A Framework for Tumor Localization in Robot-Assisted Minimally Invasive Surgery

Manual palpation of tissue is frequently used in open surgery, e.g., for localization of tumors and buried vessels and for tissue characterization. The overall objective of this work is to explore how tissue palpation can be performed in Robot-Assisted Minimally Invasive Surgery (RAMIS) using laparoscopic instruments conventionally used in RAMIS. This thesis presents a framework where a surgical tool is moved teleoperatively in a manner analogous to the repetitive pressing motion of a finger during manual palpation. We interpret the changes in parameters due to this motion such as the applied force and the resulting indentation depth to accurately determine the variation in tissue stiffness. This approach requires the sensorization of the laparoscopic tool for force sensing. In our work, we have used a da Vinci needle driver which has been sensorized in our lab at CSTAR for force sensing using Fiber Bragg Grating (FBG). A computer vision algorithm has been developed for 3D surgical tool-tip tracking using the da Vinci \u27s stereo endoscope. This enables us to measure changes in surface indentation resulting from pressing the needle driver on the tissue. The proposed palpation framework is based on the hypothesis that the indentation depth is inversely proportional to the tissue stiffness when a constant pressing force is applied. This was validated in a telemanipulated setup using the da Vinci surgical system with a phantom in which artificial tumors were embedded to represent areas of different stiffnesses. The region with high stiffness representing tumor and region with low stiffness representing healthy tissue showed an average indentation depth change of 5.19 mm and 10.09 mm respectively while maintaining a maximum force of 8N during robot-assisted palpation. These indentation depth variations were then distinguished using the k-means clustering algorithm to classify groups of low and high stiffnesses. The results were presented in a colour-coded map. The unique feature of this framework is its use of a conventional laparoscopic tool and minimal re-design of the existing da Vinci surgical setup. Additional work includes a vision-based algorithm for tracking the motion of the tissue surface such as that of the lung resulting from respiratory and cardiac motion. The extracted motion information was analyzed to characterize the lung tissue stiffness based on the lateral strain variations as the surface inflates and deflates

Bilateral Macro-Micro Teleoperation Using A Magnetic Actuation Mechanism

In recent years, there has been increasing interest in the advancement of microrobotic systems in micro-engineering, micro-fabrication, biological research and biomedical applications. Untethered magnetic-based microrobotic systems are one of the most widely developing groups of microrobotic systems that have been extensively explored for biological and biomedical micro-manipulations. These systems show promise in resolving problems related to on-board power supply limitations as well as mechanical contact sealing and lubrication. In this thesis, a high precision magnetic untethered microrobotic system is demonstrated for micro-handling tasks. A key aspect of the proposed platform concerns the integration of magnetic levitation technology and bilateral macro-micro teleoperation for human intervention to avoid imperceptible failures in poorly observed micro-domain environments. The developed platform has three basic subsystems: a magnetic untethered microrobotic system (MUMS), a haptic device, and a scaled bilateral teleoperation system. The MUMS produces and regulates a magnetic field for non-contact propelling of a microrobot. In order to achieve a controlled motion of the magnetically levitated microrobot, a mathematical force model of the magnetic propulsion mechanism is developed and used to design various control systems. In the workspace of 30 × 32 × 32 mm 3, both PID and LQG\LTR controllers perform similarly the position accuracy of 10 µ m in a vertical direction and 2 µ m in a horizontal motion. The MUMS is equipped with an eddy-current damper to enhance its inherent damping factor in the microrobot's horizontal motions. This paper deals with the modeling and analysis of an eddy-current damper that is formed by a conductive plate placed below the levitated microrobot to overcome inherent dynamical vibrations and improve motion precision. The modeling of eddy-current distribution in the conductive plate is investigated by solving the diffusion equation for vector magnetic potential, and an analytical expression for the horizontal damping force is presented and experimentally validated. It is demonstrated that eddy-current damping is a crucial technique for increasing the damping coefficient in a non-contact way and for improving levitation performance. The damping can be widely used in applications of magnetic actuation systems in micro-manipulation and micro-fabrication. To determine the position of the microrobot in a workspace, the MUMS uses high-accuracy laser sensors. However, laser positioning techniques can only be used in highly transparent environments. A novel technique based on real-time magnetic flux measurement has been proposed for the position estimation of the microrobot in case of laser beam blockage, whereby a combination of Hall-effect sensors is employed to find the microrobot's position in free motion by using the produced magnetic flux. In free motion, the microrobot tends to move toward the horizontally zero magnetic field gradient, Bmax location. As another key feature of the magnetic flux measurement, it was realized that the applied force from the environment to the microrobot can be estimated as linearly proportional to the distance of the microrobot from the Bmax location. The developed micro-domain force estimation method is verified experimentally with an accuracy of 1.27 µ N. A bilateral macro-micro teleoperation technique is employed in the MUMS for the telepresence of a human operator in the task environment. A gain-switching position-position teleoperation scheme is employed and a human operator controls the motion of the microrobot via a master manipulator for dexterous micro-manipulation tasks. The operator can sense a strong force during micro-domain tasks if the microrobot encounters a stiff environment, and the effect of hard contact is fed back to the operator's hand. The position-position method works for both free motion and hard contact. However, to enhance the feeling of a micro-domain environment in the human operator, the scaled force must be transferred to a human, thereby realizing a direct-force-reflection bilateral teleoperation. Additionally, a human-assisted virtual reality interface is developed to improve a human operator's skills in using the haptic-enabled platform, before carrying out an actual dexterous task.1 yea

