Mechanical Follow-the-Leader motion of a hyper-redundant surgical instrument: Proof-of-concept prototype and first tests

One of the most prominent drivers in the development of surgical procedures is the will to reduce their invasiveness, attested by minimally invasive surgery being the gold standards in many surgical procedures and natural orifices transluminal endoscopic surgery gaining acceptance. A logical next step in this pursuit is the introduction of hyper-redundant instruments that can insert themselves along multi-curved paths referred to as Follow-the-Leader motion. In the current state of the art, two different types of Follow-the-Leader instruments can be distinguished. One type of instrument is robotized; the movements of the shaft are controlled from outside the patient by actuators, for example, electric motors, and a controller storing a virtual track of the desired path. The other type of instrument is more mechanical; the movements of the shaft are controlled from inside the patient by a physical track that guides the shaft along the desired path. While in the robotized approach all degrees of freedom of the shaft require an individual actuator, the mechanical approach makes the number of degrees of freedom independent from the number of actuators. A desirable feature as an increasing number of actuators will inevitably drive up costs and increase the footprint of an instrument. Building the physical track inside the body does, however, impede miniaturization of the shaft's diameter. This article introduces a new fully mechanical approach for Follow-the-Leader motion using a pre-determined physical track that is placed outside the body. This new approach was validated with a prototype called MemoFlex, which supports a Ø5 mm shaft (standard size in minimally invasive surgery) that contains 28-degrees-of-freedom and utilizes a simple steel rod as its physical track. Even though the performance of the MemoFlex leaves room for improvement, especially when following multiple curves, it does validate the proposed concept for Follow-the-Leader motion in three-dimensional space.Medical Instruments & Bio-Inspired Technolog

Additive manufacturing of medical instruments: A state-of-the-art review

Goal: Additive manufacturing, also known as 3D printing, has begun to play a significant role in the field of medical devices. This review aims to provide a comprehensive overview and classification of additively manufactured medical instruments for diagnostics and surgery by identifying medical and technical aspects. Methods: A scientific literature search on additively manufactured medical instruments was conducted using the Scopus database. Results: We categorized the relevant articles (71) by considering the novelty of each proposed instrument and its clinical application. Then, we analyzed the relevant articles by examining the reasons behind choosing additive manufacturing technology to produce instruments for diagnostics and surgery. Possible customization (27%) and Cost-effectiveness (23%) were the main reasons expressed. Technical specifications of the additive manufacturing technology and the material used were also analyzed, and a tendency of using material extrusion technology (35% of the applications) and polymeric materials (86% of the applications) was shown. Conclusions: Additive manufacturing is opening the door to a new approach in the production of medical devices, which allows the complexity of their designs to be pushed to the extreme. However, we found that technical limitations need to be tackled and important aspects such as sterilization or debris contamination are still not considered to be relevant factors during the design and fabrication process. Keeping in mind the challenges of such a new field, additive manufacturing technology can be considered as a great opportunity to provide easy access to healthcare in developing countries as well as an important step toward patient-specific medicine.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Medical Instruments & Bio-Inspired Technolog

3D-printed upper limb prostheses: a review

Goal: This paper aims to provide an overview with quantitative information of existing 3D-printed upper limb prostheses. We will identify the benefits and drawbacks of 3D-printed devices to enable improvement of current devices based on the demands of prostheses users. Methods: A review was performed using Scopus, Web of Science and websites related to 3D-printing. Quantitative information on the mechanical and kinematic specifications and 3D-printing technology used was extracted from the papers and websites. Results: The overview (58 devices) provides the general specifications, the mechanical and kinematic specifications of the devices and information regarding the 3D-printing technology used for hands. The overview shows prostheses for all different upper limb amputation levels with different types of control and a maximum material cost of $500. Conclusion: A large range of various prostheses have been 3D-printed, of which the majority are used by children. Evidence with respect to the user acceptance, functionality and durability of the 3D-printed hands is lacking. Contrary to what is often claimed, 3D-printing is not necessarily cheap, e.g., injection moulding can be cheaper. Conversely, 3D-printing provides a promising possibility for individualization, e.g., personalized socket, colour, shape and size, without the need for adjusting the production machine.Implications for rehabilitation Upper limb deficiency is a condition in which a part of the upper limb is missing as a result of a congenital limb deficiency of as a result of an amputation. A prosthetic hand can restore some of the functions of a missing limb and help the user in performing activities of daily living. Using 3D-printing technology is one of the solutions to manufacture hand prostheses. This overview provides information about the general, mechanical and kinematic specifications of all the devices and it provides the information about the 3D-printing technology used to print the hands.Accepted Author ManuscriptMedical Instruments & Bio-Inspired Technolog

