An advanced robotic system incorporating haptic feedback for precision cardiac ablation procedures

This study introduces an innovative master-slave cardiac ablation catheter robot system that employs magnetorheological fluids. The system incorporates magnetorheological fluid to enable collision detection through haptic feedback, thereby enhancing the operator's situational awareness. A modular clamping and propulsion mechanism has been engineered for the ablation catheter, facilitating omnidirectional operation and force feedback within the cardiac cavity. To evaluate the proposed system, an in vitro experiment was performed. Results from the experiment indicate that the system demonstrates high motion transmission accuracy. Furthermore, the system effectively alerts operators to potential collisions, enabling swift catheter position adjustments, minimizing the risk of vascular perforation, and ultimately enhancing the overall safety and efficiency of the procedure.

Advancements in Micro/Nanorobots in Medicine: Design, Actuation, and Transformative Application

In light of the ongoing technological transformation, embracing advancements that foster shared benefits is essential. Nanorobots, a breakthrough within nanotechnology, have demonstrated significant potential in fields such as medicine, where diagnostic and therapeutic applications are the primary focus areas. This review provides a comprehensive overview of nanotechnology, robots, and their evolving role in medical applications, particularly highlighting the use of nanorobots. Various design strategies and operational principles, including sensors, actuators, and nanocontrollers, are discussed based on prior research. Key nanorobot medical applications include biomedical imaging, biosensing, minimally invasive surgery, and targeted drug delivery, each utilizing advanced actuation technologies to enhance precision. The paper further examines recent progress in micro/nanorobot actuation and addresses important considerations for the future, including biocompatibility, control, navigation, delivery, targeting, safety, and ethical implications. This review offers a holistic perspective on how nanorobots can reshape medical practices, paving the way for precision medicine and improved patient outcomes.

State of the Art and Development Trend of Laparoscopic Surgical Robot and Master Manipulator

BACKGROUND

In recent years, laparoscopic surgical robots have rapidly developed. However, most focus on the overall robotic systems, with few summaries on the laparoscopic surgical robots and the master manipulators.

METHODS

This paper provides a summary and analysis of typical laparoscopic surgical robots, including the strengths and limitations of existing laparoscopic surgical robots. Additionally, the master manipulators are analysed and summarised from four aspects: structural design and optimization, time-varying delays, tremor suppression and force feedback. Further classification and summary are made based on the different methods used in each study.

RESULTS

Laparoscopic surgical robots and the master manipulators still have some limitations. Therefore, the development trends of the laparoscopic surgical robots and the master manipulators are discussed from four aspects: structural materials, remote surgery, intelligence and human-machine interaction.

CONCLUSION

With the continuous advancement of technology, laparoscopic surgical robots will play an increasingly important role in the field of surgery.

Model-based trajectory tracking of a compliant continuum robot

Introduction: Compliant mechanisms, especially continuum robots, are becoming integral to advancements in minimally invasive surgery due to their ability to autonomously navigate natural pathways, significantly reducing collision severity. A major challenge lies in developing an effective control strategy to accurately reflect their behavior for enhanced operational precision. Methods: This study examines the trajectory tracking capabilities of a tendon-driven continuum robot at its tip. We introduce a novel feedforward control methodology that leverages a mathematical model based on Cosserat rod theory. To mitigate the computational challenges inherent in such models, we implement an implicit time discretization strategy. This approach simplifies the governing equations into space-domain ordinary differential equations, facilitating real-time computational efficiency. The control strategy is devised to enable the robot tip to follow a dynamically prescribed trajectory in two dimensions. Results: The efficacy of the proposed control method was validated through experimental tests on six different demand trajectories, with a motion capture system employed to assess positional accuracy. The findings indicate that the robot can track trajectories with an accuracy within 9.5%, showcasing consistent repeatability across different runs. Discussion: The results from this study mark a significant step towards establishing an efficient and precise control methodology for compliant continuum robots. The demonstrated accuracy and repeatability of the control approach significantly enhance the potential of these robots in minimally invasive surgical applications, paving the way for further research and development in this field.

Neurosurgical robots in China: State of the art and future prospect

Neurosurgical robots have developed for decades and can effectively assist surgeons to carry out a variety of surgical operations, such as biopsy, stereo-electroencephalography (SEEG), deep brain stimulation (DBS), and so forth. In recent years, neurosurgical robots in China have developed rapidly. This article will focus on several key skills in neurosurgical robots, such as medical imaging systems, automatic manipulator, lesion localization techniques, multimodal image fusion technology, registration method, and vascular imaging technology; introduce the clinical application of neurosurgical robots in China, and look forward to the potential improvement points in the future based on our experience and research in the field.

Interactive robots for health in Europe: Technology readiness and adoption potential

Introduction

Social robots are accompanied by high expectations of what they can bring to society and in the healthcare sector. So far, promising assumptions have been presented about how and where social robots are most relevant. We know that the industry has used robots for a long time, but what about social uptake outside industry, specifically, in the healthcare sector? This study discusses what trends are discernible, to better understand the gap between technology readiness and adoption of interactive robots in the welfare and health sectors in Europe.

Methods

An assessment of interactive robot applications at the upper levels of the Technology Readiness Level scale is combined with an assessment of adoption potential based on Rogers' theory of diffusion of innovation. Most robot solutions are dedicated to individual rehabilitation or frailty and stress. Fewer solutions are developed for managing welfare services or public healthcare.

Results

The results show that while robots are ready from the technological point of view, most of the applications had a low score for demand according to the stakeholders.

Discussion

To enhance social uptake, a more initiated discussion, and more studies on the connections between technology readiness and adoption and use are suggested. Applications being available to users does not mean they have an advantage over previous solutions. Acceptance of robots is also heavily dependent on the impact of regulations as part of the welfare and healthcare sectors in Europe.

