Review on Otological Robotic Systems: Toward Microrobot-Assisted Cholesteatoma Surgery

Application of micro/nanorobot in medicine

The development of micro/nanorobots and their application in medical treatment holds the promise of revolutionizing disease diagnosis and treatment. In comparison to conventional diagnostic and treatment methods, micro/nanorobots exhibit immense potential due to their small size and the ability to penetrate deep tissues. However, the transition of this technology from the laboratory to clinical applications presents significant challenges. This paper provides a comprehensive review of the research progress in micro/nanorobotics, encompassing biosensors, diagnostics, targeted drug delivery, and minimally invasive surgery. It also addresses the key issues and challenges facing this technology. The fusion of micro/nanorobots with medical treatments is poised to have a profound impact on the future of medicine.

Existe espaço para a microcirurgia na cirurgia robótica?

Robotic surgery opened a new era of minimally-invasive procedures, through its improved precision, elimination of tremors, greater degrees of freedom, and other facilitating aspects. The field of robotic microsurgery showed great growth in recent years in particular, since robotics offers a potentially-ideal configuration to perform the sensitive manipulations required in microsurgery. We conducted a systematic review to assess the benefits of robotic surgery and its contributions to microsurgery, comparing it with other surgical techniques used in patients of all age groups. We assessed 25 articles found in the PubMed and Cochrane databases using the terms ' robotic surgery ' AND microsurgery , with a filter for studies published in the last five years, and studies conducted in humans and published in English or Portuguese. We concluded that there is plenty of room for robotic surgery in microsurgery, such as in male infertility procedures, neurological microsurgery, ocular and otological surgeries, and transoral, hepatobiliary, microvascular, plastic and reconstructive surgeries.

Magnetic concentric tube robots: introduction and analysis

In this paper, we propose a new type of continuum robot, referred to as a magnetic concentric tube robot (M-CTR), for performing minimally invasive surgery in narrow and difficult-to-access areas. The robot combines concentric tubes and magnetic actuation to benefit from the ‘follow the leader’ behaviour, the dexterity and stability of existing robots, while targeting millimetre-sized external diameters. These three kinematic properties are assessed through numerical and experimental studies performed on a prototype of a M-CTR. They are performed with general forward and inverse kineto-static models of the robot, continuation and bifurcation analysis, and a specific experimental setup. The prototype presents unique capabilities in terms of deployment and active stability management, while its dexterity in terms of tip orientability is also among the best reported for other robots at its scale.

Shared Control Schemes for Middle Ear Surgery

This paper deals with the control of a redundant cobot arm to accomplish peg-in-hole insertion tasks in the context of middle ear surgery. It mainly focuses on the development of two shared control laws that combine local measurements provided by position or force sensors with the globally observed visual information. We first investigate the two classical and well-established control modes, i.e., a position-based end-frame tele-operation controller and a comanipulation controller. Based on these two control architectures, we then propose a combination of visual feedback and position/force-based inputs in the same control scheme. In contrast to the conventional control designs where all degrees of freedom (DoF) are equally controlled, the proposed shared controllers allow teleoperation of linear/translational DoFs while the rotational ones are simultaneously handled by a vision-based controller. Such controllers reduce the task complexity, e.g., a complex peg-in-hole task is simplified for the operator to basic translations in the space where tool orientations are automatically controlled. Various experiments are conducted, using a 7-DoF robot arm equipped with a force/torque sensor and a camera, validating the proposed controllers in the context of simulating a minimally invasive surgical procedure. The obtained results in terms of accuracy, ergonomics and rapidity are discussed in this paper.

The Use of a Robot to Insert an Electrode Array of Cochlear Implants in the Cochlea: A Feasibility Study and Preliminary Results

INTRODUCTION

Cochlear implants (CIs) are commonly used for the rehabilitation of profound bilateral hearing loss. However, patients with substantial residual acoustic hearing are potential CI candidates. Because of both improvements in technology and advancements in surgical techniques, it may be possible to preserve hearing to some extent. For more than a decade, it has been suggested that robots are used to perform middle ear surgery. We evaluated the use of the RobOtol® otologic robot specifically to insert CI electrodes into the inner ear.

