Camera sheath with transformable head for minimally invasive surgical instruments

INTRODUCTION

This paper presents a camera sheath that can be assembled to various minimally invasive surgical instruments and provide the localized view of the instrument tip.

MATERIAL AND METHODS

The advanced transformable head structure (ATHS) that overcomes the trade-off between the camera resolution and the instrument size is designed for the sheath. Design solutions to maintain the alignment between the camera's line of sight and the instrument tip direction during the transformation of the ATHS are derived and applied to the prototype of the sheath.

RESULTS

The design solution ensured proper alignment between the line of sight and the tip direction. The prototype was used with the curved micro-debrider blades in simulated functional endoscopic sinus surgery (FESS). Deep regions of the sinus that were not observable with the conventional endoscopes was accessed and observed using the prototype.

CONCLUSIONS

The presented camera sheath allows the delivery of the instrument and camera to the surgical site with minimal increase in port size. It may be applied to various surgeries to reduce invasiveness and provide additional visual information to the surgeons.

Continuum robots for endoscopic sinus surgery: Recent advances, challenges, and prospects

PURPOSE

Endoscopic sinus surgery (ESS) has been recognized as an effective treatment modality for paranasal sinus diseases. Over the past decade, continuum robots (CRs) for ESS have been studied, but there are still some challenges. This paper presents a review on the scientific studies of CRs for ESS.

METHODS

Based on the analysis of the anatomical structure of the paranasal sinus, the requirements of CRs for ESS are discussed. Recent studies on rigid robots, handheld flexible robots, and CRs for ESS are presented. Surgical path planning, navigation, and control are also included.

RESULTS

Concentric tube CRs and cable-driven CRs have great potential for applications in ESS. The CRs incorporated with multiple replaceable arms with different functions are preferable in ESS.

CONCLUSION

Further study on navigation and control is required to improve the performance of CRs for ESS.

Design and path tracking control of a continuum robot for maxillary sinus surgery

PURPOSE

Continuum robots (CRs) have been developed for maxillary sinus surgery (MSS) in recent years. However, due to the anatomically curved and narrow pathway of the maxillary sinus and the deformable characteristics of the CR, it is still a challenge to accurately approach the target in the sinus. Thus, the CR-assisted MSS demands further research, whether in robotic system design or in reliable motion control.

METHODS

A continuum robotic system integrated with essential instruments and sensors for MSS is developed, and the path tracking control of the designed CR is studied. The differential kinematic model of the CR is constructed. By analyzing the potential problem of the traditional Jacobian-based control, an iterative Jacobian transpose-based closed-loop control method is proposed to improve the path tracking performance. To validate the design of the CR and the effectiveness of the proposed control scheme, different groups of experiments are performed.

RESULTS

With the proposed method, the path tracking performance of the CR is improved. Compared with the open-loop Jacobian transpose-based control method, the path tracking error of the proposed method is much less. The maxillary sinus phantom tests are conducted to verify the reachability of the designed CR. Given the reference path from the nostril to the target in the maxillary sinus phantom, experiments show a mean error of 0.96 mm.

CONCLUSIONS

The designed CR is slender, flexible, and able to smoothly approach the target in a tortuous and constrained environment without colliding with or damaging the surrounding tissue. The designed continuum robotic system and the proposed iterative Jacobian transpose-based closed-loop control strategy have great potential for MSS. The limitations of the proposed method are also discussed.

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.

MemoBox: A mechanical follow-the-leader system for minimally invasive surgery

With the increase in Natural Orifice Transluminal Endoscopic Surgery procedures, there is an increasing demand for surgical instruments with additional degrees of freedom, able to travel along tortuous pathways and guarantee dexterity and high accuracy without compromising the surrounding environment. The implementation of follow-the-leader motion in surgical instruments allows propagating the decided shape through its body and moving through curved paths avoiding sensitive areas. Due to the limited operational area and therefore the instrument size, the steerable shaft of these instruments is usually driven by cables that are externally actuated. However, a large number of degrees of freedom requires a great number of actuators, increasing the system complexity. Therefore, our goal was to design a new memory system able to impose a follow-the-leader motion to the steerable shaft of a medical instrument without using actuators. We present a memory mechanism to control and guide the cable displacements of a cable-driven shaft able to move along a multi-curved path. The memory mechanism is based on a programmable physical track with a mechanical interlocking system. The memory system, called MemoBox, was manufactured as a proof-of-concept demonstration model, measuring 70 mm × 64 mm × 6 mm with 11 programmable elements and featuring a minimum resolution of 1 mm. The prototype shows the ability to generate and shift complex 2D pathways in real-time controlled by the user.

Quasisynchronization for Neural Networks With Partial Constrained State Information via Intermittent Control Approach

This work addresses quasisynchronization (QS) of the master-slave (MS) neural networks (NNs) with mismatched parameters. The logarithmic quantizer and the round-robin protocol (RRP) are used to deal with the limited communication channel (CC) capacity, then the intermittent control strategy is employed to improve the efficiency of CC and the controller. A transmission-dependent controller is designed, and the synchronization error system (SES) is established. The QS with a boundary is ensured for the MS NNs by a developed sufficient condition, and the controller design method is given. A numerical simulation is given to show the effectiveness of the obtained method.