Model-Based Control of a 4-DOF Rehabilitation Parallel Robot with Online Identification of the Gravitational Term

Parallel robots are being increasingly used as a fundamental component of lower-limb rehabilitation systems. During rehabilitation therapies, the parallel robot must interact with the patient, which raises several challenges to the control system: (1) The weight supported by the robot can vary from patient to patient, and even for the same patient, making standard model-based controllers unsuitable for those tasks since they rely on constant dynamic models and parameters. (2) The identification techniques usually consider the estimation of all dynamic parameters, bringing about challenges concerning robustness and complexity. This paper proposes the design and experimental validation of a model-based controller comprising a proportional-derivative controller with gravity compensation applied to a 4-DOF parallel robot for knee rehabilitation, where the gravitational forces are expressed in terms of relevant dynamic parameters. The identification of such parameters is possible by means of least squares methods. The proposed controller has been experimentally validated, holding the error stable following significant payload changes in terms of the weight of the patient's leg. This novel controller allows us to perform both identification and control simultaneously and is easy to tune. Moreover, its parameters have an intuitive interpretation, contrary to a conventional adaptive controller. The performance of a conventional adaptive controller and the proposed one are compared experimentally.

Engineers in Medicine: Foster Innovation by Traversing Boundaries

Engineers play a critical role in the advancement of biomedical science and the development of diagnostic and therapeutic technologies for human well-being. The complexity of medical problems requires the synthesis of diverse knowledge systems and clinical experiences to develop solutions. Therefore, engineers in the healthcare and biomedical industries are interdisciplinary by nature to innovate technical tools in sophisticated clinical settings. In academia, engineering is usually divided into disciplines with dominant characteristics. Since biomedical engineering has been established as an independent curriculum, the term "biomedical engineers" often refers to the population from a specific discipline. In fact, engineers who contribute to medical and healthcare innovations cover a broad range of engineering majors, including electrical engineering, mechanical engineering, chemical engineering, industrial engineering, and computer sciences. This paper provides a comprehensive review of the contributions of different engineering professions to the development of innovative biomedical solutions. We use the term "engineers in medicine" to refer to all talents who integrate the body of engineering knowledge and biological sciences to advance healthcare systems.

Characterization of the Workspace and Limits of Operation of Laser Treatments for Vascular Lesions of the Lower Limbs

The increase of the aging population brings numerous challenges to health and aesthetic segments. Here, the use of laser therapy for dermatology is expected to increase since it allows for non-invasive and infection-free treatments. However, existing laser devices require doctors' manually handling and visually inspecting the skin. As such, the treatment outcome is dependent on the user's expertise, which frequently results in ineffective treatments and side effects. This study aims to determine the workspace and limits of operation of laser treatments for vascular lesions of the lower limbs. The results of this study can be used to develop a robotic-guided technology to help address the aforementioned problems. Specifically, workspace and limits of operation were studied in eight vascular laser treatments. For it, an electromagnetic tracking system was used to collect the real-time positioning of the laser during the treatments. The computed average workspace length, height, and width were 0.84 ± 0.15, 0.41 ± 0.06, and 0.78 ± 0.16 m, respectively. This corresponds to an average volume of treatment of 0.277 ± 0.093 m³. The average treatment time was 23.2 ± 10.2 min, with an average laser orientation of 40.6 ± 5.6 degrees. Additionally, the average velocities of 0.124 ± 0.103 m/s and 31.5 + 25.4 deg/s were measured. This knowledge characterizes the vascular laser treatment workspace and limits of operation, which may ease the understanding for future robotic system development.

Robotics in laparoscopic surgery - A review

Because of the increasing use of laparoscopic surgeries, robotic technologies have been developed to overcome the challenges these surgeries impose on surgeons. This paper presents an overview of the current state of surgical robots used in laparoscopic surgeries. Four main categories were discussed: handheld laparoscopic devices, laparoscope positioning robots, master–slave teleoperated systems with dedicated consoles, and robotic training systems. A generalized control block diagram is developed to demonstrate the general control scheme for each category of surgical robots. In order to review these robotic technologies, related published works were investigated and discussed. Detailed discussions and comparison tables are presented to compare their effectiveness in laparoscopic surgeries. Each of these technologies has proved to be beneficial in laparoscopic surgeries.

Understanding the surgeon's behaviour during robot-assisted surgery: protocol for the qualitative Behav'Robot study

INTRODUCTION

Robot-assisted surgery is spreading worldwide, accounting for more than 1.2 million procedures in 2019. Data are sparse in the literature regarding the surgeon's mechanisms that mediate risk-taking during a procedure, especially robot-assisted. This study aims to describe and understand the behaviour of the surgeons during robot-assisted surgery and the change in their behaviour with increasing experience in using the robot.

METHODS AND ANALYSIS

This is a qualitative study using semistructured interviews with surgeons who perform robot-assisted surgery. An interview guide comprising open questions will be used to ensure that the points to be discussed are systematically addressed during each interview (ie, (1) difference in behaviour and preparation of the surgeon between a standard procedure and a robot-assisted procedure; (2) the influence of proprioceptive modifications, gain in stability and cognitive biases, inherent in the use of a surgical robot and (3) the intrinsic effect of the learning curve on the behaviour of the surgeons. After transcription, interviews will be analysed with the help of NVivo software, using thematic analysis.

ETHICS AND DISSEMINATION

Since this project examines professional practices in the field of social and human sciences, ethics committee was not required in accordance with current French legislation (Decree no 2017-884, 9 May 2017). Consent from the surgeons is implied by the fact that the interviews are voluntary. Surgeons will nonetheless be informed that they are free to interrupt the interview at any time.Results will be presented in peer-reviewed national and international congresses and submitted to peer-reviewed journals for publication. The communication and publication of the results will be placed under the responsibility of the principal investigator and publications will be prepared in compliance with the ICMJE uniform requirements for manuscripts.

TRIAL REGISTRATION NUMBER

NCT04869995.

Design, fabrication and application of magnetically actuated micro/nanorobots: a review

Magnetically actuated micro/nanorobots are typical micro- and nanoscale artificial devices with favorable attributes of quick response, remote and contactless control, harmless human-machine interaction and high economic efficiency. Under external magnetic actuation strategies, they are capable of achieving elaborate manipulation and navigation in extreme biomedical environments. This review focuses on state-of-the-art progresses in design strategies, fabrication techniques and applications of magnetically actuated micro/nanorobots. Firstly, recent advances of various robot designs, including helical robots, surface walkers, ciliary robots, scaffold robots and biohybrid robots, are discussed separately. Secondly, the main progresses of common fabrication techniques are respectively introduced, and application achievements on these robots in targeted drug delivery, minimally invasive surgery and cell manipulation are also presented. Finally, a short summary is made, and the current challenges and future work for magnetically actuated micro/nanorobots are discussed.

