Development of a micro manipulator for minimally invasive neurosurgery

G. Harada , ... M. Takakura , in Human Friendly Mechatronics, 2001

Surgical robots are useful for minimally invasive surgery, since it enables precise manipulation of surgical instruments beyond human power in a small operation space. In this approach, we are developing a micro manipulator for minimally invasive neurosurgery. The micro manipulator consists of two micro grasping manipulators, a rigid neuroendoscope, a suction tube, and a perfusion tube. This paper reports on the micro grasping manipulator. Information technology has two D.O.F for angle and one D.O.F for grasping. This prototype is 3.1  mm in bore and tin can bend thirty degrees in whatsoever direction. Stainless steel wire was used to activate the manipulator.

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Robotic Surgery

Pinar Boyraz , ... Marko B. Popovic , in Biomechatronics, 2019

15.ane.i Introduction: Traditional Robotic Surgery

Surgical robots assistance during surgical procedures. They have been used since the mid-1980s. Today, the bulk of prostatectomies in the United States are robot-aided procedures as chances for successful operation are higher with robotic assist than without.

Robotic surgeries are typically minimally invasive. This feature has been around long before the introduction of robots. Information technology is a broad concept that encompasses many mutual procedures, such as a laparoscopic cholecystectomy, or gall float excisions. The procedure refers to a method that avoids long cuts by operating on the body through small (usually 1 cm) entry incisions. Surgeons use long-handled instruments to operate on tissue within the body. Such operations are guided by viewing equipment called endoscopes. These are thin tubes with a camera attached to the stop of it that allows the surgeon to view highly magnified real-time three-dimensional images of the operation site on a monitor.

The current benefits of robotic surgery include better accuracy, precision, dexterity, tremor corrections, scaled motion, and more recently haptic corrective feedback. These benefits upshot in more successful surgeries and smaller necessary incision cuts. Overall, the robotic systems accept improve accurateness and precision than unaided surgeons. Surgical robots are able to position the surgical tools closer to the "right spot" and deviate less from the "right trajectory." The robot's end-effectors can be much smaller and more dexterous than a human mitt. They can record and filter out a surgeon'southward natural hand tremor and rescale movement to increase precision and reduce the chance for fault. Lastly, the robot could restrain the surgeon'south movement into undesired directions through haptic feedback.

Researchers are formulating new ways to address move and tissue resistance. For instance, the surgical robot could synchronically movement with a beating heart such that their relative speed is shut to naught. Some other possible improvement is the power for the robot to automatically adapt to the dynamical tissue resistance over fourth dimension every bit the sensitivity scale of these processes goes beyond human capabilities.

Typically, robotic surgery can exist classified as either (i) supervisory-controlled, (2) tele-surgical, or (iii) shared-controlled.

The supervisory-controlled approach is the most automatic of the three methods. The RoboDoc from Integrated Surgical Systems Inc. is an case of a supervisory-controlled system used in orthopedic surgeries. Subsequently the surgeon positions the RoboDoc's bone-milling tool at the correct position within the patient, the robot automatically cuts the bone to merely the right size for the orthopedic implant.

Prior to the surgical procedure, the surgeon needs to prepare the performance through the planning and registration stage. In the planning phase, images of the patient'due south body are used to determine the right surgical approach. Common imaging methods include figurer tomography (CT) scans, magnetic resonance imaging (MRI) scans, ultrasonography, fluoroscopy, and Ten-ray scans. Next, in the registration phase, the surgeon must locate the points on the patient's body that represent to the images created during the planning phase. These points are matched to a 3D model, which tin can be updated past images seen through cameras or other real-time imaging techniques during surgery. After the robot finds the all-time fit between the model and reality, the surgical procedure is performed.

The tele-surgical approach allows the surgical robot to be tele-operated, that is, operated from a distance by a human being surgeon. In practise, the robot and the surgeon are only a couple of meters apart. Tele-performance is also possible beyond larger distances. However, bug such as time delays (i.e., tele-surgical latencies) and the available bandwidth (i.due east., the amount of information that tin can be transferred per unit time) demand to be considered.

The tele-surgical arroyo is used by the da Vinci Surgical System, which was invented past Philip S. Green and developed by Intuitive Surgical Inc. This system currently dominates the surgical robot marketplace. Initially dubbed Mona (after Leonardo's Mona Lisa), the system was rechristened the da Vinci Surgical Robot in 1999; according to Mr. Green "…in honour of the man who had invented the start robot." Although da Vinci never invented or built a real robot (credit for that goes to Tesla), he fabricated many drawings of various mechanisms.

