Concentric Tube Robot Design and Optimization Based on Task and Anatomical Constraints

Exceeding traditional curvature limits of concentric tube robots through redundancy resolution

Understanding elastic instability has been a recent focus of concentric tube robot research. Modeling advances have enabled prediction of when instabilities will occur and produced metrics for the stability of the robot during use. In this paper, we show how these metrics can be used to resolve redundancy to avoid elastic instability, opening the door for the practical use of higher curvature designs than have previously been possible. We demonstrate the effectiveness of the approach using a three-tube robot that is stabilized by redundancy resolution when following trajectories that would otherwise result in elastic instabilities. We also show that it is stabilized when teleoperated in ways that otherwise produce elastic instabilities. Lastly, we show that the redundancy resolution framework presented here can be applied to other control objectives useful for surgical robots, such as maximizing or minimizing compliance in desired directions.

Modeling of and Experimenting with Concentric Tube Robots: Considering Clearance, Friction and Torsion

Concentric tube robots (CTRs) are a promising prospect for minimally invasive surgery due to their inherent compliance and ability to navigate in constrained environments. Existing mechanics-based kinematic models typically neglect friction, clearance, and torsion between each pair of contacting tubes, leading to large positioning errors in medical applications. In this paper, an improved kinematic modeling method is developed. The effect of clearance on tip position during concentric tube assembly is compensated by the database method. The new kinematic model is mechanic-based, and the impact of friction moment and torsion on tubes is considered. Integrating the infinitesimal torsion of the concentric tube robots eliminates the errors caused by the interaction force between the tubes. A prototype is built, and several experiments with kinematic models are designed. The results indicate that the error of tube rotations is less than 2 mm. The maximum error of the feeding experiment does not exceed 0.4 mm. The error of the new modeling method is lower than that of the previous kinematic model. This paper has substantial implications for the high-precision and real-time control of concentric tube robots.

Closed-form Kinematic Model and Workspace Characterization for Magnetic Ball Chain Robots

Magnetic ball chains are well suited to serve as the steerable tips of endoluminal robots. While it has been demonstrated that these robots produce a larger reachable workspace than magnetic soft continuum robots designed using either distributed or lumped magnetic material, here we investigate the orientational capabilities of these robots. To increase the range of orientations that can be produced at each point in the workspace, we introduce a comparatively-stiff outer sheath from which the steerable ball chain is extended. We present an energy-based kinematic model and also derive an approximate expression for the range of achievable orientations at each point in the workspace. Experiments are used to validate these results.

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.

On Surgical Planning of Percutaneous Nephrolithotomy with Patient-Specific CTRs

Percutaneous nephrolithotomy (PCNL) is considered a first-choice minimally invasive procedure for treating kidney stones larger than 2 cm. It yields higher stone-free rates than other minimally invasive techniques and is employed when extracorporeal shock wave lithotripsy or uteroscopy are, for instance, infeasible. Using this technique, surgeons create a tract through which a scope is inserted for gaining access to the stones. Traditional PCNL tools, however, present limited maneuverability, may require multiple punctures and often lead to excessive torquing of the instruments which can damage the kidney parenchyma and thus increase the risk of hemorrhage. We approach this problem by proposing a nested optimization-driven scheme for determining a single tract surgical plan along which a patient-specific concentric-tube robot (CTR) is deployed so as to enhance manipulability along the most dominant directions of the stone presentations. The approach is illustrated with seven sets of clinical data from patients who underwent PCNL. The simulated results may set the stage for achieving higher stone-free rates through single tract PCNL interventions while decreasing blood loss.

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.

