Carlo A. Seneci

Robotics in keyhole transcranial endoscope-assisted microsurgery: a critical review of existing systems and proposed specifications for new robotic platforms.

BACKGROUND: Over the past decade, advances in image guidance, endoscopy, and tube-shaft instruments have allowed for the further development of keyhole transcranial endoscope-assisted microsurgery, utilizing smaller craniotomies and minimizing exposure and manipulation of unaffected brain tissue. Although such approaches offer the possibility of shorter operating times, reduced morbidity and mortality, and improved long-term outcomes, the technical skills required to perform such surgery are inevitably greater than for traditional open surgical techniques, and they have not been widely adopted by neurosurgeons. Surgical robotics, which has the ability to improve visualization and increase dexterity, therefore has the potential to enhance surgical performance. OBJECTIVE: To evaluate the role of surgical robots in keyhole transcranial endoscope-assisted microsurgery. METHODS: The technical challenges faced by surgeons utilizing keyhole craniotomies were reviewed, and a thorough appraisal of presently available robotic systems was performed. RESULTS: Surgical robotic systems have the potential to incorporate advances in augmented reality, stereoendoscopy, and jointed-wrist instruments, and therefore to significantly impact the field of keyhole neurosurgery. To date, over 30 robotic systems have been applied to neurosurgical procedures. The vast majority of these robots are best described as supervisory controlled, and are designed for stereotactic or image-guided surgery. Few telesurgical robots are suitable for keyhole neurosurgical approaches, and none are in widespread clinical use in the field. CONCLUSION: New robotic platforms in minimally invasive neurosurgery must possess clear and unambiguous advantages over conventional approaches if they are to achieve significant clinical penetration. ABBREVIATIONS: DOF, degrees of freedom RAMS, robot-assisted microsurgery

Evaluation of a novel flexible snake robot for endoluminal surgery

BackgroundEndoluminal therapeutic procedures such as endoscopic submucosal dissection are increasingly attractive given the shift in surgical paradigm towards minimally invasive surgery. This novel three-channel articulated robot was developed to overcome the limitations of the flexible endoscope which poses a number of challenges to endoluminal surgery. The device enables enhanced movement in a restricted workspace, with improved range of motion and with the accuracy required for endoluminal surgery.ObjectiveTo evaluate a novel flexible robot for therapeutic endoluminal surgery.DesignBench-top studies.SettingResearch laboratory.InterventionTargeting and navigation tasks of the robot were performed to explore the range of motion and retroflexion capabilities. Complex endoluminal tasks such as endoscopic mucosal resection were also simulated.Main outcome measurementsSuccessful completion, accuracy and time to perform the bench-top tasks were the main outcome measures.ResultsThe robot ranges of movement, retroflexion and navigation capabilities were demonstrated. The device showed significantly greater accuracy of targeting in a retroflexed position compared to a conventional endoscope.LimitationsBench-top study and small study sample.ConclusionsWe were able to demonstrate a number of simulated endoscopy tasks such as navigation, targeting, snaring and retroflexion. The improved accuracy of targeting whilst in a difficult configuration is extremely promising and may facilitate endoluminal surgery which has been notoriously challenging with a conventional endoscope.

Toward Intraoperative Breast Endomicroscopy With a Novel Surface-Scanning Device

New optical biopsy methods such as confocal endomicroscopy represent a promising tool for breast conserving surgery, allowing real-time assessment of tumor margins. However, it remains difficult to scan over a large surface area because of the small field-of-view. This paper presents a novel robotic instrument to perform automated scanning with a fiber bundle endomicroscope probe to expand the effective imaging area. The device uses a rigid concentric tube scanning mechanism to facilitate large-area mosaicking. It has a compact design with a diameter of 6 mm, incorporating a central channel with a diameter of 3 mm for passing through a fiber bundle probe. A bespoke bearing, an inflated balloon, and a passive linear structure are used to control image rotation and ensure consistent tool-tissue contact. Experimental results show that the device is able to scan a spiral trajectory over a large hemispherical surface. Detailed performance evaluation was performed and the bending angle ranges from -90° to 90° with high repeatability and minimal rotational hysteresis errors. The device has also been validated with breast phantom and ex vivo human breast tissue, demonstrating the potential clinical value of the system.

Flexible platforms for natural orifice transluminal and endoluminal surgery

The flexible endoscope is playing an increasingly pivotal role in minimally invasive transluminal and endoluminal surgery. Whilst the flexible nature of the platform is desirable in order to navigate through the abdominal cavity or through a lumen, there are a number of issues with using the platform for this purpose. The challenges associated with using flexible endoscopes such as a lack of triangulation of instruments and force transmission, which is often inadequate for endoscopic surgery are discussed in this review. As a result of these difficulties, a number of mechanically and robotically driven devices based upon the flexible endoscope are emerging. The design of these devices and potential problems are also reviewed. Finally, future robotic systems which are still in the development and validation stage are briefly discussed. The field of gastroenterology is diverging. The narrowing divide between minimally invasive and endoluminal surgery has led to a surge of innovative and novel devices which may in the future enable precise, seamless and scar less surgery.

