Patent Publication Number: US-2022211977-A1

Title: Hydraulically driven surgical apparatus

Description:
RELATED APPLICATION 
     This application claims priority to U.S. Provisional Patent Application No. 62/397,011 filed on Sep. 20, 2016 and entitled NEUROSURGICAL OUTCOMES WITH HYDRAULIC DRIVEN, MINIMALLY-INVASIVE MICRO ACTUATORS, the disclosure of which is incorporated herein by reference in its entirety. 
    
    
     TECHNICAL FIELD 
     The subject matter disclosed herein relates generally to endovascular neurosurgery and more specifically to a hydraulically steered surgical apparatus for use during endovascular neurosurgery. 
     BACKGROUND 
     Endovascular neurosurgery may be conducted to prevent, diagnose, and/or treat a variety of neurological disorders including, for example, cerebral aneurysms, arteriovenous malformation, arteriovenous fistulas, carotid stenosis, strokes, spinal malformations, vasospasms, and/or the like. For example, endovascular embolization is a type of endovascular neurosurgery for treating cerebral aneurysms. During the procedure, a catheter may be moved through a patient&#39;s blood vessel to the site of the aneurysm in the patient&#39;s brain. Upon reaching the aneurysm, the catheter may be used to deposit one or more substances for sealing the aneurysm including, for example, metal coils, plastic particles, glue, foam, balloons, and/or the like. The same and/or similar procedure may also be used to treat other disorders including, for example, arteriovenous malformation, arteriovenous fistulas, and/or the like. 
     SUMMARY 
     Articles of manufacture, including a hydraulically driven surgical apparatus, and methods for steering the hydraulically driven surgical apparatus are provided. A hydraulically driven surgical apparatus may include a tube enclosing a first channel filled with a first fluid. A first change in a fluid pressure in the first channel may trigger a first deformation of the tube. The first deformation of the tube may perform an action associated with a surgical procedure 
     In some variations, one or more features disclosed herein including the following features can optionally be included in any feasible combination. The first channel may be a channel traversing laterally through at least a portion of an interior of the tube. At least a portion of the tube may bend in response to the change in the fluid pressure. The first channel may form a helix. At least a portion of the tube may twist in response to the change in the fluid pressure 
     In some variations, the tube may further enclose a second channel. The second channel may be filled with a second fluid. A second change in a pressure of the second fluid in the second channel may trigger the first deformation and/or a second deformation of the tube. The second deformation may occur in a different portion of the tube, have a different orientation, and/or have a different degree as the first deformation. The second channel may provide a passageway for a substance, a device, and/or a tool. The first channel may have a different shape and/or dimension as the second channel. The first channel may traverse a different portion of the tube as the second channel. 
     In some variations, the first fluid may include a contrast agent for increasing a visibility of the tube to enable medical imaging. The action may include aligning the tube with a treatment location of the surgical procedure. The action may include advancing and/or retracting the tube. The tube may be coupled with a tool and the first deformation of the tube may move the tool to perform the action. The tool may be a gripper, a drill, a cauterizer, and/or a cutter. 
     In some variations, the apparatus may be coupled with a controller configured to at least: receive, from a user, one or more inputs; and change, based at least on the one or more inputs, the fluid pressure in the first channel. The controller may include at least one fluid chamber coupled with the first channel. The controller may change the fluid pressure in the first channel by at least adjusting a compression against the at least one fluid chamber. The one or more inputs may include a mechanical input, a digital input, and/or a haptic input. 
     In some variations, the tube may be formed from a soft and/or deformable material. The soft and/or deformable material may include a contrast agent for enhancing a visibility of the tube to enable medical imaging. 
     A method for steering a hydraulically driven surgical apparatus may include changing a fluid pressure in a channel filled with a fluid. The channel may be enclosed by a tube comprising the hydraulically driven surgical apparatus. The change in the fluid pressure may trigger a deformation of the tube. The deformation of the tube may perform an action associated with a surgical procedure. 
     In some variations, the fluid pressure in the channel may be changed by at least adjusting a compression against a fluid chamber coupled with the channel. The action may include aligning the tube with a treatment location of the surgical procedure. The deformation of the tube may perform the action by at least actuating a tool coupled with the tube. 
     In some variations, one or more inputs may be received from a user. The fluid pressure in the channel may be changed based at least on the one or more inputs. The one or more inputs may include a mechanical input, a digital input, and/or a haptic input. 
     A hydraulically driven surgical apparatus may include means for changing a fluid pressure in a channel filled with a fluid. The channel may be enclosed by a tube comprising the apparatus. The change in the fluid pressure may trigger a deformation of the tube. The deformation of the tube may perform an action associated with a surgical procedure. 
     The details of one or more variations of the subject matter described herein are set forth in the accompanying drawings and the description below. Other features and advantages of the subject matter described herein will be apparent from the description and drawings, and from the claims. While certain features of the currently disclosed subject matter are described for illustrative purposes in relation to endovascular neurosurgery, it should be readily understood that such features are not intended to be limiting. The claims that follow this disclosure are intended to define the scope of the protected subject matter. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of this specification, show certain aspects of the subject matter disclosed herein and, together with the description, help explain some of the principles associated with the subject matter disclosed herein. In the drawings, 
         FIG. 1A  depicts a perspective view of a cross section of a hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 1B  depicts a deformation of a hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 1C  depicts another configuration for a hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 1D  depicts another configuration for a hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 1E  depicts another configuration for a hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 1F  depicts another configuration for a hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 1G  depicts a graph illustrating stress-strain curves for different materials, in accordance with some example embodiments; 
         FIG. 2  depicts a controller for a hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 3A  depicts an extrusion technique for fabricating a hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 3B  depicts another assembly for fabricating a hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 3C  depicts another assembly for fabricating a hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 4A  depicts a molding technique for fabricating the hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 4B  depicts a molding technique for fabricating the hydraulically driven surgical apparatus, in accordance with some example embodiments; 
         FIG. 5  depicts a flowchart illustrating a process for hydraulically driven endovascular neurosurgery, in accordance with some example embodiments; and 
         FIG. 6  depicts a block diagram illustrating a computing system, in accordance with some example embodiments. 
     