Design and Modeling of a Bio-Inspired Compound Continuum Robot for Minimally Invasive Surgery

The continuum robot is a new type of bionic robot which is widely used in the medical field. However, the current structure of the continuum robot limits its application in the field of minimally invasive surgery. In this paper, a bio-inspired compound continuum robot (CCR) combining the concentric tube continuum robot (CTR) and the notched continuum robot is proposed to design a high-dexterity minimally invasive surgical instrument. Then, a kinematic model, considering the stability of the CTR part, was established. The unstable operation of the CCR is avoided. The simulation of the workspace shows that the introduction of the notched continuum robot expands the workspace of CTR. The dexterity indexes of the robots are proposed. The simulation shows that the dexterity of the CCR is 1.472 times that of the CTR. At last, the length distribution of the CCR is optimized based on the dexterity index by using a fruit fly optimization algorithm. The simulations show that the optimized CCR is more dexterous than before. The dexterity of the CCR is increased by 1.069 times. This paper is critical for the development of high-dexterity minimally invasive surgical instruments such as those for the brain, blood vessels, heart and lungs.

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.

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.

A Continuum Robotic Cannula with Tip Following Capability and Distal Dexterity for Intracerebral Hemorrhage Evacuation

OBJECTIVE

This paper aims to investigate a new continuum robot design and its motion implementation methods appropriate for a minimally invasive intracerebral hemorrhage (ICH) evacuation.

METHODS

We propose a continuum robotic cannula, consisting of a precurved body and a 2-degree-of-freedom (DoF) flexible tip, monolithically fabricated. Kinematics model with cable elongation model, and a dedicated design optimization and motion planning algorithm were developed to enable the follow-the-leader (FTL) motion of the cannula. A task-dependent Jacobian-based closed loop control was also designed to track the cannula motion during the insertion and its independent tip motion.

RESULTS

Comprehensive experiments were conducted to verify the kinematic model and submillimeter motion coupling between the cannula precurved body and its flexible tip. The cannula was also capable of achieving FTL motion within around 2.5 mm shape deviation and control performance within submillimeter errors. It was finally demonstrated to be capable of the nonlinear insertion and tip manipulation in the brain phantom.

CONCLUSION

The new cannula design, together with the proposed algorithms, provides the unique ability to access ICH in a nonlinear trajectory and dexterous tip motion.

SIGNIFICANCE

These motion capabilities of the robot in such a slender form factor will lead to more complete ICH evacuation and reduced trauma to the healthy brain tissues.

Targeting Epilepsy Through the Foremen Ovale: How Many Helical Needles are Needed?

Laser ablation of the hippocampus offers medically refractory epilepsy patients an alternative to invasive surgeries. Emerging commercial solutions deliver the ablator through a burr hole in the back of the head. We recently introduced a new access path through the foremen ovale, using a helical needle, which minimizes the amount of healthy brain tissue the needle must pass through on its way to the hippocampus, and also enables the needle to follow the medial axis of the hippocampus more closely. In this paper, we investigate whether helical needles should be designed and fabricated on a patient-specific basis as we had previously proposed, or whether a small collection of pre-defined needle shapes can apply across many patients. We propose a new optimization strategy to determine this needle set using patient data, and investigate the accuracy with which these needles can reach the the medial axis of the hippocampus. We find that three basic tube shapes (mirrored as necessary for left vs. right hippocampi) are all that is required, across 20 patient datasets (obtained from 10 patient CT scans), to reduce worst-case maximum error below 2 mm.

Minimally Invasive Intracerebral Hemorrhage Evacuation: A review

Intracerebral hemorrhage is a leading cause of morbidity and mortality worldwide. To date, there is no specific treatment that clearly provides a benefit in functional outcome or mortality. Surgical treatment for hematoma evacuation has not yet shown clear benefit over medical management despite promising preclinical studies. Minimally invasive treatment options for hematoma evacuation are under investigation but remain in early-stage clinical trials. Robotics has the potential to improve treatment. In this paper, we review intracerebral hemorrhage pathology, currently available treatments, and potential robotic approaches to date. We also discuss the future role of robotics in stroke treatment.

