A Robotic Neuro-Musculoskeletal Simulator for Spine Research

An influential conceptual framework advanced by Panjabi represents the living spine as a complex neuromusculoskeletal system whose biomechanical functioning is rather finely dependent upon the interactions among and between three principal subsystems: the passive musculoskeletal subsystem (osteoligamentous spine plus passive mechanical contributions of the muscles), the active musculoskeletal subsystem (muscles and tendons), and the neural and feedback subsystem (neural control centers and feedback elements such as mechanoreceptors located in the soft tissues) [1]. The interplay between subsystems readily encourages thought experiments of how pathologic changes in one subsystem might influence another--for example, prompting one to speculate how painful arthritic changes in the facet joints might affect the neuromuscular control of spinal movement. To answer clinical questions regarding the interplay between these subsystems the proper experimental tools and techniques are required. Traditional spine biomechanical experiments are able to provide comprehensive characterization of the structural properties of the osteoligamentous spine. However, these technologies do not incorporate a simulated neural feedback from neural elements, such as mechanoreceptors and nociceptors, into the control loop. Doing so enables the study of how this feedback--including pain-related--alters spinal loading and motion patterns. The first such development of this technology was successfully completed in this study and constitutes a Neuro-Musculoskeletal Simulator. A Neuro-Musculoskeletal Simulator has the potential to reduce the gap between bench and bedside by creating a new paradigm in estimating the outcome of spine pathologies or surgeries. The traditional paradigm is unable to estimate pain and is also unable to determine how the treatment, combined with the natural pain avoidance of the patient, would transfer the load to other structures and potentially increase the risk for other problems. The novel Neuro-Musculo

Augmented reality (AR) for surgical robotic and autonomous systems: State of the art, challenges, and solutions

Despite the substantial progress achieved in the development and integration of augmented reality (AR) in surgical robotic and autonomous systems (RAS), the center of focus in most devices remains on improving end-effector dexterity and precision, as well as improved access to minimally invasive surgeries. This paper aims to provide a systematic review of different types of state-of-the-art surgical robotic platforms while identifying areas for technological improvement. We associate specific control features, such as haptic feedback, sensory stimuli, and human-robot collaboration, with AR technology to perform complex surgical interventions for increased user perception of the augmented world. Current researchers in the field have, for long, faced innumerable issues with low accuracy in tool placement around complex trajectories, pose estimation, and difficulty in depth perception during two-dimensional medical imaging. A number of robots described in this review, such as Novarad and SpineAssist, are analyzed in terms of their hardware features, computer vision systems (such as deep learning algorithms), and the clinical relevance of the literature. We attempt to outline the shortcomings in current optimization algorithms for surgical robots (such as YOLO and LTSM) whilst providing mitigating solutions to internal tool-to-organ collision detection and image reconstruction. The accuracy of results in robot end-effector collisions and reduced occlusion remain promising within the scope of our research, validating the propositions made for the surgical clearance of ever-expanding AR technology in the future

Flexible robotic device for spinal surgery

Surgical robots have proliferated in recent years, with well-established benefits including: reduced patient trauma, shortened hospitalisation, and improved diagnostic accuracy and therapeutic outcome. Despite these benefits, many challenges in their development remain, including improved instrument control and ergonomics caused by rigid instrumentation and its associated fulcrum effect. Consequently, it is still extremely challenging to utilise such devices in cases that involve complex anatomical pathways such as the spinal column. The focus of this thesis is the development of a flexible robotic surgical cutting device capable of manoeuvring around the spinal column. The target application of the flexible surgical tool is the removal of cancerous tumours surrounding the spinal column, which cannot be excised completely using the straight surgical tools in use today; anterior and posterior sections of the spine must be accessible for complete tissue removal. A parallel robot platform with six degrees of freedom (6 DoFs) has been designed and fabricated to direct a flexible cutting tool to produce the necessary range of movements to reach anterior and posterior sections of the spinal column. A flexible water jet cutting system and a flexible mechanical drill, which may be assembled interchangeably with the flexible probe, have been developed and successfully tested experimentally. A model predicting the depth of cut by the water jet was developed and experimentally validated. A flexion probe that is able to guide the surgical cutting device around the spinal column has been fabricated and tested with human lumber model. Modelling and simulations show the capacity for the flexible surgical system to enable entering the posterior side of the human lumber model and bend around the vertebral body to reach the anterior side of the spinal column. A computer simulation with a full Graphical User Interface (GUI) was created and used to validate the system of inverse kinematic equations for the robot platform. The constraint controller and the inverse kinematics relations are both incorporated into the overall positional control structure of the robot, and have successfully established a haptic feedback controller for the 6 DoFs surgical probe, and effectively tested in vitro on spinal mock surgery. The flexible surgical system approached the surgery from the posterior side of the human lumber model and bend around the vertebral body to reach the anterior side of the spinal column. The flexible surgical robot removed 82% of mock cancerous tissue compared to 16% of tissue removed by the rigid tool.Open Acces