    
    
     When practical, similar reference numbers denote similar structures, features, or elements. 
     DETAILED DESCRIPTION 
     A guidewire is typically used for moving a catheter through a blood vessel to a treatment location such as, for example, the site of aneurysm and/or the like. Because the aneurysm extrudes from the side of the blood vessel, the guidewire may include a flanged tip for aligning the catheter within the dome of the aneurysm. However, a conventional guidewire cannot be steered through the complex geometry of a blood vessel. In particular, the flanged tip has a fixed curvature that cannot be changed in vivo. Thus, a conventional guidewire is likely to rupture the walls of the blood vessel while being maneuvered through the blood vessel. 
     In some example embodiments, a hydraulically driven surgical apparatus may be used for moving a catheter through a blood vessel. Instead of a flanged tip having a fixed curvature, the hydraulically driven surgical apparatus may be formed from a soft tube, which may be deformed in vivo in order to steer the surgical apparatus into alignment with a treatment location. For example, the tip and/or other portions of the tube may be bent, via hydraulic forces, to align within the dome of an aneurysm. The absence of a flanged tip and the soft construction of the hydraulically driven surgical apparatus may eliminate the risk of puncturing a blood vessel, thereby increasing the maneuverability of the hydraulically driven surgical apparatus. 
       FIG. 1A  depicts a perspective view of a cross section of a hydraulically driven surgical apparatus  100 , in accordance with some example embodiments. Referring to  FIG. 1A , the surgical apparatus  100  may include a tube  110 . The tube  110  may enclose one or more channels, which may traverse laterally through at least a portion of an interior of the tube  110 . For example, as shown in  FIG. 1A , the tube  110  may enclose a first channel  120 A, a second channel  120 B, and a third channel  120 C. Although the tube  110  is shown to enclose three channels, it should be appreciated that the tube  110  may enclose other quantities of channels. Furthermore, the first channel  120 A, the second channel  120 B, and the third channel  120 C may be have any orientation relative to one another including and/or in addition to, for example, the parallel configuration shown in  FIG. 1A . 
     In some example embodiments, the tube  110  including the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may be formed from a pliable material such as, for example, silicone rubber. The material may include one or more contrast agents such as, for example, tantalum and/or the like, for enhancing the visibility of the tube  110  for medical imaging such as, for example, X-rays and/or the like. It should be appreciated that medical imaging may be performed during a surgical procedure such as, for example, endovascular embolization and/or the like, in order to track the position and/or progress of the surgical apparatus within a patient&#39;s blood vessel. 
     Referring to  FIG. 1A , the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may be filled with a fluid. It should be appreciated that the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may be filled with a fluid instead of a gas in order to minimize the risk for introducing air bubbles into a blood vessel and causing a potentially fatal air embolism. Alternatively and/or additionally, the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may be a lumen that is left as a cavity in order to serve as a passageway for a substance and/or other apparatuses (e.g., guidewires, catheters, hollow tubes, fluid-filled tubes, and/or the like). 
     In some example embodiments, the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may be filled with biocompatible and/or hemocompatible fluid such as, for example, saline and/or the like. Alternatively and/or additionally, the fluid may include one of more contrast agents such as, for example, iodine (I), barium (Ba), and/or the like. It should be appreciated that contrast agents may enhance the contrast of the tube  110  for medical imaging such as, for example, X-rays and/or the like. As such, the inclusion of the contrast agent in the fluid may increase the visibility of the tube  110  within the body, for example, as the tube  110  is being moved through a blood vessel. 
     According to some example embodiments, the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may be configured to respond to changes in fluid pressure by undergoing an axial deformation but not a radial deformation. As used herein, axial deformation may refer to a change in length while radial deformation may refer to a change in diameter. As such, changes in fluid pressure may cause a change in the length of the first channel  120 A, the second channel  120 B, and/or the third channel  120 C. However, changes in fluid pressure may cause a minimal change in the respective diameters of the first channel  120 A, the second channel  120 B, and/or the third channel  120 C. For example, changing the fluid pressure in the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may cause the first channel  120 A, the second channel  120 B, and/or the third channel  120 C to distend and/or contract lengthwise. Meanwhile, the diameter of the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may remain constant notwithstanding the changes in fluid pressure within the first channel  120 A, the second channel  120 B, and/or the third channel  120 C. 
     The changes in the length of the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may cause a deformation of the tube  110 . For example, changing the fluid pressure in the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may trigger the formation of a bend in one or more portions of the tube  110 . To further illustrate,  FIG. 1B  depicts a deformation of the hydraulically driven surgical apparatus  100 , in accordance with some example embodiments. Changing the fluid pressure in different channels and/or different combination of channels may cause a deformation of the tube  110  that differs in type, extent, orientation, and/or the like. For instance, as shown in  FIG. 1B , increasing the fluid pressure in the third channel  120 C may lengthen the third channel  120 C and cause the tube  110  to bend in one direction. Although not shown, it should be appreciated that increasing the fluid pressure in the first channel  110 A and/or the second channel  110 B may cause the tube  110  to bend in other directions. 
     It should be appreciated that the aspect ratio of a channel may be configured to both maximize the channel&#39;s tendency to distend lengthwise and minimize the channel&#39;s tendency to expand in width (or diameter). The relationship between the dimension D of a channel, the strain σ against the channel due to fluid pressure, and the resulting deformation ΔD of the channel is shown by Equation (1) below. It should be appreciated that the dimension D may be the length of the channel or the width of the channel. Meanwhile, ΔD may refer to either a corresponding change in the length of the channel or a change in the width of the channel. As Equation (1) indicates, where the length of the channel is magnitudes larger than the width of the channel, the same quantity of strain σ may trigger a much larger change in the length of the channel than in the width of the channel. 
       Δ D=D×σ   (1)
 