Wireless MRI-Powered Reversible Orientation-Locking Capsule Robot

Magnetic resonance imaging (MRI) scanners do not provide only high-resolution medical imaging but also magnetic robot actuation and tracking. However, the rotational motion capabilities of MRI-powered wireless magnetic capsule-type robots have been limited due to the very high axial magnetic field inside the MRI scanner. Medical functionalities of such robots also remain a challenge due to the miniature robot designs. Therefore, a wireless capsule-type reversible orientation-locking robot (REVOLBOT) is proposed that has decoupled translational motion and planar orientation change capability by locking and unlocking the rotation of a spherical ferrous bead inside the robot on demand. Such an on-demand locking/unlocking mechanism is achieved by a phase-changing wax material in which the ferrous bead is embedded inside. Controlled and on-demand hyperthermia and drug delivery using wireless power transfer-based Joule heating induced by external alternating magnetic fields are the additional features of this robot. The experimental feasibility of the REVOLBOT prototype with steerable navigation, medical function, and MRI tracking capabilities with an 1.33 Hz scan rate is demonstrated inside a preclinical 7T small-animal MRI scanner. The proposed robot has the potential for future clinical use in teleoperated minimally invasive treatment procedures with hyperthermia and drug delivery capabilities while being wirelessly powered and monitored inside MRI scanners.

Current Trends and Prospects in Compliant Continuum Robots: A Survey

Compliant continuum robots (CCRs) have slender and elastic bodies. Compared with a traditional serial robot, they have more degrees of freedom and can deform their flexible bodies to go through a constrained environment. In this paper, we classify CCRs according to basic transmission units. The merits, materials and potential drawbacks of each type of CCR are described. Drive systems depend on the basic transmission units significantly, and their advantages and disadvantages are reviewed and summarized. Variable stiffness and intrinsic sensing are desired characteristics of CCRs, and the methods of obtaining the two characteristics are discussed. Finally, we discuss the friction, buckling, singularity and twisting problems of CCRs, and emphasise the ways to reduce their effects, followed by several proposing perspectives, such as the collaborative CCRs.

Design Considerations for a Steerable Needle Robot to Maximize Reachable Lung Volume

Steerable needles that are able to follow curvilinear trajectories and steer around anatomical obstacles are a promising solution for many interventional procedures. In the lung, these needles can be deployed from the tip of a conventional bronchoscope to reach lung lesions for diagnosis. The reach of such a device depends on several design parameters including the bronchoscope diameter, the angle of the piercing device relative to the medial axis of the airway, and the needle's minimum radius of curvature while steering. Assessing the effect of these parameters on the overall system's clinical utility is important in informing future design choices and understanding the capabilities and limitations of the system. In this paper, we analyze the effect of various settings for these three robot parameters on the percentage of the lung that the robot can reach. We combine Monte Carlo random sampling of piercing configurations with a Rapidly-exploring Random Trees based steerable needle motion planner in simulated human lung environments to asymptotically accurately estimate the volume of sites in the lung reachable by the robot. We highlight the importance of each parameter on the overall system's reachable workspace in an effort to motivate future device innovation and highlight design trade-offs.

A modular, multi-arm concentric tube robot system with application to transnasal surgery for orbital tumors

In the development of telemanipulated surgical robots, a class of continuum robots known as concentric tube robots has drawn particular interest for clinical applications in which space is a major limitation. One such application is transnasal surgery, which is used to access surgical sites in the sinuses and at the skull base. Current techniques for performing these procedures require surgeons to maneuver multiple rigid tools through the narrow confines of the nasal passages, leaving them with limited dexterity at the surgical site. In this article, we present a complete robotic system for transnasal surgery featuring concentric tube manipulators. It illustrates a bagging concept for sterility, and intraoperatively interchangeable instruments that work in conjunction with it, which were developed with operating room workflow compatibility in mind. The system also includes a new modular, portable surgeon console, a variable view-angle endoscope to facilitate surgical field visualization, and custom motor control electronics. Furthermore, we demonstrate elastic instability avoidance for the first time on a physical prototype in a geometrically accurate surgical scenario, which facilitates use of higher curvature tubes than could otherwise be used safely in this application. From a surgical application perspective, this article presents the first robotic approach to removing tumors growing behind the eyes in the orbital apex region, which has not been attempted previously with a surgical robot.