A Human Gesture Mapping Method to Control a Multi-Functional Hand for Robot-Assisted Laparoscopic Surgery: The MUSHA Case

This work presents a novel technique to control multi-functional hand for robot-assisted laparoscopic surgery. We tested the technique using the MUSHA multi-functional hand, a robot-aided minimally invasive surgery tool with more degrees of freedom than the standard commercial end-effector of the da Vinci robot. Extra degrees of freedom require the development of a proper control strategy to guarantee high performance and avoid an increasing complexity of control consoles. However, developing reliable control algorithms while reducing the control side’s mechanical complexity is still an open challenge. In the proposed solution, we present a control strategy that projects the human hand motions into the robot actuation space. The human hand motions are tracked by a LeapMotion camera and mapped into the actuation space of the virtualized end-effector. The effectiveness of the proposed method was evaluated in a twofold manner. Firstly, we verified the Lyapunov stability of the algorithm, then an user study with 10 subjects assessed the intuitiveness and usability of the system.

Development of a Prosthetic Hand with Adaptive Grip

The aim of this paper was to make a study in the field of prosthesis, to present the long history of prostheses and the impact they have had on people with disabilities, to explain the anatomy of the skeleton of the hand and its properties. The most important aspect was by far the CAD design of a functional hand prosthesis using the Creo Parametric 5.0 program. so that it respects the aesthetic similarities with a real hand, but to ensure a space in the body of the hand for the mechanisms that will operate the fingers in compliance with the necessary calculations.

Research on Robots Used in Surgical Applications

Nowadays robotic technology provides massive advantages over traditional procedures, including shorter hospitalization and rehabilitation time, and less pain and discomfort. This paper presents the fundamental requirements of a surgical robot, its applications, advantages and disadvantages of different topologies and concludes with a comparison between surgical robots and surgeons.

Online Hypermodel-based Path Planning for Feedback Control of Tissue Denaturation in Electrosurgical Cutting

The first closed-loop control of electrosurgical power satisfying a specified tissue damage bound along the desired tissue dissection path is presented. The damage is represented by the 82 °C isotherm corresponding to the admissible tissue denaturation front position in relation to that of the cutting probe tip. The front location is assessed in real time through the infrared temperature readings of the 40 °C isotherm tightly related to the emerging denaturing patch size around the moving probe tip. A control-oriented denaturing hypermodel and its recasting into a form amenable for use in a moving-horizon locally linear model predictive control law are presented. The optimal control action is determined by solving a compound model predictive control problem that targets a number of active one-dimensional domains. This model is obtained from an offline trained nonlinear autoregressive model with exogenous input. To enforce the safety constraints, a supervisor system precedes the path planning control law. This system prevents excessive denaturation by excluding certain system moves, and determines system termination conditions. We experimentally demonstrate the system's performance in two different line-cutting tasks on ex vivo porcine tissue with a desired denaturation front.

Kinematics Constraint Modeling for Flexible Robots based on Deep Learning1

Application of flexible robotic systems and teleoperated control recently used in minimally invasive surgery have introduced paradigm shift in interventional surgery. While Prototypes of flexible robots have been proposed for surgical diagnostic and treatments, precise constraint control models are still needed for flexible pathway navigation. In this paper, a deep learning based kinematics model is proposed for motion control of flexible robots. Unlike previous approach, this study utilized the different layers of deep learning system for learning the best features to predict the damping value for each point in the robot's workspace. The method uses differential Jacobian to solve IK for given targets. Optimal damping factor that converges precisely around given target is rapidly predicted by a DNN. Simulation of the robot and implementation of the proposed control models are done in V-rep and Python. Validation with arbitrary points shows the deep-learning approach requires an average of 26.50 iterations, a mean error of 0.838, and an execution time of 3.6 ms for IK of single point; and converges faster than other existing methods.

Atomistic Assessment of Cystine Kidney Stone Behavior in a Mechanical Breakdown Process by Nanobiorobots through Classical Molecular Dynamics Simulations

Because cystine kidney stones are a more serious challenge for health-related quality of life than other types of kidney stones, the search for a new treatment for cystinuria is considered the main goal of this study. To achieve the defined goal, classical molecular dynamics simulations and quantum mechanics calculations were implemented in this study. Three nanodrills with different stiffnesses (i.e., silicon, silica, and silicon carbide) were selected to find the efficient nanodrill to break the kidney stones into smaller pieces. The related nanodrills under various forces from 20 to 100 eV/Å inclusive were exerted on the cystine kidney stones to determine the effect of the force magnitude on the rate of destruction. The exerted forces were modeled via a hypothetical spring force. To bring this investigation closer to reality, the urinary tract and the bulk of cystine kidney stones were modeled by simulation of the real blockage of the kidney stones. The obtained results from quantum mechanics calculations reveal the strong interaction (chemisorption) between the cystine stone components. Moreover, the molecular dynamics simulations show that an increase in force does not necessarily lead to more destruction of cystine kidney stones. The maximum rate of cystine kidney stone destruction occurs under forces of 80, 70, and 60 eV/Å for SiO₂, Si, and SiC nanodrills, which is about 19, 13, and 11%, respectively. In addition, the SiO₂ nanodrill has more crossing time and z-direction deformation than other nanodrills due to the attractive interaction between SiO₂ and stones, it shows less deformation during the process of kidney stone breaking because of repulsive interactions between the nanodrill and the kidney stone.

Introducer Design Concepts for an Epicardial Parallel Wire Robot

Background

Cardiac gene therapies lack effective delivery methods to the myocardium. While direct injection has demonstrated success over a small region, homogenous gene expression requires many injections over a large area. To address this need, we developed a minimally invasive flexible parallel wire robot for epicardial interventions. To accurately deploy it onto the beating heart, an introducer mechanism is required.

Methods

Two mechanisms are presented. Assessment of the robot's positioning, procedure time, and pericardium insertion forces are performed on an artificial beating heart.

Results

Successful positioning was demonstrated. The mean procedure time was 230 ± 7 seconds for mechanism I and 259 ± 4 seconds for mechanism II. The mean pericardium insertion force was 2.2 ± 0.4 N anteriorly and 3.1 ± 0.4 N posteriorly.

