bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep Imitation Learning for Automated Drop-In Gamma Probe Manipulation
Authors:   The Hamlyn Centre for Robotic Surgery, Imperial College London, UK, Deng Kaizhong , Huang Baoru ,   The Hamlyn Centre for Robotic Surgery, Imperial College London, UK, Elson Daniel S. ,   The Hamlyn Centre for Robotic Surgery, Imperial College London, UK
Published: June 2023

Prostate cancer is one of the most common cancers in the UK, and Robotic-Assisted Surgery (RAS) has become a common method for prostate cancer surgery. Sentinel lymph node biopsy (SLNB) is an important component of prostate cancer surgery and provides accurate diag- nostic evidence of disease extent. A drop-in gamma probe, SENSEI, has been designed to improve the accuracy of sentinel lymph node detection in RAS. An example of its in vivo usage can be seen in Figure 1. It can distinguish cancerous tissue from normal tissue by detecting the radiation emitted from radiolabeled probes that have been injected into the body. A feasibility study has demonstrated that the drop-in gamma probe can provide accurate identifica- tion of positive nodes following the administration of technetium-99m nanocolloid [1]. However, relying on the live gamma level display and audible feedback from the console while the probe is scanned across the tissue surface is not an easy or intuitive way to identify hidden affected lymph nodes. This might affect the effectiveness of less experienced surgeons and latent hot spots may be overlooked. To address these issues, we propose a robotic scanning method to automatically and systematically examine an entire target area and locate the hot spots. In this study, we present a deep imitation training workflow based on simulation data for an end-to-end learning- based agent capable of systematically scanning target areas using visual input and the current robot state. The evaluation result shows that this approach is promising to automatically control the drop-in gamma probe.
Learning Robotic Ultrasound through Coaching
Authors:   Purdue University, US, Balakuntala Mythra , Raina Deepak ,   Purdue University, US, Wachs Juan ,   Purdue University, US, Voyles Richard ,   Purdue University, US
Published: June 2023

Medical imaging is an essential tool for diagnosing and monitoring various health conditions. Robotic remoti- zation of such diagnostic medical procedures increases the safety of medical personnel and accessibility to the rural populace. However, ultrasound exams can be challenging and require skilled operators to obtain high- quality images. Automating such procedures requires programming robots to perform these dexterous medical skills. The programming constraint can be eliminated by leveraging human tutelage paradigms, enabling the robot to learn from observation and expert feedback. But, robots require massive libraries of demonstrations to learn effective policies using machine learning algo- rithms [1]. While such datasets are achievable for simple tasks, providing many demonstrations for contact-rich procedures such as ultrasound is not practical. This paper presents a novel method to learn complex contact-rich procedures by combining self-supervised practice with sparse expert feedback through coaching. The robotic ultrasound system (RUS) uses reinforcement learning (RL) to learn a policy for autonomous imaging of a urinary bladder phantom. Specifically, we use an off- policy soft actor-critic with a reward based on image quality assessed using a supervised convolutional neu- ral network to learn the policy for ultrasound through practice. In addition to practice, experts provide online corrective feedback (coaching), which drives the robot to learn successful policies for ultrasound imaging.
Design of an ex-vivo experimental setup for spine surgery based on in-vivo identification of respiration-induced spine movement
Authors:   Armand-Trousseau Hospital, Paris, France, Saghbiny Elie ,   Sorbonne Université, CNRS UMR 7222, INSERM U1150, ISIR, France, Vafadar Saman ,   Sorbonne Université, CNRS UMR 7222, INSERM U1150, ISIR, France, Harlé Antoine ,   Sorbonne Université, CNRS UMR 7222, INSERM U1150, ISIR, France, Morel Guillaume ,   Sorbonne Université, CNRS UMR 7222, INSERM U1150, ISIR, France
Published: June 2023

In spine surgery, e.g., pedicle screw placement, patients are in the prone position, anesthetized, and breath using respirators. Respiration-induced spine movements may interfere with the operation. For evaluating spine surgery robotic systems [1] without resorting to in-vivo experi- ments, it is necessary to provide a setup that realistically reproduces the spine movement in a lab. The literature is not very rich in documenting such a movement. Most of the time, only the range of motion of one or two vertebrae is provided. Glossop et al. [2] measured this respiration-induced motion for two human lumbar vertebrae (L3 and L4) to be 1.3 mm using optical markers screwed to the spinous process. The same authors [3] measured the respiration-induced motion, using the same techniques, for three pig lumbar vertebrae (L3-L5) under ventilation that ranged from 0.8-1.1 mm. In a more recent study, Liu et al. [4] measured this motion on different levels of vertebrae – cervical (C1), thoracic (T7), and lumbar spine (L4) – using optical markers placed on the patient’s skin. Mean ± 2SD motions were 1.3 ± 0.7 mm, 2.3 ± 1.6 mm, and 1.6 ± 0.7 mm. In this study, we measure respiration-induced spine movements (T6-L5) in an open-spine surgery on a pig. A mechanical probe mounted on a force-controlled medical robotic arm is used for measurements. Then, we propose an ex-vivo experimental setup that could implement the measured motions to emulate the respiration-induced movement.
Towards a robotic minimally invasive surgery assessment and augmentation platform for visual-haptic acuity development
Authors:   Johns Hopkins University, US, Machaca Sergio , Brown Jeremy D. ,   Johns Hopkins University, US
Published: June 2023

