Estimation of the Fracture Toughness of Soft Tissue from Needle Insertion

Multimodal Haptic Simulation for Ventriculostomy Training. Annu Int Conf IEEE Eng Med Biol Soc 2023;2023:1-4. [PMID: 38083370 DOI: 10.1109/embc40787.2023.10340701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Freehand ventriculostomy is a frequent surgical procedure and is among the first ones that junior neurosurgery residents learn. Although training simulators exist, none has been adopted in the clinical routine to train junior residents. This paper focuses on a novel multimodal haptic training simulator that will lift the limitations of current simulators. We thus propose an architecture that integrates (1) visual feedback through augmented MRIs, and (2) a physical mock-up of the patient's skull to (3) active haptic feedback.

Puncturing of soft tissues: experimental and fracture mechanics-based study

The integrity of soft materials against puncturing is of great relevance for their performance because of the high sensitivity to local rupture caused by rigid sharp objects. In this work, the mechanics of puncturing is studied with respect to a sharp-tipped rigid needle with a circular cross section, penetrating a soft target solid. The failure mode associated with puncturing is identified as a mode-I crack propagation, which is analytically described by a two-dimensional model of the target solid, taking place in a plane normal to the penetration axis. It is shown that the force required for the onset of needle penetration is dependent on two energy contributions, that are, the strain energy stored in the target solid and the energy consumed in crack propagation. More specifically, the force is found to be dependent on the fracture toughness of the material, its stiffness and the sharpness of the penetrating tool. The reference case within the framework of small strain elasticity is first investigated, leading to closed-form toughness parameters related to classical linear elastic fracture mechanics. Then, nonlinear finite element analyses for an Ogden hyperelastic material are presented. Supporting the proposed theoretical framework, a series of puncturing experiments on two commercial silicones is presented. The combined experimental-theoretical findings suggest a simple, yet reliable tool to easily handle and assess safety against puncturing of soft materials.

Anisotropic damage model for collagenous tissues and its application to model fracture and needle insertion mechanics

The analysis of tissue mechanics in biomedical applications demands nonlinear constitutive models able to capture the energy dissipation mechanisms, such as damage, that occur during tissue deformation. Furthermore, implementation of sophisticated material models in finite element models is essential to improve medical devices and diagnostic tools. Building on previous work toward microstructure-driven models of collagenous tissue, here we show a constitutive model based on fiber orientation and waviness distributions for skin that captures not only the anisotropic strain-stiffening response of this and other collagen-based tissues, but, additionally, accounts for tissue damage directly as a function of changes in the microstructure, in particular changes in the fiber waviness distribution. The implementation of this nonlinear constitutive model as a user subroutine in the popular finite element package Abaqus enables large-scale finite element simulations for biomedical applications. We showcase the performance of the model in fracture simulations during pure shear tests, as well as simulations of needle insertion into skin relevant to auto-injector design.

Cone cracks in tissue-mimicking hydrogels during hypodermic needle insertion: the role of water content

Needle insertion into soft biological tissues is a common process in various surgical procedures. During insertion, soft biological tissues with different water contents undergo large deformation often leading to uncontrollable cracks and tissue damage. Despite the numerous experimental studies and numerical modelling of needle-tissue interaction, the results do not show any consistency mainly due to the heterogeneity of tissue properties and opaqueness. In this context, understanding the fracture behaviour of soft tissues during needle insertion is important for minimally invasive surgeries and other medical procedures. Recently, we showed that the needle insertion into a transparent, tissue-mimicking polyacrylamide (PAAm) hydrogel causes periodic cone cracks. In this work, we systematically varied the water content of the PAAm hydrogel in the preparation state and performed needle insertion experiments using a hypodermic needle at a constant velocity to study the fracture characteristics of the PAAm hydrogel. The results show that the number of peaks, the magnitudes of the insertion forces, and corresponding cone cracks decrease with increasing water content. Furthermore, we discussed the influence of water on cone crack fracture characteristics, cone angle, periodicity, crack speed and fracture energy release rate. These results provide a better understanding of the fracture processes of soft tissues with different water concentrations such as the lung, liver, and brain during needle insertion and the control of tissue damage during needle insertion involved in medical procedures.

