Design and Experimental Evaluation of a Tendon-Driven Minimally Invasive Surgical Robotic Tool with Antagonistic Control

The design, implementation and experimental evaluation of a minimally invasive surgical robotic instrument is presented in this article. The tool is constructed using rapid prototyping techniques and each degree-of-freedom is actuated via an antagonistic tendon driven mechanism using servo motors. The accompanying software runs under the Robot Operating System framework. The kinematics of the tool are discussed and the efficiency of the system is investigated in experimental studies, which are showcased in order to assess its potential use in a clinical environment

A spherical joint robotic end-effector for the Expanded Endoscopic Endonasal Approach

The endonasal transsphenoidal approach allows surgeons to access the pituitary gland through the natural orifice of the nose. Recently, surgeons have also described an Expanded Endoscopic Endonasal Approach (EEEA) for the treatment of other tumours around the base of the brain. However, operating in this way with nonarticulated tools is technically very difficult and not widely adopted. The goal of this study is to develop an articulated end-effector for a novel handheld robotic tool for the EEEA. We present a design and implementation of a 3.6mm diameter, three degrees-of-freedom, tendon-driven robotic end-effector that, contrary to rigid instruments which operate under fulcrum, will give the surgeon the ability to reach areas on the surface of the brain that were previously inaccessible. We model the end-effector kinematics in simulation to study the theoretical workspace it can achieve prior to implementing a test-bench device to validate the efficacy of the end-effector. We find promising repeatability of the proposed robotic end-effector of 0.42mm with an effective workspace with limits of ±30∘, which is greater than conventional neurosurgical tools. Additionally, although the tool’s end-effector has a small enough diameter to operate through the narrow nasal access path and the constrained workspace of EEEA, it showcased promising structural integrity and was able to support approximately a 6N load, despite a large deflection angle the limiting of which is scope of future work. These preliminary results indicate the end-effector is a promising first step towards developing appropriate handheld robotic instrumentation to drive EEEA adoption

An intuitive surgical handle design for robotic neurosurgery.

PURPOSE: The expanded endoscopic endonasal approach, a representative example of keyhole brain surgery, allows access to the pituitary gland and surrounding areas through the nasal and sphenoid cavities. Manipulating rigid instruments through these constrained spaces makes this approach technically challenging, and thus, a handheld robotic instrument could expand the surgeon's capabilities. In this study, we present an intuitive handle prototype for such a robotic instrument. METHODS: We have designed and fabricated a surgical instrument handle prototype that maps the surgeon's wrist directly to the robot joints. To alleviate the surgeon's wrist of any excessive strain and fatigue, the tool is mounted on the surgeon's forearm, making it parallel with the instrument's shaft. To evaluate the handle's performance and limitations, we constructed a surgical task simulator and compared our novel handle with a standard neurosurgical tool, with the tasks being performed by a consultant neurosurgeon. RESULTS: While using the proposed handle, the surgeon's average success rate was [Formula: see text], compared to [Formula: see text] when using a conventional tool. Additionally, the surgeon's body posture while using the suggested prototype was deemed acceptable by the Rapid Upper Limb Assessment ergonomic survey, while early results indicate the absence of a learning curve. CONCLUSIONS: Based on these preliminary results, the proposed handle prototype could offer an improvement over current neurosurgical tools and procedural ergonomics. By redirecting forces applied during the procedure to the forearm of the surgeon, and allowing for intuitive surgeon wrist to robot-joints movement mapping without compromising the robotic end effector's expanded workspace, we believe that this handle could prove a substantial step toward improved neurosurgical instrumentation

Localization of Interaction using Fibre-Optic Shape Sensing in Soft-Robotic Surgery Tools

Minimally invasive surgery requires real-time tool tracking to guide the surgeon where depth perception and visual occlusion present navigational challenges. Although vision-based and external sensor-based tracking methods exist, fibre-optic sensing can overcome their limitations as they can be integrated directly into the device, are biocompatible, small, robust and geometrically versatile. In this paper, we integrate a fibre Bragg grating-based shape sensor into a soft robotic device. The soft robot is the pneumatically attachable flexible (PAF) rail designed to act as a soft interface between manipulation tools and intra-operative imaging devices. We demonstrate that the shape sensing fibre can detect the location of the tools paired with the PAF rail, by exploiting the change in curvature sensed by the fibre when a strain is applied to it. We then validate this with a series of grasping tasks and continuous US swipes, using the system to detect in real-time the location of the tools interacting with the PAF rail. The overall location-sensing accuracy of the system is 64.6%, with a margin of error between predicted location and actual location of 3.75 mm

Track-Guided Ultrasound Scanning for Tumour Margins Outlining in Robot-Assisted Partial Nephrectomy

Robot-Assisted Partial Nephrectomy (RAPN) is a medical procedure in which part of a kidney is removed, typically because of the presence of a tumour. RAPN is the second most diffused robotically assisted surgical procedure worldwide after prostatectomy [1]. The advantages of this robot-assisted procedure are detailed in [2], and in [3] it is argued that RAPN can be used in place of open surgery or total nephrectomy in some complex renal tumour cases. The RAPN procedure is thoroughly described in [4]. Methods used for the identification of the tumour include pre-operative Computer Tomography (CT) scans, Magnetic Resonance (MR) imaging and intraoperative Ultrasound (US) scans. The use of drop-in US probes for RAPN procedures is widely recognized as the golden standard for the intraoperative detection and margins outlining of the mass targeted. In [5] the authors show that the use of US dropin probes guided by robotic laparoscopic tools rather than standard laparoscopic tool is beneficial for the surgeon as it significantly increases the dexterity, hence, the field of view of the system

