Force feedback controls of multi-gripper robotic endovascular intervention: design, prototype, and experiments

Passive haptic interface for robot-assisted endovascular catheterization

Master-slave vascular interventional surgical robots reduce surgeon's exposure to radiation during procedures. However, the master-slave structure keeps the surgeon away from the patient, the surgeon loses the sense of haptics while manipulating the robot, and the surgeon's sense of surgical presence is reduced. To solve this problem, we have developed a master robot with haptic feedback. The surgeon manipulates the master robot without changing the traditional surgical manipulation posture, and the magnetorheological fluid-based haptic interface generates passive haptic feedback to the surgeon. Magnetic field simulation analysis is used to optimize the parameters of the haptic interface. The haptic interface adopts a closed-loop control strategy based on the magnetic field-resistance prediction model, which uses the magnetic field information inside the device to complete the haptic force closed-loop control. The slave robot utilizes dual linear guides for precise delivery of catheters/guidewires. Experimentally verified that the developed master robot meets the surgeon's need for haptic feedback in vascular interventional procedures and has good applicability.

Endovascular robotics: technical advances and future directions

Endovascular interventions excel in treating cardiovascular diseases in a minimally invasive manner, showing improved outcomes over open techniques. However, challenges related to precise navigation - still relying on 2D fluoroscopy - persist. This review examines the role of robotics, highlighting commercial and research platforms, while exploring emerging trends like MRI compatibility, enhanced navigation, and autonomy. MRI-compatible systems offer radiation-free 3D imaging. Human-robot interaction evolves with task-specific interfaces, while autonomy ranges from partial to full, aiding clinical operators. Challenges include complexity and cost, emphasizing compatibility and navigation advancements. Integrating MRI-compatible robots, refining human-robot interaction, and enhancing autonomy promise advancements in endovascular surgery, fueled by AI and innovative imaging.

A Hydraulic Haptic Actuator for Simulation of Cardiac Catheters

This article presents a haptic actuator made of silicone rubber to provide both passive and active haptic forces for catheter simulations. The haptic actuator has a torus outer shape with an ellipse-shaped inside chamber which is actuated by hydraulic pressure. Expansion of the chamber by providing positive pressure can squeeze the inside passage to resist the catheter traveling through. Further expansion can hold and push back the catheter in the axial direction to render active haptic forces. The size of the catheter passage is increased by providing negative pressure to the chamber, allowing various diameters of the actual medical catheters to be used and exchanged during the simulation. The diameter of the catheter passage can be enlarged up to 1.6 times to allow 5 to 7 Fr (1 Fr = 1/3 mm) medical catheters to pass through. Experiment results show that the proposed haptic actuator can render 0 to 2.0 N passive feedback force, and a maximum of 2.0 N active feedback force, sufficient for the cardiac catheter simulation. The haptic actuator can render the commanded force profile with 0.10 N RMS (root-mean-squares) and 10.51% L2-norm relative errors.

A novel endovascular robotic-assisted system for endovascular aortic repair: first-in-human evaluation of practicability and safety

OBJECTIVES

To assess the practicability and safety of a novel endovascular robotic system for performing endovascular aortic repair in human.

METHODS

A prospective observational study was conducted in 2021 with 6 months post-operative follow-up. Patients with aortic aneurysms and clinical indications for elective endovascular aortic repair were enrolled in the study. The novel developed robotic system is applicable for the majority of commercial devices and various types of endovascular surgeries. The primary endpoint was technical success without in-hospital major adverse events. Technical success was defined as the ability of the robotic system to complete all procedural steps based on procedural segments.

RESULTS

The first-in-human evaluation of robot-assisted endovascular aortic repair was performed in five patients. The primary endpoint was achieved in all patients (100%). There were no device- or procedure-related complications or no in-hospital major adverse events. The operation time and total blood loss in these cases were equal to those in the manual procedures. The radiation exposure of the surgeon was 96.5% lower than that in the traditional position while the radiation exposure of the patients was not significantly increased.

CONCLUSIONS

Early clinical evaluation of the novel endovascular aortic repair in endovascular aortic repair demonstrated practicability, safety, and procedural effectiveness comparable to manual operation. In addition, the total radiation exposure of the operator was significantly lower than that of traditional procedures.

CLINICAL RELEVANCE STATEMENT

This study applies a novel approach to perform the endovascular aortic repair in a more accurate and minimal-invasive way and lays the foundation for the perspective automation of the endovascular robotic system, which reflects a new paradigm for endovascular surgery.

KEY POINTS

• This study is a first-in-human evaluation of a novel endovascular robotic system for endovascular aortic repair (EVAR). • Our system might reduce the occupational risks associated with manual EVAR and contribute to achieving a higher degree of precision and control. • Early evaluation of the endovascular robotic system demonstrated practicability, safety, and procedural effectiveness comparable to that of manual operation.

A Novel Master-Slave Interventional Surgery Robot with Force Feedback and Collaborative Operation

In recent years, master-slave vascular robots have been developed to address the problem of radiation exposure during vascular interventions for surgeons. However, the single visual feedback reduces surgeon immersion and transparency of the system. In this work, we have developed a haptic interface based on the magnetorheological fluid (MRF) on the master side. The haptic interface can provide passive feedback force with high force fidelity and low inertia. Additionally, the manipulation of the master device does not change the operating posture of traditional surgery, which allows the surgeon to better adapt to the robotic system. For the slave robot, the catheter and guidewire can be navigated simultaneously which allows the two degrees of action on the catheter and axial action of a guidewire. The resistance force of the catheter navigation is measured and reflected to the user through the master haptic interface. To verify the proposed master-slave robotic system, the evaluation experiments are carried out in vitro, and the effectiveness of the system was demonstrated experimentally.