     In some example embodiments, the millimeter scale length of the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may be orders of magnitudes larger than the micrometer scale width of the channels. As such, based on Equation (1), changes in fluid pressure may trigger a change in the length but not in the width of the first channel  120 A, the second channel  120 B, and/or the third channel  120 C. 
     Alternatively and/or additionally, the channel may be formed from a material that prevents an excessive change in the length and/or the width of the channel. For example, in some example embodiments, the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may be formed from a material exhibiting nonlinear elasticity such as, for example, a polymer. To further illustrate nonlinear elasticity,  FIG. 1G  depicts a graph  160  illustrating stress-strain curves for different materials, in accordance with some example embodiments. 
     Referring to  FIG. 1G , the pressure applied against the interior of a channel may be quantified as stress while the channel&#39;s response to the pressure, including by expanding in length and/or width, may be quantified as strain. A change in stress (e.g., Δσ) may trigger a corresponding change in strain (e.g., Δε). The magnitude of the change in strain may depend on whether the channel is formed from a linear elastic material or a non-linear elastic material. 
     As shown in  FIG. 1G , some materials may exhibit linear elasticity, in which case the stress-strain curve for that material may a straight line on the graph  160 . A channel formed from a material having linear elasticity may show a constant increase in strain when subject to a given increment in stress. For instance, the channel may respond to an increment in stress Δσ by showing an increment in strain Δε 1 . Such a channel may continue to expand in length and/or width when subject to growing quantities of stress. By contrast, a channel formed from a material having non-linear elasticity may show a lesser increase in strain when subject to the same increment in stress. For example, the channel may respond to the same increment in stress Δσ by showing a smaller increment in strain Δε 2 . 
     Moreover, a channel formed from a material having non-linear elasticity may have a critical strain ε c , which may be a maximum amount of strain after which point the channel may cease to expand in length and/or in width even as the channel is subject to growing stress. Where the length of the channel is magnitudes larger than the width of the channel, the channel may have a significantly lower critical strain for widthwise expansion than for lengthwise expansion. As such, the channel may continue to distend lengthwise even though the channel has ceased to expand in width. This limit to the channel&#39;s tendency to expand, particularly in width, may prevent a hazardous overexpansion of the tube  110  while the tube  110  is disposed within a blood vessel, for example, during a surgical procedure (e.g., endovascular procedure). 
     In some example embodiments, the deformation of the tube  110  may perform an action associated with a surgical procedure such as, for example, endovascular embolization and/or the like. The action associated with the surgical procedure may include steering the tube  110  into alignment with a treatment location including by, for example, bending the tip and/or other portions of the tube  110  towards the dome of an aneurysm. Alternatively and/or additionally, the action may include advancing and/or retracting at least a portion the tube  110 , and/or actuating a surgical tool (e.g., gripper, cutter, drill, cauterizer, and/or the like) coupled with the surgical apparatus. 
     The responsiveness of the tube  110  to changes in fluid pressure including, for example, the degree, the type, and/or orientation of the deformation exhibited by the tube  110  in response to changes in fluid pressure, may be determined based a number of factors including, for example, the dimensions of the tube  110 , the dimensions of the channels, the shape of the tube  110 , the shape of the channels, the viscosity of the fluid filling the channels, the material forming the tube  110  and/or the channels, and/or the like. 
     To further illustrate, Equations (2) and (3) below illustrate the relationship between the pressure P applied to a channel (e.g., the third channel  120 C) and the deformation of the tube  110  as quantified, for example, by an angle of deflection θ of the tube  110 . 
     