Up to half of the technical errors made by surgical trainees result from improper tool forces on tissue [1]. This skill inadequacy is exacerbated in robotic min- imally invasive surgery (RMIS) due to the perpetual technical barriers prohibiting robust haptic (touch) sen- sations in clinical RMIS systems. Expert RMIS surgeons have developed a unique skill, termed visual-haptic acuity, that enables them to visually estimate the absent haptic sensations [2]. RMIS experts have developed this visual-haptic acuity through years of repeated surgi- cal practice, on real patient tissue. For current RMIS trainees, limitations on working hours and caseloads severely constrain practice with real patient tissue [3]. Given that skill gained in virtual reality simulation does not always transfer to the real world [4], there is a critical need for a focus on visual-haptic acuity development. Previous research has shown that supplemental hap- tic feedback provided during simulation-based RMIS training helps surgical trainees to reduce their applied forces when completing RMIS training tasks [5], and that this effect is sustained even when haptic feedback is removed [6]. In addition, supplemental haptic feedback has demonstrated the potential to help RMIS trainees increase accuracy (reduce applied forces) while also increasing speed (reducing task completion time) during RMIS training [7]. Unfortunately, the benefits of sup- plemental haptic feedback have not been demonstrated beyond basic simulated training environments. Addition- ally, we lack validated objective methods for specifically assessing an RMIS trainee’s ability to visually estimate haptic sensations when operating on real patient tissue. In light of this need, we are developing a modular data acquisition and multimodality haptic feedback system (as shown in Figure 1) to catalyze visual-haptic acuity development for novice RMIS trainees.
Soft artificial bladder with volume monitoring capabilities
Authors:   Scuola Superiore Sant'Anna, Pisa, Italy, Semproni Federica , Iacovacci Veronica ,   Scuola Superiore Sant'Anna, Pisa, Italy, Maglio Sabina ,   Scuola Superiore Sant'Anna, Pisa, Italy, Onorati Simone ,   Scuola Superiore Sant'Anna, Pisa, Italy, Ibrahimi Michele ,   Scuola Superiore Sant'Anna, Pisa, Italy, Menciassi Arianna ,   Scuola Superiore Sant'Anna, Pisa, Italy
Published: June 2023

Urinary bladder cancer is the tenth most common cancer in the world with an incidence of approximately 550,000 new cases each year [1]. Non-muscle invasive tumors are locally removed with trans urethral resection or chemotherapy, while invasive tumors (30% of cases) are generally treated with the surgical removal of the entire bladder and the urethra (radical cystectomy) to avoid recurrence [2]. Following cystectomy, uretero- cutaneostomy (i.e., urine drainage from the kidneys to an external container) or neobladder reconstruction with autologous intestine are possible solutions. Although they are standard clinical procedures, they present several complications including possible onset of infections, rupture of the neobladder, tumor recurrence, as well as low patient’s quality of life [3]. This scenario motivates the development of alternative solutions to restore bladder functions, i.e., urinary continence and controlled micturition. Over the years, researchers moved towards the development of fully implantable bioartificial [4] and artificial [5] bladder systems. Considering the Valsalva maneuver (i.e., abdominal torsion) as a possible voiding strategy, two functions are crucial for a complete bladder system: urine collection and fullness sensitivity. In this regard, some preliminary sensing systems have been proposed in literature. However, the solutions are closely related to specific and not bio-inspired geometries [5] or suitable only for small animals [6]. In this framework, we propose a novel biorobotic organ composed of a soft hexagonal-shaped artificial bladder (AB) coupled to a resistive textile sensors-based volume monitoring apparatus. The foldable structure of the AB together with the small thickness and flexibility of the embedded sensors make the system compact and suitable for implantation. The design and fabrication processes are here shown together with a preliminary validation of the sensorized AB.
A Fluidic Actuated Soft Robot for Improving Bronchoscopic Biopsy
Authors:   Boston Universtiy, US, Van Lewen Daniel , Janke Taylor ,   Boston University, US, Lee Harin ,   Boston University, US, Austin Ryan ,   Boston University, US, Billatos Ehab ,   Boston University, US, Russo Sheila ,   Boston University, US
Published: June 2023