A Dynamic Model for Concentric Tube Robots

Existing static and kinematic models of concentric tube robots are based on the ordinary differential equations of a static Cosserat rod. In this paper, we provide the first dynamic model for concentric tube continuum robots by adapting the partial differential equations of a dynamic Cosserat rod to describe the coupled inertial dynamics of precurved concentric tubes. This generates an initial-boundary-value problem that can capture robot vibrations over time. We solve this model numerically at high time resolutions using implicit finite differences in time and arc length. This approach is capable of resolving the high-frequency torsional dynamics that occur during unstable "snapping" motions and provides a simulation tool that can track the true robot configuration through such transitions. Further, it can track slower oscillations associated with bending and torsion as a robot interacts with tissue at real-time speeds. Experimental verification of the model shows that this wide range of effects is captured efficiently and accurately.

Mechatronic Design of a Two-Arm Concentric Tube Robot System for Rigid Neuroendoscopy

Open surgical approaches are still often employed in neurosurgery, despite the availability of neuroendoscopic approaches that reduce invasiveness. The challenge of maneuvering instruments at the tip of the endoscope makes neuroendoscopy demanding for the physician. The only way to aim tools passed through endoscope ports is to tilt the entire endoscope; but, tilting compresses brain tissue through which the endoscope passes and can damage it. Concentric tube robots can provide necessary dexterity without endoscope tilting, while passing through existing ports in the endoscope and carrying surgical tools in their inner lumen. In this paper we describe the mechatronic design of a new concentric tube robot that can deploy two concentric tube manipulators through a standard neuroendoscope. The robot uses a compact differential drive and features embedded motor control electronics and redundant position sensors for safety. In addition to the mechatronic design of this system, this paper contributes experimental validation in the context of colloid cyst removal, comparing our new robotic system to standard manual endoscopy in a brain phantom. The robotic approach essentially eliminated endoscope tilt during the procedure (17.09° for the manual approach vs. 1.16° for the robotic system). The robotic system also enables a single surgeon to perform the procedure - typically in a manual approach one surgeon aims the endoscope and another operates the tools delivered through its ports.

Continuum Robot With Follow-the-Leader Motion for Endoscopic Third Ventriculostomy and Tumor Biopsy

BACKGROUND

In a combined endoscopic third ventriculostomy (ETV) and endoscopic tumor biopsy (ETB) procedure, an optimal tool trajectory is mandatory to minimize trauma to surrounding cerebral tissue.

OBJECTIVE

This paper presents wire-driven multi-section robot with push-pull wire. The robot is tested to attain follow-the-leader (FTL) motion to place surgical instruments through narrow passages while minimizing the trauma to tissues.

METHODS

A wire-driven continuum robot with six sub-sections was developed and its kinematic model was proposed to achieve FTL motion. An accuracy test to assess the robot's ability to attain FTL motion along a set of elementary curved trajectory was performed. We also used hydrocephalus ventricular model created from human subject data to generate five ETV/ETB trajectories and conducted a study assessing the accuracy of the FTL motion along these clinically desirable trajectories.

RESULTS

In the test with elementary curved paths, the maximal deviation of the robot was increased from 0.47 mm at 30 ° turn to 1.78 mm at 180 ° in a simple C-shaped curve. S-shaped FTL motion had lesser deviation ranging from 0.16 to 0.18 mm. In the phantom study, the greatest tip deviation was 1.45 mm, and the greatest path deviation was 1.23 mm.

CONCLUSION

We present the application of a continuum robot with FTL motion to perform a combined ETV/ETB procedure. The validation study using human subject data indicated that the accuracy of FTL motion is relatively high. The study indicated that FTL motion may be useful tool for combined ETV and ETB.

Optimizing Motion-Planning Problem Setup via Bounded Evaluation with Application to Following Surgical Trajectories

A motion-planning problem's setup can drastically affect the quality of solutions returned by the planner. In this work we consider optimizing these setups, with a focus on doing so in a computationally-efficient fashion. Our approach interleaves optimization with motion planning, which allows us to consider the actual motions required of the robot. Similar prior work has treated the planner as a black box: our key insight is that opening this box in a simple-yet-effective manner enables a more efficient approach, by allowing us to bound the work done by the planner to optimizer-relevant computations. Finally, we apply our approach to a surgically-relevant motion-planning task, where our experiments validate our approach by more-efficiently optimizing the fixed insertion pose of a surgical robot.

