Human machine interfaces for robot-assisted colonoscopy: a clinical survey

In the last decade, a variety of Human Machine Interfaces (HMI) have been designed for robot assisted colonoscopy, including different input devices, assistive tools and feedback. However, few studies aiming at assessing the best features of the HMI have been performed so far, leading to a lack of knowledge about the optimal HMI able to minimize the cognitive and physical load of the operators and maximize their performace. Herein, we present the results of a survey administered to more than 70 endoscopists across different European countries, to get insights about the clinicians’ desires on the next generation HMI for robot assisted colonoscopy.This work was supported by the ATLAS project, which has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 813782.Peer ReviewedPreprin

A. Training Simulators for Gastrointestinal Endoscopy: Current and Future Perspectives

Over the last decades, visual endoscopy has become a gold standard for the detection and treatment of gastrointestinal cancers. However, mastering endoscopic procedures is complex and requires long hours of practice. In this context, simulation-based training represents a valuable opportunity for acquiring technical and cognitive skills, suiting the different trainees’ learning pace and limiting the risks for the patients. In this regard, the present contribution aims to present a critical and comprehensive review of the current technology for gastrointestinal (GI) endoscopy training, including both commercial products and platforms at a research stage. Not limited to it, the recent revolution played by the technological advancements in the fields of robotics, artificial intelligence, virtual/augmented reality, and computational tools on simulation-based learning is documented and discussed. Finally, considerations on the future trend of this application field are drawn, highlighting the impact of the most recent pandemic and the current demographic trends

Multi-level-assistance robotic platform for navigation in the urinary system: design and preliminary tests

This work was supported by the ATLAS project. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 813782. This work was also partially supported by French State Funds managed by the “Agence Nationale de la Recherche (ANR)” through the “Investissements d’Avenir” (Investments for the Future) Program under Grant ANR-10-IAHU-02 (IHU-Strasbourg).Peer ReviewedPostprint (published version

Automatic hands-free visualization of a six degrees of freedom agent within a complex anatomical space