Conclusion

Introducer mechanisms demonstrate feasibility in facilitating the robot's deployment on the epicardium. Pericardium insertion forces and procedure times are consistent and reasonable.

Robotic Technology in Operating Rooms: a Review

Purpose of Review

With the rapid growth and development of robotic technology, its implementation in medical fields has also been significantly increasing, with the transition from the period of mainly using surgical robots to the era with combinations of multiple types of robots. Therefore, this paper introduces the newest robotic systems and technology applied in operating rooms as well as their architectures for integration.

Recent Findings

Besides surgical robots, other types of robotic devices and machines such as diagnostic and treatment devices with robotic operating tables, robotic microscopes, and assistant robots for surgeons emerge one after another, improving the quality of surgery from different aspects. With the increasing number and type of robots, their integration platforms are also proposed and being spread.

Summary

This review paper presents state-of-the-art robot-related technology in the operating room. Robotic platforms and robot components which appeared in the last decade are described. In addition, system architectures for the integration of robots as well as other devices in operating rooms are also introduced and compared.

Robot-Assisted Maxillary Positioning in Orthognathic Surgery: A Feasibility and Accuracy Evaluation

Several methods enabling independent repositioning of the maxilla have been introduced to reduce intraoperative errors inherent in the intermediate splint. However, the accuracy is still to be improved and a different approach without time-consuming laboratory process is needed, which can allow perioperative modification of unoptimized maxillary position. The purpose of this study is to assess the feasibility and accuracy of a robot arm combined with intraoperative image-guided navigation in orthognathic surgery. The experiments were performed on 12 full skull phantom models. After Le Fort I osteotomy, the maxillary segment was repositioned to a different target position using a robot arm and image-guided navigation and stabilized. Using the navigation and the postoperative computed tomography (CT) images, the achieved maxillary position was compared with the planned position. Although the maxilla showed mild displacement during the fixation, the mean absolute deviations from the target position were 0.16 mm, 0.18 mm, and 0.20 mm in medio-lateral, antero-posterior, and supero-inferior directions, respectively, in the intraoperative navigation. Compared with the target position using postoperative CT, the achieved maxillary position had a mean absolute deviation of less than 0.5 mm for all dimensions and the mean root mean square deviation was 0.79 mm. The results of this study suggest that the robot arm combined with the intraoperative image-guided navigation may have great potential for surgical plan transfer with the accurate repositioning of the maxilla in the orthognathic surgery.

Next-generation ingestible devices: sensing, locomotion and navigation

There is significant interest in exploring the human body's internal activities and measuring important parameters to understand, treat and diagnose the digestive system environment and related diseases. Wireless capsule endoscopy (WCE) is widely used for gastrointestinal (GI) tract exploration due to its effectiveness as it provides no pain and is totally tolerated by the patient. Current ingestible sensing technology provides a valuable diagnostic tool to establish a platform for monitoring the physiological and biological activities inside the human body. It is also used for visualizing the GI tract to observe abnormalities by recording the internal cavity while moving. However, the capsule endoscopy is still passive, and there is no successful locomotion method to control its mobility through the whole GI tract. Drug delivery, localization of abnormalities, cost reduction and time consumption are improvements that can be gained from having active ingestible WCEs. In this article, the current technological developments of ingestible devices including sensing, locomotion and navigation are discussed and compared. The main features required to implement next-generation active WCEs are explored. The methods are evaluated in terms of the most important features such as safety, velocity, complexity of design, control, and power consumption.

Can Robots Earn Our Trust the Same Way Humans Do? A Systematic Exploration of Competence, Warmth, and Anthropomorphism as Determinants of Trust Development in HRI

Robots increasingly act as our social counterparts in domains such as healthcare and retail. For these human-robot interactions (HRI) to be effective, a question arises on whether we trust robots the same way we trust humans. We investigated whether the determinants competence and warmth, known to influence interpersonal trust development, influence trust development in HRI, and what role anthropomorphism plays in this interrelation. In two online studies with 2 × 2 between-subjects design, we investigated the role of robot competence (Study 1) and robot warmth (Study 2) in trust development in HRI. Each study explored the role of robot anthropomorphism in the respective interrelation. Videos showing an HRI were used for manipulations of robot competence (through varying gameplay competence) and robot anthropomorphism (through verbal and non-verbal design cues and the robot's presentation within the study introduction) in Study 1 (n = 155) as well as robot warmth (through varying compatibility of intentions with the human player) and robot anthropomorphism (same as Study 1) in Study 2 (n = 157). Results show a positive effect of robot competence (Study 1) and robot warmth (Study 2) on trust development in robots regarding anticipated trust and attributed trustworthiness. Subjective perceptions of competence (Study 1) and warmth (Study 2) mediated the interrelations in question. Considering applied manipulations, robot anthropomorphism neither moderated interrelations of robot competence and trust (Study 1) nor robot warmth and trust (Study 2). Considering subjective perceptions, perceived anthropomorphism moderated the effect of perceived competence (Study 1) and perceived warmth (Study 2) on trust on an attributional level. Overall results support the importance of robot competence and warmth for trust development in HRI and imply transferability regarding determinants of trust development in interpersonal interaction to HRI. Results indicate a possible role of perceived anthropomorphism in these interrelations and support a combined consideration of these variables in future studies. Insights deepen the understanding of key variables and their interaction in trust dynamics in HRI and suggest possibly relevant design factors to enable appropriate trust levels and a resulting desirable HRI. Methodological and conceptual limitations underline benefits of a rather robot-specific approach for future research.

Robotics cyber security: vulnerabilities, attacks, countermeasures, and recommendations

The recent digital revolution led robots to become integrated more than ever into different domains such as agricultural, medical, industrial, military, police (law enforcement), and logistics. Robots are devoted to serve, facilitate, and enhance the human life. However, many incidents have been occurring, leading to serious injuries and devastating impacts such as the unnecessary loss of human lives. Unintended accidents will always take place, but the ones caused by malicious attacks represent a very challenging issue. This includes maliciously hijacking and controlling robots and causing serious economic and financial losses. This paper reviews the main security vulnerabilities, threats, risks, and their impacts, and the main security attacks within the robotics domain. In this context, different approaches and recommendations are presented in order to enhance and improve the security level of robotic systems such as multi-factor device/user authentication schemes, in addition to multi-factor cryptographic algorithms. We also review the recently presented security solutions for robotic systems.