Lung cancer has long been one of the deadliest forms of cancer in large part due to the difficulty in diagnosis when at its earlier stages [1]. Because of their large diameter (i.e., ≈ 6 mm) preventing them from navigating in the peripheral lung, traditional bronchoscopes used in minimally invasive biopsy encounter difficulty when trying to reach smaller, deep-seated lesions [2]. Robotic solutions have been developed to address these limitations in surgical navigation. Commercial robotic bronchoscopy systems, like the Auris Monarch™ and Intuitive Ion™ , con- sist of tendon-actuated continuum robots which focus on navigation and biopsy deeper into the lung periphery [3]. Soft robots present a promising alternative to these commercial robotic systems due to their scalability, in- herent flexibility, and potential for safer interactions with biological tissue, making them well-suited for procedures in the peripheral lung [4]. Furthermore, the materials used in soft robotics are generally more economical and allow seamless integration of soft robotic actuation and sensing mechanisms. Exploration of various actuation methods, such as magnetic and fluidic, have demonstrated navigation capabilities in hard-to-reach areas of the lung and the ability to integrate useful tools, such as needles and cameras [5], [6]. However, with miniaturization, the ability of soft robots to transmit forces and interact with the surrounding biological tissue diminishes. We propose a 3.5 mm diameter soft robot with em- bedded degrees of freedom (DOFs) for tip steering, tip stabilization, and needle deployment for tissue biopsy in bronchoscopy procedures (Fig. 1). Via soft actuators embedded in its continuum body, the robot can navigate through the lung branches to the target lesion and anchor itself within an anatomical channel. After anchoring, a needle may be deployed from the robot tip using an origami-inspired soft actuator to puncture the target lesion and take a biopsy. The fluidic actuated DOFs embedded in the proposed robot seek to reach deeper into the lungs, actively increase force transmission at the millimeter scale, and distally control the biopsy needle laying the framework for enhanced surgical capabilities in minimally invasive bronchoscopy procedures.
Soft Robotic Pneumatic Actuators Assist Diaphragmatic Dysfunction in a Respiratory Simulator
Authors:   Department of Mechanical Engineering, Massachusetts Institute of Technology, US, Quevedo-Moreno Diego , Tagoe Jonathan ,   Department of Mechanical Engineering, Massachusetts Institute of Technology, US, Roche Ellen ,   Department of Mechanical Engineering, Massachusetts Institute of Technology, US
Published: June 2023

The diaphragm is a critical muscle for the respiratory system, responsible for up to 70% of the inspiration effort. Phrenic nerve trauma or neuromuscular disease can generate severe diaphragm dysfunction that ultimately leads to respiratory failure [1]. The current treatment for patients with severe diaphragm dysfunction is permanent airway tethering to mechanical ventilation, which greatly impacts patient’s quality of life and autonomy by hindering activities like speech, swallowing, and mobility. Soft robots are ideal to assist in complex biological functions like the contraction of the diaphragm. Diaphragmatic mechanical assistance using implantable soft robots has shown promising results in restoring respiratory function [2]. However, the design of the soft robotic actuator can be optimized to effectively assist the diaphragm. Here, we present a soft robotic pneumatic actuator that inverts its curvature to efficiently displace the diaphragm and assist in the inspiratory effort, restoring physiological thoracic and abdominal pressurization levels. Moreover, we show how the respiratory simulator can replicate clinically relevant pleural pressure (Ppl) and abdominal pressure (Pab), demonstrating its potential as a platform to validate this technology.
Computational Predictive Model for Full Body Controlled Soft Continuum Magnetic Robots under Hybrid Actuation
Authors:   School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK, Abolfathi Kiana , Chandler James ,   School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK, Ashkan Keyoumars ,   Department of Neurosurgery, King’s College Hospital, London, UK, Citi Luca ,   School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK, Valdastri Pietro ,   School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK, Hoshiar Ali Kafash ,   School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
Published: June 2023

In recent years, medical microrobots have emerged as a non-invasive solution to many medical interventions [1, 2]. Soft continuum magnetic robots (SCMRs), a class of soft robots, were introduced as a promising method for endovascular intervention [1]. The small scale, adaptability, flexibility, and high controllability of SCMRs made them well suited for the clinical applications. The SCMRs originally introduced for endovascular intervention [1, 3], however, utilised rigid permanent magnets within their structure, increasing the risk of vascular trauma during deployment. Therefore, fully soft continuum magnetic robots (FSCMRs), made of magneto-responsive soft material, were introduced to improve their clinical implementation [4]. Imparting a lengthwise magnetisation profile into FSCMRs, full body shape forming is possible under application of homogeneous magnetic fields, improving conformation to anatomical structures. Shapes have been predicted for homogeneous electromagnet (EM) generated fields using computational models [5], and through permanent magnet (PM) actuation with mathematical models [6]. However, the whole-body modelling of FSCMRs under actuation via combinations of PM- and EM-generated fields has not been explored.
A Pop-Up Soft Robot Driven by Hydraulic Folded Actuators for Minimally Invasive Surgery
Authors:   College of Aerospace Engineering, Nanjing University of Aeronautics and Astronautics, China, Yang Jianlin , Runciman Mark ,   Hamlyn Centre, Imperial College London, UK, Avery James ,   Hamlyn Centre, Imperial College London, UK, Sun Zhijun ,   College of Aerospace Engineering, Nanjing University of Aeronautics and Astronautics, China, Mylonas George ,   Hamlyn Centre, Imperial College London, UK
Published: June 2023