Pneumatically Attachable Flexible Rails for Track-Guided Ultrasound Scanning in Robotic-Assisted Partial Nephrectomy - A Preliminary Design Study

Robotic-assisted partial nephrectomy is a surgical operation in which part of a kidney is removed typically because of the presence of a mass. Pre-operative and intraoperative imaging techniques are used to identify and outline the target mass, thus the margins of the resection area on the kidney surface. Drop-in ultrasound probes are used to acquire intraoperative images: the probe is inserted through a trocar port, grasped with a robotic-assisted laparoscopic gripper and swiped on the kidney surface. Multiple swipes are performed to define the resection area. This is marked swipe by swipe using an electrocautery tool. During this procedure the probe often requires repositioning because of slippage from the target organ surface. Furthermore, the localization can be inaccurate when the target mass is in locations particularly hard to reach, and thus kidney repositioning could be required. A highly skilled surgeon is typically required to successfully perform this pre-operatory procedure. We propose a novel approach for the navigation of drop-in ultrasound probes: the use of pneumatically attachable flexible rails to enable swift, effortless, and accurate track-guided scanning of the kidney. The proposed system attaches on the kidney side surface with the use of a series of bio-inspired vacuum suckers. In this letter, the design of the proposed system and its use in robotic-assisted partial nephrectomy are presented for the first time

Rollout Sampling Approximate Policy Iteration

Several researchers have recently investigated the connection between reinforcement learning and classification. We are motivated by proposals of approximate policy iteration schemes without value functions which focus on policy representation using classifiers and address policy learning as a supervised learning problem. This paper proposes variants of an improved policy iteration scheme which addresses the core sampling problem in evaluating a policy through simulation as a multi-armed bandit machine. The resulting algorithm offers comparable performance to the previous algorithm achieved, however, with significantly less computational effort. An order of magnitude improvement is demonstrated experimentally in two standard reinforcement learning domains: inverted pendulum and mountain-car.Comment: 18 pages, 2 figures, to appear in Machine Learning 72(3). Presented at EWRL08, to be presented at ECML 200

[Comment] The challenges of planetary mental health in the COVID-19 era.

As the focus of the COVID-19 crisis is gradually taken away from emergency healthcare needs, increased attention is warranted on the psychological impact of the pandemic on a global level. Existing guidance on managing the COVID-19 related distress needs to be better informed by upcoming larger-scale research. Applying e-Health can be useful in dealing with the immediate psychological needs, while developing strategies to identify vulnerable populations and shifting the provision of mental health and social care to community services need to be prioritised when looking at the future. Focusing on global mental health during this universal crisis is an opportunity for promoting a more compassionate and less discriminating society

Organ curvature sensing using pneumatically attachable flexible rails in robotic-assisted laparoscopic surgery

In robotic-assisted partial nephrectomy, surgeons remove a part of a kidney often due to the presence of a mass. A drop-in ultrasound probe paired to a surgical robot is deployed to execute multiple swipes over the kidney surface to localise the mass and define the margins of resection. This sub-task is challenging and must be performed by a highly-skilled surgeon. Automating this sub-task may reduce cognitive load for the surgeon and improve patient outcomes. The eventual goal of this work is to autonomously move the ultrasound probe on the surface of the kidney taking advantage of the use of the Pneumatically Attachable Flexible (PAF) rail system, a soft robotic device used for organ scanning and repositioning. First, we integrate a shape-sensing optical fibre into the PAF rail system to evaluate the curvature of target organs in robotic-assisted laparoscopic surgery. Then, we investigate the impact of the PAF rail’s material stiffness on the curvature sensing accuracy, considering that soft targets are present in the surgical field. We found overall curvature sensing accuracy to be between 1.44% and 7.27% over the range of curvatures present in adult kidneys. Finally, we use shape sensing to plan the trajectory of the da Vinci surgical robot paired with a drop-in ultrasound probe and autonomously generate an Ultrasound scan of a kidney phantom

Estrogen receptor-α and progesterone receptor are expressed in label-retaining mammary epithelial cells that divide asymmetrically and retain their template DNA strands

INTRODUCTION: Stem cells of somatic tissues are hypothesized to protect themselves from mutation and cancer risk through a process of selective segregation of their template DNA strands during asymmetric division. Mouse mammary epithelium contains label-retaining epithelial cells that divide asymmetrically and retain their template DNA. METHOD: Immunohistochemistry was used in murine mammary glands that had been labeled with [(3)H]thymidine during allometric growth to investigate the co-expression of DNA label retention and estrogen receptor (ER)-α or progesterone receptor (PR). Using the same methods, we investigated the co-localization of [(3)H]thymidine and ER-α or PR in mammary tissue from mice that had received treatment with estrogen, progesterone, and prolactin subsequent to a long chase period to identify label-retaining cells. RESULTS: Label-retaining epithelial cells (LRECs) comprised approximately 2.0% of the entire mammary epithelium. ER-α-positive and PR-positive cells represented about 30–40% of the LREC subpopulation. Administration of estrogen, progesterone, and prolactin altered the percentage of LRECs expressing ER-α. CONCLUSION: The results presented here support the premise that there is a subpopulation of LRECs in the murine mammary gland that is positive for ER-α and/or PR. This suggests that certain mammary LRECs (potentially stem cells) remain stably positive for these receptors, raising the possibility that LRECs comprise a hierarchy of asymmetrically cycling mammary stem/progenitor cells that are distinguished by the presence or absence of nuclear steroid receptor expression