Control of the Mechanical Properties of the Synthetic Anterior Longitudinal Ligament and its Effect on the Mechanical Analogue Lumbar Spine Model

The development and validation of an anatomically correct mechanical analogue spine model would serve as a valuable tool in helping researchers and implant designers understand and alleviate low back pain. Advanced composite ligaments were designed to mimic the tensile mechanical properties of human spinal ligaments. By changing the composite properties, the stiffness and deformation at toe were controlled in a repeatable manner. Five analogue spine models, with three different Anterior Longitudinal Ligament (ALL) stiffness configurations, were tested in bending and compression using displacement control in a MTS load frame. The bending stiffness and kinematic ranges of motion of the spines were compared for each ALL stiffness configuration. The ALL stiffness had a significant effect on the stiffness and peak moment in extension of the overall spine model. The study demonstrated that a change in the synthetic ligament properties successfully controls the biomechanics of the analogue spine model and the model effectively mimics the human cadaveric biomechanical response

Aerospace medicine and biology: A continuing bibliography with indexes

This bibliography lists 223 reports, articles, and other documents introduced into the NASA scientific and technical information system in December, 1988

Intraoperative Navigation Systems for Image-Guided Surgery

Recent technological advancements in medical imaging equipment have resulted in a dramatic improvement of image accuracy, now capable of providing useful information previously not available to clinicians. In the surgical context, intraoperative imaging provides a crucial value for the success of the operation. Many nontrivial scientific and technical problems need to be addressed in order to efficiently exploit the different information sources nowadays available in advanced operating rooms. In particular, it is necessary to provide: (i) accurate tracking of surgical instruments, (ii) real-time matching of images from different modalities, and (iii) reliable guidance toward the surgical target. Satisfying all of these requisites is needed to realize effective intraoperative navigation systems for image-guided surgery. Various solutions have been proposed and successfully tested in the field of image navigation systems in the last ten years; nevertheless several problems still arise in most of the applications regarding precision, usability and capabilities of the existing systems. Identifying and solving these issues represents an urgent scientific challenge. This thesis investigates the current state of the art in the field of intraoperative navigation systems, focusing in particular on the challenges related to efficient and effective usage of ultrasound imaging during surgery. The main contribution of this thesis to the state of the art are related to: Techniques for automatic motion compensation and therapy monitoring applied to a novel ultrasound-guided surgical robotic platform in the context of abdominal tumor thermoablation. Novel image-fusion based navigation systems for ultrasound-guided neurosurgery in the context of brain tumor resection, highlighting their applicability as off-line surgical training instruments. The proposed systems, which were designed and developed in the framework of two international research projects, have been tested in real or simulated surgical scenarios, showing promising results toward their application in clinical practice

Fiber bragg gratings for medical applications and future challenges: A review

In the last decades, fiber Bragg gratings (FBGs) have become increasingly attractive to medical applications due to their unique properties such as small size, biocompatibility, immunity to electromagnetic interferences, high sensitivity and multiplexing capability. FBGs have been employed in the development of surgical tools, assistive devices, wearables, and biosensors, showing great potentialities for medical uses. This paper reviews the FBG-based measuring systems, their principle of work, and their applications in medicine and healthcare. Particular attention is given to sensing solutions for biomechanics, minimally invasive surgery, physiological monitoring, and medical biosensing. Strengths, weaknesses, open challenges, and future trends are also discussed to highlight how FBGs can meet the demands of next-generation medical devices and healthcare system

