Flow driven robotic navigation of microengineered endovascular probes

Thermally Drawn-Based Microtubule Soft Continuum Robot for Cardiovascular Intervention

Cardiovascular disease is becoming the leading cause of human mortality. In order to address this, flexible continuum robots have emerged as a promising solution for miniaturizing and automating vascular interventional equipment for diagnosing and treating cardiovascular diseases. However, existing continuum robots used for vascular intervention face challenges such as large cross-sectional sizes, inadequate driving force, and lack of navigation control, preventing them from accessing cerebral blood vessels or capillaries for medical procedures. Additionally, the complex manufacturing process and high cost of soft continuum robots hinder their widespread clinical application. In this study, we propose a thermally drawn-based microtubule soft continuum robot that overcomes these limitations. The proposed robot has cross-sectional dimensions several orders of magnitude smaller than the smallest commercially available conduits, and it can be manufactured without any length restrictions. By utilizing a driving strategy based on liquid kinetic energy advancement and external magnetic field for steering, the robot can easily navigate within blood vessels and accurately reach the site of the lesion. This innovation holds the potential to achieve controlled navigation of the robot throughout the entire blood vessel, enabling in situ diagnosis and treatment of cardiovascular diseases.

Magnetic steering continuum robot for transluminal procedures with programmable shape and functionalities

Millimeter-scale soft continuum robots offer safety and adaptability in transluminal procedures due to their passive compliance, but this feature necessitates interactions with surrounding lumina, leading to potential medical risks and restricted mobility. Here, we introduce a millimeter-scale continuum robot, enabling apical extension while maintaining structural stability. Utilizing phase transition components, the robot executes cycles of tip-based elongation, steered accurately through programmable magnetic fields. Each motion cycle features a solid-like backbone for stability, and a liquid-like component for advancement, thereby enabling autonomous shaping without reliance on environmental interactions. Together with clinical imaging technologies, we demonstrate the capability of navigating through tortuous and fragile lumina to transport microsurgical tools. Once it reaches larger anatomical spaces such as stomach, it can morph into functional 3D structures that serve as surgical tools or sensing units, overcoming the constraints of initially narrow pathways. By leveraging this design paradigm, we anticipate enhanced safety, multi-functionality, and cooperative capabilities among millimeter-scale continuum robots, opening new avenues for transluminal robotic surgery.

Multifunctional flexible magnetic drive gripper for target manipulation in complex constrained environments

Soft actuators capable of remote-controlled guidance and manipulation within complex constrained spaces hold great promise in various fields, especially in medical fields such as minimally invasive surgery. However, most current magnetic drive soft actuators only have the functions of position control and guidance, and it is still challenging to achieve more flexible operations on different targets within constrained spaces. Herein, we propose a multifunctional flexible magnetic drive gripper that can be steered within complex constrained spaces and operate on targets of various shapes. On the one hand, changing the internal pressure of the magnetic gripper can achieve functions such as suction or injection of liquid and transportation of targets with smooth surfaces. On the other hand, with the help of slit structures in the constrained environment, by simply changing the position and orientation of the permanent magnet in the external environment, the magnetic gripper can be controlled to clamp and release targets of linear, flaked, and polyhedral shapes. The full flexibility and multifunctionality of the magnetic gripper suggest new possibilities for precise remote control and object transportation in constrained spaces, so it could serve as a direct contact operation tool for hazardous drugs in enclosed spaces or a surgical tool in human body cavities.