The da Vinci System consists of three primary components: (1) a viewing and control console that is used by surgeon, (2) a vision cart that holds the endoscopes and provides visual feedback and (3) a surgical robot's manipulator arm unit that includes three or iv artillery, depending on the model. The instruments that are attached to the arms are highly specialized. Functions for them include clamping, cutting, suturing, tissue manipulation, cauterizing, etc.

It takes some time for surgeons to get accustomed to the da Vinci System. According to a study, even with initial training plan, provided by the Intuitive Surgical, it takes most 12–18 operations before surgeons feel comfortable performing the procedure. Oftentimes, during this menstruation, surgeons complain on lack of tactile force feedback or ability to "feel" the tissue.

The shared-controlled arroyo refers to the method past which the robot is not but motion tele-operated equally it can decide to resist the surgeons' intended motility if information technology deems that it would not be beneficial. Typically, the piece of work space is split up into several segments and the system behaves differently based on different localization according to safe, shut, boundary, or forbidden classification. For example, if surgeon moves a cutting tool in the direction of tissue that should not be damaged, the robot will apply the force haptic feedback that will grow stronger every bit the cutting tool comes closer to the fragile tissue. In other words, here, surgeon once again "feels" the virtual representation of tissue that may accept preprogrammed specifications different from the existent tissue equally well every bit somewhat dissimilar localization in space.

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Robin Heart surgical robot: Description and future challenges

Zbigniew Nawrat , in Command Systems Blueprint of Bio-Robotics and Bio-mechatronics with Advanced Applications, 2020

v.four Software ergonomics

A surgical robot is at present more than a mechatronic tool than an IT (data engineering) tool. Still, the challenges of appropriate determination-making flexibility and precision (specially in the absenteeism of professional person staff in the conditions of demographic problems) indicate that the direction of development toward democratic (partly or fully) medical robots is the most upwards-to-engagement. The idea of spaceflight and establishing bases in afar objects from Earth and the need to secure medical service has likewise returned.

The principles of ergonomics should be applied when creating software—ensuring the effectiveness, efficiency, and satisfaction of the employee. These three properties make up the software utility. Let us mention a few principles (called heuristics) of software ergonomics: feedback (for each activeness there should be a reaction or system information); availability (providing tools and information according to the user's needs); simple and natural dialogue; application of the user's language (language of symbols from the user's environment); reducing the load on short-term retention (no need to memorize a lot of information); confirmation of activities (data on the effect of activities); and elimination of errors. The software created equally part of the Robin Heart project meets these principles.

The issues discussed are the central to edifice the proper telemanipulator control organization and software. Man, the operator of a surgical robot, tin be treated as an chemical element of the control system (we take into account both the processing of data in the brain and its dependent motor coordination of precise control—motion control, position, speed, and strength—through the robot interfaces) connected by the organisation It and operation of the robot electromechanical organization with an executive tool. In terms of artificial organs—and so you can treat the robot (equally a prosthesis, prolonging the surgeon's hand)—it is a hybrid organ (because it is necessary for proper operation to use cells, natural organs, simply human-operator) (Nawrat, 2011).

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Robotic interventions

Sang-Eun Vocal , in Handbook of Medical Image Computing and Computer Assisted Intervention, 2020

34.3 Master–slave system

Teleoperated surgical robots provide superior instrumentation and versatile motion through small incisions controlled by the doctor. Typically, the dr. manipulates an ergonomic chief input device in a visualization environment (physician console) and these inputs are translated into motion past a 3D vision system (endoscope) and wristed laparoscopic surgical instruments. The major advantage over the traditional (hand operated) surgical method is that information technology tin compensate for human hand tremors and can also minimize the hand motion for surgical tasks, thereby reducing procedure time.

da Vinci [14,fifteen] is used in multiple fields of surgery such equally head and neck, thoracic, colorectal, gynecology, and urology in the course of laparoscopic surgery. The robot is equipped with 3 or 4 robotic artillery. Incisions will be made for each musical instrument. Ane of the arms will be equipped with a 3D endoscope that displays on the visual organisation. In order to reduce trauma, the artillery motility effectually a stock-still pin bespeak. Unlike instruments are designed with a specific purpose. Contempo advancements include a single port system shown in Fig. 34.2.

Figure 34.2

Figure 34.two. da Vinci SP organization for single incision (port) robotic surgery. The robot provides three fully-wristed, elbowed instruments through a single ii.5 cm cannula. © 2019 Intuitive Surgical.

