Optical coherence tomography-based consensus definition for lamellar macular hole.

BackgroundA consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed.MethodsThe panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions.ResultsThe panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle's fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness.ConclusionsThe use of the proposed definitions may provide uniform language for clinicians and future research

SPRK: A Low-Cost Stewart Platform For Motion Study In Surgical Robotics

To simulate body organ motion due to breathing, heart beats, or peristaltic movements, we designed a low-cost, miniaturized SPRK (Stewart Platform Research Kit) to translate and rotate phantom tissue. This platform is 20cm x 20cm x 10cm to fit in the workspace of a da Vinci Research Kit (DVRK) surgical robot and costs $250, two orders of magnitude less than a commercial Stewart platform. The platform has a range of motion of +/- 1.27 cm in translation along x, y, and z directions and has motion modes for sinusoidal motion and breathing-inspired motion. Modular platform mounts were also designed for pattern cutting and debridement experiments. The platform's positional controller has a time-constant of 0.2 seconds and the root-mean-square error is 1.22 mm, 1.07 mm, and 0.20 mm in x, y, and z directions respectively. All the details, CAD models, and control software for the platform is available at github.com/BerkeleyAutomation/sprk

Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-opera- tive morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilites by observ- ing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted in- struments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This paper reviews the state-of-the-art methods for optical intra-operative 3D reconstruction in laparoscopic surgery and discusses the technical challenges and future perspectives towards clinical translation. With the recent paradigm shift of surgical practice towards MIS and new developments in 3D opti- cal imaging, this is a timely discussion about technologies that could facilitate complex CAS procedures in dynamic and deformable anatomical regions

Autonomous Tissue Scanning under Free-Form Motion for Intraoperative Tissue Characterisation

In Minimally Invasive Surgery (MIS), tissue scanning with imaging probes is required for subsurface visualisation to characterise the state of the tissue. However, scanning of large tissue surfaces in the presence of deformation is a challenging task for the surgeon. Recently, robot-assisted local tissue scanning has been investigated for motion stabilisation of imaging probes to facilitate the capturing of good quality images and reduce the surgeon's cognitive load. Nonetheless, these approaches require the tissue surface to be static or deform with periodic motion. To eliminate these assumptions, we propose a visual servoing framework for autonomous tissue scanning, able to deal with free-form tissue deformation. The 3D structure of the surgical scene is recovered and a feature-based method is proposed to estimate the motion of the tissue in real-time. A desired scanning trajectory is manually defined on a reference frame and continuously updated using projective geometry to follow the tissue motion and control the movement of the robotic arm. The advantage of the proposed method is that it does not require the learning of the tissue motion prior to scanning and can deal with free-form deformation. We deployed this framework on the da Vinci surgical robot using the da Vinci Research Kit (dVRK) for Ultrasound tissue scanning. Since the framework does not rely on information from the Ultrasound data, it can be easily extended to other probe-based imaging modalities.Comment: 7 pages, 5 figures, ICRA 202

Computer- and robot-assisted Medical Intervention

Medical robotics includes assistive devices used by the physician in order to make his/her diagnostic or therapeutic practices easier and more efficient. This chapter focuses on such systems. It introduces the general field of Computer-Assisted Medical Interventions, its aims, its different components and describes the place of robots in that context. The evolutions in terms of general design and control paradigms in the development of medical robots are presented and issues specific to that application domain are discussed. A view of existing systems, on-going developments and future trends is given. A case-study is detailed. Other types of robotic help in the medical environment (such as for assisting a handicapped person, for rehabilitation of a patient or for replacement of some damaged/suppressed limbs or organs) are out of the scope of this chapter.Comment: Handbook of Automation, Shimon Nof (Ed.) (2009) 000-00

Robot Autonomy for Surgery

Autonomous surgery involves having surgical tasks performed by a robot operating under its own will, with partial or no human involvement. There are several important advantages of automation in surgery, which include increasing precision of care due to sub-millimeter robot control, real-time utilization of biosignals for interventional care, improvements to surgical efficiency and execution, and computer-aided guidance under various medical imaging and sensing modalities. While these methods may displace some tasks of surgical teams and individual surgeons, they also present new capabilities in interventions that are too difficult or go beyond the skills of a human. In this chapter, we provide an overview of robot autonomy in commercial use and in research, and present some of the challenges faced in developing autonomous surgical robots

Caveats on the first-generation da Vinci Research Kit: latent technical constraints and essential calibrations

Telesurgical robotic systems provide a well established form of assistance in the operating theater, with evidence of growing uptake in recent years. Until now, the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, California) has been the most widely adopted robot of this kind, with more than 6,700 systems in current clinical use worldwide [1]. To accelerate research on robotic-assisted surgery, the retired first-generation da Vinci robots have been redeployed for research use as "da Vinci Research Kits" (dVRKs), which have been distributed to research institutions around the world to support both training and research in the sector. In the past ten years, a great amount of research on the dVRK has been carried out across a vast range of research topics. During this extensive and distributed process, common technical issues have been identified that are buried deep within the dVRK research and development architecture, and were found to be common among dVRK user feedback, regardless of the breadth and disparity of research directions identified. This paper gathers and analyzes the most significant of these, with a focus on the technical constraints of the first-generation dVRK, which both existing and prospective users should be aware of before embarking onto dVRK-related research. The hope is that this review will aid users in identifying and addressing common limitations of the systems promptly, thus helping to accelerate progress in the field.Comment: 15 pages, 7 figure