       
         
           
             
               
                 
                   θ 
                   = 
                   
                     
                       ∫ 
                       0 
                       1 
                     
                     ⁢ 
                     
                       
                         
                           
                             d 
                             2 
                           
                           ⁢ 
                           y 
                         
                         
                           d 
                           ⁢ 
                           
                             x 
                             2 
                           
                         
                       
                       ⁢ 
                       ds 
                     
                   
                 
               
               
                 
                   ( 
                   2 
                   ) 
                 
               
             
             
               
                 
                   
                     
                       
                         d 
                         2 
                       
                       ⁢ 
                       y 
                     
                     
                       d 
                       ⁢ 
                       
                         x 
                         2 
                       
                     
                   
                   = 
                   
                     
                       
                         
                           P 
                           ⁢ 
                           
                               
                           
                           ⁢ 
                           π 
                           ⁢ 
                           
                               
                           
                           ⁢ 
                           
                             r 
                             2 
                           
                           ⁢ 
                           d 
                         
                         
                           
                             E 
                             ′ 
                           
                           ⁢ 
                           I 
                         
                       
                       [ 
                       
                         1 
                         + 
                         
                           
                             ( 
                             
                               
                                 d 
                                 ⁢ 
                                 x 
                               
                               
                                 d 
                                 ⁢ 
                                 y 
                               
                             
                             ) 
                           
                           2 
                         
                       
                       ] 
                     
                     
                       3 
                       / 
                       2 
                     
                   
                 
               
               
                 
                   ( 
                   3 
                   ) 
                 
               
             
           
         
       
     
