Scope actuation system for articulated laparoscopes

Background: An articulated laparoscope comprises a rigid shaft with an articulated distal end to change the viewing direction. The articulation provides improved navigation of the operating field in confined spaces. Furthermore, incorporation of an actuation system tends to enhance the control of an articulated laparoscope. Methods: A preliminary prototype of a scope actuation system to maneuver an off-the-shelf articulated laparoscope (EndoCAMaleon by Karl Storz, Germany) was developed. A user study was conducted to evaluate this prototype for the surgical paradigm of video-assisted thoracic surgery. In the study, the subjects maneuvered an articulated scope under two modes of operation: (a) actuated mode where an operating surgeon maneuvers the scope using the developed prototype and (b) manual mode where a surgical assistant directly maneuvers the scope. The actuated mode was further assessed for multiple configurations based on the orientation of the articulated scope at the incision. Results: The data show the actuated mode scored better than the manual mode on all the measured performance parameters including (a) total duration to visualize a marked region, (a) duration for which scope focus shifts outside a predefined visualization region, and (c) number of times for which scope focus shifts outside a predefined visualization region. Among the different configurations tested using the actuated mode, no significant difference was observed. Conclusions: The proposed articulated scope actuation system facilitates better navigation of an operative field as compared to a human assistant. Secondly, irrespective of the orientation in which an articulated scope’s shaft is inserted through an incision, the proposed actuation system can navigate and visualize the operative field

A generic scope actuation system for flexible endoscopes

Background: A scope actuation system assists a surgeon in steering a scope for navigating an operative field during an interventional or diagnostic procedure. Each system is tailored for a specific surgical procedure. The development of a generic scope actuation system could assist various laparoscopic and endoscopic procedures. This has the potential to reduce the deployment and maintenance costs for a hospital, making it more accessible for clinical usage. Methods: A modular actuation system (for maneuvering rigid laparoscopes) was adapted to enable incorporation of flexible endoscopes. The design simplifies the installation and disassembly processes. User studies were conducted to assess the ability of the system to focus onto a diagnostic area, and to navigate during a simulated esophagogastroduodenoscopy procedure. During the studies, the endoscope was maneuvered with (robotic mode) and without (manual mode) the actuation system to navigate the endoscope’s focus on a predefined track. Results: Results show that the robotic mode performed better than the manual mode on all the measured performance parameters including (a) the total duration to traverse a track, (b) the percentage of time spent outside a track while traversing, and (c) the number of times the scope focus shifts outside the track. Additionally, robotic mode also reduced the perceived workload based on the NASA-TLX scale. Conclusions: The proposed scope actuation system enhances the maneuverability of flexible endoscopes. It also lays the groundwork for future development of modular and generic scope assistant systems that can be used in both laparoscopic and endoscopic procedures

BNU-Net: A Novel Deep Learning Approach for LV MRI Analysis in Short-Axis MRI

This work presents a novel deep learning architecture called BNU-Net for the purpose of cardiac segmentation based on short-axis MRI images. Its name is derived from the Batch Normalized (BN) U-Net architecture for medical image segmentation. New generations of deep neural networks (NN) are called convolutional NN (CNN). CNNs like U-Net have been widely used for image classification tasks. CNNs are supervised training models which are trained to learn hierarchies of features automatically and robustly perform classification. Our architecture consists of an encoding path for feature extraction and a decoding path that enables precise localization. We compare this approach with a parallel approach named U-Net. Both BNU-Net and U-Net are cardiac segmentation approaches: while BNU-Net employs batch normalization to the results of each convolutional layer and applies an exponential linear unit (ELU) approach that operates as activation function, U-Net does not apply batch normalization and is based on Rectified Linear Units (ReLU). The presented work (i) facilitates various image preprocessing techniques, which includes affine transformations and elastic deformations, and (ii) segments the preprocessed images using the new deep learning architecture. We evaluate our approach on a dataset containing 805 MRI images from 45 patients. The experimental results reveal that our approach accomplishes comparable or better performance than other state-of-the-art approaches in terms of the Dice coefficient and the average perpendicular distance

Evaluation of user-interfaces for controlling movements of virtual minimally invasive surgical instruments

Background: Recent tele-mentoring technologies for minimally invasive surgery (MIS) augments the operative field with movements of virtual surgical instruments as visual cues. The objective of this work is to assess different user-interfaces that effectively transfer mentor's hand gestures to the movements of virtual surgical instruments. Methods: A user study was conducted to assess three different user-interface devices (Oculus-Rift, SpaceMouse, Touch Haptic device) under various scenarios. The devices were integrated with a MIS tele-mentoring framework for control of both manual and robotic virtual surgical instruments. Results: The user study revealed that Oculus Rift is preferred during robotic scenarios, whereas the touch haptic device is more suitable during manual scenarios for tele-mentoring. Conclusion: A user-interface device in the form of a stylus controlled by fingers for pointing in 3D space is more suitable for manual MIS, whereas a user-interface that can be moved and oriented easily in 3D space by wrist motion is more suitable for robotic MIS