The ameliorating approach of nanorobotics in the novel drug delivery systems: a mechanistic review

Nanoscale robotics have the ability that it can productively transform multiple energy sources into motion and strength which reflects an expeditiously appearing and captivating area for research of robotics. In today's plethora, biomedical nanorobotics played an intricate character with numerous units of robots working at the pathological site in a coordinated manner. The synergistic action of the several nanorobotics has been employed for the fulfilment of the task such as large-scale detoxification, delivery of the large pharmacological/therapeutic efficacious payloads, etc. that is nearly unfeasible or unalterable practically by using single nanorobot. The collective intelligence of the nanorobot is advancing progressively at the nanoscale to reinforce their precision treatment potentially. Conclusively, after obtaining certain consideration regarding the nanorobotics sciences, many professionals are compendiously involving in the emerging highly efficacious therapeutic technology that encourages the scientist or designing of the tissues specific for the site-specific nanorobotic diagnostic devices. As a result, the closed and professional type between the field of Nanotechnology and Medical Sciences will provide another new highly oriented level to the domain of nanorobotics.

A Historical Review of Medical Robotic Platforms

This paper provides a brief history of medical robotic systems. Since the first use of robots in medical procedures, there have been countless companies competing to developed robotic systems in hopes to dominate a field. Many companies have succeeded, and many have failed. This review paper shows the timeline history of some of the old and most successful medical robots and new robotic systems. As the patents of the most successful system, i.e., Da Vinci® Surgical System, have expired or are expiring soon, this paper can provide some insights for new designers and manufacturers to explore new opportunities in this field.

MINARO HD: control and evaluation of a handheld, highly dynamic surgical robot

Purpose

Current surgical robotic systems are either large serial arms, resulting in higher risks due to their high inertia and no inherent limitations of the working space, or they are bone-mounted, adding substantial additional task steps to the surgical workflow. The robot presented in this paper has a handy and lightweight design and can be easily held by the surgeon. No rigid fixation to the bone or a cart is necessary. A high-speed tracking camera together with a fast control system ensures the accurate positioning of a burring tool.

Methods

The capabilities of the robotic system to dynamically compensate for unintended motion, either of the robot itself or the patient, was evaluated. Therefore, the step response was analyzed as well as the capability to follow a moving target.

Results

The step response show that the robot can compensate for undesired motions up to 12 Hz in any direction. While following a moving target, a maximum positioning error of 0.5 mm can be obtained with a target motion of up to 18 mm/s.

Conclusion

The requirements regarding dynamic motion compensation, accuracy, and machining speed of unicompartmental knee arthroplasties, for which the robot was optimized, are achieved with the presented robotic system. In particular, the step response results show that the robot is able to compensate for human tremor.

Design and Evaluation of Anthropomorphic Robotic Hand for Object Grasping and Shape Recognition

We developed an anthropomorphic multi-finger artificial hand for a fine-scale object grasping task, sensing the grasped object’s shape. The robotic hand was created using the 3D printer and has the servo bed for stand-alone finger movement. The data containing the robotic fingers’ angular position are acquired using the Leap Motion device, and a hybrid Support Vector Machine (SVM) classifier is used for object shape identification. We trained the designed robotic hand on a few monotonous convex-shaped items similar to everyday objects (ball, cylinder, and rectangular box) using supervised learning techniques. We achieve the mean accuracy of object shape recognition of 94.4%.

Omnidirectional camera and head-mount display contribute to the safety of laparoscopic surgery

BACKGROUND

We focused on the availability of an omnidirectional camera and head-mount display (HMD). If the laparoscope is an omnidirectional camera, captured images are sent to the HMD worn by the operator in real time. The operator can thus view the image as they like without moving the camera and obtain a 360° view intuitively. However, the surgical system that can be used for actual laparoscopic operations has not yet been developed. In this study, we aimed to show that an omnidirectional camera and HMD would be useful in laparoscopic surgery.

MATERIAL AND METHODS

Eleven medical students and twelve surgical residents (Surgeons group) participated in this study. We created an experimental box with five marks randomly attached inside the box, and the inside cannot be seen from the outside. We measured the time it took to identify all marks between conventional laparoscope and substitute system in each group.

RESULTS

In the substitute system, the time required for the task was significantly shorter than with conventional laparoscopy in each group.

CONCLUSION

An omnidirectional camera and HMD may be a useful new device for laparoscopic surgery. This system may help improve the safety of laparoscopic surgery.

Sustainable Digital Transformation of Disaster Risk—Integrating New Types of Digital Social Vulnerability and Interdependencies with Critical Infrastructure

This article explores the relationship between digital transformation and disaster risk. Vulnerability studies aim at differentiating impacts and losses by using fine-grained information from demographic, social, and personal characteristics of humans. With ongoing digital development, these characteristics will transform and result in new traits, which need to be identified and integrated. Digital transformations will produce new social groups, partly human, semi-human, or non-human—some of which already exist, and some which can be foreseen by extrapolating from recent developments in the field of brain wearables, robotics, and software engineering. Though involved in the process of digital transformation, many researchers and practitioners in the field of Disaster Risk Reduction or Climate Change Adaptation are not yet aware of the repercussions for disaster and vulnerability assessments. Emerging vulnerabilities are due to a growing dependency on digital services and tools in the case of a severe emergency or crisis. This article depicts the different implications for future theoretical frameworks when identifying novel semi-human groups and their vulnerabilities to disaster risks. Findings include assumed changes within common indicators of social vulnerability, new indicators, a typology of humans, and human interrelations with digital extensions and two different perspectives on these groups and their dependencies with critical infrastructure.

