The objective of this article is to present the dimensional synthesis of serial or parallel spherical wrists, an important step in the design process of medical robots. This step is carried out to obtain optimal dimensions of tool-guidance medical robots. In this goal, we have first studied the specifications of two robots with different medical applications: one for minimally invasive surgery and one for tele-echography examination. Then, we have established that the medical needs expressed by the doctor were very different but the specifications in robotic terms have a lot of common points (kinematics, workspace, bulkiness). Both types of robots need a mobility of three rotations around a fixed point (trocar incision or probe contact point on patient’s skin). So a spherical wrist structure is adapted to their needs. An important constraint related to medical applications is that the robot must be compact to not obstruct the robot environment (medical personnel or patient). We perform dimensional synthesis allowing determination of dimensions of the mechanism for a spherical wrist, serial and parallel for a tele-echography robot, and serial for the minimally invasive surgery robot. We used multi-criteria optimization methods minimising a cost function to obtain both good kinematic performance and compactness for the structure. The difficulty and the difference between the presented studies are in the choice of design criteria describing the performance and the constraints of the robot. These parameters must faithfully represent the specifications of the robot so that its performance can respond to the medical requirements. We show, here, the different methods used for the chosen kinematic structure and the medical application. These studies lead to prototypes which are validated by medical experiments. This process of dimensional synthesis will be applied to other medical applications with different sets of specified constraints

A Review of Pneumatic Actuators Used for the Design of Medical Simulators and Medical Tools

International audienc

Towards the development of safe, collaborative robotic freehand ultrasound

The use of robotics in medicine is of growing importance for modern health services, as robotic systems have the capacity to improve upon human tasks, thereby enhancing the treatment ability of a healthcare provider. In the medical sector, ultrasound imaging is an inexpensive approach without the high radiation emissions often associated with other modalities, especially when compared to MRI and CT imaging respectively. Over the past two decades, considerable effort has been invested into freehand ultrasound robotics research and development. However, this research has focused on the feasibility of the application, not the robotic fundamentals, such as motion control, calibration, and contextual awareness. Instead, much of the work is concentrated on custom designed robots, ultrasound image generation and visual servoing, or teleoperation. Research based on these topics often suffer from important limitations that impede their use in an adaptable, scalable, and real-world manner. Particularly, while custom robots may be designed for a specific application, commercial collaborative robots are a more robust and economical solution. Otherwise, various robotic ultrasound studies have shown the feasibility of using basic force control, but rarely explore controller tuning in the context of patient safety and deformable skin in an unstructured environment. Moreover, many studies evaluate novel visual servoing approaches, but do not consider the practicality of relying on external measurement devices for motion control. These studies neglect the importance of robot accuracy and calibration, which allow a system to safely navigate its environment while reducing the imaging errors associated with positioning. Hence, while the feasibility of robotic ultrasound has been the focal point in previous studies, there is a lack of attention to what occurs between system design and image output. This thesis addresses limitations of the current literature through three distinct contributions. Given the force-controlled nature of an ultrasound robot, the first contribution presents a closed-loop calibration approach using impedance control and low-cost equipment. Accuracy is a fundamental requirement for high-quality ultrasound image generation and targeting. This is especially true when following a specified path along a patient or synthesizing 2D slices into a 3D ultrasound image. However, even though most industrial robots are inherently precise, they are not necessarily accurate. While robot calibration itself has been extensively studied, many of the approaches rely on expensive and highly delicate equipment. Experimental testing showed that this method is comparable in quality to traditional calibration using a laser tracker. As demonstrated through an experimental study and validated with a laser tracker, the absolute accuracy of a collaborative robot was improved to a maximum error of 0.990mm, representing a 58.4% improvement when compared to the nominal model. The second contribution explores collisions and contact events, as they are a natural by-product of applications involving physical human-robot interaction (pHRI) in unstructured environments. Robot-assisted medical ultrasound is an example of a task where simply stopping the robot upon contact detection may not be an appropriate reaction strategy. Thus, the robot should have an awareness of body contact location to properly plan force-controlled trajectories along the human body using the imaging probe. This is especially true for remote ultrasound systems where safety and manipulability are important elements to consider when operating a remote medical system through a communication network. A framework is proposed for robot contact classification using the built-in sensor data of a collaborative robot. Unlike previous studies, this classification does not discern between intended vs. unintended contact scenarios, but rather classifies what was involved in the contact event. The classifier can discern different ISO/TS 15066:2016 specific body areas along a human-model leg with 89.37% accuracy. Altogether, this contact distinction framework allows for more complex reaction strategies and tailored robot behaviour during pHRI. Lastly, given that the success of an ultrasound task depends on the capability of the robot system to handle pHRI, pure motion control is insufficient. Force control techniques are necessary to achieve effective and adaptable behaviour of a robotic system in the unstructured ultrasound environment while also ensuring safe pHRI. While force control does not require explicit knowledge of the environment, to achieve an acceptable dynamic behaviour, the control parameters must be tuned. The third contribution proposes a simple and effective online tuning framework for force-based robotic freehand ultrasound motion control. Within the context of medical ultrasound, different human body locations have a different stiffness and will require unique tunings. Through real-world experiments with a collaborative robot, the framework tuned motion control for optimal and safe trajectories along a human leg phantom. The optimization process was able to successfully reduce the mean absolute error (MAE) of the motion contact force to 0.537N through the evolution of eight motion control parameters. Furthermore, contextual awareness through motion classification can offer a framework for pHRI optimization and safety through predictive motion behaviour with a future goal of autonomous pHRI. As such, a classification pipeline, trained using the tuning process motion data, was able to reliably classify the future force tracking quality of a motion session with an accuracy of 91.82 %