Magnetic soft microfiberbots for robotic embolization

Cerebral aneurysms and brain tumors are leading life-threatening diseases worldwide. By deliberately occluding the target lesion to reduce the blood supply, embolization has been widely used clinically to treat cerebral aneurysms and brain tumors. Conventional embolization is usually performed by threading a catheter through blood vessels to the target lesion, which is often limited by the poor steerability of the catheter in complex neurovascular networks, especially in submillimeter regions. Here, we propose magnetic soft microfiberbots with high steerability, reliable maneuverability, and multimodal shape reconfigurability to perform robotic embolization in submillimeter regions via a remote, untethered, and magnetically controllable manner. Magnetic soft microfiberbots were fabricated by thermal drawing magnetic soft composite into microfibers, followed by magnetizing and molding procedures to endow a helical magnetic polarity. By controlling magnetic fields, magnetic soft microfiberbots exhibit reversible elongated/aggregated shape morphing and helical propulsion in flow conditions, allowing for controllable navigation through complex vasculature and robotic embolization in submillimeter regions. We performed in vitro embolization of aneurysm and tumor in neurovascular phantoms and in vivo embolization of a rabbit femoral artery model under real-time fluoroscopy. These studies demonstrate the potential clinical value of our work, paving the way for a robotic embolization scheme in robotic settings.

Electrochemical and Electrical Biosensors for Wearable and Implantable Electronics Based on Conducting Polymers and Carbon-Based Materials

Bioelectronic devices are designed to translate biological information into electrical signals and vice versa, thereby bridging the gap between the living biological world and electronic systems. Among different types of bioelectronics devices, wearable and implantable biosensors are particularly important as they offer access to the physiological and biochemical activities of tissues and organs, which is significant in diagnosing and researching various medical conditions. Organic conducting and semiconducting materials, including conducting polymers (CPs) and graphene and carbon nanotubes (CNTs), are some of the most promising candidates for wearable and implantable biosensors. Their unique electrical, electrochemical, and mechanical properties bring new possibilities to bioelectronics that could not be realized by utilizing metals- or silicon-based analogues. The use of organic- and carbon-based conductors in the development of wearable and implantable biosensors has emerged as a rapidly growing research field, with remarkable progress being made in recent years. The use of such materials addresses the issue of mismatched properties between biological tissues and electronic devices, as well as the improvement in the accuracy and fidelity of the transferred information. In this review, we highlight the most recent advances in this field and provide insights into organic and carbon-based (semi)conducting materials' properties and relate these to their applications in wearable/implantable biosensors. We also provide a perspective on the promising potential and exciting future developments of wearable/implantable biosensors.

Soft Fiber/Textile Actuators: From Design Strategies to Diverse Applications

Fiber/textile-based actuators have garnered considerable attention due to their distinctive attributes, encompassing higher degrees of freedom, intriguing deformations, and enhanced adaptability to complex structures. Recent studies highlight the development of advanced fibers and textiles, expanding the application scope of fiber/textile-based actuators across diverse emerging fields. Unlike sheet-like soft actuators, fibers/textiles with intricate structures exhibit versatile movements, such as contraction, coiling, bending, and folding, achieved through adjustable strain and stroke. In this review article, we provide a timely and comprehensive overview of fiber/textile actuators, including structures, fabrication methods, actuation principles, and applications. After discussing the hierarchical structure and deformation of the fiber/textile actuator, we discuss various spinning strategies, detailing the merits and drawbacks of each. Next, we present the actuation principles of fiber/fabric actuators, along with common external stimuli. In addition, we provide a summary of the emerging applications of fiber/textile actuators. Concluding with an assessment of existing challenges and future opportunities, this review aims to provide a valuable perspective on the enticing realm of fiber/textile-based actuators.

Recent Advances in Sensor-Actuator Hybrid Soft Systems: Core Advantages, Intelligent Applications, and Future Perspectives

The growing demand for soft intelligent systems, which have the potential to be used in a variety of fields such as wearable technology and human-robot interaction systems, has spurred the development of advanced soft transducers. Among soft systems, sensor-actuator hybrid systems are considered the most promising due to their effective and efficient performance, resulting from the synergistic and complementary interaction between their sensor and actuator components. Recent research on integrated sensor and actuator systems has resulted in a range of conceptual and practical soft systems. This review article provides a comprehensive analysis of recent advances in sensor and actuator integrated systems, which are grouped into three categories based on their primary functions: i) actuator-assisted sensors for intelligent detection, ii) sensor-assisted actuators for intelligent movement, and iii) sensor-actuator interactive devices for a hybrid of intelligent detection and movement. In addition, several bottlenecks in current studies are discussed, and prospective outlooks, including potential applications, are presented. This categorization and analysis will pave the way for the advancement and commercialization of sensor and actuator-integrated systems.