Research on kinematics and attitude control model of a surgical interventional catheter

To solve the problems of poor versatility and inactivity of the traditional interventional catheters, a forward kinematic model of multi-segment catheters in series is established by using D-H parameter method, which is based on the geometrical structure of the designed catheters. In order to ensure the decoupling control of the driver’s length, we look into the relationship between the driver’s length and the posture of the catheter unit. The control model of the catheter’s posture is further presented, in which the characteristics of driver is equivalent to the arc shape. Finally, the fuzzy Proportional-Integral-Differential Control (PID) control is designed to control the catheter unit which greatly improves the precision of the control model. The results show that the relationship between the predicted driver length and the catheter attitude angle is basically consistent with the experimental results, which verifies the effectiveness of the variable universe fuzzy PID control.

Design optimization of a contact-aided continuum robot for endobronchial interventions based on anatomical constraints

PURPOSE

A laser-profiled continuum robot (CR) with a series of interlocking joints has been developed in our center to reach deeper areas of the airways. However, it deflects with constant curvature, which thus increases the difficulty of entering specific bronchi without relying on the tissue reaction forces. This paper aims to propose an optimization framework to find the best design parameters for nonconstant curvature CRs to reach distal targets while attempting to avoid the collision with the surrounding tissue.

METHODS

First, the contact-aided compliant mechanisms (CCMs) are integrated with the continuum robot to achieve the nonconstant curvature. Second, forward kinematics considering CCMs is built. Third, inverse kinematics is implemented to steer the robot tip toward the desired targets within the confined anatomy. Finally, an optimization framework is proposed to find the best robot design to reach the target with the least collision to the bronchi walls.

RESULTS

Experiments are carried out to verify the feasibility of CCMs to enable the nonconstant curvature deflection, and simulations demonstrate a lower cost function value to reach a target for the nonconstant curvature optimized design with respect to the standard constant curvature robot (0.11 vs. 2.66). In addition, the higher capacity of the optimized design to complete the task is validated by interventional experiments using fluoroscopy.

CONCLUSION

Results demonstrate the effectiveness of the proposed framework to find an optimized CR with nonconstant curvature to perform safer interventions to reach distal targets.

Autonomous Robotic Intracardiac Catheter Navigation Using Haptic Vision

While all minimally invasive procedures involve navigating from a small incision in the skin to the site of the intervention, it has not been previously demonstrated how this can be done autonomously. To show that autonomous navigation is possible, we investigated it in the hardest place to do it - inside the beating heart. We created a robotic catheter that can navigate through the blood-filled heart using wall-following algorithms inspired by positively thigmotactic animals. The catheter employs haptic vision, a hybrid sense using imaging for both touch-based surface identification and force sensing, to accomplish wall following inside the blood-filled heart. Through in vivo animal experiments, we demonstrate that the performance of an autonomously-controlled robotic catheter rivals that of an experienced clinician. Autonomous navigation is a fundamental capability on which more sophisticated levels of autonomy can be built, e.g., to perform a procedure. Similar to the role of automation in fighter aircraft, such capabilities can free the clinician to focus on the most critical aspects of the procedure while providing precise and repeatable tool motions independent of operator experience and fatigue.

Asymptotically Optimal Kinematic Design of Robots using Motion Planning

In highly constrained settings, e.g., a tentaclelike medical robot maneuvering through narrow cavities in the body for minimally invasive surgery, it may be difficult or impossible for a robot with a generic kinematic design to reach all desirable targets while avoiding obstacles. We introduce a design optimization method to compute kinematic design parameters that enable a single robot to reach as many desirable goal regions as possible while avoiding obstacles in an environment. Our method appropriately integrates sampling based motion planning in configuration space into stochastic optimization in design space so that, over time, our evaluation of a design's ability to reach goals increases in accuracy and our selected designs approach global optimality. We prove the asymptotic optimality of our method and demonstrate performance in simulation for (i) a serial manipulator and (ii) a concentric tube robot, a tentacle-like medical robot that can bend around anatomical obstacles to safely reach clinically- relevant goal regions.