Improving access to ultrasound imaging in northern, remote communities

Access to healthcare services—including access to medical imaging—is an important determinant of health outcomes. This thesis aims to improve understanding of and address gaps in access to ultrasound imaging for patients in northern, remote communities, and advance a novel ultrasound technology with the ultimate goal of improving patient care and health outcomes. This thesis first brings greater understanding of patients’ perceptions of access and factors which shape access to ultrasound imaging in northern, remote communities in Saskatchewan, Canada. A qualitative study was performed using interpretive description as a methodological approach and a multi-dimensional conceptualization of access to care as a theoretical framework. The study identified barriers which patients in northern, remote communities face in accessing ultrasound imaging, and demonstrated that geographic remoteness from imaging facilities was a central barrier. To determine whether disparities in access to ultrasound imaging resulted in disparities in utilization of ultrasound services, two population-based studies assessed the association between sociodemographic and geographic factors and obstetrical and non-obstetrical ultrasound utilization in Saskatchewan. In the first study investigating obstetrical ultrasound utilization, multivariate logistic regression analysis demonstrated that women living in rural areas, remote areas, and low income neighbourhoods, as well as status First Nations women, were less likely to have a second trimester ultrasound, an important aspect of prenatal care. In a second study investigating non-obstetrical ultrasound utilization across the entire provincial population, multivariate Poisson regression analysis similarly demonstrated lower rates of non-obstetrical ultrasound utilization among individuals living in rural and remote areas, individuals residing in low income neighbourhoods, and status First Nations persons. To address the barriers which patients in northern, remote communities face in accessing ultrasound imaging and to minimize disparities in ultrasound imaging utilization as identified in previous studies in this thesis, telerobotic ultrasound technology was investigated as a solution to improve access to ultrasound imaging. Using this technology, radiologists and sonographers could remotely manipulate an ultrasound probe via a robotic arm, thereby remotely performing an ultrasound exam while patients remained in their home community. A clinical trial comparing conventional and telerobotic ultrasound approaches was undertaken, validating this technology for obstetrical ultrasound imaging. To determine the feasibility of using telerobotic technology to establish an ultrasound service delivery model to remotely provide diagnostic ultrasound exams in underserved communities, pilot telerobotic ultrasound clinics were developed in three northern, remote communities. Telerobotic ultrasound exams were sufficient for diagnosis in the majority of cases, minimizing travel or reducing wait times for these patients. This technology was subsequently evaluated during a COVID-19 outbreak in northern Saskatchewan, demonstrating the potential of this technology to provide critical ultrasound services to an underserved northern population and minimize health inequities during the COVID-19 pandemic. An economic evaluation was performed to compare a service delivery model using telerobotic ultrasound technology to alternative service delivery models. Telerobotic ultrasound combined with an itinerant sonographer service was found to be the lowest cost option from both a publicly funded healthcare payer perspective and a societal perspective for many northern, remote communities. This thesis provides key insights for health system leaders seeking improved understanding and novel solutions to improve access to ultrasound imaging in northern, remote communities. Findings suggest that telerobotic ultrasound is a viable solution to improve access to ultrasound imaging and reduce costs associated with ultrasound service delivery. Evidence in this thesis may be used to help improve ultrasound services and health equity for patients in underserved northern, remote communities. Continued respectful collaboration with northern, remote, Indigenous peoples and communities will be a critical aspect to ensure that ultrasound services meet community needs