Submillimeter Multifunctional Ferromagnetic Fiber Robots for Navigation, Sensing, and Modulation

Small-scale robots capable of remote active steering and navigation offer great potential for biomedical applications. However, the current design and manufacturing procedure impede their miniaturization and integration of various diagnostic and therapeutic functionalities. Herein, submillimeter fiber robots that can integrate navigation, sensing, and modulation functions are presented. These fiber robots are fabricated through a scalable thermal drawing process at a speed of 4 meters per minute, which enables the integration of ferromagnetic, electrical, optical, and microfluidic composite with an overall diameter of as small as 250 µm and a length of as long as 150 m. The fiber tip deflection angle can reach up to 54o under a uniform magnetic field of 45 mT. These fiber robots can navigate through complex and constrained environments, such as artificial vessels and brain phantoms. Moreover, Langendorff mouse hearts model, glioblastoma micro platforms, and in vivo mouse models are utilized to demonstrate the capabilities of sensing electrophysiology signals and performing a localized treatment. Additionally, it is demonstrated that the fiber robots can serve as endoscopes with embedded waveguides. These fiber robots provide a versatile platform for targeted multimodal detection and treatment at hard-to-reach locations in a minimally invasive and remotely controllable manner.

Magnetically assisted soft milli-tools for occluded lumen morphology detection

Methodologies based on intravascular imaging have revolutionized the diagnosis and treatment of endovascular diseases. However, current methods are limited in detecting, i.e., visualizing and crossing, complicated occluded vessels. Therefore, we propose a miniature soft tool comprising a magnet-assisted active deformation segment (ADS) and a fluid drag-driven segment (FDS) to visualize and cross the occlusions with various morphologies. First, via soft-bodied deformation and interaction, the ADS could visualize the structure details of partial occlusions with features as small as 0.5 millimeters. Then, by leveraging the fluidic drag from the pulsatile flow, the FDS could automatically detect an entry point selectively from severe occlusions with complicated microchannels whose diameters are down to 0.2 millimeters. The functions have been validated in both biologically relevant phantoms and organs ex vivo. This soft tool could help enhance the efficacy of minimally invasive medicine for the diagnosis and treatment of occlusions in various circulatory systems.

Locally Addressable Energy Efficient Actuation of Magnetic Soft Actuator Array Systems

Advances in magnetoresponsive composites and (electro-)magnetic actuators have led to development of magnetic soft machines (MSMs) as building blocks for small-scale robotic devices. Near-field MSMs offer energy efficiency and compactness by bringing the field source and effectors in close proximity. Current challenges of near-field MSM are limited programmability of effector motion, dimensionality, ability to perform collaborative tasks, and structural flexibility. Herein, a new class of near-field MSMs is demonstrated that combines microscale thickness flexible planar coils with magnetoresponsive polymer effectors. Ultrathin manufacturing and magnetic programming of effectors is used to tailor their response to the nonhomogeneous near-field distribution on the coil surface. The MSMs are demonstrated to lift, tilt, pull, or grasp in close proximity to each other. These ultrathin (80 µm) and lightweight (100 gm-2 ) MSMs can operate at high frequency (25 Hz) and low energy consumption (0.5 W), required for the use of MSMs in portable electronics.