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

PURPOSE

Laser-induced thermotherapy in the brain is a minimally invasive procedure to denature tumor tissue. However, irregularly shaped brain tumors cannot be treated using existing commercial systems. Thus, we present a new concept for laser-induced thermotherapy using a concentric tube robotic system. The planning procedure is complex and consists of the optimal distribution of thermal laser ablations within a volume as well as design and configuration parameter optimization of the concentric tube robot.

METHODS

We propose a novel computer-assisted planning procedure that decomposes the problem into task- and robot-specific planning and uses a multi-objective particle swarm optimization algorithm with variable length.

RESULTS

The algorithm determines a Pareto-front of optimal ablation distributions for three patient datasets. It considers multiple objectives and determines optimal robot parameters for multiple trajectories to access the tumor volume.

CONCLUSIONS

We prove the effectiveness of our planning procedure to enable the treatment of irregularly shaped brain tumors. Multiple trajectories further increase the applicability of the procedure.

Can Elastic Instability be Beneficial in Concentric Tube Robots?

Concentric tube manipulators exhibit elastic instability in which tubes snap from one configuration to another, rapidly releasing stored strain energy. While this has long been viewed as a negative phenomenon to be avoided at all costs, in this paper we explore for the first time whether the effect can be harnessed beneficially for certain applications. Specifically, we show that the energy released in an instability can be useful for challenging, high-force surgical tasks such as driving a needle through tissue. We use concentric tube models to define the energy released during elastic instability and experimentally evaluate a two-tube concentric manipulator that can drive suture needles through tissue by harnessing elastic instability beneficially.

Toward the Design of Personalized Continuum Surgical Robots

Robot-assisted minimally invasive surgical systems enable procedures with reduced pain, recovery time, and scarring compared to traditional surgery. While these improvements benefit a large number of patients, safe access to diseased sites is not always possible for specialized patient groups, including pediatric patients, due to their anatomical differences. We propose a patient-specific design paradigm that leverages the surgeon's expertise to design and fabricate robots based on preoperative medical images. The components of the patient-specific robot design process are a virtual reality design interface enabling the surgeon to design patient-specific tools, 3-D printing of these tools with a biodegradable polyester, and an actuation and control system for deployment. The designed robot is a concentric tube robot, a type of continuum robot constructed from precurved, elastic, nesting tubes. We demonstrate the overall patient-specific design workflow, from preoperative images to physical implementation, for an example clinical scenario: nonlinear renal access to a pediatric kidney. We also measure the system's behavior as it is deployed through real and artificial tissue. System integration and successful benchtop experiments in ex vivo liver and in a phantom patient model demonstrate the feasibility of using a patient-specific design workflow to plan, fabricate, and deploy personalized, flexible continuum robots.

In Vivo Inspection of the Olfactory Epithelium: Feasibility of Robotized Optical Biopsy

Inspecting the olfactory cleft can be of high interest, as it is an open access to neurons, and thus an opportunity to collect in situ related data in a non-invasive way. Also, recent studies show a strong link between olfactory deficiency and neurodegenerative diseases such as Alzheimer and Parkinson diseases. However, no inspection of this area is possible today, as it is very difficult to access. Only robot-assisted interventions seem viable to provide the required dexterity. The feasibility of this approach is demonstrated in this article, which shows that the path complexity to the olfactory cleft can be managed with a concentric tube robot (CTR), a particular type of continuum robot. First, new anatomical data are elaborated, in particular for the olfactory cleft, that remains hardly characterized. 3D reconstructions are conducted on the database of 20 subjects, using CT scan images. Measurements are performed to describe the anatomy, including metrics with inter-subject variability. Then, the existence of collision-free passageways for CTR is shown using the 3D reconstructions. Among the 20 subjects, 19 can be inspected using only 3 different robot geometries. This constitutes an essential step towards a robotic device to inspect subjects for clinical purposes.