Rapid manufacturing with selective laser melting for robotic surgical tools: Design and process considerations

Additive manufacturing is a technology in constant evolution. It is able to produce objects otherwise either impractical or unfavorable for traditional manufacturing technologies, especially in relatively limited quantities. The advancement of Selective Laser Melting (SLM) has made it possible to manufacture functional, production-quality components directly from rapid prototyping for long-term use. This work studies the SLM process and identifies the optimal process parameters for the rapid manufacturing of a miniaturized robotic surgical instrument. The proposed robotic instrument has been designed to exploit the advantages of rapid manufacturing and rapid assembly, following a shift from large scale manufacturing of generalized surgical instruments to the production of small batches of patient or procedure-specific.

Effective Manipulation in Confined Spaces of Highly Articulated Robotic Instruments for Single Access Surgery

The field of robotic surgery increasingly advances towards highly articulated and continuum robots, requiring new kinematic strategies to enable users to perform dexterous manipulation in confined workspaces. This development is driven by surgical interventions accessing the surgical workspace through natural orifices such as the mouth or the anus. Due to the long and narrow nature of these access pathways, external triangulation at the fulcrum point is very limited or absent, which makes introducing multiple degrees of freedom at the distal end of the instrument necessary. Additionally, high force and miniaturization requirements make the control of such instruments particularly challenging. This letter presents the kinematic considerations needed to effectively manipulate these novel instruments and allow us their dexterous control in confined spaces. A nonlinear calibration model is further used to map joint to actuator space and improve significantly the precision of the instruments motion. The effectiveness of the presented approach is quantified with bench tests, and the usability of the system is assessed by three user studies simulating the requirements of a realistic surgical task.

Development of a large area scanner for intraoperative breast endomicroscopy

Recent work on probe-based confocal endomicroscopy has demonstrated its potential role for real-time assessment of tumour margins during breast conserving surgery. However, endomicroscope probes tend to have a very small field-of-view, making surveillance of large areas of tissue difficult, and limiting practical clinical deployment. In this paper, a new robotic device for controlled, large area scanning based on a fibre bundle endomicroscope probe is proposed. The prototype uses a 2-DOF mechanism (-90 to +90 degrees bending on one axis, 360 degrees of rotation on a second axis) as well as a passive linear structure to conform to undulating surfaces. Both axes are driven by brushless DC servo motors with computer control, thus facilitating large field-of-view mosaicing. Experimental results have shown good repeatability and low hysteresis of the device, which is able to scan different surface trajectories (e.g. a spiral pattern over a hemi-spherical surface) with consistent tissue contact. Ex vivo human breast tissue results are demonstrated, illustrating a viable scanning approach for breast endomicroscopy.

Design and evaluation of a novel flexible robot for transluminal and endoluminal surgery

Precise and repetitive positional control of surgical robots is important to reduce time and risks of surgical procedures. These factors become particularly important when deploying the surgical system through a flexible path to areas with a tight workspace such as the stomach or oesophagus where high dexterity, flexibility, accuracy and stability are required. This paper presents a flexible access robot combining articulated joints and continuum flexible section for both transluminal and endoluminal surgeries. Kinematic model and control strategy for the flexible robot are described in the paper. The experiment simulating a transoral gastric procedure demonstrates great flexibility and dexterity of the device. The results show that good accuracy and repetitive control of the device are achieved, which demonstrate the potential application of the device for transluminal or endoluminal surgery.

Snake robot shape sensing using micro-inertial sensors

Real-time shape sensing and state acquisition is important for closed-loop control of hyper-redundant snake robots in minimally invasive surgery. Due to the miniaturized size of such minimally invasive surgery robots, it is not feasible to use existing angular sensors involving rotary encoders. With recent advances of the MEMS technology, micro inertial sensors have shown their potential for robot state estimation. Previous studies have demonstrated that accurate joint angles can be estimated for one degree-of-freedom (DoF) joints. However, higher DoF joints of the robot can impose a number of challenges to the current joint angle estimation methods. This paper presents a micro-sensing platform and shape reconstruction algorithm for minimally invasive surgery snake robot with two DoF joints. The method incorporates both gravitational and gyroscopic sensing for calculating the rotation difference between any consecutive robot segments. The gyroscope measurements are first used as the input to predict the rotation difference by direct orientation integration. The orientation difference is then derived from the consecutive acceleration vectors to update the prediction through a complementary filter. To demonstrate the performance of our proposed approach, a robot prototype with two universal joints was fabricated. Detailed experimental results have demonstrated that high accuracy can be achieved by using the proposed method for joint angle estimation.

A Single-Port Robotic System for Transanal Microsurgery—Design and Validation

This letter introduces a single-port robotic platform for transanal endoscopic microsurgery (TEMS). Two robotically controlled articulated surgical instruments are inserted via a transanal approach to perform submucosal or full-thickness dissection. This system is intended to replace the conventional TEMS approach that uses manual laparoscopic instruments. The new system is based on master–slave robotically controlled tele-manipulation. The slave robot comprises a support arm that is mounted on the operating table, supporting a surgical port and a robotic platform that drives the surgical instruments. The master console includes a pair of haptic devices, as well as a three-dimensional display showing the live video stream of a stereo endoscope inserted through the surgical port. The surgical instrumentation consists of energy delivery devices, graspers, and needle drivers allowing a full TEMS procedure to be performed. Results from benchtop tests, ex vivo animal tissue evaluation, and in vivo studies demonstrate the clinical advantage of the proposed system.