Five degrees-of-freedom mechanical arm with remote center of motion (RCM) device for volumetric optical coherence tomography (OCT) retinal imaging.

Handheld optical coherence tomography (HH-OCT) is gaining popularity for diagnosing retinal diseases in neonates (e.g. retinopathy of prematurity).

Endovascular Detection of Catheter-Thrombus Contact by Vacuum Excitation.

Objective: The objective of this work is to introduce and demonstrate the effectiveness of a novel sensing modality for contact detection between an off-the-shelf aspiration catheter and a thrombus.

Methods: A custom robotic actuator with a pressure sensor was used to generate an oscillatory vacuum excitation and sense the pressure inside the extracorporeal portion of the catheter. Vacuum pressure profiles and robotic motion data were used to train a support vector machine (SVM) classification model to detect contact between the aspiration catheter tip and a mock thrombus.

A Multi-Modal Sensor Array for Human-Robot Interaction and Confined Spaces Exploration Using Continuum Robots.

Safe human-robot interaction requires robots endowed with perception. This paper presents the design of a multi-modal sensory array for continuum robots, targeting operation in semi-structured confined spaces with human users. Active safety measures are enabled via sensory arrays capable of simultaneous sensing of proximity, contact, and force.

Continuum Robots for Medical Interventions.

Continuum robots are not constructed with discrete joints but, instead, change shape and position their tip by flexing along their entire length. Their narrow curvilinear shape makes them well suited to passing through body lumens, natural orifices, or small surgical incisions to perform minimally invasive procedures. Modeling and controlling these robots are, however, substantially more complex than traditional robots comprised of rigid links connected by discrete joints.

A decade retrospective of medical robotics research from 2010 to 2020.

Robotics is a forward-looking discipline. Attention is focused on identifying the next grand challenges. In an applied field such as medical robotics, however, it is important to plan the future based on a clear understanding of what the research community has recently accomplished and where this work stands with respect to clinical needs and commercialization.

A Review of Robotic and OCT-Aided Systems for Vitreoretinal Surgery.

The introduction of the intraocular vitrectomy instrument by Machemer et al. has led to remarkable advancements in vitreoretinal surgery enabling the limitations of human physiologic capabilities to be reached. To overcome the barriers of perception, tremor, and dexterity, robotic technologies have been investigated with current advancements nearing the feasibility for clinical use.

Modal-Based Kinematics and Contact Detection of Soft Robots.

Soft robots offer an alternative approach to manipulate within a constrained space while maintaining a safe interaction with the external environment. Owing to its adaptable compliance characteristic, external contact force can easily deform the robot shapes and lead to undesired robot kinematic and dynamic properties. Accurate contact detection and contact location estimation are of critical importance for soft robot modeling, control, trajectory planning, and eventually affect the success of task completion.

Sensitivity Ellipsoids for Force Control of Magnetic Robots with Localization Uncertainty.

The navigation of magnetic medical robots typically relies on localizing an actuated, intracorporeal, ferromagnetic body and back-computing a necessary field and gradient that would result in a desired wrench on the device. Uncertainty in this localization degrades the precision of force transmission. Reducing applied force uncertainty may enhance tasks such as navigation of miniature robots, actuation of magnetically guided catheters, tissue palpation, as well as simply ensuring a bound on forces applied on sensitive tissue.

Sensorless Estimation of the Planar Distal Shape of a Tip-Actuated Endoscope.

Traditional endoscopes consist of a flexible body and a steerable tip with therapeutic capability. Although prior endoscopes have relied on operator pushing for actuation, recent robotic concepts have relied on the application of a tip force for guidance. In such case, the body of the endoscope can be passive and compliant; however, the body can have significant effect on mechanics of motion and may require modeling.

Investigating variability in cochlear implant electrode array alignment and the potential of visualization guidance.

Background Internal cochlear anatomy is difficult to discern from external inspection, hindering cochlear implant electrode insertion. Methods A user study characterized the repeatability of standard surgical technique and examined the role of visual inspection and guidance cues in reducing electrode array insertion misalignment. Results Without guidance, a large spread in angles of insertion, up to 30°, was observed, highlighting the need for intraoperative guidance.

Dual-Continuum Design Approach for Intuitive and Low-Cost Upper Gastrointestinal Endoscopy.

Objective: This paper introduces a methodology to design intuitive, low-cost, and portable devices for visual inspection of the upper gastrointestinal tract.

Methods: The proposed approach mechanically couples a multi-backbone continuum structure, as the user interface, and a parallel bellows actuator, as the endoscopic tip. Analytical modeling techniques derived from continuum robotics were adopted to describe the endoscopic tip motion from user input, accounting for variations in component size and pneumatic compressibility.

Preliminary Porcine In Vivo Evaluation of a Telerobotic System for Transurethral Bladder Tumor Resection and Surveillance.

Introduction: Transurethral resection of bladder tumors (TURBTs) can be a challenging procedure, primarily due to limitations in tooltip dexterity, visualization, and lack of tissue depth information. A transurethral robotic system was developed to revolutionize TURBTs by addressing some of these limitations. The results of three pilot in vivo porcine studies using the novel robotic system are presented and potential improvements are proposed based on experimental observations.

Steerable Robot-assisted Micromanipulation in the Middle Ear: Preliminary Feasibility Evaluation.

Hypothesis: The use of a robotic manipulator with a dexterously orientable gripper will expand the ability of middle ear surgeons to perform precise tasks and access otherwise challenging anatomic regions.

Background: Middle ear surgery presents unique challenges because of the constrained operative space and limited access to certain anatomic regions.