Numerical investigation of the effect of bone cement porosity on osteoporotic femoral augmentation

Femoroplasty is the injection of bone cement into the proximal femur, enhances the bone load capacity, and is typically applied to osteoporotic femora. To minimize the required injected volume of bone cement and maximize the load capacity enhancement, an optimization problem must be solved, where the modulus of elasticity of the augmented bone is a key element. This paper, through the numerical investigation of a fall on the greater trochanter of an osteoporotic femur, compares different ways to calculate this modulus and introduces an approach, based on the concept of bone cement porosity, which provides results statistically similar to those obtained with other considerations. Based on this approach, the present paper quantifies the correlation between degree of osteoporosis and optimum volume of bone cement. It concludes with an exhaustive search that reveals the effect of the bone cement porosity on the optimum volume of PMMA, for various combinations of the frontal and transverse angles of the fall on the greater trochanter.

Varying ultrasound power level to distinguish surgical instruments and tissue

We investigate a new framework of surgical instrument detection based on power-varying ultrasound images with simple and efficient pixel-wise intensity processing. Without using complicated feature extraction methods, we identified the instrument with an estimated optimal power level and by comparing pixel values of varying transducer power level images. The proposed framework exploits the physics of ultrasound imaging system by varying the transducer power level to effectively distinguish metallic surgical instruments from tissue. This power-varying image-guidance is motivated from our observations that ultrasound imaging at different power levels exhibit different contrast enhancement capabilities between tissue and instruments in ultrasound-guided robotic beating-heart surgery. Using lower transducer power levels (ranging from 40 to 75% of the rated lowest ultrasound power levels of the two tested ultrasound scanners) can effectively suppress the strong imaging artifacts from metallic instruments and thus, can be utilized together with the images from normal transducer power levels to enhance the separability between instrument and tissue, improving intraoperative instrument tracking accuracy from the acquired noisy ultrasound volumetric images. We performed experiments in phantoms and ex vivo hearts in water tank environments. The proposed multi-level power-varying ultrasound imaging approach can identify robotic instruments of high acoustic impedance from low-signal-to-noise-ratio ultrasound images by power adjustments.

Design of a Magnetic Resonance Imaging Guided Magnetically Actuated Steerable Catheter

This paper presents design optimization of a magnetic resonance imaging (MRI) actuated steerable catheter for atrial fibrillation ablation in the left atrium. The catheter prototype, built over polymer tubing, is embedded with current-carrying electromagnetic coils. The prototype can be deflected to a desired location by controlling the currents passing through the coils. The design objective is to develop a prototype that can successfully accomplish the ablation task. To complete the tasks, the catheter needs to be capable of reaching a set of desired targets selected by a physician on the chamber and keeping a stable contact with the chamber surface. The design process is based on the maximization of the steering performance of the catheter by evaluating its workspace in free space. The selected design is validated by performing a simulation of an ablation intervention on a virtual model of the left atrium with a real atrium geometry. This validation shows that the prototype can reach every target required by the ablation intervention and provide an appropriate contact force against the chamber.

Evaluating the deflection of dexterous continuum manipulators with unevenly distributed compliant joints

Dexterous continuum manipulators (DCMs) offer great potential for increasing instrument reach in minimally-invasive surgical procedures. We previously designed and fabricated a tendon driven DCM with a large instrument channel and evenly distributed compliant joints for minimally-invasive skull base surgery and the treatment of osteolysis during hip revision surgery. The evenly distributed compliant joints, in some cases, may limit the reach of the DCM during lesion removal. In this paper, we propose a finite element analysis (FEA) method for optimizing the distribution of the compliant joints based on treatment space requirements determined preoperatively. After performing experiments to validate the FEA results, we investigated the effects of height and cross distance of unevenly distributed compliant joints on tip trajectories and deflection shapes of DCMs. A boundary exploration for skull base surgery was performed to investigate the improvement in the percent of boundary explored by the optimized DCMs with the unevenly distributed compliant joints. Results show the advantage of using DCMs with unevenly distributed joints in reaching the boundary of the lesion. For a typical lesion in the petrous apex during skull base surgery, simulation results indicates that the design of unevenly distributed compliant joints can increase the reach of the DCM accomplishing 71% lesion removal compared with 59% from the DCM with evenly distributed compliant joints.