Conception d'un système robotique sécuritaire pour la prise d'images échographiques

La sténose consiste en un blocage des vaisseaux sanguins qui peut survenir n'importe où dans le corps humain. Lorsqu'un vaisseau alimentant les membres inférieurs est partiellement bloqué, la pression sanguine diminue, causant des douleurs chroniques. Les systèmes modernes d'imagerie médicale en trois dimensions peuvent aider le diagnostic ou la planification d'une intervention chirurgicale de la sténose. Ces appareils coûteux soumettent souvent le patient à de fortes doses de radiations tout en lui injectant un agent contraste pour rehausser la visibilité du système vasculaire. L'échographie fait l'objet de plus en plus de recherches en imagerie 3D comme alternative potentielle permettant de poser un diagnostic de sténose. De plus, les ultrasons ne présentent aucune radiation ionisante et l'appareil est plus abordable. Afin d'effectuer la prise d'images échographiques par le déplacement d'une sonde en contact avec le patient, des robots sont développés. Un robot donne en tout temps la position de la sonde, en plus d'alléger la tâche du radiologue et de rendre possible l'automatisation de l'examen. Cette thèse propose le concept d'un nouveau robot effectuant l'examen échographique 3D des artères des membres inférieurs. Le design mécanique original de ce robot a été élaboré avec pour objectif un fonctionnement hautement sécuritaire pour le personnel de la santé et le patient. Puisqu'aucune norme de sécurité en robotique médicale n"a pu être recensée, une recherche approfondie de la littérature a permis l'élaboration d'une stratégie adaptée au défi posé par l'objectif de départ. Le robot à structure parallèle proposé permet de partager les efforts aux différents moteurs. Ses dimensions ont été mathématiquement déterminées afin qu'il soit en mesure d'effectuer l'examen échographique vasculaire demandant le plus grand déplacement : le balayage des vaisseaux sanguins des membres inférieurs. Conséquemment, tout autre examen demandant un déplacement plus petit pourra être réalisé. Des dispositifs mécaniques d'équilibrage statique ont par ailleurs permis de prédire le comportement du robot lorsqu'il est mis hors tension, en plus de minimiser les effets de la gravité. Enfin, les équations mécaniques détaillées rendront possible la fabrication d'un prototype du système robotique proposé

Design and Quantitative Assessment of Teleoperation-Based Human–Robot Collaboration Method for Robot-Assisted Sonography