The incidence rate of colorectal cancer ranks third among all cancers, which is a serious threat to human health [1]. Endoscopic submucosal dissection (ESD) is an effective endoscopic surgical method for early gastric and colorectal cancers [2]. However, ESD is a procedure with high technical requirements, which brings a higher risk of complications and requires long training for clinicians [3]. Robots are expected to simplify ESD procedures and reduce training time. But there is no standard flexible robotic endoscope at present. Soft robots can potentially offer better adaptability and safer interaction with the environment. As such, they hold great potential in solving the technical challenges of the current minimally invasive surgery (MIS), which are difficult to be solved by rigid robots. Here we demonstrate an inflatable robot which is largely made of flexible plastic film. In the deflated state, it is easy to collapse, fold and roll into a small size, promising easier delivery by a carrier endoscope to the proximal colon. After reaching the target site, the robot is inflated and the surgery is performed. This work is based on the inflatable Cyclops robot [4][5]. However, small folded hydraulic actuators are used to replace the contraction-based pouch actuators used in [5], which have a larger size. The anchor points of the cables with planar layout replace the spatial layout in [4], which reduces the axial size of the robot, allowing it to pass through the colon bends more easily. Folded actuators made of an airbag are flexible and adaptable [6]. The actuator volume is very small under deflated condition, but it can achieve large deformation after inflation. The proposed actuator uses a folded chamber to pull the cable to produce a large displacement without the need of displacement amplification mechanisms. In the deflated state, the length of soft scaffold of the robot is about 65mm, and the overall size of the robot is 100mm ×6mm×20mm. In the state of inflation, the soft scaffold deploys into a hexagonal prism with a length of 55mm, and the bottom side length of the prism is 30mm. The tip workspace of the robot can reach 40mm in all three directions of the local coordinate system.
Development of an Untethered Inflatable Capsule Robot for Stricture Dilation - a Preliminary Study
Authors:   Automatic Control and Systems Engineering Department, The University of Sheffield, UK, Esendag Kaan , McAlindon Mark ,   Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK, Rus Daniela ,   Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, United States, Miyashita Shuhei ,   Automatic Control and Systems Engineering Department, The University of Sheffield, UK, Damian Dana ,   Automatic Control and Systems Engineering Department, The University of Sheffield, UK
Published: June 2023

Capsule robots have the potential to provide untethered access to the gastrointestinal tract and perform simple tasks that could reduce invasiveness and provide a better alternative method of access than an endoscopy or colonoscopy. Current state-of-the-art for capsule robots already fulfil the need for inspection, but there is a gap that exists between the capabilities of current capsule robots when compared with those of endoscopic surgical robots [1]. For example, strictures occurring throughout the gastrointestinal tract due to inflammation or Crohn’s disease needs a source of pressure to break the strained organ and unblock the stenosis. Additionally, access to the distal parts of the small intestine remains difficult even for Endoscopic Balloon Dilation (EBD). A capsule robot with an actuator that can provide volumetric expansion could fulfil both of these needs, i.e., opening the lumen at a stricture site, anchoring for surgical procedures in difficult-to-access GI areas. This paper presents a capsule robot prototype, of 14 mm diameter and 28 mm length, with a soft internal actuator capable of providing wireless volumetric expansion as seen in Fig. 1. The inflation of the capsule is based on the chemical reaction between NaHCO3 and C6 H8 O7 , which releases carbon dioxide (CO2 ) gas. The inflation of the internal actuator is wirelessly controlled through magnetic induction which generates thermal energy. The capsule also deflates over time due to the CO2 being slowly reabsorbed into water as carbonic acid (H2 CO3 ). Mechanisms that can provide wireless expansion, such as using a wireless electronic module with a pump to inflate and deflate a balloon, using liquid-to-gas transition of chemicals as the source of expansion, or using chemical reactions that release gas as a source of pressure have been previously presented [2]–[4]. However, the method of actuation should not require operating at temperatures that can cause permanent tissue damage [5]. In the current work the generated thermal energy is below limits of hyperthermia [5].The chemicals and the dissolution medium used are all safe for ingestion, making them suitable for gastroin- testinal applications, and the capsule design provides a novel and promising alternative for ballooning operations without using electronics or a battery.
Real-Time Cognitive Workload States Recognition from Ultra Short-Term ECG Signals on Trainee Surgeons Using 1D Convolutional Neural Networks
Authors:   Imperial College London, UK, Jin Kaizhe , Naik Ravi ,   Imperial College London, UK, Solis Adrian Rubio ,   Imperial College London, UK, Mylonas George ,   Imperial College London, UK
Published: June 2023

Surgery is a mentally demanding task that is focused on patient safety and requires the precise execution of motor control and decision making in a timely manner. Episodes of high Cognitive Workload (CWL) induced by stressors or distractions have been shown to lead to inferior performance potentially compromising patient safety [1]. We have proposed a promising CWL assess- ment platform utilising a wide range of physiological sensors [2]. However, there are some disadvantages associated with a complex multimodal sensing design, including high device cost, long set up time and the dis- comfort caused by wearing multiple wearable sensors for long periods during surgery. To address this problem, the proposed one-dimensional convolutional neural network (1D-CNN) model discussed here, offers an alternative solution to recognising CWL states, achieving satisfac- tory performance (91.3% accuracy) with the use of a wireless ECG sensor alone, showing great potential for widespread deployment in the operating room (OR). MATERIALS AND METHODS
A Novel Handheld Robotic System for Endoscopic Neurosurgery: A Cadaver Pilot Study
Authors:   Wellcome/EPSRC Centre for Surgical and Interventional Sciences (WEISS), University College London (UCL), London, UK, Dimitrakakis Emmanouil , Dwyer George ,   Wellcome/EPSRC Centre for Surgical and Interventional Sciences (WEISS), University College London (UCL), London, UK, Newall Nicola ,   National Hospital for Neurology and Neurosurgery, London, UK, Khan Danyal ,   National Hospital for Neurology and Neurosurgery, London, UK, Marcus Hani ,   National Hospital for Neurology and Neurosurgery, London, UK, Stoyanov Danail ,   Wellcome/EPSRC Centre for Surgical and Interventional Sciences (WEISS), University College London (UCL), London, UK
Published: June 2023