Ultraflexible endovascular probes for brain recording through micrometer-scale vasculature

Implantable neuroelectronic interfaces have enabled advances in both fundamental research and treatment of neurological diseases but traditional intracranial depth electrodes require invasive surgery to place and can disrupt neural networks during implantation. We developed an ultrasmall and flexible endovascular neural probe that can be implanted into sub-100-micrometer-scale blood vessels in the brains of rodents without damaging the brain or vasculature. In vivo electrophysiology recording of local field potentials and single-unit spikes have been selectively achieved in the cortex and olfactory bulb. Histology analysis of the tissue interface showed minimal immune response and long-term stability. This platform technology can be readily extended as both research tools and medical devices for the detection and intervention of neurological diseases.

Stability of navigation in catheter-based endovascular procedures

Endovascular procedures provide surgeons and other interventionalists with minimally invasive methods to treat vascular diseases by passing guidewires, catheters, sheaths and treatment devices into the vasculature to and navigate toward a treatment site. The efficiency of this navigation affects patient outcomes, but is frequently compromised by catheter "herniation", in which the catheter-guidewire system bulges out from the intended endovascular pathway so that the interventionalist can no longer advance it. Here, we showed herniation to be a bifurcation phenomenon that can be predicted and controlled using mechanical characterizations of catheter-guidewire systems and patientspecific clinical imaging. We demonstrated our approach in laboratory models and, retrospectively, in patients who underwent procedures involving transradial neurovascular procedures with an endovascular pathway from the wrist, up in the arm, around the aortic arch, and into the neurovasculature. Our analyses identified a mathematical navigation stability criterion that predicted herniation in all of these settings. Results show that herniation can be predicted through bifurcation analysis, and provide a framework for selecting catheter-guidewire systems to avoid herniation in specific patient anatomy.

Microfluidic Approaches for Microactuators: From Fabrication, Actuation, to Functionalization

Microactuators can autonomously convert external energy into specific mechanical motions. With the feature sizes varying from the micrometer to millimeter scale, microactuators offer many operation and control possibilities for miniaturized devices. In recent years, advanced microfluidic techniques have revolutionized the fabrication, actuation, and functionalization of microactuators. Microfluidics can not only facilitate fabrication with continuously changing materials but also deliver various signals to stimulate the microactuators as desired, and consequently improve microfluidic chips with multiple functions. Herein, this cross-field that systematically correlates microactuator properties and microfluidic functions is comprehensively reviewed. The fabrication strategies are classified into two types according to the flow state of the microfluids: stop-flow and continuous-flow prototyping. The working mechanism of microactuators in microfluidic chips is discussed in detail. Finally, the applications of microactuator-enriched functional chips, which include tunable imaging devices, micromanipulation tools, micromotors, and microsensors, are summarized. The existing challenges and future perspectives are also discussed. It is believed that with the rapid progress of this cutting-edge field, intelligent microsystems may realize high-throughput manipulation, characterization, and analysis of tiny objects and find broad applications in various fields, such as tissue engineering, micro/nanorobotics, and analytical devices.

Ultra-flexible endovascular probes for brain recording through micron-scale vasculature

Implantable neuroelectronic interfaces have enabled significant advances in both fundamental research and treatment of neurological diseases, yet traditional intracranial depth electrodes require invasive surgery to place and can disrupt the neural networks during implantation. To address these limitations, we have developed an ultra-small and flexible endovascular neural probe that can be implanted into small 100-micron scale blood vessels in the brains of rodents without damaging the brain or vasculature. The structure and mechanical properties of the flexible probes were designed to meet the key constraints for implantation into tortuous blood vessels inaccessible with existing techniques. In vivo electrophysiology recording of local field potentials and single-unit spikes has been selectively achieved in the cortex and the olfactory bulb. Histology analysis of the tissue interface showed minimal immune response and long-term stability. This platform technology can be readily extended as both research tools and medical devices for the detection and intervention of neurological diseases.

Development of an in-vitro model based on patient vessel geometry for simulated use testing in neurointerventional surgery

BACKGROUND

Neurointerventionalists use in-vitro vascular models to train for worst-case scenarios and test new devices in a simulated use environment to predict clinical performance. According to the Food and Drug Administration (FDA), any neurovascular navigation device should be able to successfully navigate two 360-degree turns and two 180-degree turns at the distal portion of the anatomical model. Here, we present a device benchmarking vascular model that complies with FDA recommendations.