     wherein y=y(x) may be the finite lateral movement of the tube  110 , P may be the pressure applied to the third channel  120 C, r may be a radius of the third channel  120 C, E′ may be a bulk modulus taken from a generalized Mooney-Rivlin model for a material forming the third channel  120 C, I may be a moment of inertia of the tube  110 , and d may be a width or a diameter of the tube  110 . 
       FIG. 1C  depicts another configuration for the hydraulically driven surgical apparatus  100 , in accordance with some example embodiments. Referring to  FIG. 1C , the tube  110  may enclose one or more helix (e.g., spiral in form) channels instead of and/or in addition to the channels shown in  FIGS. 1A-B . For example, as shown in  FIG. 1C , the tube  110  may enclose a fourth channel  130 , which may be a helix channel that traverses laterally through the interior of the tube  110 . The fourth channel  130  may be filled with a fluid. Furthermore, the fourth channel  130  may also respond to changes in fluid pressure by changing in length but not in width. In some example embodiments, the change in fluid pressure in the fourth channel  130  may cause the tube  100  to twist in a spiraling pattern. The twisting of the tube  110  may further cause at least a portion of the tube  110  to advance and/or retract during, for example, a surgical procedure. 
       FIG. 1D  depicts another configuration for the hydraulically driven surgical apparatus  100 , in accordance with some example embodiments. In some example embodiments, the tube  110  may be coupled with one or more surgical tools or tools such as, for example, a gripper, a cutter, a drill, a cauterizer, and/or the like. 
     The motion and/or the deformation of the tube  110  may actuate and/or maneuver the surgical tool. For instance, as shown in  FIG. 1D , the tip of the tube  110  may include a gripper. As noted, changes in fluid pressure in the first channel  120 A, the second channel  120 B, the third channel  120 C, and/or the fourth channel  130 , may cause a deformation in one or more portions of the tube  110 . This deformation may further actuate the surgical tools coupled with the tube  110 . For instance, deforming one or more portions of the tube  110  may cause the jaws of the gripper to open and/or to close. In some example embodiments, the jaws of the gripper may be opened and/or closed to perform a variety of actions including, for example, suturing and/or the like. 
       FIG. 1E  depicts another configuration for the hydraulically driven surgical apparatus  100 , in accordance with some example embodiments. Referring to  FIG. 1E , the tube  110  may enclose both straight channels and/or helix channels including, for example, the first channel  120 A, the second channel  120 B, the third channel  120 C, and/or the fourth channel  130 . It should be appreciated that the first channel  120 A, the second channel  120 B, the third channel  120 C, and/or the fourth channel  130  may have the same and/or different dimensions including, for example, channel length, channel diameter, channel height, channel width, and/or the like. 
     To further illustrate,  FIG. 1E  shows the first channel  120 A, the second channel  120 B, the third channel  120 C, and/or the fourth channel  130  as having different lengths. For example, the third channel  120 C may have a same length as the tube  110  and may therefore extend the entire length of the tube  110  from one end of the tube  110  to the other end of the tube  110 . By contrast, the first channel  120 A, the second channel  120 B, the third channel  120 C, and/or the fourth channel  130  may have varying lengths and may therefore start and/or terminate at different points along the length of the tube  110 . 
     Alternatively and/or additionally, the first channel  120 A, the second channel  120 B, the third channel  120 C, and/or the fourth channel  130  may have different diameters. For example, the first channel  120 A may have a first diameter d 1 , which may be wider and/or more narrow than a second diameter d 2  of the second channel  120 B, a third diameter d 3  of the third channel  120 C, and/or a fourth diameter d 4  of the fourth channel  140 . 
     Furthermore, the dimensions of a channel may change. For instance, the diameter, height, and/or width of a channel may taper and/or expand at one or more points along the length of the channel. To further illustrate,  FIG. 1E  shows that a first portion of the first channel  120 A may have the first diameter d 1  while a second portion of the first channel  120 A may have a fifth diameter d 5  that is different than the first diameter d 1 . 
     Referring again to  FIG. 1E , it should be appreciated that the tube  110  may split into multiple branches including, for example, a first branch  140 A and a second branch  140 B. Some channels may extend through one branch of the tube  110  while other channels may extend through a different branch of the tube  110 . For example, as shown in  FIG. 1E , the first channel  120 A and the second channel  120 B may extend through the first branch  140 A of the tube  110  whereas the third channel  120 C may extend through the second branch  140 B of the tube  110 . 
       FIG. 1F  depicts another configuration for the hydraulically driven surgical apparatus  100 , in accordance with some example embodiments. In some example embodiments, the tube  110  as well as the channels enclosed by the tube  110  may have any shape. For instance, the tube  110  and/or the enclosed channels may be circular. Alternatively and/or additionally, the tube  110  and/or the enclosed channels may be any type of polygon including, for example, equilateral polygons, regular polygons, non-equilateral polygons, non-regular polygons, and/or the like. 
     To further illustrate,  FIG. 1F  shows a cross section of the surgical apparatus  100 . As shown in  FIG. 1F , the tube  110  may be hexagonal and/or a different shape. Meanwhile, the first channel  120 A may be triangular and/or a different shape, the second channel  120 B may be circular and/or a different shape, and the third channel  120 C may be rectangular and/or a different shape. It should be appreciated that shape of the tube  110  and/or any channel enclosed therein may change at various points along their respective lengths. For example, a first portion of the tube  110  may be one shape (e.g., hexagonal) while a second portion of the tube  110  may be a different shape (e.g., circular). 
       FIG. 2  depicts a controller  200  for the hydraulically driven surgical apparatus  100 , in accordance with some example embodiments. In some example embodiments, the surgical apparatus  100  may be coupled with the controller  200 , which may be configured to steer the tube  110  of the surgical apparatus  100 . For instance, as noted, the tube  110  may be steered, via hydraulic forces, into alignment with a treatment location such as, for example, the site of an aneurysm and/or the like. 
