AUGMENTED REALITY AND INTRAOPERATIVE C-ARM CONE-BEAM COMPUTED TOMOGRAPHY FOR IMAGE-GUIDED ROBOTIC SURGERY

Minimally-invasive robotic-assisted surgery is a rapidly-growing alternative to traditionally open and laparoscopic procedures; nevertheless, challenges remain. Standard of care derives surgical strategies from preoperative volumetric data (i.e., computed tomography (CT) and magnetic resonance (MR) images) that benefit from the ability of multiple modalities to delineate different anatomical boundaries. However, preoperative images may not reflect a possibly highly deformed perioperative setup or intraoperative deformation. Additionally, in current clinical practice, the correspondence of preoperative plans to the surgical scene is conducted as a mental exercise; thus, the accuracy of this practice is highly dependent on the surgeon’s experience and therefore subject to inconsistencies. In order to address these fundamental limitations in minimally-invasive robotic surgery, this dissertation combines a high-end robotic C-arm imaging system and a modern robotic surgical platform as an integrated intraoperative image-guided system. We performed deformable registration of preoperative plans to a perioperative cone-beam computed tomography (CBCT), acquired after the patient is positioned for intervention. From the registered surgical plans, we overlaid critical information onto the primary intraoperative visual source, the robotic endoscope, by using augmented reality. Guidance afforded by this system not only uses augmented reality to fuse virtual medical information, but also provides tool localization and other dynamic intraoperative updated behavior in order to present enhanced depth feedback and information to the surgeon. These techniques in guided robotic surgery required a streamlined approach to creating intuitive and effective human-machine interferences, especially in visualization. Our software design principles create an inherently information-driven modular architecture incorporating robotics and intraoperative imaging through augmented reality. The system's performance is evaluated using phantoms and preclinical in-vivo experiments for multiple applications, including transoral robotic surgery, robot-assisted thoracic interventions, and cocheostomy for cochlear implantation. The resulting functionality, proposed architecture, and implemented methodologies can be further generalized to other C-arm-based image guidance for additional extensions in robotic surgery

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

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

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

Image-guided robots for dot-matrix tumor ablation

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2010.Cataloged from PDF version of thesis.Includes bibliographical references (p. 203-208).Advances in medical imaging now provides detailed images of solid tumors inside the body and miniaturized energy delivery systems enable tumor destruction through local heating powered by a thin electrode. However, the use of thermal ablation as a first line of treatment is limited due to the difficulty in accurately matching a desired treatment and a limited region of active heating around an electrode. The purpose of this research is to identify and quantify the current limitations of image-guided interventional procedures and subsequently develop a procedure and devices to enable accurate and efficient execution of image-based interventional plans and thus ablation of a tumor of any shape with minimal damage to surrounding tissue. Current limitations of probe placement for ablation therapy were determined by a detailed retrospective study of 50 representative CT-guided procedures. On average, 21 CT scans were performed for a given procedure (range 11-38), with the majority devoted to needle orientation and insertion (mean number of scans was 54%) and trajectory planning (mean number of scans was 19%). A regression analysis yielded that smaller and deeper lesions were associated with a higher number of CT scans for needle orientation and insertion; highlighting the difficulty in targeting. Another challenge identified was repositioning the instrument distal tip within tissue. The first robot is a patient-mounted device that aligns an instrument along a desired trajectory via two motor-actuated concentric, crossed, and partially nested hoops. A carriage rides in the hoops and grips and inserts an instrument via a two degree-of-freedom friction drive. An imagebased point-and-click user interface relates appropriate clicks on the medical images to robot commands. Mounting directly on the patient provides a sufficiently stable and safe platform for actuation and eliminates the need to compensate for chest motion; thereby reducing the cost and complexity compared to other devices. Phantom experiments in a realistic clinical setting demonstrated a mean targeting accuracy of 3.5 mm with an average of five CT scans. The second robot is for repositioning the distal tip of a medical instrument to adjacent points within tissue. The steering mechanism is based on the concept of substantially straightening a pre-curved Nitinol stylet by retracting it into a concentric outer cannula, and re-deploying it at different axial and rotational cannula positions. The proximal end of the cannula is attached to the distal end of a screw-spline that enables it to be translated and rotated with respect to the casing. Translation of the stylet relative to the cannula is achieved with a second concentric, nested smaller diameter screw that is constrained to rotate with the cannula. The robot mechanism is compatible with the CT images, light enough to be supported on a patient's chest or attached to standard stereotactic frames. Targeting experiments in a gelatin phantom demonstrated a mean targeting error of 1.8 mm between the stylet tip and that predicted with a kinematic model. Ultimately, these types of systems are envisioned being used together as part of a highly dexterous patient-mounted positioning platform that can accurately perform ablation of large and irregularly shaped tumors inside medical imaging machines - offering the potential to replace expensive and traumatic surgeries with minimally invasive out-patient procedures.by Conor James Walsh.Ph.D