Tele-echography has emerged as a promising and effective solution, leveraging the expertise of sonographers and the autonomy of robots to perform ultrasound scanning for patients residing in remote areas, without the need for in-person visits by the sonographer. Designing effective and natural human-robot interfaces for tele-echography remains challenging, with patient safety being a critical concern. In this article, we develop a teleoperation system for robot-assisted sonography with two different interfaces, a haptic device-based interface and a low-cost 3D Mouse-based interface, which can achieve continuous and intuitive telemanipulation by a leader device with a small workspace. To achieve compliant interaction with patients, we design impedance controllers in Cartesian space to track the desired position and orientation for these two teleoperation interfaces. We also propose comprehensive evaluation metrics of robot-assisted sonography, including subjective and objective evaluation, to evaluate tele-echography interfaces and control performance. We evaluate the ergonomic performance based on the estimated muscle fatigue and the acquired ultrasound image quality. We conduct user studies based on the NASA Task Load Index to evaluate the performance of these two human-robot interfaces. The tracking performance and the quantitative comparison of these two teleoperation interfaces are conducted by the Franka Emika Panda robot. The results and findings provide guidance on human-robot collaboration design and implementation for robot-assisted sonography. Note to Practitioners —Robot-assisted sonography has demonstrated efficacy in medical diagnosis during clinical trials. However, deploying fully autonomous robots for ultrasound scanning remains challenging due to various constraints in practice, such as patient safety, dynamic tasks, and environmental uncertainties. Semi-autonomous or teleoperation-based robot sonography represents a promising approach for practical deployment. Previous work has produced various expensive teleoperation interfaces but lacks user studies to guide teleoperation interface selection. In this article, we present two typical teleoperation interfaces and implement a continuous and intuitive teleoperation control system. We also propose a comprehensive evaluation metric for assessing their performance. Our findings show that the haptic device outperforms the 3D Mouse, based on operators’ feedback and acquired image quality. However, the haptic device requires more learning time and effort in the training stage. Furthermore, the developed teleoperation system offers a solution for shared control and human-robot skill transfer. Our results provide valuable guidance for designing and implementing human-robot interfaces for robot-assisted sonography in practice

Robot manipulator skill learning and generalising through teleoperation

Robot manipulators have been widely used for simple repetitive, and accurate tasks in industrial plants, such as pick and place, assembly and welding etc., but it is still hard to deploy in human-centred environments for dexterous manipulation tasks, such as medical examination and robot-assisted healthcare. These tasks are not only related to motion planning and control but also to the compliant interaction behaviour of robots, e.g. motion control, force regulation and impedance adaptation simultaneously under dynamic and unknown environments. Recently, with the development of collaborative robotics (cobots) and machine learning, robot skill learning and generalising have attained increasing attention from robotics, machine learning and neuroscience communities. Nevertheless, learning complex and compliant manipulation skills, such as manipulating deformable objects, scanning the human body and folding clothes, is still challenging for robots. On the other hand, teleoperation, also namely remote operation or telerobotics, has been an old research area since 1950, and there have been a number of applications such as space exploration, telemedicine, marine vehicles and emergency response etc. One of its advantages is to combine the precise control of robots with human intelligence to perform dexterous and safety-critical tasks from a distance. In addition, telepresence allows remote operators could feel the actual interaction between the robot and the environment, including the vision, sound and haptic feedback etc. Especially under the development of various augmented reality (AR), virtual reality (VR) and wearable devices, intuitive and immersive teleoperation have received increasing attention from robotics and computer science communities. Thus, various human-robot collaboration (HRC) interfaces based on the above technologies were developed to integrate robot control and telemanipulation by human operators for robot skills learning from human beings. In this context, robot skill learning could benefit teleoperation by automating repetitive and tedious tasks, and teleoperation demonstration and interaction by human teachers also allow the robot to learn progressively and interactively. Therefore, in this dissertation, we study human-robot skill transfer and generalising through intuitive teleoperation interfaces for contact-rich manipulation tasks, including medical examination, manipulating deformable objects, grasping soft objects and composite layup in manufacturing. The introduction, motivation and objectives of this thesis are introduced in Chapter 1. In Chapter 2, a literature review on manipulation skills acquisition through teleoperation is carried out, and the motivation and objectives of this thesis are discussed subsequently. Overall, the main contents of this thesis have three parts: Part 1 (Chapter 3) introduces the development and controller design of teleoperation systems with multimodal feedback, which is the foundation of this project for robot learning from human demonstration and interaction. In Part 2 (Chapters 4, 5, 6 and 7), we studied primitive skill library theory, behaviour tree-based modular method, and perception-enhanced method to improve the generalisation capability of learning from the human demonstrations. And several applications were employed to evaluate the effectiveness of these methods.In Part 3 (Chapter 8), we studied the deep multimodal neural networks to encode the manipulation skill, especially the multimodal perception information. This part conducted physical experiments on robot-assisted ultrasound scanning applications.Chapter 9 summarises the contributions and potential directions of this thesis. Keywords: Learning from demonstration; Teleoperation; Multimodal interface; Human-in-the-loop; Compliant control; Human-robot interaction; Robot-assisted sonography