Microfluidic Surgery in Single Cells and Multicellular Systems

Microscale surgery on single cells and small organisms has enabled major advances in fundamental biology and in engineering biological systems. Examples of applications range from wound healing and regeneration studies to the generation of hybridoma to produce monoclonal antibodies. Even today, these surgical operations are often performed manually, but they are labor intensive and lack reproducibility. Microfluidics has emerged as a powerful technology to control and manipulate cells and multicellular systems at the micro- and nanoscale with high precision. Here, we review the physical and chemical mechanisms of microscale surgery and the corresponding design principles, applications, and implementations in microfluidic systems. We consider four types of surgical operations: (1) sectioning, which splits a biological entity into multiple parts, (2) ablation, which destroys part of an entity, (3) biopsy, which extracts materials from within a living cell, and (4) fusion, which joins multiple entities into one. For each type of surgery, we summarize the motivating applications and the microfluidic devices developed. Throughout this review, we highlight existing challenges and opportunities. We hope that this review will inspire scientists and engineers to continue to explore and improve microfluidic surgical methods.

Needle-free Mental Incisive Nerve Block:In vitro, Cadaveric, and Pilot Clinical Studies

The present study aimed to optimize Needle-Free Liquid Jet Injection (NFLJI) for Mental Incisive Nerve Blocks (MINB) and evaluate its clinical safety and feasibility. A MINB protocol was developed and optimized by series of NFLJI experiments in soft tissue phantoms and cadavers, then validated in two pilot Randomized Controlled Trials (RCT). The NFLJI penetration depth was found to be directly proportional to the supply pressure and volume. High-pressure NFLJIs (620 kPa or above) created maximum force and total work significantly greater than needle injections. Low-pressure NFLJIs (413 kPa), however, produced results similar to those of needle injections. Additionally, high-pressure NFLJIs created jet impingement pressure and maximum jet penetration pressure higher than low-pressure NFLJIs. Pilot RCTs revealed that high-pressure NFLJI caused a high risk of discomfort (60%) and paresthesia (20%); meanwhile, low-pressure NFLJI was less likely to cause complications (0%). The preliminary success rates of MINB from cadavers using NFLJIs and needles were 83.3% and 87.5%. In comparison, those from RCTs are 60% and 70%, respectively. To conclude, NFLJI supply pressure can be adjusted to achieve effective MINB with minimal complications. Furthermore, the cadaver study and pilot RCTs confirmed the feasibility for further non-inferiority RCT.

A novel material point method (MPM) based needle-tissue interaction model

Needle-tissue interaction model is essential to tissue deformation prediction, interaction force analysis and needle path planning system. Traditional FEM based needle-tissue interaction model would encounter mesh distortion or continuous mesh subdivision in dealing with penetration, in which the computational instability and poor accuracy could be introduced. In this work, a novel material point method (MPM) is applied to establish the needle-tissue interaction model which is suitable to handle the discontinuous penetration problem. By integrating a hyperelastic material model, the tissue deformation and interaction force can be solved simultaneously and independently. A testbed of needle insertion into a Polyvinyl alcohol (PVA) hydrogel phantom was constructed to validate both tissue deformation and interaction force. The results showed the experimental data agrees well with the simulation results of the proposed model.

Predictive mechanics-based model for depth of cut (DOC) of waterjet in soft tissue for waterjet-assisted medical applications

The use of waterjet technology is now prevalent in medical applications including surgery, soft tissue resection, bone cutting, waterjet steerable needles, and wound debridement. The depth of the cut (DOC) of a waterjet in soft tissue is an important parameter that should be predicted in these applications. For instance, for waterjet-assisted surgery, selective cutting of tissue layers is a must to avoid damage to deeper tissue layers. For our proposed fracture-directed waterjet steerable needles, predicting the cut depth of the waterjet in soft tissue is important to develop an accurate motion model, as well as control algorithms for this class of steerable needles. To date, most of the proposed models are only valid in the conditions of the experiments and if the soft tissue or the system properties change, the models will become invalid. The model proposed in this paper is formulated to allow for variation in parameters related to both the waterjet geometry and the tissue. In this paper, first the cut depths of waterjet in soft tissue simulants are measured experimentally, and the effect of tissue stiffness, waterjet velocity, and nozzle diameter are studied on DOC. Then, a model based on the properties of the tissue and the waterjet is proposed to predict the DOC of waterjet in soft tissue. In order to verify the model, soft tissue properties (constitutive response and fracture toughness) are measured using low strain rate compression tests, Split-Hopkinson-Pressure-Bar (SHPB) tests, and fracture toughness tests. The results show that the proposed model can predict the DOC of waterjet in soft tissue with acceptable accuracy if the tissue and waterjet properties are known. Graphical Abstract (Left) An overview of the problems of traditional steerable needles and the solutions provided by waterjet steerable needles. (A) Traditional tip-steerable needles and tip-bent needles suffer from poor curvature, especially in soft tissues. (B) Traditional steerable needles are unable to accomplish many bends because the cutting force only results from drastic tissue deformation. (C) The first step for realization of waterjet steerable needles is to understand and model the interaction between waterjet and soft tissues at the tip (predictive model for depth of cut). (D) Then, the equilibrium between shapes cut in the tissue and the straight elastic needle should be understood. (Right) Waterjet steerable needles in which the direction of the tissue fracture is contr olled by waterjet and then the flexible needle follows. The first step for waterjet steerable needle realization is to predict the depth of waterjet cut.