Monarch platform [sixteen,17] by Auris is intended for diagnostic and therapeutic bronchoscopic procedures. The teleoperated endolumenal robot can navigate within the torso, image, and care for conditions without making incisions. Monarch Platform is a neither a haptic feedback nor monitoring tool, as the robot only transmits visual information to the dr.. It is not autonomous. Monarch Platform uses a custom controller to permit the doctor to directly command the endoscope as the md navigates the lungs. Visual feedback is given from the endoscope likewise equally an image display for navigation. The robot is mounted on a stationary platform that controls the feed rate of the endoscope. The feed rate and navigation are all controlled by the physician at the visual platform in a master–slave relationship.

Virtual Incision'south miniaturized robot [xviii] is used for gastrointestinal operations. The Virtual Incision robot is inserted into the abdominal cavity after an incision is made at the abdomen button. The two-arm manipulator robot, equipped with an HD camera, performs the operation within the abdomen. It is mounted onto the side of the operating table with an adjustable positioning arm. Virtual Incision provides neither haptic feedback nor monitoring. Data is received through a monitor system for arm positioning. Video footage shows physicians controlling the robot with two Geomagic Affect devices and a custom master device. The slave device is a telemanipulator using a wireless connectedness between the primary–slave system. Video is streamed from the Hard disk camera for an endoscope image-based navigation.

Revo-I [nineteen,twenty] is a laparoscopic surgical robot. Revo-I has been marketed in Southward Korea to be more than price effective than the da Vinci of Intuitive Surgical. Like da Vinci, Revo-I is a 4-arm robotic platform with one arm equipped with a 3D photographic camera. Dissimilar finish effector attachments allow customization of the operating procedure. It is currently designed with tactile feedback, which results in decreased grasping strength simply improved performance. Haptic feedback will exist implemented in future revisions afterwards development of kinesthetic feedback is added. A periscopic control station is used by the physician for the custom primary device in the primary–slave system with visual imaging used for navigation.

Avatera [21] is based on a four-arm robot platform design with interchangeable tools. Avatera is nonetheless in early on evolution so lilliputian is known as to whether haptic feedback or monitoring systems will be used. Imagery shows a control unit of measurement with an HD monitor for open brandish as well every bit a periscopic side periphery.

ARTAS [22] is a hair restoration robot adult by Restoration Robotics Inc. It restores hair to a patient's head through the transplantation of hair follicles. A dissecting punch removes sections of healthy hair follicles and grafts the pilus by inserting the plugs at the transplant location. A robot arm and guidance organisation determine the angle and location of the operating tool while following the doctor'southward operative plan. ARTAS operates via a monitoring style system with a standard master device that allows control through a keyboard or touch interface. The robot arm acts as a telemanipulator and operates semiautonomously.

Canady Hybrid Plasma Scalpel [23] is also a laparoscopic surgical robot. Canady Robotic Surgical Organisation'south primary tools are the Canady Flex Lapo Wrist and Canady Hybrid Plasma Scalpel. The Lapo Wrist is a seven DOF, directly operated surgical instrument with a grasping tool at the terminate. The Plasma Scalpel delivers a beam that simultaneously cuts and coagulates the operating tissue. Canady Robotic Surgical Organization is neither haptic nor monitoring, every bit the md receives optical feedback from an endoscope. The Canady is a true hands-on system with the physician straight manipulating the instruments.

Overall, chief and slave type surgical robots are plant in large numbers due to the fact that they combine the performance and precision of a robot while allowing the surgeon, who is proficient in performing that particular surgical activeness, to maintain overall control.

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Haptics in Surgical Robots

Peter Culmer , ... David Jayne , in Handbook of Robotic and Prototype-Guided Surgery, 2020

15.two.2.one General surgery: Senhance

Senhance is a surgical robot platform developed for laparoscopy, originally conceived and developed by the Joint Research Centre of the European Committee in collaboration with SOFAR SpA (Italy) as the Telelap Alf-ten and afterwards rebranded equally Senhance surgical robot system when the technology was acquired by TransEnterix (Morrisville, North Carolina, United States). The system was approved for general surgical procedures in Europe in 2012 and obtained FDA approval for the United states of america in 2017 [55,57].

