Computer-assisted planning for a concentric tube robotic system in neurosurgery

Design, analysis, and demonstration of the COAST guidewire robot with middle tube rotation for endovascular interventions

Minimally invasive procedures for endovascular interventions involve manual navigation of a guidewire. Endovascular interventions encompassing highly tortuous vessels would benefit from guidewires which exhibit higher dexterity. This paper introduces a version of the COAST (COaxially Aligned STeerable) guidewire system capable of exhibiting higher dexterity. The system presented in this paper consists of three coaxially aligned tubes with a tendon to actuate the middle tube. Furthermore, it is possible to independently rotate the middle tube with respect to the outer tube. This variation enables the guidewire to achieve curvature in different planes while avoiding rotation of the entire structure. We also present the simulated stability of the guidewire with different outer tube geometries and experimentally validate the model. Experimental analysis and modeling of the kinematic behavior of the system is presented. A model to calculate the curvature vs. tendon stroke relationship for the optimal notch geometry is presented with an average RMSE of 0.16 mm. A control strategy addressing the snapping instabilities to ensure reliable operation is discussed. A custom phantom vessel and an aortic arch phantom model were used to demonstrate the ability of the system to safely navigate through tortuous pathways without exhibiting these elastic instabilities.

Automatic Path-Planning Techniques for Minimally Invasive Stereotactic Neurosurgical Procedures-A Systematic Review

This review systematically examines the recent research from the past decade on diverse path-planning algorithms tailored for stereotactic neurosurgery applications. Our comprehensive investigation involved a thorough search of scholarly papers from Google Scholar, PubMed, IEEE Xplore, and Scopus, utilizing stringent inclusion and exclusion criteria. The screening and selection process was meticulously conducted by a multidisciplinary team comprising three medical students, robotic experts with specialized knowledge in path-planning techniques and medical robotics, and a board-certified neurosurgeon. Each selected paper was reviewed in detail, and the findings were synthesized and reported in this review. The paper is organized around three different types of intervention tools: straight needles, steerable needles, and concentric tube robots. We provide an in-depth analysis of various path-planning algorithms applicable to both single and multi-target scenarios. Multi-target planning techniques are only discussed for straight tools as there is no published work on multi-target planning for steerable needles and concentric tube robots. Additionally, we discuss the imaging modalities employed, the critical anatomical structures considered during path planning, and the current status of research regarding its translation to clinical human studies. To the best of our knowledge and as a conclusion from this systematic review, this is the first review paper published in the last decade that reports various path-planning techniques for different types of tools for minimally invasive neurosurgical applications. Furthermore, this review outlines future trends and identifies existing technology gaps within the field. By highlighting these aspects, we aim to provide a comprehensive overview that can guide future research and development in path planning for stereotactic neurosurgery, ultimately contributing to the advancement of safer and more effective neurosurgical procedures.

Continuum Robots for Medical Interventions

Continuum robots are not constructed with discrete joints but, instead, change shape and position their tip by flexing along their entire length. Their narrow curvilinear shape makes them well suited to passing through body lumens, natural orifices, or small surgical incisions to perform minimally invasive procedures. Modeling and controlling these robots are, however, substantially more complex than traditional robots comprised of rigid links connected by discrete joints. Furthermore, there are many approaches to achieving robot flexure. Each presents its own design and modeling challenges, and to date, each has been pursued largely independently of the others. This article attempts to provide a unified summary of the state of the art of continuum robot architectures with respect to design for specific clinical applications. It also describes a unifying framework for modeling and controlling these systems while additionally explaining the elements unique to each architecture. The major research accomplishments are described for each topic and directions for the future progress needed to achieve widespread clinical use are identified.

A simulation study to investigate the use of concentric tube robots for epilepsy surgery

PURPOSE

Patients with pharmacoresistant refractory epilepsy may require epilepsy surgery to prevent future seizure occurrences. Conventional surgery consists of a large craniotomy with straight rigid tools with associated outcomes of morbidity, large tissue resections, and long post-operative recovery times. Concentric tube robots have recently been developed as a promising application to neurosurgery due to their nonlinear form and small diameter. The authors present a concept study to explore the feasibility of performing minimally invasive hemispherotomy with concentric tube robots.

METHODS

A model simulation was used to achieve the optimal design and surgical path planning parameters of the concentric tube robot for corpus callosotomy and temporal lobectomy. A single medial burr hole was chosen to access the lateral ventricles for both white matter disconnections.

RESULTS

The concentric tube robot was able to accurately reach the designated surgical paths on the corpus callosum and the temporal lobe.

CONCLUSION

In a model simulation, the authors demonstrated the feasibility of performing corpus callosotomy and temporal lobectomy using concentric tube robots. Further advancements in the technology may increase the applicability of this technique for epilepsy surgery to better patient outcomes.

Multiple objective planning for thermal ablation of liver tumors

PURPOSE

Preoperative treatment planning is key to ensure successful thermal ablation of liver tumors. The planning aims to minimize the number of electrodes required for complete ablation and the damage to the surrounding tissues while satisfying multiple clinical constraints. This is a challenging multiple objective planning problem, in which the trade-off between different objectives must be considered.

METHODS

We propose a novel method to solve the multiple objective planning problem, which combines the set cover-based model and Pareto optimization. The set cover-based model considers multiple clinical constraints and generates several clinically feasible treatment plans, among which the Pareto optimization is performed to find the trade-off between different objectives.

RESULTS

We evaluated the proposed method on 20 tumors of 11 patients in two different situations used in common thermal ablation approaches: with and without the pull-back technique. Pareto optimal plans were found and verified to be clinically acceptable in all cases, which can find the trade-off between the number of electrodes and the damage to the surrounding tissues.

CONCLUSION

The proposed method performs well in the two different situations we considered: with or without the pull-back technique. It can generate Pareto optimal plans satisfying multiple clinical constraints. These plans consider the trade-off between different planning objectives.