Imaging skins: stretchable and conformable on-organ beta particle detectors for radioguided surgery

While radioguided surgery (RGS) traditionally relied on detecting gamma rays, direct detection of beta particles could facilitate the detection of tumour margins intraoperatively by reducing radiation noise emanating from distant organs, thereby improving the signal-to-noise ratio of the imaging technique. In addition, most existing beta detectors do not offer surface sensing or imaging capabilities. Therefore, we explore the concept of a stretchable scintillator to detect beta-particles emitting radiotracers that would be directly deployed on the targeted organ. Such detectors, which we refer to as imaging skins, would work as indirect radiation detectors made of light-emitting agents and biocompatible stretchable material. Our vision is to detect scintillation using standard endoscopes routinely employed in minimally invasive surgery. Moreover, surgical robotic systems would ideally be used to apply the imaging skins, allowing for precise control of each component, thereby improving positioning and task repeatability. While still in the exploratory stages, this innovative approach has the potential to improve the detection of tumour margins during RGS by enabling real-time imaging, ultimately improving surgical outcomes

Autonomous Object Handover Using Wrist Tactile Information

Grasping in an uncertain environment is a topic of great interest in robotics. In this paper we focus on the challenge of object handover capable of coping with a wide range of different and unspecified objects. Handover is the action of object passing an object from one agent to another. In this work handover is performed from human to robot. We present a robust method that relies only on the force information from the wrist and does not use any vision and tactile information from the fingers. By analyzing readings from a wrist force sensor, models of tactile response for receiving and releasing an object were identified and tested during validation experiments

A Fluidic Soft Robot for Needle Guidance and Motion Compensation in Intratympanic Steroid Injections

Intratympanic steroid injections are commonly employed in treating ear diseases, such as sudden sensorineural hearing loss or Meniere's disease through drug delivery via the middle ear. Whilst being an effective treatment, the procedure has to be performed by a trained surgeon to avoid delicate regions in the patient's anatomy and is considered painful despite the use of topical anaesthesia. In this letter we introduce a fluid-driven soft robotic system which aims at increasing patient-comfort during the injection by counteracting unwanted needle motion, reducing the cognitive load of the clinician by autonomously identifying sensitive regions in the ear and de-risking the procedure by steering the needle towards the desired injection site. A design comprising of six embedded fluidic actuators is presented, which allow for translation and rotation of the needle as well as adaptive stiffening in the coupling between needle and ear canal. The system's steering-capabilities are investigated and the differential kinematics derived to demonstrate trajectory tracking in Cartesian space. A vision system is developed which enables tracking of anatomical landmarks on the tympanic membrane and thus locating the desired needle insertion site. The integrated system shows the ability to provide a safe guide for the inserted needle towards a desired target direction while significantly reducing needle motion. The proposed tracking algorithm is able to identify the desired needle insertion site and could be employed to avoid delicate anatomical regions

Paediatric orthopaedic surgery with 3D printing: Improvements and cost reduction

This paper presents a a novel alghorithm of diagnosis and treatment of rigid flatfoot due to tarsal coalition. It introduces a workflow based on 3D printed models, that ensures more efficiency, not only by reducing costs and time, but also by improving procedures in the preoperative clinical phase. Since this paper concerns the development of a new methodology that integrates both engineering and medical fields, it highlights symmetry. An economic comparison is made between the traditional method and the innovative one; the results demonstrate a reduction in costs with the latter. The current, traditional method faces critical issues in diagnosing the pathologies of a limb (such as the foot) and taking decisions for further treatment of the same limb. The proposed alternative methodology thus uses new technologies that are part of the traditional workflow, only replacing the most obsolete ones. In fact, it is increasingly becoming necessary to introduce new technologies in orthopedics, as in other areas of medicine, to offer improved healthcare services for patients. Similar clinical treatments can be performed using the aforementioned technologies, offering greater effectiveness, more simplicity of approach, shorter times, and lower costs. An important technology that fits into this proposed methodology is 3D printing

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

Good subjective outcomes, stable knee and high return to sport after tibial eminence avulsion fracture in children

Avulsion fracture of the tibial spine (TSA) is uncommon in children, although its incidence is increasing with the earlier practice of competitive sport activities. This study aims to report mid to long term outcomes in children who sustained a TSA, with a special focus on a return to sport activities. Skeletally immature patients with a TSA, treated in two orthopedic hospitals, were evaluated for range of motion and knee laxity using KT1000, KiRA and Rolimeter. The pediatric International Knee Documentation Committee score (Pedi-IKDC) and the Hospital for Special Surgery pediatric Functional Activity Brief Scale (Pedi-FABS) questionnaires were recorded during the latest visit. Forty-two children were included. Twenty-six were treated nonoperatively and 16 underwent surgery. At a mean follow-up of 6.9 ± 3.6 years, 36 patients completed the questionnaires and 23 patients were tested with arthrometers. Among them, 96% had normal knee laxity. The Pedi-IKDC score averaged 96.4 ± 5.7 points, while the mean Pedi-FABS was 22.2 ± 5.9 points, without statistically significant differences between groups. Twenty-eight patients (78%) returned to their previous level of sport activity (eight amateur, 13 competitive, seven elite athletes). Eight patients (22%) quit sport, mostly because of re-injury fear. If properly treated, pediatric TSAs achieve a high rate of successful healing, with complete restoration of knee stability and an early return to sport activities