Neurosurgery has always been in need of adapting new technologies. Endoscopic Endonasal Transsphenoidal Surgery (EETS), a common minimally invasive neurosurgical technique, is especially in the need of innovation. This approach is performed via an anterior sphenoidotomy and aims at the removal of sellar and parasellar lesions with the use of an endoscope and rigid instruments [1]. Although a promising alternative to open brain-surgery, it comes with its limitations, namely the lack of instrument articulation and the constrained operative space of the nasal channel [2]. This work presents a novel handheld robotic instrument for endoscopic neurosurgery. The system is comprised of a series of articulated spherical-joint tendondriven 3𝑚𝑚 end-effectors, paired with an ergonomically designed handheld controller which does not require the shaft to be resting against a trocar-port. This first-of-itskind robotic instrument for neurosurgery was evaluated during a cadaver pilot study with preliminary results suggesting feasibility within a clinical context.
Developing a personalised inflatable rectal obturator
Authors:   The Hamlyn Centre, Department of Surgery and Cancer, Imperial College London, London, UK, Maleki Aryan Niknam , Runciman Mark ,   The Hamlyn Centre, Department of Surgery and Cancer, Imperial College London, London, UK, Thompson Alexander ,   The Hamlyn Centre, Department of Surgery and Cancer, Imperial College London, London, UK, Murray Julia ,   The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Dept of Radiotherapy and Imaging, London, UK, Mylonas George ,   The Hamlyn Centre, Department of Surgery and Cancer, Imperial College London, London, UK
Published: June 2023

Rectal obturators like ProSpare and endorectal balloons (ERB) may reduce prostate motion during prostate radiotherapy, improving dosimetry of the target volume and surrounding healthy tissue [1-3]. ERBs are inflatable and well-tolerated, but an accumulation of gas proximal to the device can decrease its efficacy in reducing prostate motion [4]. ProSpare’s angled shape allows it to “lock in” at the anorectal angle and is made of high-impact ABS to reduce prostate motion. However, initial data from the POPS trial (NCT02978014) has shown 7/19 (37%) of patients could not insert ProSpare at their initial attempt, possibly because of the anal sphincter not stretching enough to accommodate the device. To address this issue, we present a deployable or inflatable device that becomes rigid and angled like ProSpare upon deployment, aiming to improve outcomes by reducing motion during prostate radiotherapy, while achieving good tolerance for nearly all patients. Laser welding was used to create inflatable chambers, forming ridges that provide rigidity once inflated [5]. Here, we report initial designs and validations of rigidity
An application of SlicerROS2: Haptic latency evaluation for virtual fixture guidance in breast conserving surgery
Authors:   Queen's University, Canada, Connolly Laura , Deguet Anton ,   Johns Hopkins University, US, Ungi Tamas ,   Queen's University, Canada, Kumar Aravind ,   Johns Hopkins University, US, Lasso Andras ,   Queen's University, Canada, Sunderland Kyle ,   Queen's University, Canada, Krieger Axel ,   Johns Hopkins University, US, Leonard Simon ,   Johns Hopkins University, US, Fichtinger Gabor ,   Queen's University, Canada, Mousavi Parvin ,   Queen's University, Canada, Taylor Russell H. ,   Johns Hopkins University, US
Published: June 2023

Breast conserving surgery (BCS) is a surgical intervention for breast cancer where the surgeon resects the primary tumor and preserves the surrounding healthy tissue. These procedures have a high failure rate because it is often difficult to localize breast tumor boundaries intraoperatively. Emerging surgical robotic technology demonstrates promise for addressing such challenges. Hand-over-hand control is a design concept that involves cooperative handling of a surgical instrument by the surgeon and a robot. These systems can be used to reduce hand-tremor, improve dexterity, and implement virtual guidance [1]. One way to do this is with a virtual fixture (VF) which is a computer-generated constraint that is communicated from robotic devices to human operators via force and position signals [2]. A forbidden region VF can be used to enforce a safety region or “no-go zone” that can prevent the operator from damaging delicate or critical anatomy. In this paper, we use an Omni Bundle robot (formerly known as a Phantom Omni) to introduce haptic feedback in BCS. In doing so, we demonstrate a new and simplified approach to implementing a VF using open-source software tools such as 3D Slicer and robot operating system (ROS). We also make use of an existing surgical navigation platform that is used for BCS and describe how to deploy this system to encourage adaptation to other clinical applications.
Optimizing Heart Valve Surgery with Model-Free Catheter Control
Authors:   Politecnico di Milano, Italy, Bicchi Anna , Fati Francesca ,   Politecnico di Milano, Italy, Fati Mariagrazia ,   Politecnico di Milano, Italy, Votta Emiliano ,   Politecnico di Milano, Italy, De Momi Elena ,   Politecnico di Milano, Italy
Published: June 2023