Toward Transoral Peripheral Lung Access: Combining Continuum Robots and Steerable Needles

Lung cancer is the most deadly form of cancer in part because of the challenges associated with accessing nodules for diagnosis and therapy. Transoral access is preferred to percutaneous access since it has a lower risk of lung collapse, yet many sites are currently unreachable transorally due to limitations with current bronchoscopic instruments. Toward this end, we present a new robotic system for image-guided trans-bronchoscopic lung access. The system uses a bronchoscope to navigate in the airway and bronchial tubes to a site near the desired target, a concentric tube robot to move through the bronchial wall and aim at the target, and a bevel-tip steerable needle with magnetic tracking to maneuver through lung tissue to the target under closed-loop control. In this work, we illustrate the workflow of our system and show accurate targeting in phantom experiments. Ex vivo porcine lung experiments show that our steerable needle can be tuned to achieve appreciable curvature in lung tissue. Lastly, we present targeting results with our system using two scenarios based on patient cases. In these experiments, phantoms were created from patient-specific computed tomography information and our system was used to target the locations of suspicious nodules, illustrating the ability of our system to reach sites that are traditionally inaccessible transorally.

Optimizing Tube Precurvature to Enhance Elastic Stability of Concentric Tube Robots

Robotic instruments based on concentric tube technology are well suited to minimally invasive surgery since they are slender, can navigate inside small cavities and can reach around sensitive tissues by taking on shapes of varying curvature. Elastic instabilities can arise, however, when rotating one precurved tube inside another. In contrast to prior work that considered only tubes of piecewise constant precurvature, we allow precurvature to vary along the tube's arc length. Stability conditions for a planar tube pair are derived and used to formulate an optimal design problem. An analytic formulation of the optimal precurvature function is derived that achieves a desired tip orientation range while maximizing stability and respecting bending strain limits. This formulation also includes straight transmission segments at the proximal ends of the tubes. The result, confirmed by both numerical and physical experiment, enables designs with enhanced stability in comparison to designs of constant precurvature.

Biometry-based concentric tubes robot for vitreoretinal surgery

Vitreoretinal surgery requires dexterous manoeuvres of tiny surgical tools in the confined cavity of the human eye through incisions made on the sclera. The fulcrum effect stemming from these incisions limits the safely reachable intraocular workspace and may result in scleral stress and collision with the intraocular lens. This paper proposes a concentric tube robot for panretinal interventions without risking scleral or lens damage. The robot is designed based on biometric measurements of the human eye, the required workspace, and the ease of incorporation in the clinical workflow. Our system is suited to 23 G vitreoretinal surgery, which does not require post-operative suturing, by comprising sub-millimetre concentric tubes. The proposed design is modular and features a rapid tube-exchange mechanism. To grasp and manipulate tissue, a sub-millimetre flexible gripper is fabricated. Experiments demonstrate the ability to reach peripheral retinal regions with limited motion at the incision point and no risk of lens contact.

Adaptive Nonparametric Kinematic Modeling of Concentric Tube Robots

Concentric tube robots comprise telescopic precurved elastic tubes. The robot's tip and shape are controlled via relative tube motions, i.e. tube rotations and translations. Non-linear interactions between the tubes, e.g. friction and torsion, as well as uncertainty in the physical properties of the tubes themselves, e.g. the Young's modulus, curvature, or stiffness, hinder accurate kinematic modelling. In this paper, we present a machine-learning-based methodology for kinematic modelling of concentric tube robots and in situ model adaptation. Our approach is based on Locally Weighted Projection Regression (LWPR). The model comprises an ensemble of linear models, each of which locally approximates the original complex kinematic relation. LWPR can accommodate for model deviations by adjusting the respective local models at run-time, resulting in an adaptive kinematics framework. We evaluated our approach on data gathered from a three-tube robot, and report high accuracy across the robot's configuration space.