METHODS

CI surgery with the conventional approach was performed under general anesthesia. The MED-El Flex 24-electrode array was inserted using RobOtol®. Video recordings were used to calculate the speed of insertion. The positions of the electrodes were evaluated using a cone beam CT. All subjects underwent pure-tone audiometry tests before and after surgery, and the pure-tone average (PTA) was calculated from 250 to 4,000 Hz.

RESULTS

The robot inserted implants in 5 patients, and complete insertion of the electrode array was achieved. The speed of insertion of the electrode array was 0.88 ± 0.12 mm/s. The mean loss of the PTA for 5 frequencies (250, 500, 1,000, 2,000, and 4,000 Hz) was 13.60 ± 7.70 dB. Only 1 patient showed a loss of the PTA by >20 dB. For these 5 patients, the cone beam CT findings showed that all the electrode arrays were in the tympanic ramp and had a grade of 0. The results were compared with those obtained from a cohort of 17 patients who underwent manual implantation of a MED-El Flex 24-electrode array.

CONCLUSION

To minimize disturbance to the cochlea while atraumatic electrode arrays are inserted, electrodes can be inserted at a constant, slow speed in the inner ear with the assistance of the RobOtol® robot in a normal clinical surgical setting.

Eyes in Ears: A Miniature Steerable Digital Endoscope for Trans-Nasal Diagnosis of Middle Ear Disease

The aim of this work is to design, fabricate and experimentally validate a miniature steerable digital endoscope that can provide comprehensive, high-resolution imaging of the middle ear using a trans-nasal approach. The motivation for this work comes from the high incidence of middle ear diseases, and the current reliance on invasive surgery to diagnose and survey these diseases which typically consists of the eardrum being lifted surgically to directly visualize the middle ear using a trans-canal approach. To enable less-invasive diagnosis and surveillance of middle ear disease, we propose an endoscope that is small enough to pass into the middle ear through the Eustachian tube, with a steerable tip that carries a 1 Megapixel image sensor and fiber-optic illumination to provide high-resolution visualization of critical middle ear structures. The proposed endoscope would enable physicians to diagnose middle ear disease using a non-surgical trans-nasal approach instead, enabling such procedures to be performed in an office setting and greatly reducing invasiveness for the patient. In this work, the computational design of the steerable tip based on computed tomography models of real human middle ear anatomy is presented, and these results informed the fabrication of a clinical-scale steerable endoscope prototype. The prototype was used in a pilot study in three cadaveric temporal bone specimens, where high-quality middle ear visualization was achieved as determined by an unbiased cohort of otolaryngologists. This is the first paper to demonstrate cadaveric validation of a digital, steerable, clinical-scale endoscope for middle ear disease diagnosis, and the experimental results illustrate that the endoscope enables the visualization of critical middle ear structures (such as the epitympanum or sinus tympani) that were seldom or never visualized in prior published trans-Eustachian tube endoscopy feasibility studies.

Design, prototype development and pre-clinical validation of a novel instrument with a compliant steerable tip to facilitate endoscopic ear surgery

This work presents the design of a novel compliant steerable tip (CST) instrument to facilitate transcanal (or totally) endoscopic ear surgery (TEES). The evolution of the instrument's design is shown, where prototypes were evaluated by surgeons and their feedback was used to inform the design changes for the next prototype iteration. The final prototype enables the surgeon to articulate the compliant tip to achieve the desired bending curvature while automatically locking in place and providing dissection and suction capabilities. Pre-clinical validation testing was performed in goat and human cadaver models by two surgeons who successfully removed an allograft from the middle ear. Time and the number of blockages while suctioning saline in both cadaver models were measured and compared with current instruments used during TEES. The CST took significantly less time to suction saline within a flooded middle ear compared to the Panetti suction dissector (PSD) for atticus and underwent less blockages than the PSD for atticus, ear drum and sinus tympani instruments, Wilcoxon Method p < .05. Our study demonstrates the development and successful clinical evaluation of a minimally invasive surgical instrument designed to facilitate endoscopic approaches to the ear.

Computational Optimization of Notch Spacing for a Transnasal Ear Endoscopy Continuum Robot

This paper presents a computational framework to optimize the visual coverage attainable by a notched-tube continuum robotic endoscope inside the middle ear cavity. Our framework combines anatomically-accurate geometric (mesh) models of the middle ear with a sampling-based motion planning algorithm (RRT) and a ray-casting procedure to quantify what regions of the middle ear can be accessed and visualized by the endoscope. To demonstrate the use of this framework, we run computer simulations to investigate the effect of varying the distance between each pair of consecutive flexure elements (i.e., notches) in our robotic endoscope.