Currently, cardiac catheters for Structural Heart Disease (SHD), are maneuvered manually through the vascular pathway to the chambers of the heart by skilled surgeons. Given the complexity of these maneuvers, we aim at introducing a variable shared autonomy robotic platform for intra-procedural support, by robotizing the commercial MitraClipTM System (MCS). The MCS allows the treatment of mitral regurgitation by percutaneously implanting a clip that grasps the valve leaflets. In light of that, the aim of this paper is to propose a position control strategy that guarantees good trajectory tracking. In the field of control of catheter robots, having a good model is a key point in order to obtain reliable control. A model-based approach on the assumption of a constant curvature (CC) model has been proposed by [1]. The CC model, however, involves simplifying assumptions about catheter shape and external loading, moreover, nonlinearities of the catheter (as dead zones and tendon slack) are usually neglected. In order to include such nonlinearities, the Cosserat Rod model has been exploited by [2]; however, this complicates the model and involves high computational costs which makes the control not feasible in real-time. Modelfree controllers based on machine learning represent a valid alternative to analytical models, considering their potential in model uncertainties that strongly influence soft robot control [3]. In [4] they proposed a formulation for learning the inverse kinematics of a continuum manipulator while integrating the end-effector position feedback. We developed a Neural Network based Inverse Kinematic Controller (IKC) shown in the scheme in Fig. 1. The inputs of the net are the target tip pose, 𝒑¯𝑘+1 at the next time instant, the current servomotors position, 𝒒𝑘 , and the current tip pose 𝒑𝑘 , while the output is the position of the servomotor at the next time instant 𝒒𝑘+1 . Our goal is to build a robust control starting from the state-of-the-art control applied to the MCS presented in [5] by X. Zhang et all and adding to it the control also in the orientation of the tip. Moreover, we characterize the control model proposed, by testing its robustness at different motors’ velocities.
Percutaneous focal tumour ablation assisted by mini-stereotactic frame: proof-of-concept
Authors:   Western University, Canada, Cambranis-Romero Joeana , Peters Terry ,   Western University/Robarts Research Institute, Canada, Chen Elvis ,   Western University/Robarts Research Institute, Canada
Published: June 2023

The success of percutaneous focal tumour ablation largely depends on precise needle placement: an abla- tion zone, typically described as an ellipsoid centred on the ablation active needle tip, needs to completely enclose the tumour with a positive margin [1]. To facilitate precise needle placement, many types of needle guidance devices were developed, providing mechanical support and improving the targeting of the lesion [2]. Designs of these guiding apparatuses vary, including those that are rigidly attached to the Ultrasound (US) probe, enforcing the “in-plane” needle insertion. This type of targeting device forcefully maintains the needle within the US plane with the potential to improve the targeting accuracy, but at the same time, limits the entry angles of the needle and US probe placement. Other designs include mechanical and robotic (i.e., with electronic characteristics) guiders, which are large and need to be attached/positioned close to the surgical table, potentially restricting the range of movement of the healthcare providers (i.e., physicians and nurses) [3]. In this paper, we present a proof-of-principle surgi- cal navigation system based on a disposable mini- stereotactic frame, which provides mechanical support for precise needle guidance. The pose of this stereotactic needle guider is magnetically tracked and calibrated, allowing the surgeon to visualize the potential needle trajectory in a 3D Virtual Reality (VR) environment prior to needle insertion.
Losing Focus: Can It Be Useful in Robotic Laser Surgery?
Authors:   Worcester Polytechnic Institute, US, Pacheco Nicholas , Garje Yash ,   Worcester Polytechnic Institute, United US, Rohra Aakash ,   Worcester Polytechnic Institute, US, Fichera Loris ,   Worcester Polytechnic Institute, US
Published: June 2023