End-user evaluation of software-generated intervention planning environment for transrectal magnetic resonance-guided prostate biopsies

Background: This study presents user evaluation studies to assess the effect of information rendered by an interventional planning software on the operator's ability to plan transrectal magnetic resonance (MR)-guided prostate biopsies using actuated robotic manipulators. Methods: An intervention planning software was developed based on the clinical workflow followed for MR-guided transrectal prostate biopsies. The software was designed to interface with a generic virtual manipulator and simulate an intervention environment using 2D and 3D scenes. User studies were conducted with urologists using the developed software to plan virtual biopsies. Results: User studies demonstrated that urologists with prior experience in using 3D software completed the planning less time. 3D scenes were required to control all degrees-of-freedom of the manipulator, while 2D scenes were sufficient for planar motion of the manipulator. Conclusions: The study provides insights on using 2D versus 3D environment from a urologist's perspective for different operational modes of MR-guided prostate biopsy systems

Telementoring System Assessment Integrated with Laparoscopic Surgical Simulators

Laparoscopic simulators have emerged as effective tools for surgical training. The virtual environment is used in the simulator for the training of procedure-specific surgical skills. These simulators can be enhanced if an expert can provide guidance on every surgical step of the procedure, as well as provide feedback as each step is performed by the trainee. In pursuit of this objective, this study introduces a telementoring system designed to be seamlessly integrated with surgical simulators, thereby enabling remote training. The system incorporates guidance from an expert located remotely, utilizing audio-visual cues as a means of instruction. The visual cues consist of the virtual laparoscopic instruments, which is remote-controlled by the expert and superimposed onto the operative field displayed on the simulator's visualization screen. The system was evaluated for its technical performance, and a user study was conducted. The technical evaluation showed low latency to enable real-time communication, whereas the user study demonstrated effective transfer of surgical skills

Tele-Mentoring Using Augmented Reality: A Feasibility Study to Assess Teaching of Laparoscopic Suturing Skills

The work assesses the efficacy of computer based remote tele-mentoring system (i.e. when the mentor and mentee are physically separated) for teaching minimally invasive surgical skills. The visual cues used for tele-mentoring comprises real-time virtual surgical instruments' motion augmented onto the operative field and remotely controlled by the mentor. In the feasibility study, the surgical task of laparoscopic intracorporeal suturing was simulated among 18 mentor-mentee pairs. Three modes of mentoring were used. Mode-I included traditional learning using pre-recorded videos (in absence of a mentor). Mode-II used traditional in-person hands-on mentoring. In Mode-III, a tele-mentoring prototype was used that connected a mentee with a remote mentor. Error count and duration were recorded for a learning stage followed by a testing stage for the three modes. The results show the error count for Mode-III reduces significantly as compared to Mode-I in the learning stage. Similarly, the error count for Mode-III also reduces significantly as compared to Mode-I in the testing stage. The errors count for Mode-III were equivalent to that of Mode-II for both learning and teaching stages. Furthermore, in Mode-III the duration reduces from learning to testing stage exhibiting the learning effect. Thus, computer based remote tele-mentoring is effective and more convenient to demonstrate surgical sub-steps consisting of tool-tissue interaction facilitating surgical skill transfer

Evaluation of Interventional Planning Software Features for MR-guided Transrectal Prostate Biopsies

This work presents an interventional planning software to be used in conjunction with a robotic manipulator to perform transrectal MR guided prostate biopsies. The interventional software was designed taking in consideration a generic manipulator used under the two modes of operation: side-firing and end-firing of the biopsy needle. Studies were conducted with urologists using the software to plan virtual biopsies. The results show features of software relevant for operating efficiently under the two modes of operation

Preliminary evaluation of robotic transrectal biopsy system on an interventional planning software

Prostate biopsy is considered as a definitive way for diagnosing prostate malignancies. Urologists are currently moving towards MR-guided prostate biopsies over conventional transrectal ultrasound-guided biopsies for prostate cancer detection. Recently, robotic systems have started to emerge as an assistance tool for urologists to perform MR-guided prostate biopsies. However, these robotic assistance systems are designed for a specific clinical environment and cannot be adapted to modifications or changes applied to the clinical setting and/or workflow. This work presents the preliminary design of a cable-driven manipulator developed to be used in both MR scanners and MR-ultrasound fusion systems. The proposed manipulator design and functionality are evaluated on a simulated virtual environment. The simulation is created on an in-house developed interventional planning software to evaluate the ergonomics and usability. The results show that urologists can benefit from the proposed design of the manipulator and planning software to accurately perform biopsies of targeted areas in the prostate