METHODS

Our vascular model was assembled from quantitative characterization of 49 patients who underwent CT angiography either for acute ischemic stroke caused by large vessel occlusion or for aneurysm treatment. Following complete characterization of these data, the vascular segments were 3D reconstructed from CT angiograms of 6 selected patients that presented with challenging anatomy. The curvature and total rotational angle were calculated for each segment and the anatomical parts that complied with FDA recommendations were fused together into a single in-vitro model.

RESULTS

The model was constructed containing two common carotid branches arising from a type two aortic arch and the dimensions of the overall model exceeded the recommendations of the FDA. Two experienced neurointerventionalists tested the model for navigation difficulty using several devices on an in-vitro perfusion system and concluded that the model provided a realistic, challenging scenario.

CONCLUSIONS

This model provides a first prototype designed according to FDA recommendations of cumulative angle while also integrating an aggregation of actual patient-specific anatomy. The availability of this clinically relevant benchmark model presents a potential standardized approach for neurovascular device testing.

Magnetic Soft Helical Manipulators with Local Dipole Interactions for Flexibility and Forces

Magnetic continuum manipulators (MCMs) are a class of continuum robots that can be actuated without direct contact by an external magnetic field. MCMs operating in confined workspaces, such as those targeting medical applications, require flexible magnetic structures that contain combinations of magnetic components and polymers to navigate long and tortuous paths. In cylindrical MCM designs, a significant trade-off exists between magnetic moment and bending flexibility as the ratio between length and diameter decreases. In this study, we propose a new MCM design framework that enables increasing diameter without compromising on flexibility and magnetic moment. Magnetic soft composite helices constitute bending regions of the MCM and are separated by permanent ring magnets. Local dipole interactions between the permanent magnets can reduce bending stiffness, depending on their size and spacing. For the particular segment geometry presented herein, the local dipole interactions result in a 31% increase in angular deflection of composite helices inside an external magnetic field, compared to helices without local interactions. In addition, we demonstrate fabrication, maneuverability, and example applications of a multisegment MCM in a phantom of the abdominal aorta, such as passing contrast dye and guidewires.

Exploiting ferrofluidic wetting for miniature soft machines

Miniature magnetic soft machines could significantly impact minimally invasive robotics and biomedical applications. However, most soft machines are limited to solid magnetic materials, whereas further progress also relies on fluidic constructs obtained by reconfiguring liquid magnetic materials, such as ferrofluid. Here we show how harnessing the wettability of ferrofluids allows for controlled reconfigurability and the ability to create versatile soft machines. The ferrofluid droplet exhibits multimodal motions, and a single droplet can be controlled to split into multiple sub-droplets and then re-fuse back on demand. The soft droplet machine can negotiate changing terrains in unstructured environments. In addition, the ferrofluid droplets can be configured as a liquid capsule, enabling cargo delivery; a wireless omnidirectional liquid cilia matrix capable of pumping biofluids; and a wireless liquid skin, allowing multiple types of miniature soft machine construction. This work improves small magnetic soft machines' achievable complexity and boosts their future biomedical applications capabilities.

Multifunctional Fiber-Enabled Intelligent Health Agents

The application of wearable devices is promoting the development toward digitization and intelligence in the field of health. However, the current smart devices centered on human health have disadvantages such as weak perception, high interference degree, and unfriendly interaction. Here, an intelligent health agent based on multifunctional fibers, with the characteristics of autonomy, activeness, intelligence, and perceptibility enabling health services, is proposed. According to the requirements for healthcare in the medical field and daily life, four major aspects driven by intelligent agents, including health monitoring, therapy, protection, and minimally invasive surgery, are summarized from the perspectives of materials science, medicine, and computer science. The function of intelligent health agents is realized through multifunctional fibers as sensing units and artificial intelligence technology as a cognitive engine. The structure, characteristics, and performance of fibers and analysis systems and algorithms are reviewed, while discussing future challenges and opportunities in healthcare and medicine. Finally, based on the above four aspects, future scenarios related to health protection of a person's life are presented. Intelligent health agents will have the potential to accelerate the realization of precision medicine and active health.