Lasers are an essential tool in modern medical practice, and their applications span a wide spectrum of specialties. In laryngeal microsurgery, lasers are frequently used to excise tumors from the vocal folds [1]. Several research groups have recently developed robotic systems for these procedures [2-4], with the goal of providing enhanced laser aiming and cutting precision. Within this area of research, one of the problems that has received considerable attention is the automatic control of the laser focus. Briefly, laser focusing refers to the process of optically adjusting a laser beam so that it is concentrated in a small, well-defined spot – see Fig. 1. In surgical applications, tight laser focusing is desirable to maximize cutting efficiency and precision; yet, focusing can be hard to perform manually, as even slight variations (< 1 mm) in the focal distance can significantly affect the spot size. Motivated by these challenges, Kundrat and Schoob [3] recently introduced a technique to robotically maintain constant focal distance, thus enabling accurate, consistent cutting. In another study, Geraldes et al. [4] developed an automatic focus control system based on a miniaturized varifocal mirror, and they obtained spot sizes as small as 380 μm for a CO2 laser beam. Whereas previous work has mainly dealt with the problem of creating – and maintaining – small laser spots, in this paper we propose to study the utility of defocusing surgical lasers. In clinical practice, physicians defocus a laser beam whenever they wish to change its effect from cutting to heating – e.g., to thermally seal a blood vessel [5]. To the best of our knowledge, no previous work has studied the problem of robotically regulating the laser focus to achieve controlled tissue heating, which is precisely the contribution of the present manuscript. In the following sections, we first briefly review the dynamics of thermal laser-tissue interactions and then propose a controller capable of heating tissue according to a prescribed temperature profile. Laser-tissue interactions are generally considered hard to control due to the inherent inhomogeneity of biological tissue [6], which can create significant variability in its thermal response to laser irradiation. In this paper, we use methods from nonlinear control theory to synthesize a temperature controller capable of working on virtually any tissue type without any prior knowledge of its physical properties.
Design and Evaluation of a Sealing Valve Mechanism for Stoma Patients
Authors:   School for Biomedical Engineering and Imaging Sciences, King’s College London, UK, Al-Hamadani Maleeha , Seneci Carlo ,   School for Biomedical Engineering and Imaging Sciences, King’s College London, UK, Norton Christine ,   Florance Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s college, UK, Botha Abrie ,   Guy’s and St Thomas’ Hospital NHS Foundation Trust, UK, UK, Jha Prashant ,   School for Biomedical Engineering and Imaging Sciences, King’s College London, UK, Ourselin Sebastien ,   School for Biomedical Engineering and Imaging Sciences, King’s College London, UK
Published: June 2023

Bowel cancer and other bowel conditions are becoming increasingly dominant in the UK across all age groups. Every year, around 21,000 patients undergo stoma formation surgery, leading to either a temporary or permanent stoma being fitted [1]. Stoma management presents many complications that lead to extensive physical and psychological burdens, including aesthetics, leakage, production of unpleasant odour, skin blistering and infection, all contributing towards a more complex social life [2][3]. The current state-of-the-art technology failed to produce a solution that overcomes the aforementioned complications and research in the field is only addressing some complications without providing a solution to address them all. In this study, we have designed and manufactured a proof-of-concept prototype of a controllable valve, aiming to overcome the physical and psychological burden by eliminating the use of an actual stoma bag and allowing the patient to have full control over the stool release. With the sealable valve, stoma patients would be able to improve their quality of life. The proof-of-concept valve is then evaluated through two different experiments for validating the leakage-free mechanism, one through a static experiment and the second through a dynamic motion experiment.
Toward Robotic Craniosynostosis Surgery: Development of a Novel Articulated Minimally Invasive Bone Cutting Tool
Authors:   The University of Toronto, Canada, Law Jones , Podolsky Dale ,   The University of Toronto, Canada
Published: June 2023

Craniosynostosis involves premature fusion of the cranial sutures resulting in an abnormal head shape and functional sequelae such as raised intracranial pressure [1]. Surgery is required and can be performed open or endoscopically. Both approaches require osteotomies to either remove the fused suture or to remodel the bone. The endoscopic approach is performed using smaller incisions and has reduced blood loss, operative time and cost in comparison to the open approach [2]. However, with the endoscopic approach, the osteotomy extent is limited due to reduced access using currently available surgical tools [3]. As a result, the patient is required to wear a molding helmet post-operatively and only certain types of craniosynostosis can be treated using this approach. Conventional instruments for craniosynostosis surgery consists of straight rigid tools. They are simple and intuitive to manipulate with open accessibility, but are difficult to use in restricted areas. Furthermore, the unique curvature of the skull limits the reach of the instruments during craniosynostosis surgery. A novel steerable instrument would allow performance of extensive osteotomies on the skull using key-hole incisions. Such a device would eliminate the need for a molding helmet and can be used to treat all types of craniosynostosis. The following paper describes a novel articulating bone cutting device specifically designed for keyhole craniosynostosis surgery that can also be utilized for any procedure requiring a craniotomy. This device would represent a paradigm shift in minimal access cranial surgery.
Design and Calibration of a Robot-Driven Catheter Actuation System
Authors:   Western University, Canada, Feizi Navid , Pedrosa Filipe C. ,   Western University, Canada, Arefinia Elaheh ,   Western University, Canada, Jayender Jagadeesan ,   Harvard Medical School, US, Patel Rajni V. ,   Western University, Canada
Published: June 2023