Virtual Reality-Based Interface for Advanced Assisted Mobile Robot Teleoperation

This work proposes a new interface for the teleoperation of mobile robots based on virtual reality that allows a natural and intuitive interaction and cooperation between the human and the robot, which is useful for many situations, such as inspection tasks, the mapping of complex environments, etc. Contrary to previous works, the proposed interface does not seek the realism of the virtual environment but provides all the minimum necessary elements that allow the user to carry out the teleoperation task in a more natural and intuitive way. The teleoperation is carried out in such a way that the human user and the mobile robot cooperate in a synergistic way to properly accomplish the task: the user guides the robot through the environment in order to benefit from the intelligence and adaptability of the human, whereas the robot is able to automatically avoid collisions with the objects in the environment in order to benefit from its fast response. The latter is carried out using the well-known potential field-based navigation method. The efficacy of the proposed method is demonstrated through experimentation with the Turtlebot3 Burger mobile robot in both simulation and real-world scenarios. In addition, usability and presence questionnaires were also conducted with users of different ages and backgrounds to demonstrate the benefits of the proposed approach. In particular, the results of these questionnaires show that the proposed virtual reality based interface is intuitive, ergonomic and easy to use.

Augmented Reality-Based Interface for Bimanual Robot Teleoperation

Teleoperation of bimanual robots is being used to carry out complex tasks such as surgeries in medicine. Despite the technological advances, current interfaces are not natural to the users, who spend long periods of time in learning how to use these interfaces. In order to mitigate this issue, this work proposes a novel augmented reality-based interface for teleoperating bimanual robots. The proposed interface is more natural to the user and reduces the interface learning process. A full description of the proposed interface is detailed in the paper, whereas its effectiveness is shown experimentally using two industrial robot manipulators. Moreover, the drawbacks and limitations of the classic teleoperation interface using joysticks are analyzed in order to highlight the benefits of the proposed augmented reality-based interface approach.

DNA-Helix Inspired Wire Routing in Cylindrical Structures and Its Application to Flexible Surgical Devices

In general wire-driven continuum robot mechanisms, the wires are used to control the motion of the devices attached at the distal end. The slack and taut wire is one of the challenging issues to solve in flexible mechanism. This phenomenon becomes worse when the continuum robot is inserted into the natural orifices of the human body, which inherently have uncertain curvilinear geometries consisting of multiple curvatures. Inspired by the unique characteristic of DNA-helix structure that the length of the helix remains almost constant regardless of the deflection of the DNA structure, this article proposes a new idea to design useful flexible mechanism to resolve slack of wires. Using modern Lie-group screw theory, the analytic model for length of helix wire wrapped around a single flexible backbone is proposed and then extended to a general model with multiple flexible backbones and different curvatures. Taking advantage of this helix type wire mechanism, we designed and implemented a flexible surgical device suitable for laryngopharyngeal surgery. The effectiveness of the proposed flexible mechanism is demonstrated through both simulation and phantom experiment.

A miniature robotic steerable endoscope for maxillary sinus surgery called PliENT

In endoscopic maxillary sinus surgery, the maxillary sinus is accessed through the nasal cavity which constitutes a narrow and tortuous pathway. However, surgeons still use rigid endoscopes and rigid, straight or pre-bent instruments for this procedure. Resection of the uncinate process and creation of a medial antrostomy is warranted to access the pathology inside the maxillary sinus and depending on the location of the pathology (lateral, inferior or anterior wall), additional resection of healthy tissue and/or functional structures like the lacrimal duct and/or inferior turbinate is necessary to gain optimal access. In order to avoid this additional resection, a functional single-handed, steerable endoscope for endoscopic maxillary sinus surgery has been designed and built. This endoscope is, to our knowledge, the most slender active steerable endoscope ever reported for maxillary sinus surgery. The performance of the endoscope was validated by two surgeons on a cadaver. An increased field of view was found in comparison to currently used endoscopes. As a direct consequence, a reduced need for resection of healthy tissue was confirmed.

Development and validation of a two-segment continuum robot for maxillary sinus surgery

BACKGROUND

Existing rigid instruments have difficulties in backward inspection and operation. Moreover, the pathway to the maxillary sinus is curved and narrow, resulting in complex and repetitive manual operations. There is a necessity to develop a retro-flexing robot and achieve path-following motion.

METHODS

A continuum robotic system is developed for maxillary sinus surgery (MSS). And the system adopts an anatomical constraint-based optimization of the follow-the-leader strategy to generate a safe control scheme along a given path.

RESULTS

The accuracy of the system is evaluated, and the task of reaching deep-seated targets is performed in a constrained anatomical space. The simulations and experiments of the path-following motion have validated the feasibility of the proposed method. Furthermore, a preliminary porcine study is performed to assess the capability of instruments.

CONCLUSIONS

The developed continuum robotic system can meet the requirements of MSS.

Design and analysis of a continuum robot for transnasal skull base surgery

BACKGROUND

The traditional surgical instruments for transnasal endoscopic skull base surgery have poor flexibility and continuum robot has attracted extensive attention for its high dexterity and safety.