Review of surgical robotic systems for keyhole and endoscopic procedures: state of the art and perspectives

Minimally invasive surgery, including laparoscopic and thoracoscopic procedures, benefits patients in terms of improved postoperative outcomes and short recovery time. The challenges in hand-eye coordination and manipulation dexterity during the aforementioned procedures have inspired an enormous wave of developments on surgical robotic systems to assist keyhole and endoscopic procedures in the past decades. This paper presents a systematic review of the state-of-the-art systems, picturing a detailed landscape of the system configurations, actuation schemes, and control approaches of the existing surgical robotic systems for keyhole and endoscopic procedures. The development challenges and future perspectives are discussed in depth to point out the need for new enabling technologies and inspire future researches.

Laparoscopic Robotic Surgery: Current Perspective and Future Directions

Just as laparoscopic surgery provided a giant leap in safety and recovery for patients over open surgery methods, robotic-assisted surgery (RAS) is doing the same to laparoscopic surgery. The first laparoscopic-RAS systems to be commercialized were the Intuitive Surgical, Inc. (Sunnyvale, CA, USA) da Vinci and the Computer Motion Zeus. These systems were similar in many aspects, which led to a patent dispute between the two companies. Before the dispute was settled in court, Intuitive Surgical bought Computer Motion, and thus owned critical patents for laparoscopic-RAS. Recently, the patents held by Intuitive Surgical have begun to expire, leading to many new laparoscopic-RAS systems being developed and entering the market. In this study, we review the newly commercialized and prototype laparoscopic-RAS systems. We compare the features of the imaging and display technology, surgeons console and patient cart of the reviewed RAS systems. We also briefly discuss the future directions of laparoscopic-RAS surgery. With new laparoscopic-RAS systems now commercially available we should see RAS being adopted more widely in surgical interventions and costs of procedures using RAS to decrease in the near future.

Information Fusion of GPS, INS and Odometer Sensors for Improving Localization Accuracy of Mobile Robots in Indoor and Outdoor Applications

In mobile robot localization with multiple sensors, myriad problems arise as a result of inadequacies associated with each of the individual sensors. In such cases, methodologies built upon the concept of multisensor fusion are well-known to provide optimal solutions and overcome issues such as sensor nonlinearities and uncertainties. Artificial neural networks and fuzzy logic (FL) approaches can effectively model sensors with unknown nonlinearities and uncertainties. In this article, a robust approach for localization (positioning) of a mobile robot in indoor as well as outdoor environments is proposed. The neural network is utilized as a pseudo-sensor that models the global positioning system (GPS) and is used to predict the robot’s position in case of GPS signal loss in indoor environments. The data from proprioceptive sensors such as inertial sensors and GPS are fused using the Kalman and the complementary filter-based fusion schemes in the outdoor case. To eliminate the position inaccuracies due to wheel slippage, an expert FL system (FLS) is implemented and cascaded with the sensor fusion module. The proposed technique is tested both in simulation and in real scenarios of robot movements. The simulations and results from the experimental platform validate the efficacy of the proposed algorithm.

Motion and Trajectory Constraints Control Modeling for Flexible Surgical Robotic Systems

Success of the da Vinci surgical robot in the last decade has motivated the development of flexible access robots to assist clinical experts during single-port interventions of core intrabody organs. Prototypes of flexible robots have been proposed to enhance surgical tasks, such as suturing, tumor resection, and radiosurgery in human abdominal areas; nonetheless, precise constraint control models are still needed for flexible pathway navigation. In this paper, the design of a flexible snake-like robot is presented, along with the constraints model that was proposed for kinematics and dynamics control, motion trajectory planning, and obstacle avoidance during motion. Simulation of the robot and implementation of the proposed control models were done in Matlab. Several points on different circular paths were used for evaluation, and the results obtained show the model had a mean kinematic error of 0.37 ± 0.36 mm with very fast kinematics and dynamics resolution times. Furthermore, the robot’s movement was geometrically and parametrically continuous for three different trajectory cases on a circular pathway. In addition, procedures for dynamic constraint and obstacle collision detection were also proposed and validated. In the latter, a collision-avoidance scheme was kept optimal by keeping a safe distance between the robot’s links and obstacles in the workspace. Analyses of the results showed the control system was optimal in determining the necessary joint angles to reach a given target point, and motion profiles with a smooth trajectory was guaranteed, while collision with obstacles were detected a priori and avoided in close to real-time. Furthermore, the complexity and computational effort of the algorithmic models were negligibly small. Thus, the model can be used to enhance the real-time control of flexible robotic systems.

Robots and Tools for Remodeling Bone

The field of robotic surgery has progressed from small teams of researchers repurposing industrial robots, to a competitive and highly innovative subsection of the medical device industry. Surgical robots allow surgeons to perform tasks with greater ease, accuracy, or safety, and fall under one of four levels of autonomy; active, semi-active, passive, and remote manipulator. The increased accuracy afforded by surgical robots has allowed for cementless hip arthroplasty, improved postoperative alignment following knee arthroplasty, and reduced duration of intraoperative fluoroscopy among other benefits. Cutting of bone has historically used tools such as hand saws and drills, with other elaborate cutting tools now used routinely to remodel bone. Improvements in cutting accuracy and additional options for safety and monitoring during surgery give robotic surgeries some advantages over conventional techniques. This article aims to provide an overview of current robots and tools with a common target tissue of bone, proposes a new process for defining the level of autonomy for a surgical robot, and examines future directions in robotic surgery.

Is secondary robotic pyeloplasty safe and effective as primary robotic pyeloplasty? A systematic review and meta-analysis

Robot-assisted laparoscopic pyeloplasty (RLP) has excellent surgical safety and efficacy in primary pyeloplasty. In recent, the application of robotics has explored to more complex surgical conditions such as failed pyeloplasty. This meta-analysis aimed to evaluate the surgical and clinical outcomes of secondary RLP compared with primary RLP. Following PRISMA guidelines, we carried out an extensive literature search in the PubMed, Web of Science, Cochrane Library, Scopus, and Google Scholar to extract the published articles comparing primary vs. secondary RLP up to April 2019. Interested surgical and clinical outcomes were extracted from each study and then used RevMan 5.3 Software for meta-analysis comparison. Furthermore, the quality of each study was assessed using the Modified Newcastle-Ottawa Scale for cohort studies. Our search has yielded seven studies that met our inclusion criteria. These studies contained 613 vs. 107 patients in primary vs. secondary RLP, respectively. Using random effect model, the analysis showed no statistical difference between the groups in the presence of a crossing vessel, complications, length of hospital stays (LOS), and follow-up period. However, the operative time, estimated blood loss (EBL), and recurrence rate were significantly higher in the secondary RLP compared with primary RLP (p = 0.004), (p = 0.01), and (p = 0.04), respectively. Our results indicate that secondary RLP is associated with significantly increased operative time and EBL and higher recurrence rates compared with primary RLP. We believe that our findings might help surgeon's decision making in patient selection and consultation during redo pyeloplasty surgical planning.

