Kevin C. Olds

Toward Clinically Applicable Steady-Hand Eye Robot for Vitreoretinal Surgery

This paper reports new developments and optimizations for clinical use of the Steady-Hand Eye Robot for vitreoretinal surgery. Vitreoretinal surgery requires precise micro-manipulation of delicate tissues. Surgical performance is limited by physiological hand tremor, fatigue, poor kinesthetic feedback, as well as patient movement. The previously developed Steady-Hand Eye Robot has been extensively used in in vivo experiments. Several safety and ergonomic limitations observed in the in vivo environment serve as motivation for a novel robot wrist design. The new robot wrist consists of a symmetric remote center of motion (RCM) tilt mechanism and a slim tool holder with a quick release mechanism for the surgical instruments. The RCM tilt mechanism provides a tilt motion range of ±45° and a stiffness of 21 N/mm. Two different release force thresholds for the quick release mechanism were designed. The soft configuration requires 2–3 N to retract the surgical instruments while the hard configuration requires 5–6 N.Copyright

A FORCE-SENSING MICROSURGICAL INSTRUMENT THAT DETECTS FORCES BELOW HUMAN TACTILE SENSATION

Purpose: To test the sensitivity and reproducibility of a 25-gauge force-sensing micropick during microsurgical maneuvers that are below tactile sensation. Methods: Forces were measured during membrane peeling in a “raw egg” and the chick chorioallantoic membrane models (N = 12) of epiretinal membranes. Forces were also measured during posterior hyaloid detachment and creation of retinal tears during vitrectomy in live rabbits (n = 6). Results: With the raw egg model, 0.5 ± 0.4 mN of force was detected during membrane peeling. In the chorioallantoic membrane model, delaminating the upper membrane produced 2.8 ± 0.2 mN of force. While intentionally rupturing the lower membrane to simulate a retinal tear, 7.3 ± 0.5 mN (range, 5.1–9.2 mN; P < 0.001) of force was generated while peeling the upper membrane. During vitrectomy, the minimum force that detached the posterior hyaloid was 6.7 ± 1.1 mN, which was similar to the force of 6.4 ± 1.4 mN that caused a retinal tear. The rate of force generation, as indicated by the first derivative of force generation, was 3.4 ± 1.2 mN/second during posterior hyaloid detachment, compared with 7.7 ± 2.4 mN/second during the creation of a retinal tear (P = 0.04). Conclusion: Force-sensing microsurgical instruments can detect forces below tactile sensation, and importantly, they can distinguish the forces generated during normal maneuvers from those that cause a surgical complication.

Robotic endolaryngeal flexible (Robo-ELF) scope: A preclinical feasibility study†‡§

This article presents a novel robotic endolaryngeal flexible (Robo‐ELF) scope driver for minimally invasive laryngeal surgery. The Robo‐ELF consists of a simple, robust robotic scope driver with three active and two passive degrees of freedom, allowing it to manipulate any standard flexible endoscope. The system is controlled by a joystick‐like three dimensional mouse that interfaces with the scope driver via a laptop. Because the scope is supported and controlled by the robot, motor control and therefore visualization are enhanced. Additionally, because the robot remains stationary when the mouse is not being manipulated, the surgeon can position it and operate bimanually.

Global Indices for Kinematic and Force Transmission Performance in Parallel Robots

This paper defines, develops, and demonstrates new indices for quantifying kinematic and force transmission performance of parallel robotic mechanisms. Conventional indices are first analyzed and shown to be insufficient for characterizing common design specifications based on worst-case performance. New indices are then developed, analyzed, and extended to simply and intuitively quantify global worst-case kinematic and force performance. These new tools are then successfully applied to the design, optimization, and analysis of a linear delta robot for medical applications.

A new ENT microsurgery robot: Error analysis and implementation

This paper reports the error specifications and error analysis for a new cooperatively controlled ENT microsurgery robot. The new robot is designed for three specific ENT surgeries, endonasal skull base surgery, transoral laryngeal surgery, and cochlear implant surgery. The design requirements for the robot resolution, accuracy, stiffness, and repeatability for these surgery types are discussed and analyzed, and the required robot parameters are calculated. The mechanical design of the robot is then analyzed and shown to fulfill these requirements in the case where it is in its home configuration. The analysis is then extended to cover the robots whole workspace.

Preliminary evaluation of a new microsurgical robotic system for head and neck surgery

This paper presents an implementation and evaluation of the Robotic ENT Microsurgery System (REMS). The implementation is discussed in reference to analysis from previous work, and evaluated using a simulated surgical task designed to resemble microlaryngeal phonosurgery. Preliminary technical evaluations of resolution and accuracy are also presented. The results of the evaluations reveal that the system statistically significantly improves surgical precision (p <; 0.01) with only a small increase in operating time. The force data recorded also reveals that operating force can be significantly affected by ergonomic factors, and that warnings for excessive force and workspace limits are needed.

The robotic ENT microsurgery system: A novel robotic platform for microvascular surgery

Assess the feasibility of a novel robotic platform for use in microvascular surgery.

Human eye phantom for developing computer and robot-assisted epiretinal membrane peeling

A number of technologies are being developed to facilitate key intraoperative actions in vitreoretinal microsurgery. There is a need for cost-effective, reusable benchtop eye phantoms to enable frequent evaluation of these developments. In this study, we describe an artificial eye phantom for developing intraocular imaging and force-sensing tools. We test four candidate materials for simulating epiretinal membranes using a handheld tremor-canceling micromanipulator with force-sensing micro-forceps tip and demonstrate peeling forces comparable to those encountered in clinical practice.

Evaluation, optimization, and verification of the wrist mechanism of a new cooperatively controlled bimanual ENT microsurgery robot

This paper reports the evaluation, optimization, and verification of five different design proposals for the wrist system of a new microsurgery robot. The robot targets three main types of Ear Nose and Throat (ENT) surgeries. These surgeries require a compact design and configuration synthesis to decrease collisions, provide high precision and stiffness, and accommodate the clinical requirements of each surgery type. The system is composed of two 6 DOF active robots, each composed of a 3 DOF linear stage and a 3 DOF rotary wrist mechanism. The linear stage uses a 3 DOF parallel design to increase the accuracy and stiffness of the whole system while minimizing size and weight. However, to remain compact, this parallel mechanism introduces the problem of limited linear range of motion.Five different kinematic arrangements have been considered, and the evaluation and optimization of these configurations is discussed in detail. The main parameters considered in the evaluation include the range of motion of each DOF, the required linear movement to implement a virtual remote center of motion (RCM), and the environment occupation near the surgical tool. The optimal design of the wrist mechanism was determined by evaluating each design with respect to these parameters, and comparing the results.A prototype of the resulting optimal kinematic arrangement was mounted on a 3 DOF linear robot to verify the results of this optimization process. A series of verification experiments was performed. These experiments successfully verified the validity of the selected design.Copyright

A robotic assistant for trans-oral surgery: the robotic endo-laryngeal flexible (Robo-ELF) scope

This paper describes the continued development of the Robotic EndoLaryngeal (Robo-ELF) Scope System, a simple clinically usable robot for manipulating flexible endoscopes, particularly in laryngeal surgery. The system includes a robot with three active and two passive degrees of freedom, a five degree of freedom passive positioning arm, a malleable scope shaft support, and a custom joystick controller. The Robo-ELF Scope allows a surgeon to control a flexible endoscope with only one hand and also to release the controls and perform bimanual surgery if desired. We have evaluated the Robo-ELF Scope system in both phantom and cadaver studies and found it superior to hand manipulation of flexible endoscopes and conventional rigid endoscopes.