Degradable silk-based soft actuators with magnetic responsiveness

Soft actuators with stimuli-responsiveness have great potential in biomedical applications such as drug delivery and minimally invasive surgery. In this study, protein-based soft actuators with magnetic actuation are fabricated using naturally occurring silk proteins and synthesized Fe₃O₄ magnetic nanoparticles (NPs). Briefly, magnetic silk films are first prepared by solution casting of a mixture containing silk proteins, synthesized Fe₃O₄ NPs, and glycerol. The molecular structures of the magnetic silk films are characterized by FTIR spectroscopy, which show that the β-sheet content in the films is about 20%. The mechanical tests show that the magnetic silk films can be stretched to over 200% under wet conditions and Young's modulus is estimated to be 4.89 ± 0.69 MPa, matching the stiffness of soft tissues. Furthermore, the enzymatic degradability, good biocompatibility, and in vivo X-ray visibility of the films are demonstrated by the in vitro enzymatic degradation test, in vivo biocompatibility test, and micro-CT imaging, respectively. Degradable silk-based soft actuators with magnetic responsiveness are successfully prepared by thermal forming or plastic molding of the magnetic silk films. The fabricated soft actuators can be actuated and move with precise locomotive gaits in solutions using a magnet. In addition, the retention of the soft actuators and localized drug delivery in gastrointestinal tracts by attaching a magnet to the abdominal skin are demonstrated using model systems. The degradable silk-based soft actuators provide many opportunities for improving current therapeutic strategies in biomedicine.

Adaptive wireless millirobotic locomotion into distal vasculature

Microcatheters have enabled diverse minimally invasive endovascular operations and notable health benefits compared with open surgeries. However, with tortuous routes far from the arterial puncture site, the distal vascular regions remain challenging for safe catheter access. Therefore, we propose a wireless stent-shaped magnetic soft robot to be deployed, actively navigated, used for medical functions, and retrieved in the example M4 segment of the middle cerebral artery. We investigate shape-adaptively controlled locomotion in phantoms emulating the physiological conditions here, where the lumen diameter shrinks from 1.5 mm to 1 mm, the radius of curvature of the tortuous lumen gets as small as 3 mm, the lumen bifurcation angle goes up to 120^°, and the pulsatile flow speed reaches up to 26 cm/s. The robot can also withstand the flow when the magnetic actuation is turned off. These locomotion capabilities are confirmed in porcine arteries ex vivo. Furthermore, variants of the robot could release the tissue plasminogen activator on-demand locally for thrombolysis and function as flow diverters, initiating promising therapies towards acute ischemic stroke, aneurysm, arteriovenous malformation, dural arteriovenous fistulas, and brain tumors. These functions should facilitate the robot’s usage in new distal endovascular operations.

Accessibility into the distal vascular systems to treat various diseases remains challenging using medical catheters. Here, Wang et al. demonstrate that a stent-shaped wireless magnetic soft robot enables adaptive locomotion and medical functions into these distal vascular regions.

3D Printed Acoustically Programmable Soft Microactuators

The concept of creating all-mechanical soft microrobotic systems has great potential to address outstanding challenges in biomedical applications, and introduce more sustainable and multifunctional products. To this end, magnetic fields and light have been extensively studied as potential energy sources. On the other hand, coupling the response of materials to pressure waves has been overlooked despite the abundant use of acoustics in nature and engineering solutions. In this study, we show that programmed commands can be contained on 3D nanoprinted polymer systems with the introduction of selectively excited air bubbles and rationally designed compliant mechanisms. A repertoire of micromechanical systems is engineered using experimentally validated computational models that consider the effects of primary and secondary pressure fields on entrapped air bubbles and the surrounding fluid. Coupling the dynamics of bubble oscillators reveals rich acoustofluidic interactions that can be programmed in space and time. We prescribe kinematics by harnessing the forces generated through these interactions to deform structural elements, which can be remotely reconfigured on demand with the incorporation of mechanical switches. These basic actuation and analog control modules will serve as the building blocks for the development of a novel class of micromechanical systems powered and programmed by acoustic signals.