The Future of Robotic Surgery in Pediatric Urology: Upcoming Technology and Evolution Within the Field

Since the introduction of the Da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) in 1999, the market for robot assisted laparoscopic surgery has grown with urology. The initial surgical advantage seen in adults was for robotic prostatectomy, and over time this expanded to the pediatric population with robotic pyeloplasty. The introduction of three-dimensional visualization, tremor elimination, a 4th arm, and 7-degree range of motion allowed a significant operator advantage over laparoscopy, especially for anastomotic suturing. After starting with pyeloplasty, the use of robotic technology with pediatric urology has expanded to include ureteral reimplantation and even more complex reconstructive procedures, such as enterocystoplasty, appendicovesicostomy, and bladder neck reconstruction. However, limitations of the Da Vinci Surgical Systems still exist despite its continued technological advances over multiple generations in the past 20 years. Due to the smaller pediatric market, less focus appears to have been placed on the development of the smaller 5 mm instruments. As pediatric urology continues to utilize robotic technology for minimally invasive surgery, there is hope that additional pediatric-friendly instruments and components will be developed, either by Intuitive Surgical or one of the new robotic platforms in development that are working to address many of the shortcomings of current systems. These new robotic platforms include improved haptic feedback systems, flexible scopes, easier maneuverability, and even adaptive machine learning concepts to bring robotic assisted laparoscopic surgery to the next level. In this report, we review the present and upcoming technological advances of the current Da Vinci surgical systems as well as various new robotic platforms, each offering a unique set of technological advantages. As technology progresses, the understanding of and access to these new robotic platforms will help guide pediatric urologists into the next forefront of minimally invasive surgery.

A minimally invasive robotic surgery approach to perform totally endoscopic coronary artery bypass on beating hearts

The currently available robotic systems rely on rigid heart stabilizers to perform totally endoscopic coronary artery bypass (TECAB) surgery on beating hearts. Although such stabilizers facilitate the anastomosis procedure by immobilizing the heart and holding the surgery site steady, they can cause damage to the heart tissue and rupture of the capillary vessels, due to applying relatively large pressures on the epicardium. In this paper, we propose an advanced robotic approach to perform TECAB on a beating heart with minimal invasiveness. The idea comes from the fact that the main pulsations of the heart occur as excursions in normal direction, i.e., perpendicular to the heart surface. We devise a 1-DOF flexible heart stabilizer which eliminates the lateral movements of the heart, and a 1-DOF compensator mechanism which follows the heart trajectory in the normal direction, thus canceling the relative motion between the surgical tool and the heart surface. In fact, we bring a compromise between two radical approaches of operating on a completely immobilized beating heart with no heart motion compensation, and operating on a freely beating heart with full compensation of heart motion, considering the invasiveness of the first and the technical challenges of the second approach. We propose operating on a partially stabilized beating heart with unidirectional compensation of the heart motion; the flexible stabilizer would exert much less holding force to the heart tissue and the robotic system with unidirectional compensator would be technically feasible. In the proposed approach, a motion sensor mounted on the stabilizer measures the heart excursion data and sends it into a control unit. A predictive controller uses this data to generate an automated trajectory. The slave robots follow this trajectory, which is superimposed on the surgeon's tele-operation commands received from a master console. Finally, the tool-activation units in the slave robots actuate the articulated laparoscopic tools to perform the anastomosis procedure. The evaluation of the hypothesis showed that our solution for the robotic TECAB on beating heart is both practical and cost effective. We showed in an in-vivo study that the flexible stabilizer can effectively restrict the heart lateral movements, while allowing for its normal excursion. We found readily available linear motors which could afford the high forces, speeds and accelerations required for following the heart trajectory. Finally, we showed that the tool-activation unit is capable of providing the maneuverability and workspace required for the most challenging task of CABG procedure, i.e., anastomosis suturing.

A Study of Damage Patterns on Passenger Cars Involved in Road Traffic Accidents

Health emergencies occur in passenger cars where victims do not have immediate access to either layperson or professional, proper medical services, resulting in deterioration of their health or death. Installation of robotic first aid system for passenger-car occupants has been proposed. This study is part of a larger work of designing the system and seeks to identify the safest location inside the vehicle for it to survive any form of impact in a crash and retain the ability to assist the victims. The study population comprised 70 passenger cars (14 automakers across 7 segments) involved in road traffic accidents, which had been recovered by a roadside vehicle assistance company based in Harare, Zimbabwe, and were on the company’s premises on September 23rd, 2017. Vehicle damage was rated considering direction of force in comparison to a clock-point diagram, area damaged, and the damage severity on a scale of 1 to 7, following an official vehicle damage guide for traffic crash investigators. Data were analysed in Microsoft Office Excel 2016. In cases where vehicles were damaged in more than one area, all areas were recorded, hence 95 points of impact were analysed. Damage direct to the front denoted by 12 on the clock-point was the most common at 26%. This was compatible with the rate of frontal damage on vehicles, which was the highest at 51%, followed by the right and left sides that had 22% and 19%, respectively, the rear at 6%, and lastly the top (due to 2 recorded rollovers) at 2%. 56% of the damaged areas had a severity rating of either 5, 6, or 7. By eliminating all areas which had received damage in the study population, the robotic first aid system’s best chances of car crash survival are at the middle, towards the floor of the vehicle. It is advisable that the system does not depend on components in the proximity of the vehicle’s body as they are prone to damage in crashes. There is need for further research into the magnitude of impact that could reach the middle of different vehicles to define the strength of the robotic first aid system.

Objective Assessment of the Early Stages of the Learning Curve for the Senhance Surgical Robotic System

OBJECTIVE

The purpose of this research is to study the early stages of the Senhance learning curve to report how force feedback impacts learning rate. This serves as an exploratory investigation into assumptions that fellows and faculty will adjust faster to the Senhance in comparison with residents, and that force feedback will not hinder skill acquisition.