METHODS

A new type of micro continuum surgical robot is designed. On the basis of kinematic analysis, a superposition method is proposed to analyse the reachable configuration space of the system, and the workspace is analysed. The results obtained by superposition method can provide reference for the selection of joint parameters. At last, the static model of the system is established considering friction and coupling between two segments.

RESULTS

The simulation results show that the workspace can meet the requirements of surgery. And the validity of the static model is verified by numerical simulation and experiment, which lays a foundation for the establishment of the driving force transmission system and precise control of the robot.

CONCLUSIONS

The research results of this study contribute to the real-time control and movement of robot. The proposed continuum robot provides convenient conditions for the clinical application.

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.

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 Method Based on 3D Shape Analysis Towards the Design of Flexible Instruments for Endoscopic Maxillary Sinus Surgery

The emergence of steerable flexible instruments has widened the uptake of minimally invasive surgical techniques. In sinus surgery, such flexible instruments could enable the access to difficult-to-reach anatomical areas. However, design-oriented metrics, essential for the development of steerable flexible instruments for maxillary sinus surgery, are still lacking. This paper proposes a method to process measurements and provides the instrument designer with essential information to develop adapted flexible instruments for limited access surgery. This method was applied to maxillary sinus surgery and showed that an instrument with a diameter smaller than 2.4 mm can be used on more than 72.5% of the subjects' set. Based on the statistical analysis and provided that this flexible instrument can bend up to [Formula: see text] it is estimated that all areas within the maxillary sinus could be reached through a regular antrostomy without resorting to extra incision or tissue removal in 94.9% of the population set. The presented method was partially validated by conducting cadaver experiments.

Quasi-Synchronization of Time Delay Markovian Jump Neural Networks With Impulsive-Driven Transmission and Fading Channels

The problem of quasi-synchronization (QS) for the Markovian jump master-slave neural networks with time-varying delay is studied in this article, where the mismatch parameters and unreliable communication channels are considered as well. A set of stochastic variables with different expectations are used to describe the fading phenomena of parallel communication channels. An impulsive-driven transmission strategy is designed to reduce the communication load, and a corresponding impulsive controller is then designed. A synchronization error system (SES) is obtained, and a convex QS condition is established for the SES. A linear matrix inequality-based iterative algorithm is proposed to reduce the bound of the SES, and the corresponding controller gains are calculated. A numerical example is provided to illustrate the effectiveness of the developed result.

A handheld flexible manipulator system for frontal sinus surgery

Purpose

Draf drainage is the standard treatment procedure for frontal sinus diseases. In this procedure, rigid angled endoscopes and rigid curved instruments are used. However, laterally located pathologies in the frontal sinus cannot be reached with rigid instrumentation. In order to assist surgeons with such complicated cases, we propose a novel handheld flexible manipulator system.

Methods

A cross section of 3 mm × 4.6 mm enables transnasal guiding of a flexible endoscope with 1.4 mm diameter and a standard flexible surgical instrument with up to 1.8 mm diameter into the frontal sinus with increased reachability. The developed system consists of an electrical discharge-machined flexure hinge-based nitinol manipulator arm and a purely mechanical handheld control unit. The corresponding control unit enables upward and left–right bending of the manipulator arm, translation, rolling, actuation and also quick exchange of the surgical instrument. In order to verify the fulfillment of performance requirements, tests regarding reachability and payload capacity were conducted.

Results

Reachability tests showed that the manipulator arm can be inserted into the frontal sinus and reach its lateral regions following a Draf IIa procedure. The system can exert forces of at least 2 N in the vertical direction and 1 N in the lateral direction which is sufficient for manipulation of frontal sinus pathologies.

Conclusion

Considering the fact that the anatomical requirements of the frontal sinus are not addressed satisfactorily in the development of prospective flexible instruments, the proposed system shows great potential in terms of therapeutic use owing to its small cross section and dexterity.

Electronic supplementary material

The online version of this article (10.1007/s11548-020-02220-0) contains supplementary material, which is available to authorized users.

Exploring non-assembly 3D printing for novel compliant surgical devices

In minimally invasive surgery, maneuverability is usually limited and a large number of degrees of freedom (DOF) is highly demanded. However, increasing the DOF usually means increasing the complexity of the surgical instrument leading to long fabrication and assembly times. In this work, we propose the first fully 3D printed handheld, multi-steerable device. The proposed device is mechanically actuated, and possesses five serially controlled segments. We designed a new compliant segment providing high torsion and axial stiffness as well as a low bending stiffness by merging the functions of four helicoids and a continuum backbone. Compliant segments were combined to form the compliant shaft of the new device. In order to control this compliant shaft, a control handle was designed that mimics the shaft structure. A prototype called the HelicoFlex was built using only three 3D printed parts. HelicoFlex, with its 10 degrees of freedom, showed a fluid motion in performing single and multi-curved paths. The multi-steerable instrument was 3D printed without any support material in the compliant shaft itself. This work contributes to enlarge the body of knowledge regarding how additive manufacturing could be used in the production of multi-steerable surgical instruments for personalized medicine.