An adaptive finite element model for steerable needles

Penetration of a flexible and steerable needle into a soft target material is a complex problem to be modelled, involving several mechanical challenges. In the present paper, an adaptive finite element algorithm is developed to simulate the penetration of a steerable needle in brain-like gelatine material, where the penetration path is not predetermined. The geometry of the needle tip induces asymmetric tractions along the tool–substrate frictional interfaces, generating a bending action on the needle in addition to combined normal and shear loading in the region where fracture takes place during penetration. The fracture process is described by a cohesive zone model, and the direction of crack propagation is determined by the distribution of strain energy density in the tissue surrounding the tip. Simulation results of deep needle penetration for a programmable bevel-tip needle design, where steering can be controlled by changing the offset between interlocked needle segments, are mainly discussed in terms of penetration force versus displacement along with a detailed description of the needle tip trajectories. It is shown that such results are strongly dependent on the relative stiffness of needle and tissue and on the tip offset. The simulated relationship between programmable bevel offset and needle curvature is found to be approximately linear, confirming empirical results derived experimentally in a previous work. The proposed model enables a detailed analysis of the tool–tissue interactions during needle penetration, providing a reliable means to optimise the design of surgical catheters and aid pre-operative planning.

Fatigue exhaustion of the mitral valve tissue

Sudden failure and rupture of the tissue is a rare but serious short-term complication after the mitral valve surgical repair. Excessive cyclic loading on the suture line of the repair can progressively damage the surrounding tissue and finally cause tissue rupture. Moreover, mechanical over-tension, which occurs in a diseased mitral valve, gradually leads to tissue floppiness, mitral annular dilation, and leaflet rupture. In this work, the rupture mechanics of mitral valve is studied by characterizing the fracture toughness exhaustion of healthy tissue. Results of this study show that fracture toughness of the posterior mitral valve is lower than its anterior counterpart, indicating that posterior tissue is more prone to failure. Moreover, the decrease in fracture toughness by increasing the number of fatigue cycles shows that excessive mechanical loading leads to progressive failure and rupture of mitral valve tissue within a damage accumulative process.

Mathematical Modeling and Virtual Reality Simulation of Surgical Tool Interactions With Soft Tissue: A Review and Prospective

This is an informed assessment of the state of the art and an extensive inventory of modeling approaches and methods for soft tissue/medical cutting tool interaction and of the associated medical processes and phenomena. Modeling and simulation through numerical, theoretical, computational, experimental, and other methods was discussed in comprehensive review sections each of which is concluded with a plausible prospective discussion biased toward the development of so-called virtual reality (VR) simulator environments. The finalized prospective section reflects on the future demands in the area of soft tissue cutting modeling and simulation mostly from a conceptual angle with emphasis on VR development requirements including real-time VR simulator response, cost-effective “close-to-reality” VR implementations, and other demands. The review sections that serve as the basis for the suggested prospective needs are categorized based on: (1) Major VR simulator applications including virtual surgery education, training, operation planning, intraoperative simulation, image-guided surgery, etc. and VR simulator types, e.g., generic, patient-specific and surgery-specific and (2) Available numerical, theoretical, and computational methods in terms of robustness, time effectiveness, computational cost, error control, and accuracy of modeling of certain types of virtual surgical interventions and their experimental validation, geared toward ethically driven artificial “phantom” tissue-based approaches. Digital data processing methods used in modeling of various feedback modalities in VR environments are also discussed.