Heat-Mitigated Design and Lorentz Force-Based Steering of an MRI-Driven Microcatheter toward Minimally Invasive Surgery

Catheters integrated with microcoils for electromagnetic steering under the high, uniform magnetic field within magnetic resonance (MR) scanners (3-7 Tesla) have enabled an alternative approach for active catheter operations. Achieving larger ranges of tip motion for Lorentz force-based steering have previously been dependent on using high power coupled with active cooling, bulkier catheter designs, or introducing additional microcoil sets along the catheter. This work proposes an alternative approach using a heat-mitigated design and actuation strategy for a magnetic resonance imaging (MRI)-driven microcatheter. A quad-configuration microcoil (QCM) design is introduced, allowing miniaturization of existing MRI-driven, Lorentz force-based catheters down to 1-mm diameters with minimal power consumption (0.44 W). Heating concerns are experimentally validated using noninvasive MRI thermometry. The Cosserat model is implemented within an MR scanner and results demonstrate a desired tip range up to 110° with 4° error. The QCM is used to validate the proposed model and power-optimized steering algorithm using an MRI-compatible neurovascular phantom and ex vivo kidney tissue. The power-optimized tip orientation controller conserves as much as 25% power regardless of the catheter's initial orientation. These results demonstrate the implementation of an MRI-driven, electromagnetic catheter steering platform for minimally invasive surgical applications without the need for camera feedback or manual advancement via guidewires. The incorporation of such system in clinics using the proposed design and actuation strategy can further improve the safety and reliability of future MRI-driven active catheter operations.

Robotics and Artificial Intelligence in Endovascular Neurosurgery

The use of artificial intelligence (AI) and robotics in endovascular neurosurgery promises to transform neurovascular care. We present a review of the recently published neurosurgical literature on artificial intelligence and robotics in endovascular neurosurgery to provide insights into the current advances and applications of this technology.

The PubMed database was searched for "neurosurgery" OR "endovascular" OR "interventional" AND "robotics" OR "artificial intelligence" between January 2016 and August 2021. A total of 1296 articles were identified, and after applying the inclusion and exclusion criteria, 38 manuscripts were selected for review and analysis. These manuscripts were divided into four categories: 1) robotics and AI for the diagnosis of cerebrovascular pathology, 2) robotics and AI for the treatment of cerebrovascular pathology, 3) robotics and AI for training in neuroendovascular procedures, and 4) robotics and AI for clinical outcome optimization.

The 38 articles presented include 23 articles on AI-based diagnosis of cerebrovascular disease, 10 articles on AI-based treatment of cerebrovascular disease, two articles on AI-based training techniques for neuroendovascular procedures, and three articles reporting AI prediction models of clinical outcomes in vascular disorders of the brain. Innovation with robotics and AI focus on diagnostic efficiency, optimizing treatment and interventional procedures, improving physician procedural performance, and predicting clinical outcomes with the use of artificial intelligence and robotics. Experimental studies with robotic systems have demonstrated safety and efficacy in treating cerebrovascular disorders, and novel microcatheterization techniques may permit access to deeper brain regions. Other studies show that pre-procedural simulations increase overall physician performance. Artificial intelligence also shows superiority over existing statistical tools in predicting clinical outcomes.

The recent advances and current usage of robotics and AI in the endovascular neurosurgery field suggest that the collaboration between physicians and machines has a bright future for the improvement of patient care. The aim of this work is to equip the medical readership, in particular the neurosurgical specialty, with tools to better understand and apply findings from research on artificial intelligence and robotics in endovascular neurosurgery.