S-matrix oriented CAD-tool for simulating complex integrated optical circuits

A design tool for simulation of complex integrated optical circuits, based on a professional microwave design system has been developed. Implementation of a number of components is described and a simulation example of an add-drop node using a 4*4 phased array is presente

The MemoSlide: An explorative study into a novel mechanical follow-the-leader mechanism

Follow-the-leader propagation allows for the insertion of flexible surgical instruments along curved paths, reducing the access required for natural orifice transluminal endoscopic surgery. Currently, the most promising follow-the-leader instruments use the alternating memory method containing two mechanical memory-banks for controlling the motion of the flexible shaft, which reduces the number of actuators to a minimum. These instruments do, however, require concentric structures inside the shaft, limiting its miniaturization. The goal of this research was, therefore, to develop a mechanism conforming the principles of the alternating memory method that could be located at the controller-side instead of inside the shaft of the instrument, which is positioned outside the patient and is therefore less restricted in size. First, the three-dimensional motion of the shaft was decoupled into movement in a horizontal and vertical plane, which allowed for a relatively simple planar alternating memory mechanism design for controlling planar follow-the-leader motion. Next, the planar movement of the alternating memory mechanism was discretized, increasing its resilience to errors. The resulting alternating memory mechanism was incorporated and tested in a proof-of-concept prototype called the MemoSlide. This prototype does not include a flexible shaft, but was fully focused on proving the function of the alternating memory mechanism. Evaluation of the MemoSlide shows the mechanism to work very well, being able to transfer any planar path that lays within its physical boundaries along the body of the mechanism without accumulating errors.Medical Instruments & Bio-Inspired Technolog

Ten guidelines for the design of non-assembly mechanisms: The case of 3D-printed prosthetic hands

In developing countries, prosthetic workshops are limited, difficult to reach, or even non-existent. Especially, fabrication of active, multi-articulated, and personalized hand prosthetic devices is often seen as a time-consuming and demanding process. An active prosthetic hand made through the fused deposition modelling technology and fully assembled right after the end of the 3D printing process will increase accessibility of prosthetic devices by reducing or bypassing the current manufacturing and post-processing steps. In this study, an approach for producing active hand prosthesis that could be fabricated fully assembled by fused deposition modelling technology is developed. By presenting a successful case of non-assembly 3D printing, this article defines a list of design considerations that should be followed in order to achieve fully functional non-assembly devices. Ten design considerations for additive manufacturing of non-assembly mechanisms have been proposed and a design case has been successfully addressed resulting in a fully functional prosthetic hand. The hand prosthesis can be 3D printed with an inexpensive fused deposition modelling machine and is capable of performing different types of grasping. The activation force required to start a pinch grasp, the energy required for closing, and the overall mass are significantly lower than body-powered commercial prosthetic hands. The results suggest that this non-assembly design may be a good alternative for amputees in developing countries.Medical Instruments & Bio-Inspired TechnologyBiomaterials & Tissue Biomechanic

Comparison of two cable configurations in 3D printed steerable instruments for minimally invasive surgery