At that place is petty detailed technical information on the Senhance system, but the capabilities of the system tin be inferred from a series of publications evaluating its clinical efficacy (run across Section 15.two.3). The system was designed to be both cost-effective and to minimize disruption to existing operating theater environments and workflows. Instruments are held by a serial of up to four robot artillery, each situated on private mobile carts to allow a flexible configuration around the patient. Senhance promotes that its instruments are similar to those used in manual laparoscopy, designed to promote familiarity with the surgeon they too lack the additional "wristed" degrees of freedom (DoFs) establish in competing systems like da Vinci [58]. The surgeon sits at a panel providing iii-dimensional (3D) visualization, eye-tracking control of the endoscope, and haptic feedback via two strength feedback manipulators which resemble laparoscopic instruments [55,57]. The manipulators transmit grasp forcefulness, enabling tissue consistency, or object manipulation, to exist felt past the surgeon [57]. Information technology is reported that the capabilities are instructive during thread and needle manipulation when suturing [58].

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Robotics for minimally invasive surgery (MIS) and natural orifice transluminal endoscopic surgery (NOTES)

J. Reynoso , ... D. Oleynikov , in Medical Robotics, 2012

ix.3 Natural orifice transluminal endoscopic surgery (NOTES)

Natural orifice transluminal endoscopic surgery (NOTES) utilizes natural orifices to access the peritoneal cavity. The feasibility of the NOTES technique was demonstrated in animal studies utilizing peroral gastrotomy, transurethral cystotomy, transvaginal and transcolonic approaches. several procedures including organ resection, gastrojejunostomy, gastrojejunal anastomosis, oopherectomy, salpingectomy, cholecystectomy and appendectomy have been performed in fauna studies. NOTES cholecystectomy, appendectomy and nephrectomy have since been performed in humans (santos and Hungness, 2011).

Initially, a standard flexible endoscope was introduced through a NOTES incision, to visualize the intraperitoneal cavity. This approach has several inherent limitations when compared with open or laparoscopic surgery. Triangulation is lost when the standard endoscopic channels are used, equally the instruments passed though these ports are in line with the videoimaging. In this configuration, forces must be applied off-centrality in society to combat this limitation. one is also limited by the available instruments that may laissez passer through the endoscope. Dexterity is significantly decreased owing to the constraints of this platform. To overcome these constraints, prototypes such as the EndoSAMURAI (Olympus Corp., Tokyo, Nippon) accept been developed. This endoscopic platform has ii independent terminate effectors with 5 degrees-of-freedom, equally well equally a standard endoscopic aqueduct. The operator interface includes controllers which are very similar in design to standard laparoscopic handles. An overtube has been used with this device to increase stability. The EndoSAMURAI has been used in NOTES porcine cholecystectomy via the transgastric approach and has been demonstrated in benchtop experiments to exist able to perform surgical tasks such equally suturing and knot-tying (Spaun et al., 2009). The TransPort multichannel access device (USGI Medical, san Clemente, CA, Us) is an endoscope with iv ports (6, 6, 4 and iv   mm) available for passing flexible instruments. This device has been used in clinical studies to perform transgastric appendectomy, transumbilical appendectomy and endoluminal pouch and stoma reduction (Horgan et al., 2011). The Anubiscope (Karl-storz, Tuttlingen, Germany) is a flexible endoscopic platform for NOTES that has a light and video source. The articulating head contains two opposing movable arms, capable of triangulation, that contain ii four.2   mm working channels. The distal head has jaws that open to reveal the functioning arms but when closed serve as a edgeless tipped trocar during insertion (Dallemagne and Marescaux, 2010). The Direct-Bulldoze Endoscopic System (Boston Scientific, Natick, MA, USA) has iii lumens through which interchangeable 4   mm flexible instruments can be inserted. Bachelor flexible instruments include graspers, scissors, needle drivers and cautery. This flexible laparoscopic multitasking platform is capable of seven degrees of freedom. This device is controlled past track-guided bulldoze handles and has a sheath that can lock into position (Shaikh and Thompson, 2010).

The chief and slave translumenal endoscopic robot (Primary) developed past Phee et al. (2010) at the National University of Singapore represents another novel solution to the decreased dexterity inherently institute in the endoscopic NOTES platform. It is like to the EndoSAMURAI in that it has two robotic arms which cap the end of an endoscope. However, with the MASTER, any standard upper endoscope may be outfitted with these robotic artillery that are capable of tissue manipulation, triangulation, off-centrality forces and monopolar cautery. Mechanical forces are applied to the end effectors through a tendon-sheath power transmission mechanism which allows for 9 degrees of freedom. The surgical interface is a 'passive, steerable, motion-sensing exoskeleton with two articulating arms'. The surgeon's hand and wrist movements are directly mirrored past the robotic grasper and cautery end effectors. In a porcine fauna study, this organization was able to perform a transgastric hepatic wedge resection with minimal bleeding. All imaging and lighting was provided past a standard upper endoscope. A sterile endotube was placed through the esophagus. The gastrotomy was created using the monopolar cautery of the robotic arm. The standard upper endoscope was retroflexed in the peritoneal cavity to provide the surgical robot access to the liver. Tissue retraction provided admission for the robotic cautery arm to excise a suitable liver sample. The specimen was then extracted though the oral cavity. The gastrotomy was non closed in this non-survivable animal study ( Phee et al., 2010).