Optimization and validation of a new 3D-US imaging robot to detect, localize and quantify lower limb arterial stenoses

L’athérosclérose est une maladie qui cause, par l’accumulation de plaques lipidiques, le durcissement de la paroi des artères et le rétrécissement de la lumière. Ces lésions sont généralement localisées sur les segments artériels coronariens, carotidiens, aortiques, rénaux, digestifs et périphériques. En ce qui concerne l’atteinte périphérique, celle des membres inférieurs est particulièrement fréquente. En effet, la sévérité de ces lésions artérielles est souvent évaluée par le degré d’une sténose (réduction >50 % du diamètre de la lumière) en angiographie, imagerie par résonnance magnétique (IRM), tomodensitométrie ou échographie. Cependant, pour planifier une intervention chirurgicale, une représentation géométrique artérielle 3D est notamment préférable. Les méthodes d’imagerie par coupe (IRM et tomodensitométrie) sont très performantes pour générer une imagerie tridimensionnelle de bonne qualité mais leurs utilisations sont dispendieuses et invasives pour les patients. L’échographie 3D peut constituer une avenue très prometteuse en imagerie pour la localisation et la quantification des sténoses. Cette modalité d’imagerie offre des avantages distincts tels la commodité, des coûts peu élevés pour un diagnostic non invasif (sans irradiation ni agent de contraste néphrotoxique) et aussi l’option d’analyse en Doppler pour quantifier le flux sanguin. Étant donné que les robots médicaux ont déjà été utilisés avec succès en chirurgie et en orthopédie, notre équipe a conçu un nouveau système robotique d’échographie 3D pour détecter et quantifier les sténoses des membres inférieurs. Avec cette nouvelle technologie, un radiologue fait l’apprentissage manuel au robot d’un balayage échographique du vaisseau concerné. Par la suite, le robot répète à très haute précision la trajectoire apprise, contrôle simultanément le processus d’acquisition d’images échographiques à un pas d’échantillonnage constant et conserve de façon sécuritaire la force appliquée par la sonde sur la peau du patient. Par conséquent, la reconstruction d’une géométrie artérielle 3D des membres inférieurs à partir de ce système pourrait permettre une localisation et une quantification des sténoses à très grande fiabilité. L’objectif de ce projet de recherche consistait donc à valider et optimiser ce système robotisé d’imagerie échographique 3D. La fiabilité d’une géométrie reconstruite en 3D à partir d’un système référentiel robotique dépend beaucoup de la précision du positionnement et de la procédure de calibration. De ce fait, la précision pour le positionnement du bras robotique fut évaluée à travers son espace de travail avec un fantôme spécialement conçu pour simuler la configuration des artères des membres inférieurs (article 1 - chapitre 3). De plus, un fantôme de fils croisés en forme de Z a été conçu pour assurer une calibration précise du système robotique (article 2 - chapitre 4). Ces méthodes optimales ont été utilisées pour valider le système pour l’application clinique et trouver la transformation qui convertit les coordonnées de l’image échographique 2D dans le référentiel cartésien du bras robotisé. À partir de ces résultats, tout objet balayé par le système robotique peut être caractérisé pour une reconstruction 3D adéquate. Des fantômes vasculaires compatibles avec plusieurs modalités d’imagerie ont été utilisés pour simuler différentes représentations artérielles des membres inférieurs (article 2 - chapitre 4, article 3 - chapitre 5). La validation des géométries reconstruites a été effectuée à l`aide d`analyses comparatives. La précision pour localiser et quantifier les sténoses avec ce système robotisé d’imagerie échographique 3D a aussi été déterminée. Ces évaluations ont été réalisées in vivo pour percevoir le potentiel de l’utilisation d’un tel système en clinique (article 3- chapitre 5).Atherosclerosis is a disease caused by the accumulation of lipid deposits inducing the remodeling and hardening of the vessel wall, which leads to a progressive narrowing of arteries. These lesions are generally located on the coronary, carotid, aortic, renal, digestive and peripheral arteries. With regards to peripheral vessels, lower limb arteries are frequently affected. The severity of arterial lesions are evaluated by the stenosis degree (reduction > 50.0 % of the lumen diameter) using angiography, magnetic resonance angiography (MRA), computed tomography (CT) and ultrasound (US). However, to plan a surgical therapeutic intervention, a 3D arterial geometric representation is notably preferable. Imaging methods such as MRA and CT are very efficient to generate a three-dimensional imaging of good quality even though their use is expensive and invasive for patients. 