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

Scaled Autonomy for Networked Humanoids

Humanoid robots have been developed with the intention of aiding in environments designed for humans. As such, the control of humanoid morphology and effectiveness of human robot interaction form the two principal research issues for deploying these robots in the real world. In this thesis work, the issue of humanoid control is coupled with human robot interaction under the framework of scaled autonomy, where the human and robot exchange levels of control depending on the environment and task at hand. This scaled autonomy is approached with control algorithms for reactive stabilization of human commands and planned trajectories that encode semantically meaningful motion preferences in a sequential convex optimization framework. The control and planning algorithms have been extensively tested in the field for robustness and system verification. The RoboCup competition provides a benchmark competition for autonomous agents that are trained with a human supervisor. The kid-sized and adult-sized humanoid robots coordinate over a noisy network in a known environment with adversarial opponents, and the software and routines in this work allowed for five consecutive championships. Furthermore, the motion planning and user interfaces developed in the work have been tested in the noisy network of the DARPA Robotics Challenge (DRC) Trials and Finals in an unknown environment. Overall, the ability to extend simplified locomotion models to aid in semi-autonomous manipulation allows untrained humans to operate complex, high dimensional robots. This represents another step in the path to deploying humanoids in the real world, based on the low dimensional motion abstractions and proven performance in real world tasks like RoboCup and the DRC

The Shape of Damping: Optimizing Damping Coefficients to Improve Transparency on Bilateral Telemanipulation

This thesis presents a novel optimization-based passivity control algorithm for hapticenabled bilateral teleoperation systems involving multiple degrees of freedom. In particular, in the context of energy-bounding control, the contribution focuses on the implementation of a passivity layer for an existing time-domain scheme, ensuring optimal transparency of the interaction along subsets of the environment space which are preponderant for the given task, while preserving the energy bounds required for passivity. The involved optimization problem is convex and amenable to real-time implementation. The effectiveness of the proposed design is validated via an experiment performed on a virtual teleoperated environment. The interplay between transparency and stability is a critical aspect in haptic-enabled bilateral teleoperation control. While it is important to present the user with the true impedance of the environment, destabilizing factors such as time delays, stiff environments, and a relaxed grasp on the master device may compromise the stability and safety of the system. Passivity has been exploited as one of the the main tools for providing sufficient conditions for stable teleoperation in several controller design approaches, such as the scattering algorithm, timedomain passivity control, energy bounding algorithm, and passive set position modulation. In this work it is presented an innovative energy-based approach, which builds upon existing time-domain passivity controllers, improving and extending their effectiveness and functionality. The set of damping coefficients are prioritized in each degree of freedom, the resulting transparency presents a realistic force feedback in comparison to the other directions. Thus, the prioritization takes effect using a quadratic programming algorithm to find the optimal values for the damping. Finally, the energy tanks approach on passivity control is a solution used to ensure stability in a system for robotics bilateral manipulation. The bilateral telemanipulation must maintain the principle of passivity in all moments to preserve the system\u2019s stability. This work presents a brief introduction to haptic devices as a master component on the telemanipulation chain; the end effector in the slave side is a representation of an interactive object within an environment having a force sensor as feedback signal. The whole interface is designed into a cross-platform framework named ROS, where the user interacts with the system. Experimental results are presented