Flexible steerable tendon-driven systems are crucial in medical interventions, due to their ease of access to narrow spaces and safe operation [1]. Two examples of these systems are ablation and intra-cardiac echocardiog- raphy (ICE) catheters, used for non-invasive ultrasound imaging and ablation in cardiac procedures inside the heart. However, precise positioning of these devices to obtain optimal anatomical views is challenging for the cardiologist and requires specialized training [2]. Custom-made tendon-driven robots have been developed and modeled using Cosserat rod theory [3], [4]. How- ever, most of these efforts have been directed towards creating new flexible robots with known parameters rather than adapting pre-existing tendon-driven systems, such as conventional ICE or ablation catheters. In [5] a 4-DoF robot was developed to manipulate and con- trol a 4-tendon ICE catheter by actuating the knobs on the catheter handle. Nevertheless, the dynamics of the catheter’s knob introduce friction and dead zones in the system. In our study, we developed a novel robot for catheter control and experimentally determined the parameters of a 2-DoFs quasi-static model of the ICE catheter. Our design eliminates the complexity of catheter knob dynamics by employing direct tendon actuation, distinguishing it from existing literature. The proposed robot will later be used in a visual-servoing mode to autonomously follow an ablation catheter.
Handheld Concentric Tube Robot for Percutaneous Nephrolithotomy
Authors:   Western University, Canada, Pedrosa Filipe , Zhang Ruisi ,   Intuitive Surgical, US, Feizi Navid ,   Western University, Canada, Sacco Dianne ,   Massachussets General Hospital, US, Patel Rajni ,   Western University, Canada, Jayender Jagadeesan ,   Harvard Medical School, US
Published: June 2023

The field of continuum robotics continues to advance rapidly, giving these manipulators potential to change the paradigm of minimally invasive medical surgery (MIS) in a near future. As MIS techniques are refined to improve recovery and cosmesis and reduce invasiveness and co-morbidity, continuum robot requirements in MIS applications have become ever stricter. One such application is Percutaneous Nephrolithotomy (PCNL), a first-choice minimally invasive urological procedure for the extraction of large renal calculi (kidney stones) > 2 cm. The standard of care in PCNL entails the percutaneous insertion of a nephroscope via a small incision in the lumbar or lateral abdominal wall regions, followed by accessing a renal calyx to allow direct manipulation of the stone using specialized lithotripsy devices such as ultrasonic or laser equipment, which aids in reducing blood loss during survery [1]. This study proposes a lightweight, compact handheld Concentric Tube Robot (CTR) as an alternative to the conventional straight and rigid PCNL tools. Unlike Girerd et al. [2] our design was conceived solely for the use in PCNL. Our envisaged device aims to provide an alternative to the conventional rigid nephroscopes by flexibly maneuvering the handheld CTR through a prescribed renal calyx and reaching clinical targets while safeguarding sensitive anatomical structures, as illustrated in Fig. 1. Additionally, it is designed to deliver an energy source through its lumen to the renal calculi for laser ablation.
Surface-Enhanced Raman Spectroscopy and Transfer Learning Toward Accurate Reconstruction of the Surgical Zone
Authors:   Duke University, US, Raman Ashutosh , Odion Ren ,   Duke University, US, Yamamoto Kent ,   Duke University, US, Ross Weston ,   Duke University, US, Codd Patrick ,   Duke University, US, Vo-Dinh Tuan ,   Duke University, US
Published: June 2023

Raman spectroscopy is a photonic modality defined as the inelastic backscattering of excitation coherent laser light. It is particularly beneficial for rapid tissue diagnosis in sensitive intraoperative environments like those involving the brain, due to its nonionizing potential, point-scanning capability, and highly-specific spectral fingerprint signatures that can characterize tissue pathology [1]. While Raman scattering is an inherently weak process, Surface-Enhanced Raman Spectroscopy (SERS), which is based on the use of metal nanostructure surfaces to amplify Raman signals, has become a compelling method for achieving highly specific Raman spectra with detection sensitivity comparable to conventional modalities such as fluorescence [2]. A unique plasmonics-active nanoplatform, SERS gold nanostars (GNS) have previously been designed in our group to accumulate preferentially in brain tumors [2]. Raman detection, when combined with machine learning and robotics, stands to enhance the diagnosis of ambiguous tissue during tumor resection surgery, with the potential to improve extent-of-resection and rapidly reconstruct the dynamic surgical field. Here we demonstrate preliminary results from the use of a SERS-based robotics platform to efficiently recreate a tumor embedded in healthy tissue, which is modeled here as a GNS-infused phantom. Transfer learning, specifically through use of the open-source RRUFF mineral database, is employed here to address the dearth of collected biomedical Raman data [3].
Breast surface reconstruction utilising autonomous robotic assisted ultrasound image acquisition
Authors:   University of Twente, Netherlands, de Groot A.G. , Groenhuis V. ,   University of Twente, Netherlands, Stramigioli S. ,   University of Twente, Netherlands, Siepel F.J. ,   University of Twente, Netherlands
Published: June 2023

One in eight females will be diagnosed with breast cancer in their lifetime, making it the most diagnosed cancer globally [1]. Three phases are essential for the outcome of breast cancer; early detection, accurate diag- nosis and treatment. Magnetic resonance imaging (MRI) has proven to be highly sensitive in detecting possible tu- mors lesions compared to other image modalities. How- ever, ultrasound (US) guided biopsies are the standard and biopsies on MRI detected lesions is challenging, because these lesions may not be visible on US images. Registration of pre-operative MRI with the intra- operative US combines the benefits of both imaging modalities and subsequently improve tumor localisation. Therefore, this work presents an US image-based sur- face reconstruction based on autonomous acquired US images to increase the accuracy of MRI/US registration. Thereby the proposed work eliminates the need for inter- sensor calibration as would be needed if stereo camera- based, depth camera-based or marker-based breast sur- face reconstruction would be used.