     Referring to  FIG. 2 , the controller  200  may include one or more fluid chambers including, for example, a first fluid chamber  210 A, a second fluid chamber  210 B, and a third fluid chamber  210 C. Each fluid chamber may be filled with a liquid and may be coupled with a channel in the tube  110  of the surgical apparatus  100 . For example, as shown in  FIG. 2 , the first fluid chamber  210 A may be coupled with the first channel  120 A, the second fluid chamber  210 B may be coupled with the second channel  120 B, and the third fluid chamber  210 C may be coupled with the third channel  120 C. In some example embodiments, the fluid pressure in a channel may be controlled via the corresponding fluid chamber. For instance, the fluid pressure in the first channel  120 A may be increased by at least compressing the first fluid chamber  210 A. The fluid pressure in the second channel  120 B may be increased by at least compressing the second fluid chamber  210 B. Alternatively and/or additionally, the fluid pressure in the third channel  120 C may be increased by at least compressing the third fluid chamber  210 C. 
     In some example embodiments, the controller  200  may be configured to receive one or more inputs. For example, a user may provide mechanical, digital, and/or haptic inputs indicative of a desired deformation in the tube  110 . Alternatively and/or additionally, the user may provide inputs indicative of a desired change in the fluid pressure in the first channel  120 A, the second channel  120 B, and/or the third channel  120 C. Meanwhile, the controller  200  may respond to these inputs by at least applying compression against the first fluid chamber  210 A, the second fluid chamber  210 B, and/or the third fluid chamber  210 C. The controller  200  may apply sufficient compression to achieve the desired deformation in the tube  110 . Alternatively and/or additionally, the controller  200  may apply sufficient compression to achieve the desired change in fluid pressure in the first channel  120 A, the second channel  120 B, and/or the third channel  120 C. 
     As noted, changing the fluid pressure in the first channel  120 A, the second channel  120 B, and/or the third channel  120 C may cause a deformation in one or more portions of the tube  110 . For example, the controller  200  may respond to inputs from the user by at least compressing the third fluid chamber  210 C. Compressing the third fluid chamber  210 C may increase the fluid pressure in the third channel  120 C, thereby causing the formation of a bend in the tube  110 . 
     In some example embodiments, tube  110  of the surgical apparatus  100 , for example, as shown in  FIGS. 1A-F , may be formed using a variety of different techniques including, for example, extrusion, molding, and/or the like.  FIG. 3A  depicts an extrusion technique for fabricating the tube  110 , in accordance with some example embodiments. 
     Referring to  FIG. 3A , an extrusion technique may be used to form the tube  110 , which may include the tube  110  having, for example, the first channel  120 A, the second channel  120 B, the third channel  120 C, and/or the fourth channel  130 . In some example embodiments, the tube  110  may be formed using a tubing  310  having an inner diameter that is equivalent to a desired outer diameter of the tube  110 . The tubing  310  may be any type of tubing including, for example, a glass capillary tube and/or the like. As shown in  FIG. 3A , the tubing  310  may be attached to a connector  320 , for example, using glue. The connector  320  may be a female Luer lock and/or any other type of connector. A release agent may be pumped through the tubing  310  using a syringe (not shown) and/or any other pumping mechanism coupled with the connector  320 . To remove any excess release agent, a compressed liquid and/or gaseous substance (e.g., air and/or the like) may subsequently be pumped through the tubing  310 , thereby leaving a thin layer of the release agent on the inner walls of the tubing  310 . 
     As shown in  FIG. 3A , additional tubes  330  may be positioned inside the tubing  310  and coated with the release agent. The additional tubes  330  may be any type of tubes including, for example, glass capillary tubes and/or the like. Furthermore, the additional tubes  330  may be a multi-bore tube and/or individual tubes. The additional tubes  330  may and/or may not be bonded to the tubing  310  using an epoxy such as, for example, an ultraviolet (UV) epoxy and/or the like. 
     In some example embodiments, the tubing  310  and the additional tubes  330  may be filled with a silicone rubber (e.g., a two part biocompatible platinum cure silicone rubber), which may be pumped into the tubing  310  and/or the additional tubes  330  using the syringe coupled with the connector  320 . The silicone rubber may be mixed with a contrast agent such as, for example tantalum and/or the like, in order to enhance the visibility of the resulting surgical apparatus for medical imaging. One or more rods  340  may be slipped through each of the additional tubes  330 . It should be appreciated that the additional tubes  330  may align the rods  340 . The rods  340  may be formed from any material having sufficient rigidity including, for example, rhenium (Re), tungsten (W), and/or the like. Upon curing the silicon rubber, the rods  340  may be removed and the resulting tube  110  may be removed from the tubing  310 . 
       FIG. 3B  depicts another assembly  350  for fabricating the tube  110 , in accordance with some example embodiments. Referring to  FIGS. 3A-B , a solid rod  355  may be inserted in the tubing  310  in order to create a lumen serving as a passageway for a substance and/or other apparatuses (e.g., guidewires, catheters, hollow tubes, fluid-filled tubes, and/or the like). 
       FIG. 3C  depicts another assembly  360  for fabricating the tube  110 , in accordance with some example embodiments. Referring to  FIGS. 3A and 3C , a spring  352  may be inserted into the tubing  310  where the spring  362  may be aligned by an inner tube  364  positioned, for example, at a center of the spring  362 . In some example embodiments, the assembly  360  may be used to form the tube  110  having the configuration shown in  FIG. 1C , in which the helix fourth channel  130  traverses laterally through the interior of the tube  110 . 
       FIGS. 4A-B  depict a molding technique for fabricating the tube  110 , in accordance with some example embodiments. Referring to  FIG. 4A , a mold may be prepared by assembling, on a microscope slide, circular and/or rectangular tubes in parallel. The diameter D of the circular tubes may be equivalent to the desired diameter of the tube  110  while the height of the rectangular tubes may be 
     