New methodology for diagnosis of orthopedic diseases through additive manufacturing models

Our purpose is to develop the preoperative diagnosis stage for orthopedic surgical treatments using additive manufacturing technology. Our methods involve fast implementations of an additive manufactured bone model, converted from CAT data, through appropriate software use. Then, additive manufacturing of the formed surfaces through special 3D-printers. With the structural model redesigned and printed in three dimensions, the surgeon is able to look at the printed bone and he can handle it because the model perfectly reproduces the real one upon which he will operate. We found that additive manufacturing models can precisely characterize the anatomical structures of fractures or lesions. The studied practice helps the surgeon to provide a complete preoperative valuation and a correct surgery, with minimized duration and risks. This structural model is also an effective device for communication between doctor and patient

Ultrasound 3D reconstruction of malignant masses in robotic-assisted partial nephrectomy using the PAF rail system: a comparison study

PURPOSE: In robotic-assisted partial nephrectomy (RAPN), the use of intraoperative ultrasound (IOUS) helps to localise and outline the tumours as well as the blood vessels within the kidney. The aim of this work is to evaluate the use of the pneumatically attachable flexible (PAF) rail system for US 3D reconstruction of malignant masses in RAPN. The PAF rail system is a novel device developed and previously presented by the authors to enable track-guided US scanning. METHODS: We present a comparison study between US 3D reconstruction of masses based on: the da Vinci Surgical System kinematics, single- and stereo-camera tracking of visual markers embedded on the probe. An US-realistic kidney phantom embedding a mass is used for testing. A new design for the US probe attachment to enhance the performance of the kinematic approach is presented. A feature extraction algorithm is proposed to detect the margins of the targeted mass in US images. RESULTS: To evaluate the performance of the investigated approaches the resulting 3D reconstructions have been compared to a CT scan of the phantom. The data collected indicates that single camera reconstruction outperformed the other approaches, reconstructing with a sub-millimetre accuracy the targeted mass. CONCLUSIONS: This work demonstrates that the PAF rail system provides a reliable platform to enable accurate US 3D reconstruction of masses in RAPN procedures. The proposed system has also the potential to be employed in other surgical procedures such as hepatectomy or laparoscopic liver resection

Long-Term Oral Administration of Theaphenon-E Improves Cardiomyocyte Mechanics and Calcium Dynamics by Affecting Phospholamban Phosphorylation and ATP Production

Background/Aims: Dietary polyphenols from green tea have been shown to possess cardio-protective activities in different experimental models of heart diseases and age-related ventricular dysfunction. The present study was aimed at evaluating whether long term in vivo administration of green tea extracts (GTE), can exert positive effects on the normal heart, with focus on the underlying mechanisms. Methods: The study population consisted of 20 male adult Wistar rats. Ten animals were given 40 mL/day tap water solution of GTE (concentration 0.3%) for 4 weeks (GTE group). The same volume of water was administered to the 10 remaining control rats (CTRL). Then, in vivo and ex vivo measurements of cardiac function were performed in the same animal, at the organ (hemodynamics) and cellular (cardiomyocyte mechanical properties and intracellular calcium dynamics) levels. On cardiomyocytes and myocardial tissue samples collected from the same in vivo studied animals, we evaluated: (1) the intracellular content of ATP, (2) the endogenous mitochondrial respiration, (3) the expression levels of the Sarcoplasmic Reticulum Ca2+-dependent ATPase 2a (SERCA2), the Phospholamban (PLB) and the phosphorylated form of PLB, the L-type Ca2+ channel, the Na+-Ca2+ exchanger, and the ryanodine receptor 2. Results: GTE cardiomyocytes exhibited a hyperdynamic contractility compared with CTRL (the rate of shortening and re-lengthening, the fraction of shortening, the amplitude of calcium transient, and the rate of cytosolic calcium removal were significantly increased). A faster isovolumic relaxation was also observed at the organ level. Consistent with functional data, we measured a significant increase in the intracellular ATP content supported by enhanced endogenous mitochondrial respiration in GTE cardiomyocytes, as well as higher values of the ratios phosphorylated-PLB/PLB and SERCA2/PLB. Conclusions: Long-term in vivo administration of GTE improves cell mechanical properties and intracellular calcium dynamics in normal cardiomyocytes, by increasing energy availability and removing the inhibitory effect of PLB on SERCA2

Dynamic Response Characteristics in Variable Stiffness Soft Inflatable Links

© Springer Nature Switzerland AG 2019. In soft robotics, there is the fundamental need to develop devices that are flexible and can change stiffness in order to work safely in the vicinity of humans. Moreover, these structures must be rigid enough to withstand the force application and accuracy in motion. To solve these issues, previous research proposed to add a compliance element between motor and load – Series Elastic Actuators (SEAs). This approach benefits from improved force control and shock tolerance due to the elasticity introduced at joint level. However, series compliance at the joint level comes at the cost of inferior position controllability and additional mechanical complexity. In this research, we move the elastic compliance to the link, and evaluate the characteristics of variable stiffness soft inflatable links. The detailed investigation of the dynamic behaviour of inflatable link takes into consideration different internal pressures and applied loads. Our results demonstrate that the use of soft inflatable links leads to good weight lifting capability whilst preserving compliance which is beneficial for safety critical applications