ADVANCED ROBOTIC TECHNOLOGY IS THE FUTURE OF SURGERY

Currently, we live in a new era of minimally invasive surgery. Operations are more like video games thantraditional open surgeries. The old-fashioned expression that “a good surgery requires a large incision”has been completely abandoned in countries where medical technology and research are well structured.Within the modern minimally invasive surgeries over the last 30 years, laparoscopic surgery is the mostwell established and recognized approach. However, with development of advanced technologiesand intense research, robotic surgery has emerged in the last decade as an attractive alternative tolaparoscopic surgery. DOI: https://doi.org/10.25176/RFMH.v17.n3.106

A Robotic System for Transanal Endoscopic Microsurgery: Design, Dexterity Optimization, and Prototyping

This article proposes a master–slave operated robotic system that features the novel slave manipulator with a modular distal continuum section to address the shortcomings of traditional transanal endoscopic microsurgery (TEM). The slave manipulator consists of two seven degrees-of-freedom (7-DoF) surgical instruments and a 5-DoF endoscopic arm that are designed with distal continuum structures and unfolded with a Y configuration after inserting through a transanal port to enhance hand–eye coordination and instrument triangulation. The proposed robot is designed for adaptation in narrow and shallow rectal spaces, facilitating intuitive hand–eye coordination and enhanced operational dexterity with reduced obstruction of the field of view

Snake Robots for Surgical Applications: A Review

Although substantial advancements have been achieved in robot-assisted surgery, the blueprint to existing snake robotics predominantly focuses on the preliminary structural design, control, and human–robot interfaces, with features which have not been particularly explored in the literature. This paper aims to conduct a review of planning and operation concepts of hyper-redundant serpentine robots for surgical use, as well as any future challenges and solutions for better manipulation. Current researchers in the field of the manufacture and navigation of snake robots have faced issues, such as a low dexterity of the end-effectors around delicate organs, state estimation and the lack of depth perception on two-dimensional screens. A wide range of robots have been analysed, such as the i2Snake robot, inspiring the use of force and position feedback, visual servoing and augmented reality (AR). We present the types of actuation methods, robot kinematics, dynamics, sensing, and prospects of AR integration in snake robots, whilst addressing their shortcomings to facilitate the surgeon’s task. For a smoother gait control, validation and optimization algorithms such as deep learning databases are examined to mitigate redundancy in module linkage backlash and accidental self-collision. In essence, we aim to provide an outlook on robot configurations during motion by enhancing their material compositions within anatomical biocompatibility standards

Robotic manipulators for single access surgery

This thesis explores the development of cooperative robotic manipulators for enhancing surgical precision and patient outcomes in single-access surgery and, specifically, Transanal Endoscopic Microsurgery (TEM). During these procedures, surgeons manipulate a heavy set of instruments via a mechanical clamp inserted in the patient’s body through a surgical port, resulting in imprecise movements, increased patient risks, and increased operating time. Therefore, an articulated robotic manipulator with passive joints is initially introduced, featuring built-in position and force sensors in each joint and electronic joint brakes for instant lock/release capability. The articulated manipulator concept is further improved with motorised joints, evolving into an active tool holder. The joints allow the incorporation of advanced robotic capabilities such as ultra-lightweight gravity compensation and hands-on kinematic reconfiguration, which can optimise the placement of the tool holder in the operating theatre. Due to the enhanced sensing capabilities, the application of the active robotic manipulator was further explored in conjunction with advanced image guidance approaches such as endomicroscopy. Recent advances in probe-based optical imaging such as confocal endomicroscopy is making inroads in clinical uses. However, the challenging manipulation of imaging probes hinders their practical adoption. Therefore, a combination of the fully cooperative robotic manipulator with a high-speed scanning endomicroscopy instrument is presented, simplifying the incorporation of optical biopsy techniques in routine surgical workflows. Finally, another embodiment of a cooperative robotic manipulator is presented as an input interface to control a highly-articulated robotic instrument for TEM. This master-slave interface alleviates the drawbacks of traditional master-slave devices, e.g., using clutching mechanics to compensate for the mismatch between slave and master workspaces, and the lack of intuitive manipulation feedback, e.g. joint limits, to the user. To address those drawbacks a joint-space robotic manipulator is proposed emulating the kinematic structure of the flexible robotic instrument under control.Open Acces