The standard NOTES flexible endoscope platform is unstable, and forces applied to the target organ are transmitted to the endoscope. This results in a demand to continually reposition the endoscope. To overcome the instability produced past flexible endoscopes passed through a hollow lumen, fixation and stiffening of the endoscope has been employed. A flexible robotics platform aims to drive a stiffened endoscope through a 3D space with calculator assist. At the Stanford University School of Medicine, a prototype has been demonstrated by Eisenberg et al. (2010) to be feasible in cadaver studies in which a multichannel flexible robotic endoscope was navigated using a joystick interface. Transgastric intraperitoneal access was achieved, and the platform was able to tolerate forces generated by tissue manipulation and endoclipping. Imaging was provided by the endoscope for this report. Additionally, the endoscope was repositioned without difficulty for access to dissimilar target organs.

The dVSS has been used to perform a robot-assisted NOTES nephrectomy in a porcine model, although an additional transabdominal port was placed for laparoscopic visualization. Intraperitoneal access was achieved via transvaginal and transcolonic placement of the robotic arms. The renal artery and vein were dissected using the robot and so transected using standard vascular endoscopic staplers through the vaginal port. The kidney was removed through the vagina. The NOTES technique with the dVSS was likewise utilized for a porcine pyeloplasty.

Use of the dVSS for NOTES has been confined to animate being study and has not been used to date in humans. Although the surgical arrangement provides several advantages, such equally multiple degrees of freedom, increased dexterity and stereovision, its size has precluded a widespread application of the dVSS for NOTES. Additionally, the robotic arms are prone to collide and do non conform to the geometry of the intraperitoneal infinite. For this reason, novel prototypes, equally described below, have been created to further develop a robotic platform for NOTES.

9.3.1 Miniature surgical robots for NOTES

Miniature in vivo surgical robots offer an alternative solution to the inherent limitations of NOTES. As previously mentioned, the flexible endoscopic and flexible robotics platform for NOTES are constrained by the distribution of instruments through a hollow visceral lumen into the intestinal cavity while still coupled to external control. Multiple miniature robots may be serially deployed through a unmarried transvisceral access, allowing for a most unlimited number of surgical instruments. in this epitome each miniature robot tin can serve a separate function, a singled-out advantage over any single instrument that must provide all functionality. separate robots may provide imaging, lighting, tissue manipulation, and mobility. A family of these robots can cooperate to perform a NOTES procedure, and have done so in experimental models ( Tiwari et al., 2010). standard upper endoscopes have been used to place an esophageal overtube through which these miniature robots have been sequentially placed in the stomach and so into the intestinal cavity. The gastrotomy is created with a standard endoscopic needle knife.

Initial prototypes of in vivo miniature robots for NOTES included a fixed-base imaging robot significant, once placed, information technology was unable to self navigate to an alternative intraperitoneal position. The cosmos and use of the pan and tilt photographic camera has resolved this navigational bulwark. This 15   mm metallic cylinder has 3 retractable legs, which provide stability when this device is placed on its stop. Two independent motors afforded 360° panning and 45° tilting adequacy. Nevertheless, the motor originally used for the panning mechanism was later employed for image focusing. visual feedback from this musical instrument was used in a porcine cholecystectomy.

Advancing this technology farther are self navigating, mobile robots powered past ii helical-profiled wheels. Each bike moves independently, allowing for forward, reverse and turning motions. initial prototypes included a cylindrical robot that measured xv   mm in bore and 75   mm in length (Fig. nine.three). The small diameter allows this mobile imaging robot to be easily deployed through a transgastric incision or a small intestinal incision. The prophylactic and feasibility of this design was demonstrated in animal studies. The next epitome of this pattern included a camera, and the diameter was increased to xx   mm. The mobile adjustable-focus robotic photographic camera (MARC) was able to transverse the deformable intraperitoneal cavity utilizing the dual helical-profiled wheel design. During a porcine cholecystectomy, this miniature imaging robot supplied the sole video required to consummate the procedure.