3D-ultrasound can be perceived as a promising avenue in imaging for the location and the quantification of stenoses. This non invasive, non allergic (i.e, nephrotoxic contrast agent) and non-radioactive imaging modality offers distinct advantages in convenience, low cost and also multiple diagnostic options to quantify blood flow in Doppler. Since medical robots already have been used with success in surgery and orthopedics, our team has conceived a new medical 3D-US robotic imaging system to localize and quantify arterial stenoses in lower limb vessels. With this new technology, a clinician manually teaches the robotic arm the scanning path. Then, the robotic arm repeats with high precision the taught trajectory and controls simultaneously the ultrasound image acquisition process at even sampling and preserves safely the force applied by the US probe. Consequently, the reconstruction of a lower limb arterial geometry in 3D with this system could allow the location and quantification of stenoses with high accuracy. The objective of this research project consisted in validating and optimizing this 3D-ultrasound imaging robotic system. The reliability of a 3D reconstructed geometry obtained with 2D-US images captured with a robotic system depends considerably on the positioning accuracy and the calibration procedure. Thus, the positioning accuracy of the robotic arm was evaluated in the workspace with a lower limb-mimicking phantom design (article 1 - chapter 3). In addition, a Z-phantom was designed to assure a precise calibration of the robotic system. These optimal methods were used to validate the system for the clinical application and to find the transformation which converts image coordinates of a 2D-ultrasound image into the robotic arm referential. From these results, all objects scanned by the robotic system can be adequately reconstructed in 3D. Multimodal imaging vascular phantoms of lower limb arteries were used to evaluate the accuracy of the 3D representations (article 2 - chapter 4, article 3 - chapter 5). The validation of the reconstructed geometry with this system was performed by comparing surface points with the manufacturing vascular phantom file surface points. The accuracy to localize and quantify stenoses with the 3D-ultrasound robotic imaging system was also determined. These same evaluations were analyzed in vivo to perceive the feasibility of the study

Kinematics and Robot Design II (KaRD2019) and III (KaRD2020)

This volume collects papers published in two Special Issues “Kinematics and Robot Design II, KaRD2019” (https://www.mdpi.com/journal/robotics/special_issues/KRD2019) and “Kinematics and Robot Design III, KaRD2020” (https://www.mdpi.com/journal/robotics/special_issues/KaRD2020), which are the second and third issues of the KaRD Special Issue series hosted by the open access journal robotics.The KaRD series is an open environment where researchers present their works and discuss all topics focused on the many aspects that involve kinematics in the design of robotic/automatic systems. It aims at being an established reference for researchers in the field as other serial international conferences/publications are. Even though the KaRD series publishes one Special Issue per year, all the received papers are peer-reviewed as soon as they are submitted and, if accepted, they are immediately published in MDPI Robotics. Kinematics is so intimately related to the design of robotic/automatic systems that the admitted topics of the KaRD series practically cover all the subjects normally present in well-established international conferences on “mechanisms and robotics”.KaRD2019 together with KaRD2020 received 22 papers and, after the peer-review process, accepted only 17 papers. The accepted papers cover problems related to theoretical/computational kinematics, to biomedical engineering and to other design/applicative aspects

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