Exploiting Temporal Image Information in Minimally Invasive Surgery

Minimally invasive procedures rely on medical imaging instead of the surgeons direct vision. While preoperative images can be used for surgical planning and navigation, once the surgeon arrives at the target site real-time intraoperative imaging is needed. However, acquiring and interpreting these images can be challenging and much of the rich temporal information present in these images is not visible. The goal of this thesis is to improve image guidance for minimally invasive surgery in two main areas. First, by showing how high-quality ultrasound video can be obtained by integrating an ultrasound transducer directly into delivery devices for beating heart valve surgery. Secondly, by extracting hidden temporal information through video processing methods to help the surgeon localize important anatomical structures. Prototypes of delivery tools, with integrated ultrasound imaging, were developed for both transcatheter aortic valve implantation and mitral valve repair. These tools provided an on-site view that shows the tool-tissue interactions during valve repair. Additionally, augmented reality environments were used to add more anatomical context that aids in navigation and in interpreting the on-site video. Other procedures can be improved by extracting hidden temporal information from the intraoperative video. In ultrasound guided epidural injections, dural pulsation provides a cue in finding a clear trajectory to the epidural space. By processing the video using extended Kalman filtering, subtle pulsations were automatically detected and visualized in real-time. A statistical framework for analyzing periodicity was developed based on dynamic linear modelling. In addition to detecting dural pulsation in lumbar spine ultrasound, this approach was used to image tissue perfusion in natural video and generate ventilation maps from free-breathing magnetic resonance imaging. A second statistical method, based on spectral analysis of pixel intensity values, allowed blood flow to be detected directly from high-frequency B-mode ultrasound video. Finally, pulsatile cues in endoscopic video were enhanced through Eulerian video magnification to help localize critical vasculature. This approach shows particular promise in identifying the basilar artery in endoscopic third ventriculostomy and the prostatic artery in nerve-sparing prostatectomy. A real-time implementation was developed which processed full-resolution stereoscopic video on the da Vinci Surgical System

Fiber Bragg Gratings for Medical Applications and Future Challenges: A Review

[EN] In the last decades, fiber Bragg gratings (FBGs) have become increasingly attractive to medical applications due to their unique properties such as small size, biocompatibility, immunity to electromagnetic interferences, high sensitivity and multiplexing capability. FBGs have been employed in the development of surgical tools, assistive devices, wearables, and biosensors, showing great potentialities for medical uses. This paper reviews the FBG-based measuring systems, their principle of work, and their applications in medicine and healthcare. Particular attention is given to sensing solutions for biomechanics, minimally invasive surgery, physiological monitoring, and medical biosensing. Strengths, weaknesses, open challenges, and future trends are also discussed to highlight how FBGs can meet the demands of next-generation medical devices and healthcare system.This work was supported in part by INAIL (the Italian National Institute for Insurance against Accident at Work), through the BRIC (Bando ricerche in collaborazione) 2018 SENSE-RISC (Sviluppo di abiti intelligENti Sensorizzati per prevenzione e mitigazione di Rischi per la SiCurezza dei lavoratori) Project under Grant ID10/2018, in part by the UCBM (Universita Campus Bio-Medico di Roma) under the University Strategic HOPE (HOspital to the PatiEnt) Project, in part by the EU Framework Program H2020-FETPROACT-2018-01 NeuHeart Project under Grant GA 824071, by FCT/MEC (Fundacao para a Ciencia e Tecnologia) under the Projects UIDB/50008/2020 - UIDP/50008/2020, and by REACT (Development of optical fiber solutions for Rehabilitation and e-Health applications) FCT-IT-LA scientific action.Lo Presti, D.; Massaroni, C.; Leitao, CSJ.; Domingues, MDF.; Sypabekova, M.; Barrera, D.; Floris, I.... (2020). Fiber Bragg Gratings for Medical Applications and Future Challenges: A Review. IEEE Access. 8:156863-156888. https://doi.org/10.1109/ACCESS.2020.3019138S156863156888