Study on the tribological behavior of surgical suture interacting with a skin substitute by using a penetration friction apparatus

Surgical sutures have different sizes, structures, whereas they are being used for various surgeries. The high friction performance of surgical sutures in the suturing process may cause inflammation and pain, leading to a longer recovery time. This paper presents an understanding of the tribological behavior of surgical suture with monofilament and multifilament structures, by means of a penetration friction apparatus (PFA). The results indicated that structure and surface topography of the surgical suture had a pronounced effect on the tribological interactions. It was found that the friction force and abrasion area of skin substitute with the penetration of polyglycolic acid (PGA) multifilament surgical suture were larger than that of Nylon monofilament surgical suture. Meanwhile, more abrasion at the pull-in boundary of skin substitute was observed compared with that at the pull-out boundary.

Design and Fabrication of MR-Tracked Metallic Stylet for Gynecologic Brachytherapy

Active magnetic resonance (MR) tracking for gynecologic brachytherapy was made possible by attaching the micro radiofrequency coils to the brachytherapy applicator. The rectangular planar micro coil was fabricated using flexible printed circuits with dimensions of 8mm×1.5mm. A 5-Fr (1.6mm) tungsten brachytherapy stylet was custom-machined to incorporate the micro coils. The finite element analysis and the phantom tissue studies show that the proposed device enables in situ, real-time guidance of access routes to the target anatomy safely and accurately. The setup was tested in a Siemens 3T MR scanner. The micro coils can be localized rapidly (up to 40 Hz) and precisely (resolution: 0.6×0.6×0.6mm³) using an MR-tracking sequence.

Structures, properties, and functions of the stings of honey bees and paper wasps: a comparative study

Through natural selection, many animal organs with similar functions have evolved different macroscopic morphologies and microscopic structures. Here, we comparatively investigate the structures, properties and functions of honey bee stings and paper wasp stings. Their elegant structures were systematically observed. To examine their behaviors of penetrating into different materials, we performed penetration-extraction tests and slow motion analyses of their insertion process. In comparison, the barbed stings of honey bees are relatively difficult to be withdrawn from fibrous tissues (e.g. skin), while the removal of paper wasp stings is easier due to their different structures and insertion skills. The similarities and differences of the two kinds of stings are summarized on the basis of the experiments and observations.

Needle Insertion Force Modeling using Genetic Programming Polynomial Higher Order Neural Network

Precise insertion of a medical needle as an end-effecter of a robotic or computer-aided system into biological tissue is an important issue and should be considered in different operations, such as brain biopsy, prostate brachytherapy, and percutaneous therapies. Proper understanding of the whole procedure leads to a better performance by an operator or system. In this chapter, the authors use a 0.98 mm diameter needle with a real-time recording of force, displacement, and velocity of needle through biological tissue during in-vitro insertions. Using constant velocity experiments from 5 mm/min up to 300 mm/min, the data set for the force-displacement graph of insertion was gathered. Tissue deformation with a small puncture and a constant velocity penetration are the two first phases in the needle insertion process. Direct effects of different parameters and their correlations during the process is being modeled using a polynomial neural network. The authors develop different networks in 2nd and 3rd order to model the two first phases of insertion separately. Modeling accuracies were 98% and 86% in phase 1 and 2, respectively.

Detailed finite element simulations of probe insertion into solid elastic material using a cohesive zone approach

In this paper a method is presented for detailed finite element modelling of probe insertion into an elastic material. This is part of an ongoing investigation into the mechanics of a novel, biomimetic, soft-tissue probe currently under development at Imperial College, London. Analysis is performed using a 'cohesive zone' approach by integrating multiple cohesive elements into a finite element mesh using Abaqus software. Cohesive zones with variable crack paths, generated by both remote tensile and contact loading, and substantial probe penetration along an arbitrarily curved crack path are demonstrated. These advances are critical to understanding probe interactions for the development of an existing prototype and control strategy.

Needle-Tissue Interaction Forces for Bevel-Tip Steerable Needles

The asymmetry of a bevel-tip needle results in the needle naturally bending when it is inserted into soft tissue. As a first step toward modeling the mechanics of deflection of the needle, we determine the forces at the bevel tip. In order to find the forces acting at the needle tip, we measure rupture toughness and nonlinear material elasticity parameters of several soft tissue simulant gels and chicken tissue. We incorporate these physical parameters into a finite element model that includes both contact and cohesive zone models to simulate tissue cleavage. We investigate the sensitivity of the tip forces to tissue rupture toughness, linear and nonlinear tissue elasticity, and needle tip bevel angle. The model shows that the tip forces are sensitive to the rupture toughness. The results from these studies contribute to a mechanics-based model of bevel-tip needle steering, extending previous work on kinematic models.