9.3. In vivo miniature robot for NOTES.

In a subsequent prototype, the mobile in vivo surgical imaging robot was augmented with a ii.4   mm wide robotic grasper. All of the imaging and mobility capabilities inherent in previous designs were present in this design. The force generated from powered wheels was sufficient to procure a tissue biopsy. The photographic camera on this miniature robot was used for visual feedback while selecting a porcine hepatic biopsy site. This robot was deployed in animal studies through the intestinal wall and demonstrated cocky navigation, imaging and tissue biopsy capability.

The mobile endoluminal robot was the first in vivo miniature surgical robot to exist used in a NOTES process. In a porcine study, a standard upper endoscope was introduced per ora into the stomach, and a sterile esophageal overtube was placed with directly visualization. The 12   mm (diameter) and 75   mm (length) miniature robot explored the gastric crenel nether endoscopic imaging. A gastrotomy was created with an endoscopic needle-knife and this robot was placed into the intraperitoneal space. Utilizing the same helical-profiled wheels design, the robot was able to self navigate over the liver and the deformable territory of the porcine intestines. Visualization was provided via the endoscope. Afterward this robot was retracted back into the tummy, the gastrotomy was closed with two standard endoclips and one endoloop.

In vivo co-operative robots represent the adjacent pace in NOTES prototypes. In this concept, the functions of imaging, lighting and tissue manipulation are executed separately past a family unit of robots. As previously demonstrated, these miniature robots were deployed into the porcine intraperitoneal space through a sterile esophageal overtube. A standard upper endoscope was used to create a gastrotomy using a needle-knife. The lighting, imaging and retraction robots were serially placed into the intestinal cavity and held in identify against the abdominal wall using magnets. Using this technique, the family of co-operative robots was able to dispense tissue under their own lighted imaging. These initial prototypes were tethered by wires for both power source and command. Currently in development at the Academy of Nebraska are in vivo miniature robots, powered by on-lath batteries and radio-controlled.

These initial NOTES porcine experiments included miniature robots with minimal power to manipulate tissue. The in vivo dexterous robot was designed to improve dexterity. Half-dozen degrees of freedom were achieved with 2 arms attached to a central torso. One arm was fitted with monopolar cautery and the other a grasper. Triangulation is made possible by stereovision cameras placed on the torso of the robot between the 2 arms. A lower arm telescopes in and out of the upper arm, which is attached to the body via a rotational shoulder joint. Robotic arms were remotely controlled at a surgical console consisting of two analog joysticks and a foot pedal that controlled the monopolar cautery. The feasibility of NOTES cholecystectomy was demonstrated over several animal studies. Transabdominal and transgastric placement were both employed. Using the onboard imaging, the porcine gallbladder was dissected free from its hepatic attachments and the cystic duct was severed. Transabdominal magnets were used to maintain the robot's position. The ability to triangulate, utilise off-axis forces, provide visualization and dexterously manipulate tissue was demonstrated in these in vivo dexterous robot beast studies.

Every bit previously mentioned, in electric current prototypes of this multifunctional dexterous robot, the SILS technique has been employed. The proficiency of both the surgical robot and the surgical console has increased significantly, and complex tasks such as intracorporeal suturing are now possible. Continuing blueprint of this robot includes decreasing size, increasing the capability of the surgical interface, and expanding the surgical applications to more complex procedures such as colectomy.

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S-Surge: A Portable Surgical Robot Based on a Novel Mechanism With Strength-Sensing Capability for Robotic Surgery

Uikyum Kim , ... Hyouk Ryeol Choi , in Handbook of Robotic and Epitome-Guided Surgery, 2020

16.5 Implementation

16.five.1 Surgical manipulator

We implemented the surgical robot using the designs of the above robots and instruments. Fig. sixteen.ix shows an assembled RCM manipulator with three-DoF motility forming a cone with a vertex angle of ninety degrees.

Effigy 16.9. Implementation of the proposed surgical manipulator.

The robot consists of three brushless DC (BLDC) motors and four DC motors for decision-making the RCM robot and instrument, respectively, controlled in position control manner. 3 8-W BLDC motors are used every bit linear actuators (EC-max 16, Maxon Motor AG, Switzerland). BLDC motors were called because of their loftier ability density, which provides eight   W of continuous power at a 16-mm diameter. For linear move, nosotros apply a commercial ball-screw mechanism (Spindle drive GP xvi, Maxon Motor AG, Switzerland), which includes a v.4:1 planetary gear head. For angular and insertion movements, the brawl screws have a pitch of 2   mm and a length of 200   mm. We use a 3-aqueduct 512-pulse/speed encoder for position measurement (MR, Maxon Motor AG, Switzerland). The linear move has a resolution of 256 pulses/mm. For the position control of BLDC motors, we apply a commercial motor controller (EPOS2, Maxon Motor AG, Switzerland).