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

Anthropomorphic surgical system for soft tissue robot-assisted surgery

Over the past century, abdominal surgery has seen a rapid transition from open procedures to less invasive methods such as laparoscopy and robot-assisted minimally invasive surgery (R-A MIS). These procedures have significantly decreased blood loss, postoperative morbidity and length of hospital stay in comparison with open surgery. R-A MIS has offered refined accuracy and more ergonomic instruments for surgeons, further minimising trauma to the patient.This thesis aims to investigate, design and prototype a novel system for R-A MIS that will provide more natural and intuitive manipulation of soft tissues and, at the same time, increase the surgeon's dexterity. The thesis reviews related work on surgical systems and discusses the requirements for designing surgical instrumentation. From the background research conducted in this thesis, it is clear that training surgeons in MIS procedures is becoming increasingly long and arduous. Furthermore, most available systems adopt a design similar to conventional laparoscopic instruments or focus on different techniques with debatable benefits. The system proposed in this thesis not only aims to reduce the training time for surgeons but also to improve the ergonomics of the procedure.In order to achieve this, a survey was conducted among surgeons, regarding their opinions on surgical training, surgical systems, how satisfied they are with them and how easy they are to use. A concept for MIS robotic instrumentation was then developed and a series of focus group meetings with surgeons were run to discuss it. The proposed system, named microAngelo, is an anthropomorphic master-slave system that comprises a three-digit miniature hand that can be controlled using the master, a three-digit sensory exoskeleton. While multi-fingered robotic hands have been developed for decades, none have been used for surgical operations. As the system has a human centred design, its relation to the human hand is discussed. Prototypes of both the master and the slave have been developed and their design and mechanisms is demonstrated. The accuracy and repeatability of the master as well as the accuracy and force capabilities of the slave are tested and discussed

A Robotic Biopsy Endoscope with Magnetic 5-DOF Locomotion and a Retractable Biopsy Punch

Capsule endoscopes (CEs) have emerged as an advanced diagnostic technology for gastrointestinal diseases in recent decades. However, with regard to robotic motions, they require active movability and multi-functionalities for extensive, untethered, and precise clinical utilization. Herein, we present a novel wireless biopsy CE employing active five degree-of-freedom locomotion and a biopsy needle punching mechanism for the histological analysis of the intestinal tract. A medical biopsy punch is attached to a screw mechanism, which can be magnetically actuated to extrude and retract the biopsy tool, for tissue extraction. The external magnetic field from an electromagnetic actuation (EMA) system is utilized to actuate the screw mechanism and harvest biopsy tissue; therefore, the proposed system consumes no onboard energy of the CE. This design enables observation of the biopsy process through the capsule's camera. A prototype with a diameter of 12 mm and length of 30 mm was fabricated with a medical biopsy punch having a diameter of 1.5 mm. Its performance was verified through numerical analysis, as well as in-vitro and ex-vivo experiments on porcine intestine. The CE could be moved to target lesions and obtain sufficient tissue samples for histological examination. The proposed biopsy CE mechanism utilizing punch biopsy and its wireless extraction-retraction technique can advance untethered intestinal endoscopic capsule technology at clinical sites.ope

Fine-grained Haptics: Sensing and Actuating Haptic Primary Colours (force, vibration, and temperature)