       
         
           
             
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     For example, if the desired diameter for the tube  110  is 500 μm, tubes that are 500 μm in diameter may be laid out in parallel on a microscope slide as shown in  FIG. 4 . Similarly, if the desired diameter for the tube  110  is 1 millimeter, tubes that are 1 millimeter in diameter may be placed in parallel on a microscope slide. In various example embodiments, the tubes may or may not be bonded to the microscope slide using an epoxy such as, for example, an ultraviolet (UV) epoxy and/or the like. 
     In some example embodiments, silane may be deposited onto the assembly including the tubings bonded to the microscope slide. The silane may be deposited via chemical vapor deposition (e.g., under a 0.05 megapascals (MPa) vacuum for one hour). The silane may provide a nanometer thick hydrophobic coating on the surface of the tubings. Furthermore, the silane may provide flat glass strips, which may enable easy demolding. A molding material such as, for example, a two-part polyurethane plastic, may be poured onto the assembly and degassed. Upon curing, the molding material may be peeled off from the assembly of tubes to form rigid mold having a smooth surface. 
     As shown in  FIG. 4B , multi-bore tubes may be placed in the mold and covered with a silicone rubber (e.g., a two part biocompatible platinum cure silicone rubber). Furthermore, the silicone rubber may be cured to form the tube  110  of the surgical apparatus  100 . As noted, the multi-bore tubes may align one or more rods for creating the channels with the tube  110 . The rods may be formed from any material exhibiting sufficient rigidity such as, for example, rhenium (Re), tungsten (W), and/or the like. 
     To further illustrate, as shown in  FIG. 4B , a 4-bore tube may be used to fabricate the tube  110  having four channels. If a tubing with an outer diameter of 500 μm is used to fabricate a 500 μm tube  110 , then the diameter of the individual bores may be 127 μm while the rods may have a diameter of 50 Alternatively and/or additionally, if a tubing with an outer diameter of 1 millimeter is used to fabricate a 1 millimeter tube  110 , then the diameter of the individual bores may be 127 μm while the rods may have a diameter of 100 μm. 
       FIG. 5  depicts a flowchart illustrating a process  500  for hydraulically driven endovascular neurosurgery, in accordance with some example embodiments. Referring to  FIG. 5 , the process  500  may be performed by the controller  200  in order to trigger a deformation of the tube  110 . 
     At  502 , the controller  200  may receive, from a user, an input indicating a desired deformation of the tube  110 . For example, a user may provide a mechanical, digital, electrical, and/or haptic input indicative of a desired deformation in the tube  110 . The surgical apparatus  100  may include the tube  110  having a plurality of channels including, for example, the first channel  120 A, the second channel  120 B, the third channel  120 C, and/or the third channel  130 . As noted, the tube  110  may be steered, for example, during endovascular neurosurgery, to align one or more portions of the tube  110  with a treatment location (e.g., site of aneurysm). Alternatively and/or additionally, the deformation of the tube  110  may actuate one or more surgical tools (e.g., gripper, cutter, drill, cauterizer, and/or the like) coupled with the tube  110 . 
     At  504 , the controller  200  may change, based on the input, a fluid pressure in one or more channels in the tube  110  to at least trigger the desired deformation of the tube  110 . In some example embodiments, the fluid pressure in a channel may be changed via the fluid chamber coupled with the channel. For instance, as shown in  FIG. 2 , the fluid pressure in the first channel  120 A may be increased by at least compressing the first fluid chamber  210 A. The fluid pressure in the second channel  120 B may be increased by at least compressing the second fluid chamber  210 B. Alternatively and/or additionally, the fluid pressure in the third channel  120 C may be increased by at least compressing the third fluid chamber  210 C. As noted, changing the fluid pressure in a channel may trigger a deformation of the tube  110 . For example, as shown in  FIGS. 1A-B , increasing the fluid pressure in the third channel  120 C and/or a different channel may trigger the formation of a bend in one or more portions of the tube  110 . Alternatively and/or additionally, as shown in  FIG. 1C , changing the fluid pressure in the helix fourth channel  130  may trigger a spiraling motion in the tube  110 . 
       FIG. 6  depicts a block diagram illustrating a computing system  600  consistent with implementations of the current subject matter. Referring to  FIGS. 1-6 , the computing system  600  can be used to implement the controller  200  and/or any components therein. 
     As shown in  FIG. 5 , the computing system  600  can include a processor  610 , a memory  620 , a storage device  630 , and input/output devices  640 . The processor  610 , the memory  620 , the storage device  630 , and the input/output devices  640  can be interconnected via a system bus  650 . The processor  610  is capable of processing instructions for execution within the computing system  600 . Such executed instructions can implement one or more components of, for example, the controller  200 . In some implementations of the current subject matter, the processor  610  can be a single-threaded processor. Alternately, the processor  610  can be a multi-threaded processor. The processor  610  is capable of processing instructions stored in the memory  620  and/or on the storage device  630  to display graphical information for a user interface provided via the input/output device  640 . 
     The memory  620  is a computer readable medium such as volatile or non-volatile that stores information within the computing system  600 . The memory  620  can store data structures representing configuration object databases, for example. The storage device  630  is capable of providing persistent storage for the computing system  600 . The storage device  630  can be a floppy disk device, a hard disk device, an optical disk device, or a tape device, or other suitable persistent storage means. The input/output device  640  provides input/output operations for the computing system  600 . In some implementations of the current subject matter, the input/output device  640  includes a keyboard and/or pointing device. In various implementations, the input/output device  640  includes a display unit for displaying graphical user interfaces. 