Triboelectric nanogenerator sensors for soft robotics aiming at digital twin applications

Designing efficient sensors for soft robotics aiming at human machine interaction remains a challenge. Here, we report a smart soft-robotic gripper system based on triboelectric nanogenerator sensors to capture the continuous motion and tactile information for soft gripper. With the special distributed electrodes, the tactile sensor can perceive the contact position and area of external stimuli. The gear-based length sensor with a stretchable strip allows the continuous detection of elongation via the sequential contact of each tooth. The triboelectric sensory information collected during the operation of soft gripper is further trained by support vector machine algorithm to identify diverse objects with an accuracy of 98.1%. Demonstration of digital twin applications, which show the object identification and duplicate robotic manipulation in virtual environment according to the real-time operation of the soft-robotic gripper system, is successfully created for virtual assembly lines and unmanned warehouse applications.

Retrospective in silico evaluation of optimized preoperative planning for temporal bone surgery

Purpose

Robot-assisted surgery at the temporal bone utilizing a flexible drilling unit would allow safer access to clinical targets such as the cochlea or the internal auditory canal by navigating along nonlinear trajectories. One key sub-step for clinical realization of such a procedure is automated preoperative surgical planning that incorporates both segmentation of risk structures and optimized trajectory planning.

Methods

We automatically segment risk structures using 3D U-Nets with probabilistic active shape models. For nonlinear trajectory planning, we adapt bidirectional rapidly exploring random trees on Bézier Splines followed by sequential convex optimization. Functional evaluation, assessing segmentation quality based on the subsequent trajectory planning step, shows the suitability of our novel segmentation approach for this two-step preoperative pipeline.

Results

Based on 24 data sets of the temporal bone, we perform a functional evaluation of preoperative surgical planning. Our experiments show that the automated segmentation provides safe and coherent surface models that can be used in collision detection during motion planning. The source code of the algorithms will be made publicly available.

Conclusion

Optimized trajectory planning based on shape regularized segmentation leads to safe access canals for temporal bone surgery. Functional evaluation shows the promising results for both 3D U-Net and Bézier Spline trajectories.

Unilaterally Constrained Motion of a Curved Surgical Tool

Constrained motion is essential for varying robotics tasks, especially in surgical robotics, for instance, the case of minimally invasive interventions. This article proposes generic formulations of the classical bilateral constrained motion (i.e., when the incision hole has almost the same diameter as that of the tool) as well as unilaterally constrained motion (i.e., when the hole incision has a larger diameter compared to the tool diameter). One of the latter constraints is combined with another surgical task such as incision/ablation or suturing a wound (modeled here by 3D geometric paths). The developed control methods based on the hierarchical task approach are able to manage simultaneously the constrained motion (depending on the configuration case, i.e., bilateral or unilateral constraint) and a 3D path following. In addition, the proposed methods can operate with both straight or curved surgical tools. The proposed methods were successfully validated in various scenarios. Foremost, a simulation framework was proposed to access the performances of each proposed controller. Thereafter, several experimental validations were carried out. Both the simulation and experimental results have demonstrated the relevance of the proposed approach, as well as promising performances in terms of behavior as well as accuracy.

Frontiers of Medical Robotics: From Concept to Systems to Clinical Translation

Medical robotics is poised to transform all aspects of medicine—from surgical intervention to targeted therapy, rehabilitation, and hospital automation. A key area is the development of robots for minimally invasive interventions. This review provides a detailed analysis of the evolution of interventional robots and discusses how the integration of imaging, sensing, and robotics can influence the patient care pathway toward precision intervention and patient-specific treatment. It outlines how closer coupling of perception, decision, and action can lead to enhanced dexterity, greater precision, and reduced invasiveness. It provides a critical analysis of some of the key interventional robot platforms developed over the years and their relative merit and intrinsic limitations. The review also presents a future outlook for robotic interventions and emerging trends in making them easier to use, lightweight, ergonomic, and intelligent, and thus smarter, safer, and more accessible for clinical use.