Then, in the manipulator, we include the bulldoze module for the actuation unit of measurement of the instrument. From Fig. sixteen.9, we use grooves to transmit ability to the joints of the instrument. Fig. 16.nine shows how iv DC motors (DC1724, Faulhaber Mini-Motor SA, Switzerland) are embedded in the bulldoze module to commencement the instrument. The DC motor is also controlled by two position controllers embedded in the drive module. The DC motor is controlled by an embedded position controller in the musical instrument drive unit of measurement. Owing to the limited space of the instrument drive unit, we developed a new DC motor controller that can control dual DC motors in a single circuit. As a driver, we use the L6205, a DMOS dual full-bridge commuter (ST Micro, United states of america); it can provide 2.eight   A for each channel. For controller fries, nosotros apply an STM32F103 (ST Micro, United States) microcontroller, which has a Cortex M3 architecture and operates at seventy   MHz. We perform the position control of the DC motors based on a traditional proportional-integral derivative control scheme. In club to drive four DC motors, 2 of the controller's drive units are stacked. In improver, three low-level controllers for linear actuators are connected to the host PC using universal serial motorcoach (USB) communication (version 2.0). Two DC motor controllers use a control area network (Tin) for communication between high-level controllers.

For linear actuators, we connect three depression-level controllers to the host PC using a USB link (version 2.0). Two DC motor controllers use CAN to communicate between the high-level controllers. Similarly, the strength sensor controller shares the CAN motorbus to transmit the measured force information to the high-level controller.

16.5.2 Sensorized surgical instrument

Fig. 16.10 shows an assembled sensor surgical instrument for mounting a four-axis strength-sensing organization. To mensurate the strength sensing, a three-centrality force sensor and 2 torque sensors are integrated into the wrist and actuation unit, respectively. Four joints (rolling, wrist, and two gripping joints) are placed at the end of the instrument. Based on the tendon-driven actuation mechanism, the joints and pulleys in the actuation unit of measurement are connected by a bulldoze cable. The range of motion and transmission of each joint are shown in Table xvi.two. Furthermore, the information about the bulldoze module of the instrument joint is explained to a higher place. The knobs shown in Fig. 16.10 are used to receive ability from the bulldoze module of the manipulator.

Figure sixteen.x. Implementation of the sensorized surgical musical instrument.

The capacitance generated in the sensor is measured past a single-flake configuration of a capacitance-to-digital converter (AD7147, Analog Devices Inc., MA). The sampling frequency and sensing range are i.3   kHz and xvi   pF, respectively. The chip is integrated in the sensor. Fig. sixteen.ten shows the implemented force sensor controller. In the controller, we use an STM32F103 controller chip as the controller flake. The controller contains two I ii C channels that observe the measured forcefulness from the iii-centrality strength sensor and two torque sensors.

16.5.3 Entire surgical robot: South-surge

Fig. 16.eleven shows an assembled surgical robot consisting of an RCM manipulator and instrument. The robot has seven-DoF movement and four-axis force sensing. Information technology weighs 4.seven  kg and measures 34×18×20   cmiii. Table xvi.3 lists the detailed specifications of the robot.

Figure 16.11. Implementation of the unabridged surgical robot called "S-surge" and comprising the developed manipulator and instrument.

Table 16.3. Specifications of the developed surgical robot.

Quantity Value
Weight iv.vii   kg
Maximum workspace 90 degrees circular cone (radius of 15   cm)
Degrees of freedom 7
Force sensing Four-centrality force
Power consumption 34   W

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Robotic Retinal Surgery

Emmanuel Vander Poorten , ... Iulian Iordachita , in Handbook of Robotic and Paradigm-Guided Surgery, 2020

36.five.7 General considerations with respect to condom and usability

Regardless of the surgical robot used, at that place is all the same a risk of human error, which may lead to iatrogenic trauma and incomprehension. For example, excessive tool pivoting around the entry incision may lead to astigmatism, wound leak, or hypotony. Accidental motions of the tool may nonetheless puncture the retina or cause bleeding, or fifty-fifty bear on the intraocular lens and cause a cataract [180]. All of these risks are indeed present, since the previously described robotic systems exercise not demonstrate "intelligence," they merely replicate or scale-down the motions of the commanding surgeon. Thus, robots tin can improve surgical dexterity but not necessarily surgical performance. Functionalization of the tools with force or force per unit area sensors, besides as ophthalmic image processing, can improve the perception of the surgeon and enable him/her to link with artificial intelligence algorithms toward further improving the success rate of interventions.

