Development of an instrumented thoracoscopic surgical trainer for objective evaluation of esophageal atresiatracheoesophageal fistula repair Operative repair of complex conditions such as esophageal atresia and tracheoesophageal fistula (EATEF) is technically demanding, but few training opportunities exist outside the operating theater for surgeons to attain these skills. Learning them during surgery on actual neonates where the stakes are high, margins for error narrow, and where outcomes are influenced by technical expertise, is problematic. There is an increasing demand for highfidelity simulation that can objectively measure performance. We developed such a simulator to measure force and motion reliably, allowing quantitative feedback of technical skill. A 3Dprinted simulator for thoracoscopic repair of EATEF was instrumented with motion and force tracking components. A 3D mouse, inertial measurement unit (IMU), and optical sensor that captured force and motion data in four degrees of freedom (DOF) were calibrated and verified for accuracy. The 3D mouse had low average relative errors of 2.81%, 3.15%, and 6.15% for 0xc2xa0mm, 10xc2xa0mm offset in Y, and 10xc2xa0mm offset in X, respectively. This increased to xe2x88x92xe2x80x8923.5% at an offset of 42xc2xa0mm. The optical sensors and IMU displayed high precision and accuracy with low SDs and average relative errors, respectively. These parameters can be a useful measurement of performance for thoracoscopic EATEF simulation prior to surgery.

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.