Tesi amb menció internacionalTesi en modalitat de cotutela: Universitat Politècnica de Catalunya i Scuola Superiore Sant'AnnaAl reverso de la portada: ATLAS Marie-Curie Training Network, GA No 813782(English) Over the years, a continuous development of intraluminal procedures resulted in strong benefits for the patients. Reduced blood loss, lower risk of infections, diminished scaring impact and quicker recovery time are among the most valuable ones. However, these improvements imposed high mental and physical stress to the clinicians. In this context, the introduction of robotic technologies has resulted in notable improvements in terms of flexibility of the endoscopes and control stability, by designing multi-steerable snake like robots and endoscopic capsules. Robotic devices also introduced additional degrees of freedom (DOF) to control, as well as sensing information to process, posing the basis for a new framework of human-robot interaction. Therefore, in the context of intraluminal robotic surgery, the present research focuses on the human-robot interaction, aiming at investigating the optimal way to design Human Machine Interface (HMI) with multiple levels of assistance. Accordingly, a modular bio-engineering framework was designed and developed for the analysis, evaluation and comparison of different HMI for robot assisted endoluminal procedure (i.e., colonoscopy). The main component of the framework is a virtual simulator of the robotic colonoscopy procedure, developed using the SOFA. The simulator, endowed with 3D models of colons reconstructed from real patients' CT scans, realistically reproduces the anatomy and its performance during the robotic medical procedure in terms of timings, visual rendering and mechanical behaviour. Its open design allows to measure several metrics correlated with the quality of the procedure (e.g., force exerted on the intestinal walls, timings etc.) and of control (e.g., smoothness of trajectory). Therefore, the different HMI can be used to control the robotic endoscope in the virtual simulator and tested with user studies involving the endoscopists. This framework also comprises the use of wearable sensors to measure the cognitive load of the users through physiological data when testing the HMI in the simulation environment. Finally, a set of questionnaires were designed to be filled by the subjects after the tests for measuring their perceived physical and mental stress, and their overall impression on the interfaces. The framework was tested for the first time by 42 clinicians with the goal of deriving the optimal device for teleoperated control of robotic colonoscopes. To this end, a preliminary survey was driven among 71 endoscopists to derive the main characteristics and configuration of the control device desired by the final users. Accordingly, two selected systems were compared with the framework: an haptic serial-kinematic device and a standard videogame joypad. This users' test represented a first case study for the validation of the framework allowing to compare different HMI and derive their optimal features. Nevertheless, being the framework highly modular and open, is meant to be applied for the testing of different aspects of the HMI, both software and hardware e.g., types of feedback, control strategies etc. Indeed, the final goal of the framework, and more in general of the present thesis, is to extract insights, guidelines and metrics over the design of the next generation intraluminal robotic devices.(Català) Al llarg dels anys, un desenvolupament continu dels procediments intraluminals va donar lloc a grans beneficis per als pacients. La reducció de la pèrdua de sang, el menor risc d'infecció, la disminució de l'impacte espantant i el temps de recuperació més ràpid es troben entre els més valuosos. Tanmateix, aquestes millores van imposar un alt estrès mental i físic als metges. En aquest context, la introducció de les tecnologies robòtiques ha donat com a resultat millores notables pel que fa a la flexibilitat dels endoscopis i l'estabilitat del control, mitjançant el disseny de serps multidireccionables com robots i càpsules endoscòpiques. No obstant això, també va introduir graus de llibertat addicionals (DOF) per controlar, com a informació de detecció a processar, posant la base per a un nou marc d'interacció humà-robot. Per tant, en el context de la cirurgia robòtica intraluminal, la present investigació se centra en la interacció home-robot, amb l'objectiu d'investigar i dissenyar una interfície humà-màquina (HMI) d'autonomia multinivell. En conseqüència, es va dissenyar i desenvolupar un marc de bioenginyeria modular per a l'anàlisi, l'avaluació i la comparació de l'HMI per al procediment endoluminal assistit per robot (és a dir, la colonoscòpia). El component principal del marc és un simulador virtual del procediment de colonoscòpia, desenvolupat mitjançant el SOFA. El simulador, dotat de models 3D de còlons reconstruïts a partir de TAC de pacients reals, reprodueix de manera realista el procediment mèdic en termes de temps, representació visual i comportament mecànic. El seu disseny obert permet mesurar diverses mètriques correlacionades amb la qualitat del procediment (per exemple, força exercida sobre les parets intestinals, temps, etc.) i de control (per exemple, suavitat de la trajectòria). Per tant, les diferents HMI es poden connectar o implementar en el simulador virtual, i provar-se amb estudis d'usuaris que involucren els endoscopistes. El marc també inclou l'ús de sensors portàtils per mesurar la càrrega cognitiva dels usuaris mitjançant dades fisiològiques quan es prova l'HMI en l'entorn de simulació. Finalment, es dissenya un conjunt de qüestionaris per ser administrats als subjectes després de les proves per fer el seguiment de l'estrès físic i mental percebut i la seva impressió global a les interfícies. El marc es va provar per primera vegada amb 42 metges que investigaven el dispositiu òptim per al control teleoperat de colonoscopis robòtics. Amb aquesta finalitat, es va dur a terme una enquesta preliminar entre 71 endoscopistes per derivar les principals característiques i configuració del dispositiu de control desitjat pels usuaris finals. En conseqüència, es van comparar dos sistemes seleccionats amb el marc: un dispositiu cinemàtic en sèrie hàptic i un joypad estàndard de videojocs. Aquesta prova d'usuaris va representar un primer cas pràctic per a la validació del framework que permet comparar diferents HMI i derivar les característiques òptimes. No obstant això, al ser el framework altament modular i obert, està pensat per ser aplicat per a la prova de diferents aspectes de l'HMI, tant de programari com de maquinari, p. tipus de retroalimentació, estratègies de control, etc. De fet, l'objectiu final del marc, i més en general de la present tesi, és extreure coneixements, directrius i mètriques sobre el disseny dels dispositius robòtics intraluminals de nova generació.DOCTORAT EN ENGINYERIA BIOMÈDICA (Pla 2012

