Follow-The-Leader Mechanisms in Medical Devices: A Review on Scientific and Patent Literature

Conventional medical instruments are not capable of passing through tortuous anatomy as required for natural orifice transluminal endoscopic surgery due to their rigid shaft designs. Nevertheless, developments in minimally invasive surgery are pushing medical devices to become more dexterous. Amongst devices with controllable flexibility, so-called Follow-The-Leader (FTL) devices possess motion capabilities to pass through confined spaces without interacting with anatomical structures. The goal of this literature study is to provide a comprehensive overview of medical devices with FTL motion. A scientific and patent literature search was performed in five databases (Scopus, PubMed, Web of Science, IEEExplore, Espacenet). Keywords were used to isolate FTL behavior in devices with medical applications. Ultimately, 35 unique devices were reviewed and categorized. Devices were allocated according to their design strategies to obtain the three fundamental sub-functions of FTL motion: steering, (controlling the leader/end-effector orientation), propagation, (advancing the device along a specific path), and conservation (memorizing the shape of the path taken by the device). A comparative analysis of the devices was carried out, showing the commonly used design choices for each sub-function and the different combinations. The advantages and disadvantages of the design aspects and an overview of their performance were provided. Devices that were initially assessed as ineligible were considered in a possible medical context or presented with FTL potential, broadening the classification. This review could aid in the development of a new generation of FTL devices by providing a comprehensive overview of the current solutions and stimulating the search for new ones.

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.

FAS—A Fully Actuated Segment for Tendon-Driven Continuum Robots

We propose a segment design that combines two distinct characteristics of tendon-driven continuum robots, i.e. variable length and non-straight tendon routing, into a single segment by enabling rotation of its backbone. As a result, this segment can vary its helical tendon routing and has four degrees-of-freedom, while maintaining a small-scale design with an overall outer diameter of 7 mm thanks to an extrinsic actuation principle. In simulation and on prototypes, we observe improved motion capabilities, as evidenced by position redundancy and follow-the-leader deployment along spatially tortuous paths. To demonstrate the latter on a physical prototype, a simple, yet effective area-based error measure for follow-the-leader deployment is proposed to evaluate the performance. Furthermore, we derive a static model which is used to underpin the observed motion capabilities. In summary, our segment design extends previous designs with minimal hardware overhead, while either archiving similar accuracy in position errors and planar follow-the-leader deployment, or exhibiting superior motion capabilities due to position redundancy and spatial follow-the-leader deployment.