DESIGN

In this study, participants completed the peg transfer and precision cutting task from the Fundamentals of Laparoscopic Surgery (FLS) manual skills assessment five times each using the Senhance while instrument motion was tracked.

SETTING

This study took place in the Surgical Education and Activities Laboratory at Duke University Medical Center.

PARTICIPANTS

Participants for this study were residents, fellows, and faculty from Duke University Medical Center in general surgery and gynecology specialties (N = 16).

RESULTS

Postulated linear mixed effects models with participant level random effects showed significant improvement with additional attempts for the peg transfer task after adjusting for surgical experience and force feedback respectively for the primary FLS score metric. The secondary metric of total instrument path length also showed improvement (significant decreases) in path length with additional attempts after respectively adjusting for surgical experience and force feedback.

CONCLUSIONS

This study investigates the early stages of the learning curve of the Senhance. Exploratory modeling indicates that residents, fellows, and faculty surgeons rapidly adapt to the controls of the Senhance regardless of experience level and force feedback engagement. The results from this study may serve as motivation for future prospective studies that achieve sufficient statistical power with a larger sample size and strict experimental design.

Behind the Robot's Smiles and Frowns: In Social Context, People Do Not Mirror Android's Expressions But React to Their Informational Value

Facial actions are key elements of non-verbal behavior. Perceivers' reactions to others' facial expressions often represent a match or mirroring (e.g., they smile to a smile). However, the information conveyed by an expression depends on context. Thus, when shown by an opponent, a smile conveys bad news and evokes frowning. The availability of anthropomorphic agents capable of facial actions raises the question of how people respond to such agents in social context. We explored this issue in a study where participants played a strategic game with or against a facially expressive android. Electromyography (EMG) recorded participants' reactions over zygomaticus muscle (smiling) and corrugator muscle (frowning). We found that participants' facial responses to android's expressions reflect their informational value, rather than a direct match. Overall, participants smiled more, and frowned less, when winning than losing. Critically, participants' responses to the game outcome were similar regardless of whether it was conveyed via the android's smile or frown. Furthermore, the outcome had greater impact on people's facial reactions when it was conveyed through android's face than a computer screen. These findings demonstrate that facial actions of artificial agents impact human facial responding. They also suggest a sophistication in human-robot communication that highlights the signaling value of facial expressions.

Review of emerging surgical robotic technology

BACKGROUND

The use of laparoscopic and robotic procedures has increased in general surgery. Minimally invasive robotic surgery has made tremendous progress in a relatively short period of time, realizing improvements for both the patient and surgeon. This has led to an increase in the use and development of robotic devices and platforms for general surgery. The purpose of this review is to explore current and emerging surgical robotic technologies in a growing and dynamic environment of research and development.

METHODS

This review explores medical and surgical robotic endoscopic surgery and peripheral technologies currently available or in development. The devices discussed here are specific to general surgery, including laparoscopy, colonoscopy, esophagogastroduodenoscopy, and thoracoscopy. Benefits and limitations of each technology were identified and applicable future directions were described.

RESULTS

A number of FDA-approved devices and platforms for robotic surgery were reviewed, including the da Vinci Surgical System, Sensei X Robotic Catheter System, FreeHand 1.2, invendoscopy E200 system, Flex® Robotic System, Senhance, ARES, the Single-Port Instrument Delivery Extended Research (SPIDER), and the NeoGuide Colonoscope. Additionally, platforms were reviewed which have not yet obtained FDA approval including MiroSurge, ViaCath System, SPORT™ Surgical System, SurgiBot, Versius Robotic System, Master and Slave Transluminal Endoscopic Robot, Verb Surgical, Miniature In Vivo Robot, and the Einstein Surgical Robot.

CONCLUSIONS

The use and demand for robotic medical and surgical platforms is increasing and new technologies are continually being developed. New technologies are increasingly implemented to improve on the capabilities of previously established systems. Future studies are needed to further evaluate the strengths and weaknesses of each robotic surgical device and platform in the operating suite.

Acceptance and perceived usefulness of robots to assist with activities of daily living and healthcare tasks

As the number of older adults living with chronic conditions continues to rise, they will require assistance with activities of daily living (ADL) and healthcare tasks to continue living independently in their homes. One proposed solution to assist with the care needs of an aging population and a shrinking healthcare workforce is robotic technology. Using a cross-sectional survey design, we purposively sampled adults (≥18 years old) to assess generational acceptance and perceived usefulness of robots to assist with ADLs, healthcare tasks, and evaluate acceptance of robotic healthcare assistance across different settings. A total of 499 adults (age range [years] 18-98, Mean = 38.7, SD = 22.7) responded to the survey. Significant differences were found among young, middle-aged, and older adults on perceived usefulness of robots for cleaning, escorting them around town, acting as companionship, delivering meals, assessing sadness and calling for help, providing medical advice, taking vital sign assessments, and assisting with personal care (p < 0.05). The majority of younger adults reported that they would like a robot to provide healthcare assistance in the hospital, compared to middle-aged and older adults (p < 0.001). Results of this study can guide the design of robots to assist adults of all ages with useful tasks.

A Robotic Flexible Drill and Its Navigation System for Total Hip Arthroplasty

This paper presents a robotic flexible drill and its navigation system for total hip arthroplasty (THA). The new robotic system provides an unprecedented and unique capability to perform curved femoral milling under the guidance of a multimodality navigation system. The robotic system consists of three components. Firstly, a flexible drill manipulator comprises multiple rigid segments that act as a sheath to a flexible shaft with a drill/burr attached to the end. The second part of the robotic system is a hybrid tracking system that consists of an optical tracking system and a position tracking system. Optical tracking units are used to track the surgical objects and tools outside the drilling area, while a rotary encoder placed at each joint of the sheath is synchronized to provide the position information for the flexible manipulator with its virtual object. Finally, the flexible drill is integrated into a computer-aided navigation system. The navigation system provides real time guidance to a surgeon during the procedure. The flexible drill system is then able to implement THA by bone milling. The final section of this paper is an evaluation of the flexible and steerable drill and its navigation system for femoral bone milling in sawbones.