Methods: A custom-designed robot with a sideways-reaching gripper was used to evaluate feasibility of manipulation tasks in different middle-ear anatomical zones.

Kinematic and experimental investigation of manual resection tools for transurethral bladder tumor resection.

Background: Transurethral Resection of Bladder Tumors (TURBT) is a challenging procedure partly due to resectoscope limitations. To date, manual resection performance has not been fully characterized. This work characterizes manual resection performance in the bladder while analyzing the effect of resection location on accuracy.

Detection of modiolar proximity through bipolar impedance measurements.

Objectives: To test the hypothesis that bipolar electrical impedance measurements in perimodiolar cochlear implants (CIs) may be used to differentiate between perimodiolar insertion technique favoring proximity to the modiolus or lateral wall.

Study Design And Methods: Bipolar impedances are a measure of electrical resistance between pairs of electrode contacts in a CI. Stimulation is through biphasic pulses at fixed frequency.

Jacobian-Based Iterative Method for Magnetic Localization in Robotic Capsule Endoscopy.

The purpose of this study is to validate a Jacobian-based iterative method for real-time localization of magnetically controlled endoscopic capsules. The proposed approach applies finite-element solutions to the magnetic field problem and least-squares interpolations to obtain closed-form and fast estimates of the magnetic field. By defining a closed-form expression for the Jacobian of the magnetic field relative to changes in the capsule pose, we are able to obtain an iterative localization at a faster computational time when compared with prior works, without suffering from the inaccuracies stemming from dipole assumptions.

Evaluation of microsurgical tasks with OCT-guided and/or robot-assisted ophthalmic forceps.

Real-time intraocular optical coherence tomography (OCT) visualization of tissues with surgical feedback can enhance retinal surgery. An intraocular 23-gauge B-mode forward-imaging co-planar OCT-forceps, coupling connectors and algorithms were developed to form a unique ophthalmic surgical robotic system. Approach to the surface of a phantom or goat retina by a manual or robotic-controlled forceps, with and without real-time OCT guidance, was performed.

Robot-assisted transnasal laryngoplasty in cadaveric models: Quantifying forces and identifying challenges.

Objectives/hypothesis: We expanded our prior work with transnasal robotic surgery (TNRS) in this study with the following aims: 1) use a cadaveric model to evaluate the feasibility of laryngoplasty with TNRS, 2) measure robot insertion times and forces, and 3) identify operational challenges to further guide the development of a flexible robotic system.

Study Design: Cadaveric study.

Methods: A 5-mm robot was guided to the larynx via a transnasal approach.

A pilot ex vivo evaluation of a telerobotic system for transurethral intervention and surveillance.

Introduction: Transurethral resection of bladder tumor (TURBT) and pathological staging are both standard surgical therapies for nonmuscle-invasive bladder cancer and integral parts of the diagnostic evaluation and progression monitoring of all bladder tumors. We developed and tested a dexterous robot that can fit through a standard resectoscope for evaluation for possible en bloc resection of bladder tumors, especially tumors along the dome and anterior wall of the bladder.

Materials And Methods: Our dexterous robot uses a continuum (snake-like) mechanical architecture with three working channels through which a fiberscope, biopsy graspers, and a holmium laser were placed.

Evaluation of a Telerobotic System for Transnasal Surgery of the Larynx and Airways in Cadavers.

Objectives: Minimally invasive, transnasal endoscopic approaches to the larynx have been utilized but are limited by the precision and accuracy afforded to the surgeon. The objective of this study is to analyze the feasibility of a rapidly deployable telerobotic system for enabling transnasal microsurgery of the larynx and upper airways, specifically injection laryngoplasty.

Study Design: This is a feasibility study.

Forces and trauma associated with minimally invasive image-guided cochlear implantation.

Objective: Minimally invasive image-guided cochlear implantation (CI) utilizes a patient-customized microstereotactic frame to access the cochlea via a single drill-pass. We investigate the average force and trauma associated with the insertion of lateral wall CI electrodes using this technique.

Study Design: Assessment using cadaveric temporal bones.

Future robotic platforms in urologic surgery: recent developments.

Purpose Of Review: To review recent developments at Vanderbilt University of new robotic technologies and platforms designed for minimally invasive urologic surgery and their design rationale and potential roles in advancing current urologic surgical practice.

Recent Findings: Emerging robotic platforms are being developed to improve performance of a wider variety of urologic interventions beyond the standard minimally invasive robotic urologic surgeries conducted currently with the da Vinci platform. These newer platforms are designed to incorporate significant advantages of robotics to improve the safety and outcomes of transurethral bladder surgery and surveillance, further decrease the invasiveness of interventions by advancing LESS surgery, and to allow for previously impossible needle access and ablation delivery.

Design and Coordination Kinematics of an Insertable Robotic Effectors Platform for Single-Port Access Surgery.

Single port access surgery (SPAS) presents surgeons with added challenges that require new surgical tools and surgical assistance systems with unique capabilities. To address these challenges, we designed and constructed a new insertable robotic end-effectors platform (IREP) for SPAS. The IREP can be inserted through a Ø15 mm trocar into the abdomen and it uses 21 actuated joints for controlling two dexterous arms and a stereo-vision module.

Design and performance evaluation of a minimally invasive telerobotic platform for transurethral surveillance and intervention.

Bladder cancer, a significant cause of morbidity and mortality worldwide, presents a unique opportunity for aggressive treatment due to the ease of transurethral accessibility. While the location affords advantages, transurethral resection of bladder tumors can pose a difficult challenge for surgeons encumbered by current instrumentation or difficult anatomic tumor locations. This paper presents the design and evaluation of a telerobotic system for transurethral surveillance and surgical intervention.