Design and testing of a robotic device for bowel lengthening

The following thesis focuses on translational research, which combines the emergent and exciting world of robotic implants with tissue regeneration engineering. The ultimate goal is the treatment of a devastating disease called Short Bowel Syndrome (SBS) in paediatrics patients. The SBS is associated with the loss of a big portion of bowel and the consequential inability of the patient to absorb enough nutrients. While existing surgical procedures and intestinal transplants lead to several complications, the solution proposed here involves the in-vivo regeneration of intestinal tissue through mechanotransduction. This thesis introduces a robotic implant for inducing bowel growth, without compromising the internal flow, by applying controlled distraction forces extraluminally. With the ultimate goal of developing a device sized for paediatric patients, a scalable design is presented, with two sets of specifications; one for humans and one for piglets. A prototype sized for 20 kg pigs is built and assessed through benchtop experiments. The final prototype, controllable by a laptop, has a cylindrical body of 21x2.5 cm and is encapsulated in two layers of biocompatible materials. In order to generate an animal model of the paediatric SBS, six pigs of 20 kg underwent 75-80% short bowel resection. Three of these animals received the implants, while the other three worked as a control group. One animal from the group that received the implant successfully grew 87 mm of bowel. The remaining two had to be prematurely euthanised. While the robot successfully overcame the design challenges of the medical implant, the interface with the biological tissue needs to be further investigated

Tyrosinemia type I: long-term outcome in a patient treated with doses of NTBC lower than recommended

[No abstract available

Malattie Metaboliche Ereditarie

Seconda Edizion

35. Healthcare (Data Science in)

This Encyclopedia brings together jurists, computer scientists, and data analysts to map the emerging field of data science and law for the first time, uncovering the challenges, opportunities, and fault lines that arise as these groups are increasingly thrown together by expanding attempts to regulate and adapt to a data-driven world. It explains the concepts and tools at the crossroads of the many disciplines involved in data science and law, bridging scientific and applied domains. Entries span algorithmic fairness, consent, data protection, ethics, healthcare, machine learning, patents, surveillance, transparency and vulnerability.Peer ReviewedPreprin

Reduction of plasma taurine level in children affected by Osteogenesis Imperfecta during bisphosphonate therapy

Osteogenesis Imperfecta (OI) is a heritable disease of connective tissue characterized by increased bone fragility. To date, bisphosphonates seem to be the most promising therapy, at least for children. In the last decade experimental and clinical studies indicate that several amino acids are implicated in bone mineralization. Particularly, taurine is localized in matrices of the bone and can regulate osteoblast metabolism with antiosteopenic effect. To investigate a possible interaction between pharmacological effects of bisphosphonates and amino acids involved in bone metabolism, we performed plasma and urine amino acids analysis in children affected by OI before and during treatment with bisphosphonates. Fourteen prepubertal children with moderate to severe types of OI, 8 males and 6 females, aged from 2 to 11 years (mean (SD) 6,9 ± 2,53) were enrolled in the study. Patients were treated with neridronate infusion (1 mg/Kg/body weight) every three months. Plasma and urine specimens for amino acid analysis were kept at baseline (T0) and three months after each infusion of four consecutive cycles (T1-T4). A significant decrease in respect to the pre-treatment levels (T0) was observed after the fourth infusion for taurine (p < 0.01). In addition, urinary excretion of this amino acid showed a significant decrease after the fourth infusion. No significant correlations were found between plasma level or urinary excretion of hydroxyproline, taurine, arginine and lysine in respect to bone mineral density. The progressive reduction of plasma taurine found in our patients treated with bisphosphonates could be implicated in the action mechanism of this drug in OI and possibly in other disorders of bone metabolism. This knowledge could provide new opportunities to improve treatment with bisphosphonates and address novel strategies for the therapeutic approach to bone disorders. © 2006 Elsevier Masson SAS. All rights reserved