Design and Shared Control of a Flexible Endoscope with Autonomous Distal Tip Alignment Open womb surgery for prenatal therapy is an extreme option which may induce severe side effects on both the fetus and the mother. Minimal invasive surgery (MIS) is, in general, less strenuous than open surgery. Unfortunately, the current tools and techniques are not optimized for the unique environment of the womb. Used in prenatal MIS, the physician visually assesses the inutero environment, the fetus and the placenta. This work deals with the use of fetoscopic instruments in photocoagulation therapy using lasers for TwintoTwin Transfusion Syndrome (TTTS). The TTTS procedure consists of identifying and coagulating the anastomosing vessels. We propose a fetoscopic instrument with a flexible steerable distal tip as opposed to currently used rigid scopes. The enhanced dexterity improves the ability of the surgeon to coagulate otherwise hard to access regions. We anticipate usability issues and a potentially steep learning curve as currently surgeons solely work with nonbendable instruments. To alleviate this problem, a shared control approach is proposed in which the surgeon controls the position of the instrument inside the uterus while an autonomous controller controls the orientation. The system is validated by testing on a novel instrument with 2 actuated degrees of freedom in an insilico setup featuring a real placenta image, a motion tracking system and a mechanical fulcrum point to mimic the incision port. The autonomous distal tip controller achieved an overall 4.75xc2xb0 RMSE with respect to the desired orientation, which is within the targeted range of orientations.

Endoscopic BiManual Robotic Instrument Design Using a Genetic Algorithm Over the last few years, there has been a significant rise in designing small, agile and flexible medical systems that can navigate through natural orifices. In the case of endoscopic surgery, existing systems vary significantly from each other which raises the question of the existence of a general design that can do it all. In this context, this paper proposes to use a genetic algorithm combined with recorded suturing and anatomical data to automatically design a pair of robotic instruments for the i2Snake under strict mechanical constraints. The resulting automatically generated instrument designs include a 6 degrees of freedom instrument that can follow a predefined trajectory accurately and a more simple 4 degrees of freedom instrument that can accomplish most of the task. The results also showed the importance of having a prismatic joint to gain the precision required for endoscopic surgery.