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

Simple and low-cost manufacturing of customisable drug delivery devices and flexible sensors for biomedical applications

In recent years, 3D printing technologies have been adopted into the medical and pharmaceutical industry for the fabrication of personalised medicines, oral dosage forms, medical implants, medical devices, tissue engineering applications, and many more. However, the use of 3D printing, in particular the low-cost Fused Deposition Modelling (FDM) 3D printing technique, has been limited due to the limited number of biocompatible materials suitable for pharmaceutical and biomedical applications. In this study, the FDM 3D printing technique was being explored for the fabrication of pharmaceutical products as it is the most widely available and easily accessible 3D printing technology. In order to improve the usability of FDM 3D printing for pharmaceutical and biomedical applications, the studies to fabricate several different biocompatible filaments composition that can be used for drug loading were carried out. Firstly, filaments made of several pharmaceutical grade polymers were being developed using hot-melt extrusion (HME). Three types of biocompatible polymeric filaments have been developed. They are (Polylactic Acid) PLA-based, (Hydroxypropyl Cellulose) HPC-based and (Polycaprolactone) PCL-based. These filaments were added with a plasticiser, polyethylene glycol (PEG), to improve their processability and physicochemical properties of the produced filaments so that they can used in an FDM 3D printer. The HPC-based filaments were loaded with a model drug, theophylline, that exhibits poor aqueous solubility, whereas the PCL-based filaments were loaded with a readily soluble model drug, metformin. The studies showed that the filaments were effective in sustaining the release of both drug, and the sustain release properties of the filaments can be adjusted by altering the composition of the polymers. The studies showed that the HME technology is very compatible with FDM 3D printing as it is able to produce 3D printable filaments by mixing different polymeric materials. The filaments can also be loaded with a desired drug at a required dose to allow the 3D printing of drug delivery systems. This technique allows the fabrication of personalised drug delivery systems in-house. It can be beneficial for clinics and hospitals in remote areas as the lead times can be reduced when in-house fabrication is possible. The ability to fabricate personalised medicines at hand also means that the dose can drug release patterns can be altered for the patients at any point of time when required. Apart from that, this technique can change way medicines are transported and stored, which could potentially help save cost on transportation and inventory. In addition to medicines, the FDM 3D printing technique can also be used to produce other personalised drug delivery systems such as microneedles, braces and implants of various shapes due to the flexibility of the 3D printing process. The other aspect of this research was on the fabrication of biomedical sensors that can potentially be integrated with the 3D printed drug delivery systems to form a smart drug delivery device. The idea of smart drug delivery device is that it is capable of continuous monitoring the health of a patient and then administer drug to the patient whenever it is required. The development of such smart medical devices has been one of the hottest interests in the biomedical sector. One of the main issues with such technologies is the high cost which has caused the technologies to be not so affordable for many people. Therefore, the studies to fabricate some simple biomedical sensors such as a temperature sensor and a glucose sensor using simple and cost-effective manufacturing technique were being explored. The fabrication techniques used are FDM 3D printing and a thin-film fabrication technique that involves deposition of material using a thermal evaporator. Low-cost manufacturing techniques were being explored in order to help reduce manufacturing cost which could help improve the affordability of such technologies. The fabricated temperature and glucose sensors exhibit great stability in performance and mechanical flexibility. The flexibility allows the sensors to be conformable to curved surfaces such as the skin. Hence, the sensors are suitable to be used as a wearable device or integrated into some other medical devices to form a smart medical device