Efficient design of precision medical robotics

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2012.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Cataloged from student-submitted PDF version of thesis.Includes bibliographical references (p. 106-114).Medical robotics is increasingly demonstrating the potential to improve patient care through more precise interventions. However, taking inspiration from industrial robotics has often resulted in large, sometimes cumbersome designs, which represent high capital and per procedure expenditures, as well as increased procedure times. This thesis proposes and demonstrates an alternative model and method for developing economical, appropriately scaled medical robots that improve care and efficiency, while moderating costs. Key to this approach is a structured design process that actively reduces complexity. A selected medical procedure is decomposed into discrete tasks which are then separated into those that are conducted satisfactorily and those where the clinician encounters limitations, often where robots' strengths would be complimentary. Then by following deterministic principles and with continual user participation, prototyping and testing, a system can be designed that integrates into and assists with current procedures, rather than requiring a completely new protocol. This model is expected to lay the groundwork for increasing the use of hands-on technology in interventional medicine.by Nevan Clancy Hanumara.Ph.D

下腹部を対象とした極細針によるCTガイド下高正確度穿刺プランニング

早大学位記番号:新8149早稲田大

Evaluation of robotic catheter technology in complex endovascular intervention

The past four decades have witnessed tremendous strides in the evolution of endovascular devices and techniques. Catheter-based intervention has revolutionized the management of arterial disease allowing treatment of aortic and peripheral pathologies via a minimally invasive approach. Despite the exponential advances in endovascular equipment, devices and techniques, catheter-based endovascular intervention has certain morphological and technological constraints. Complex patient anatomy, technological impediments and suboptimal fluoroscopic imaging, can make endovascular intervention challenging using traditional endovascular means. Conventional endovascular catheters lack active manoeuvrability of the tip. Manual control can hinder overall stability and control at key target areas, leading to significantly prolonged overall procedure and fluoroscopic times. Repeated instrumentation increases the risk of vessel trauma and distal embolization. More importantly, guidewire-catheter skills are not necessarily intuitive but must be developed and are highly dependent on operator skill with long training pathways as a result. Recognizing the pressing need to address some of the limitations of standard catheter technology this thesis aims to evaluate the role of advanced robotic endovascular catheters in the aortic arch and the visceral segment. Clinical use of this technology is currently limited to transvenous cardiac mapping and ablation procedures. A comprehensive pre-clinical comparison and analysis of robotic versus manual catheter techniques is presented to reveal both their advantages and limitations, with particular emphasis on the potential of robotic catheter technology to reduce the manual skill required for complex tasks, improve stability at key target areas, reduce the risk of vessel trauma, embolization and radiation exposure, whilst improving overall operator performance. The worlds first clinical report of robot-assisted aortic aneurysm repair, a “proof - of - concept” resulting from this research, is also presented, and the potential for future advanced applications in order to increase the applicability of endovascular therapy to a larger cohort of patients discussed