A typical stride in retinal surgery is a rotation of the center in its orbit to visualize unlike regions of the retina. This is achieved by applying forces at the scleral trocars with the instrument shafts. When done bimanually, surgeons have force feedback to ensure that their hands are working together to reach the rotation, without putting undue stress on the sclera. When using more than one robotic manipulator in retinal surgery, whether in a cooperative or teleoperated paradigm, the control system must ensure that the robots work in a coordinated fashion. This kinematically constrained problem is solved in Ref. [142].

Farther, all teleoperation systems and especially systems using curved and shape-irresolute instruments or untethered agents require retraining of the surgical personnel to get accepted to this remote-manipulation paradigm, which may disrupt surgical workflow. Many of the master interfaces have been designed to brand this transition every bit intuitive every bit possible, and are based on either recreating the kinematic constraints of handheld and cooperative-command systems (i.e., with the surgeon's paw on the instrument handle outside of the centre) or on creating kinematics that finer place the surgeon's mitt at the cease-effector of the instrument inside the eye (with the kinematic constraint of the trocar explicitly implemented in the interface). However, recent work suggests that placing the surgeon'south manus at the end-effector of the instrument, but not explicitly presenting the kinematic constraints of the trocar to the user, may lead to improved performance, likely due to the improved ergonomics that it affords [181].

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Slender ophidian-like endoscopic robots in surgery

Shumei Yu , ... Hongliang Ren , in Flexible Robotics in Medicine, 2020

1.3.ii Statics and dynamics

A snake-like surgical robot'southward static modeling solves the human relationship of the force, moment, and deformation. For tendon-driven serpent-like surgical robots, statics is normally combined with kinematics when Cosserat Rod Theory is practical in the modeling. Based on Cosserat Rod Theory, Gao et al. [17] built a shape prediction model for a helical spring backboned snake robot, in which the deformation of the robot is related to the tendon force, friction strength, and external forces. Lumped-parameter model is an alternative basis for static analysis, for instance, Kato et al. [16] built the tension propagation model with friction betwixt the wires and the robot body. The principle of virtual work was used to compute the actuation force on building a load transmission model in the piece of work of Roy et al. [48]. Dong et al. [29] analyzed the cable tension and stiffness of a compliant joint backboned snake robot based on the Jacobian. A dynamic model to compensate for the dubiousness and asymmetry has been proposed past Haraguchi et al. [31] by defining the driving forces related to the bending angle, friction strength, and elastic forces.

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Single-port multichannel multi-degree-of-freedom robot with variable stiffness for natural orifice transluminal endoscopic surgery

Changsheng Li , ... Hongliang Ren , in Flexible Robotics in Medicine, 2020

17.two.two Organisation overview

Fig. 17.1 presents a surgical robot with variable stiffness for NOTES. This robot is composed of two aforementioned manipulators attached to an endoscopic platform and a commuter. The endoscopic platform has 2 channels with the diameters of 2.viii and 3.8   mm for surgical tools, respectively, a channel for the camera, and 2 channels for the air/water nozzle. The diameter of each manipulator is 3.6   mm, with six DOFs. The distribution of the manipulator DOFs in Fig. 17.2 includes iii parts: a compliant arm, a flexible wrist joint, and a gripper. The stiffness of the compliant arm with ii DOFs can exist tuned in real-time during the operation to fulfill the accuracy and safety requirements of the surgery surround. The wrist articulation is flexible with 1 DOF. The gripper can bend in a broad range with ii DOFs. A screw motor–based driver drives the manipulators via Bowden cables. The main parameters of each manipulator are summarized in Table 17.1.

Effigy 17.one. Surgical robotic organization with variable stiffness for NOTES. (A) 3D model. (B) Image.

Effigy 17.2. The distribution of the DOFs. (A) DOF 1: translation forth the axis. (B) DOF 2: abduction. (C) DOF 3: adduction. (D) DOF four: bending of the wrist. (E) DOF 5: bending of the forceps. (F) DOF half-dozen: grasping of the forceps.

Table 17.1. Main parameters of the robotic system.

Parameters Values Units References
Channels 3 – A minimum of three endoscopic channels [15]
Length 40 mm –
The diameter of the manipulator iii.6 mm The size of the current robotics for NOTES mainly ranges from ∅v to ∅14 [16]
Bending angle of the arm xxx Degrees –
Bending angle of the wrist joint ±90 degrees – –
DOF 6 for each manipulator – DOFs should non be less than 4 [14]
Drive mode Bowden cable – –
Textile 45# steel – –
Features Compliance; variable stiffness – –

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