This thesis discusses the development of a multimodal, fine-grained visual-haptic system for teleoperation and robotic applications. This system is primarily composed of two complementary components: an input device known as the HaptiTemp sensor (combines “Haptics” and “Temperature”), which is a novel thermosensitive GelSight-like sensor, and an output device, an untethered multimodal finegrained haptic glove. The HaptiTemp sensor is a visuotactile sensor that can sense haptic primary colours known as force, vibration, and temperature. It has novel switchable UV markers that can be made visible using UV LEDs. The switchable markers feature is a real novelty of the HaptiTemp because it can be used in the analysis of tactile information from gel deformation without impairing the ability to classify or recognise images. The use of switchable markers in the HaptiTemp sensor is the solution to the trade-off between marker density and capturing high-resolution images using one sensor. The HaptiTemp sensor can measure vibrations by counting the number of blobs or pulses detected per unit time using a blob detection algorithm. For the first time, temperature detection was incorporated into a GelSight-like sensor, making the HaptiTemp sensor a haptic primary colours sensor. The HaptiTemp sensor can also do rapid temperature sensing with a 643 ms response time for the 31°C to 50°C temperature range. This fast temperature response of the HaptiTemp sensor is comparable to the withdrawal reflex response in humans. This is the first time a sensor can trigger a sensory impulse that can mimic a human reflex in the robotic community. The HaptiTemp sensor can also do simultaneous temperature sensing and image classification using a machine vision camera—the OpenMV Cam H7 Plus. This capability of simultaneous sensing and image classification has not been reported or demonstrated by any tactile sensor. The HaptiTemp sensor can be used in teleoperation because it can communicate or transmit tactile analysis and image classification results using wireless communication. The HaptiTemp sensor is the closest thing to the human skin in tactile sensing, tactile pattern recognition, and rapid temperature response. In order to feel what the HaptiTemp sensor is touching from a distance, a corresponding output device, an untethered multimodal haptic hand wearable, is developed to actuate the haptic primary colours sensed by the HaptiTemp sensor. This wearable can communicate wirelessly and has fine-grained cutaneous feedback to feel the edges or surfaces of the tactile images captured by the HaptiTemp sensor. This untethered multimodal haptic hand wearable has gradient kinesthetic force feedback that can restrict finger movements based on the force estimated by the HaptiTemp sensor. A retractable string from an ID badge holder equipped with miniservos that control the stiffness of the wire is attached to each fingertip to restrict finger movements. Vibrations detected by the HaptiTemp sensor can be actuated by the tapping motion of the tactile pins or by a buzzing minivibration motor. There is also a tiny annular Peltier device, or ThermoElectric Generator (TEG), with a mini-vibration motor, forming thermo-vibro feedback in the palm area that can be activated by a ‘hot’ or ‘cold’ signal from the HaptiTemp sensor. The haptic primary colours can also be embedded in a VR environment that can be actuated by the multimodal hand wearable. A VR application was developed to demonstrate rapid tactile actuation of edges, allowing the user to feel the contours of virtual objects. Collision detection scripts were embedded to activate the corresponding actuator in the multimodal haptic hand wearable whenever the tactile matrix simulator or hand avatar in VR collides with a virtual object. The TEG also gets warm or cold depending on the virtual object the participant has touched. Tests were conducted to explore virtual objects in 2D and 3D environments using Leap Motion control and a VR headset (Oculus Quest 2). Moreover, a fine-grained cutaneous feedback was developed to feel the edges or surfaces of a tactile image, such as the tactile images captured by the HaptiTemp sensor, or actuate tactile patterns in 2D or 3D virtual objects. The prototype is like an exoskeleton glove with 16 tactile actuators (tactors) on each fingertip, 80 tactile pins in total, made from commercially available P20 Braille cells. Each tactor can be controlled individually to enable the user to feel the edges or surfaces of images, such as the high-resolution tactile images captured by the HaptiTemp sensor. This hand wearable can be used to enhance the immersive experience in a virtual reality environment. The tactors can be actuated in a tapping manner, creating a distinct form of vibration feedback as compared to the buzzing vibration produced by a mini-vibration motor. The tactile pin height can also be varied, creating a gradient of pressure on the fingertip. Finally, the integration of the high-resolution HaptiTemp sensor, and the untethered multimodal, fine-grained haptic hand wearable is presented, forming a visuotactile system for sensing and actuating haptic primary colours. Force, vibration, and temperature sensing tests with corresponding force, vibration, and temperature actuating tests have demonstrated a unified visual-haptic system. Aside from sensing and actuating haptic primary colours, touching the edges or surfaces of the tactile images captured by the HaptiTemp sensor was carried out using the fine-grained cutaneous feedback of the haptic hand wearable

Minimally Invasive Expeditionary Surgical Care Using Human-Inspired Robots

This technical report serves as an updated collection of subject matter experts on surgical care using human-inspired robotics for human exploration. It is a summary of the Blue Sky Meeting, organized by the Florida Institute for Human and Machine Cognition (IHMC), Pensacola, Florida, and held on October 2-3, 2018. It contains an executive summary, the final report, all of the presentation materials, and an updated reference list