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.

Magnetic Soft Materials and Robots

In conventional classification, soft robots feature mechanical compliance as the main distinguishing factor from traditional robots made of rigid materials. Recent advances in functional soft materials have facilitated the emergence of a new class of soft robots capable of tether-free actuation in response to external stimuli such as heat, light, solvent, or electric or magnetic field. Among the various types of stimuli-responsive materials, magnetic soft materials have shown remarkable progress in their design and fabrication, leading to the development of magnetic soft robots with unique advantages and potential for many important applications. However, the field of magnetic soft robots is still in its infancy and requires further advancements in terms of design principles, fabrication methods, control mechanisms, and sensing modalities. Successful future development of magnetic soft robots would require a comprehensive understanding of the fundamental principle of magnetic actuation, as well as the physical properties and behavior of magnetic soft materials. In this review, we discuss recent progress in the design and fabrication, modeling and simulation, and actuation and control of magnetic soft materials and robots. We then give a set of design guidelines for optimal actuation performance of magnetic soft materials. Lastly, we summarize potential biomedical applications of magnetic soft robots and provide our perspectives on next-generation magnetic soft robots.

Soft actuators for real-world applications

Inspired by physically adaptive, agile, reconfigurable and multifunctional soft-bodied animals and human muscles, soft actuators have been developed for a variety of applications, including soft grippers, artificial muscles, wearables, haptic devices and medical devices. However, the complex performance of biological systems cannot yet be fully replicated in synthetic designs. In this Review, we discuss new materials and structural designs for the engineering of soft actuators with physical intelligence and advanced properties, such as adaptability, multimodal locomotion, self-healing and multi-responsiveness. We examine how performance can be improved and multifunctionality implemented by using programmable soft materials, and highlight important real-world applications of soft actuators. Finally, we discuss the challenges and opportunities for next-generation soft actuators, including physical intelligence, adaptability, manufacturing scalability and reproducibility, extended lifetime and end-of-life strategies.

ADRC-Based Control Method for the Vascular Intervention Master-Slave Surgical Robotic System

In vascular interventional surgery, surgeons operate guidewires and catheters to diagnose and treat patients with the assistance of the digital subtraction angiography (DSA). Therefore, the surgeon will be exposed to X-rays for extended periods. To protect the surgeon, the development of a robot-assisted surgical system is of great significance. The displacement tracking accuracy is the most important issue to be considered in the development of the system. In this study, the active disturbance rejection control (ADRC) method is applied to guarantee displacement tracking accuracy. First, the core contents of the proportional–integral–derivative (PID) and ADRC methods are analyzed. Second, comparative evaluation experiments for incremental PID and ADRC methods are presented. The results show that the ADRC method has better performance of than that of the incremental PID method. Finally, the calibration experiments for the ADRC control method are implemented using the master–slave robotic system. These experiments demonstrate that the maximum tracking error is 0.87 mm using the ADRC method, effectively guaranteeing surgical safety.

A Submillimeter Continuous Variable Stiffness Catheter for Compliance Control

Minimally invasive robotic surgery often requires functional tools that can change their compliance to adapt to the environment and surgical needs. This paper proposes a submillimeter continuous variable stiffness catheter equipped with a phase-change alloy that has a high stiffness variation in its different states, allowing for rapid compliance control. Variable stiffness is achieved through a variable phase boundary in the alloy due to a controlled radial temperature gradient. This catheter can be safely navigated in its soft state and rigidified to the required stiffness during operation to apply a desired force at the tip. The maximal contact force that the catheter applies to tissue can be continuously modified by a factor of 400 (≈20 mN-8 N). The catheter is equipped with a magnet and a micro-gripper to perform a fully robotic ophthalmic minimally invasive surgery on an eye phantom by means of an electromagnetic navigation system.

Probing the entire vascular system

Microscopic endovascular probes that navigate by blood flow and an external magnetic field may increase the capabilities of vascular catheterization.