In laparoscopy, a small incision size improves the surgical outcome but increases at the same time the rigidity of the instrument, with consequent impairment of the surgeon’s maneuverability. Such reduction introduces new challenges, such as the loss of wrist articulation or the impossibility of overcoming obstacles. A possible approach is using multi-steerable cable-driven instruments fully mechanical actuated, which allow great maneuverability while keeping the wound small. In this work, we compared the usability of the two most promising cable configurations in 3D printed multi-steerable instruments: a parallel configuration with all cables running straight from the steerable shaft to the handle; and a multi configuration with straight cables in combination with helical cables. Twelve participants were divided into two groups and asked to orient the instrument shaft and randomly hit six targets following the instructions in a laparoscopic simulator. Each participant carried out four trials (two trials for each instrument) with 12 runs per trial. The average task performance time showed a significant decrease over the first trial for both configurations. The decrease was 48% for the parallel and 41% for the multi configuration. Improvement of task performance times reached a plateau in the second trial with both instruments. The participants filled out a TLX questionnaire after each trial. The questionnaire showed a lower burden score for the parallel compared to multi configuration (23% VS 30%). Even though the task performance time for both configurations was comparable, a final questionnaire showed that 10 out of 12 participants preferred the parallel configuration due to a more intuitive hand movement and the possibility of individually orienting the distal end of the steerable shaftMedical Instruments & Bio-Inspired TechnologyEMSD EEMCS Project technician

Passive prosthetic hands and tools: A literature review

The group of passive prostheses consists of prosthetic hands and prosthetic tools. These can either be static or adjustable. Limited research and development on passive prostheses has been performed although many people use these prosthesis types. Although some publications describe passive prostheses, no recent review of the peer-reviewed literature on passive prostheses is available.Medical Instruments & Bio-Inspired TechnologyBiomechatronics & Human-Machine Contro

Crosstalk performance of integrated optical cross-connects

Crosstalk performance of monolithically integrated multiwavelength optical cross-connects (OXC's) depends strongly on their architecture. In this paper, a semiquantitative analysis of crosstalk in 11 different architectures is presented. Two architectures are analyzed numerically in more detail and the results of the analysis show good agreement with previously reported experimental result

Design of a 3D-printed hand prosthesis featuring articulated bio-inspired fingers

Various upper-limb prostheses have been designed for 3D printing but only a few of them are based on bio-inspired design principles and many anatomical details are not typically incorporated even though 3D printing offers advantages that facilitate the application of such design principles. We therefore aimed to apply a bio-inspired approach to the design and fabrication of articulated fingers for a new type of 3D printed hand prosthesis that is body-powered and complies with basic user requirements. We first studied the biological structure of human fingers and their movement control mechanisms in order to devise the transmission and actuation system. A number of working principles were established and various simplifications were made to fabricate the hand prosthesis using a fused deposition modelling (FDM) 3D printer with dual material extrusion. We then evaluated the mechanical performance of the prosthetic device by measuring its ability to exert pinch forces and the energy dissipated during each operational cycle. We fabricated our prototypes using three polymeric materials including PLA, TPU, and Nylon. The total weight of the prosthesis was 92 g with a total material cost of 12 US dollars. The energy dissipated during each cycle was 0.380 Nm with a pinch force of ≈16 N corresponding to an input force of 100 N. The hand is actuated by a conventional pulling cable used in BP prostheses. It is connected to a shoulder strap at one end and to the coupling of the whiffle tree mechanism at the other end. The whiffle tree mechanism distributes the force to the four tendons, which bend all fingers simultaneously when pulled. The design described in this manuscript demonstrates several bio-inspired design features and is capable of performing different grasping patterns due to the adaptive grasping provided by the articulated fingers. The pinch force obtained is superior to other fully 3D printed body-powered hand prostheses, but still below that of conventional body powered hand prostheses. We present a 3D printed bio-inspired prosthetic hand that is body-powered and includes all of the following characteristics: adaptive grasping, articulated fingers, and minimized post-printing assembly. Additionally, the low cost and low weight make this prosthetic hand a worthy option mainly in locations where state-of-the-art prosthetic workshops are absent.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Biomechatronics & Human-Machine ControlBiomaterials & Tissue BiomechanicsMedical Instruments & Bio-Inspired Technolog