     According to some implementations of the current subject matter, the input/output device  640  can provide input/output operations for a network device. For example, the input/output device  640  can include Ethernet ports or other networking ports to communicate with one or more wired and/or wireless networks (e.g., a local area network (LAN), a wide area network (WAN), the Internet). 
     In some implementations of the current subject matter, the computing system  600  can be used to execute various interactive computer software applications that can be used for organization, analysis and/or storage of data in various (e.g., tabular) format (e.g., Microsoft Excel®, and/or any other type of software). Alternatively, the computing system  600  can be used to execute any type of software applications. These applications can be used to perform various functionalities, e.g., planning functionalities (e.g., generating, managing, editing of spreadsheet documents, word processing documents, and/or any other objects, etc.), computing functionalities, communications functionalities, etc. The applications can include various add-in functionalities or can be standalone computing products and/or functionalities. Upon activation within the applications, the functionalities can be used to generate the user interface provided via the input/output device  640 . The user interface can be generated and presented to a user by the computing system  600  (e.g., on a computer screen monitor, etc.). 
     One or more aspects or features of the subject matter described herein can be realized in digital electronic circuitry, integrated circuitry, specially designed application specific integrated circuits (ASICs), field programmable gate arrays (FPGAs) computer hardware, firmware, software, and/or combinations thereof. These various aspects or features can include implementation in one or more computer programs that are executable and/or interpretable on a programmable system including at least one programmable processor, which can be special or general purpose, coupled to receive data and instructions from, and to transmit data and instructions to, a storage system, at least one input device, and at least one output device. The programmable system or computing system may include clients and servers. A client and server are generally remote from each other and typically interact through a communication network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other. 
     These computer programs, which can also be referred to as programs, software, software applications, applications, components, or code, include machine instructions for a programmable processor, and can be implemented in a high-level procedural and/or object-oriented programming language, and/or in assembly/machine language. As used herein, the term “machine-readable medium” refers to any computer program product, apparatus and/or device, such as for example magnetic discs, optical disks, memory, and Programmable Logic Devices (PLDs), used to provide machine instructions and/or data to a programmable processor, including a machine-readable medium that receives machine instructions as a machine-readable signal. The term “machine-readable signal” refers to any signal used to provide machine instructions and/or data to a programmable processor. The machine-readable medium can store such machine instructions non-transitorily, such as for example as would a non-transient solid-state memory or a magnetic hard drive or any equivalent storage medium. The machine-readable medium can alternatively, or additionally, store such machine instructions in a transient manner, such as for example, as would a processor cache or other random access memory associated with one or more physical processor cores. 
     To provide for interaction with a user, one or more aspects or features of the subject matter described herein can be implemented on a computer having a display device, such as for example a cathode ray tube (CRT) or a liquid crystal display (LCD) or a light emitting diode (LED) monitor for displaying information to the user and a keyboard and a pointing device, such as for example a mouse or a trackball, by which the user may provide input to the computer. Other kinds of devices can be used to provide for interaction with a user as well. For example, feedback provided to the user can be any form of sensory feedback, such as for example visual feedback, auditory feedback, or tactile feedback; and input from the user may be received in any form, including, but not limited to, acoustic, speech, or tactile input. Other possible input devices include, but are not limited to, touch screens or other touch-sensitive devices such as single or multi-point resistive or capacitive track pads, voice recognition hardware and software, optical scanners, optical pointers, digital image capture devices and associated interpretation software, and the like. 
     The subject matter described herein can be embodied in systems, apparatus, methods, and/or articles depending on the desired configuration. The implementations set forth in the foregoing description do not represent all implementations consistent with the subject matter described herein. Instead, they are merely some examples consistent with aspects related to the described subject matter. Although a few variations have been described in detail above, other modifications or additions are possible. In particular, further features and/or variations can be provided in addition to those set forth herein. For example, the implementations described above can be directed to various combinations and subcombinations of the disclosed features and/or combinations and subcombinations of several further features disclosed above. In addition, the logic flows depicted in the accompanying figures and/or described herein do not necessarily require the particular order shown, or sequential order, to achieve desirable results. Other implementations may be within the scope of the following claims.