Design, development and evaluation of an ergonomically designed dual-use mechanism for robot-assisted cardiovascular intervention

PURPOSE

Robot-assisted cardiovascular intervention has been recently developed, which enables interventionists to avoid x-ray radiation and improve their comfort. However, there are still some challenges in the robotic design, such as the inability of the interventionist to freely perform natural clinical techniques and the limited motion travel of the interventional tool. To overcome these challenges, this paper proposes an ergonomically designed dual-use mechanism for cardiovascular intervention (DMCI).

METHODS

DMCI can work as an ergonomic interface or a compact slave robot with unlimited motion travel. Our kinematic analysis of DMCI includes motion decoupling and coupling. Motion decoupling decomposes the translation and rotation from the interventionist's natural clinical actions at the master side. Motion coupling can calculate the input pulses of motors according to the desired rotation and translation, thus composing the motion of the intervention tool at the slave side.

RESULTS

Our kinematic analysis of DMCI has been experimentally verified, where the overall mean rotational errors are all less than 1° and translational errors are all less than 1 mm. We also evaluated the performance of the DMCI-based master-slave system, where the overall rotational and translational errors are 0.821 ± 0.753° and 0.608 ± 0.512 mm. Moreover, operators were found to be generally more efficient when using the DMCI-based interface compared to the conventional joystick.

CONCLUSION

We have validated our kinematic analysis of DMCI. The master-slave teleoperation experiment demonstrated that operators can freely perform natural clinical techniques through the DMCI-based interface, and the slave robot can replicate the operators' manipulation at the master side well.

Novel Endovascular Interventional Surgical Robotic System Based on Biomimetic Manipulation

Endovascular therapy has emerged as a crucial therapeutic method for treating vascular diseases. Endovascular surgical robots have been used to enhance endovascular therapy. However, to date, there are no universal endovascular surgical robots that support molds of different types of devices for treating vascular diseases. We developed a novel endovascular surgical robotic system that can independently navigate the intravascular region, advance and retract devices, and deploy stents. This robot has four features: (1) The bionic design of the robot can fully simulate the entire grasping process; (2) the V-shaped relay gripper waived the need to redesign special guidewires and catheters for continuous rotation; (3) the handles designed based on the feedback mechanism can simulate push resistance and reduce iatrogenic damage; and (4) the detachable design of the grippers can reduce cross-infection risk and medical costs. We verified its performance by demonstrating six different types of endovascular surgeries. Early evaluation of the novel endovascular robotic system demonstrated its practicability and safety in endovascular surgeries.

Remote vascular interventional surgery robotics: a literature review

Vascular interventional doctors are exposed to radiation hazards during surgery and endure high work intensity. Remote vascular interventional surgery robotics is a hot research field, in which researchers aim to not only protect the health of interventional doctors, but to also improve surgical accuracy and efficiency. However, the current vascular interventional robots have numerous shortcomings, such as poor haptic feedback, few compatible surgeries and instruments, and cumbersome maintenance and operational procedures. Nevertheless, vascular interventional surgery combined with robotics provides more cutting-edge directions, such as Internet remote surgery combined with 5G network technology and the application of artificial intelligence in surgical procedures. To summarize the developmental status and key technical points of intravascular interventional surgical robotics research, we performed a systematic literature search to retrieve original articles related to remote vascular interventional surgery robotics published up to December 2020. This review, which includes 113 articles published in English, introduces the mechanical and structural characteristics of various aspects of vascular interventional surgical robotics, discusses the current key features of vascular interventional surgical robotics in force sensing, haptic feedback, and control methods, and summarizes current frontiers in autonomous surgery, long-distance robotic telesurgery, and magnetic resonance imaging (MRI)-compatible structures. On the basis of summarizing the current research status of remote vascular interventional surgery robotics, we aim to propose a variety of prospects for future robotic systems.

An Endovascular Catheterization Robotic System Using Collaborative Operation with Magnetically Controlled Haptic Force Feedback

Robot-assisted technology is often used to perform endovascular catheterization surgeries, which generally depend on the flexible operability and the accurate force feedback of a robotic system. In this paper, an endovascular catheterization robotic system (ECRS) was developed to improve collaborative operation and haptic force feedback. A couple of operating handles were designed to maximize the use of the natural operations of surgeons on the master side, which is a flexible and ergonomic device. A magnetically controlled haptic force feedback structure is proposed based on hydrogel and solid magnetorheological (MR) fluid to offer a sense of haptic feedback to operators; this has potential influence on the field of force feedback. In addition, a unique tremor-reduction structure is introduced to enhance operating safety. Tracking performance experiments and in vitro experiments were conducted to evaluate the performance of the developed ECRS. According to these experimental results, the average translation-tracking error is 0.94 mm, and the average error of rotation is 0.89 degrees. Moreover, in vitro experiments demonstrated that haptic feedback has the advantage of reducing workload and shortening surgery completion time. The developed ECRS also has the benefits of inspiring other researchers to study collaborative robots and magnetically controlled feedback.