Scopes too flexible...and too stiff

The First Interlaced Continuum Robot, Devised to Intrinsically Follow the Leader

Flexible probes that are safely deployed to hard-to-reach targets while avoiding critical structures are strategic in several high-impact application fields, including the biomedical sector and the sector of inspections at large. A critical problem for these tools is the best approach for deploying an entire tool body, not only its tip, on a sought trajectory. A probe that achieves this deployment is considered to follow the leader (or to achieve follow-the-leader deployment) because its body sections follow the track traced by its tip. Follow-the-leader deployment through cavities is complicated due to a lack of external supports. Currently, no definitive implementation for a probe that is intrinsically able to follow the leader, i.e., without relying on external supports, has been achieved. In this paper, we present a completely new device, namely the first interlaced continuum robot, devised to intrinsically follow the leader. We developed the interlaced configuration by pursuing a conceptual approach irrespective of application-specific constraints and assuming two flexible tools with controllable stiffness. We questioned the possibility of solving the previously mentioned deployment problem by harnessing probe symmetry during the design process. This study examines the entire development of the novel interlaced probe: model-based conceptual design, detailed design and prototyping, and preliminary experimental assessment. Our probe can build a track with a radius of curvature that is as small as twice the probe diameter, which enables it to outperform state-of-the-art tools that are aimed at follow-the-leader deployment. Despite the limitations that are inherently associated with its original character, this study provides a prototypical approach to the design of interlaced continuum systems and demonstrates the first interlaced continuum probe, which is intrinsically able to follow the leader.

HelixFlex: bioinspired maneuverable instrument for skull base surgery

Endoscopic endonasal surgery is currently regarded as the 'gold standard' for operating on pituitary gland tumors, and is becoming more and more accepted for treatment of other skull base lesions. However, endoscopic surgical treatment of most skull base pathologies, including certain pituitary tumors, is severely impaired by current instruments lack of maneuverability. Especially, gaining access to, and visibility of, difficult-to-reach anatomical corners without interference with surrounding neurovascular structures or other instruments, is a challenge. In this context there is the need for instruments that are able to provide a stable shaft position, while both the orientation and the position of the end-effector can be independently controlled. Current instruments that allow for this level of maneuverability are usually mechanically complex, and hence less suitable for mass production. This study therefore focuses on the development of a new actuation technique that allows for the required maneuverability while reducing the construction complexity. This actuation technique, referred to as multi-actuation, integrates multiple cable routings into a single steerable structure. Multi-actuation has been successfully integrated and tested in a handheld prototype instrument called HelixFlex. HelixFlex contains a 4 degrees of freedom maneuverable 5.8 mm (diameter) tip and shows promising results concerning its maneuverability and potential rigidity.

Design and Fabrication of an Elastomeric Unit for Soft Modular Robots in Minimally Invasive Surgery

In recent years, soft robotics technologies have aroused increasing interest in the medical field due to their intrinsically safe interaction in unstructured environments. At the same time, new procedures and techniques have been developed to reduce the invasiveness of surgical operations. Minimally Invasive Surgery (MIS) has been successfully employed for abdominal interventions, however standard MIS procedures are mainly based on rigid or semi-rigid tools that limit the dexterity of the clinician. This paper presents a soft and high dexterous manipulator for MIS. The manipulator was inspired by the biological capabilities of the octopus arm, and is designed with a modular approach. Each module presents the same functional characteristics, thus achieving high dexterity and versatility when more modules are integrated. The paper details the design, fabrication process and the materials necessary for the development of a single unit, which is fabricated by casting silicone inside specific molds. The result consists in an elastomeric cylinder including three flexible pneumatic actuators that enable elongation and omni-directional bending of the unit. An external braided sheath improves the motion of the module. In the center of each module a granular jamming-based mechanism varies the stiffness of the structure during the tasks. Tests demonstrate that the module is able to bend up to 120° and to elongate up to 66% of the initial length. The module generates a maximum force of 47 N, and its stiffness can increase up to 36%.

A bioinspired soft manipulator for minimally invasive surgery

This paper introduces a novel, bioinspired manipulator for minimally invasive surgery (MIS). The manipulator is entirely composed of soft materials, and it has been designed to provide similar motion capabilities as the octopus's arm in order to reach the surgical target while exploiting its whole length to actively interact with the biological structures. The manipulator is composed of two identical modules (each of them can be controlled independently) with multi-directional bending and stiffening capabilities, like an octopus arm. In the authors' previous works, the design of the single module has been addressed. Here a two-module manipulator is presented, with the final aim of demonstrating the enhanced capabilities that such a structure can have in comparison with rigid surgical tools currently employed in MIS. The performances in terms of workspace, stiffening capabilities, and generated forces are characterized through experimental tests. The combination of stiffening capabilities and manipulation tasks is also addressed to confirm the manipulator potential employment in a real surgical scenario.

A Novel Device for Measuring Forces in Endoluminal Procedures

In this paper a simple but effective measuring system for endoluminal procedures is presented. The device allows measuring forces during the endoluminal manipulation of tissues with a standard surgical instrument for laparoscopic procedures. The force measurement is performed by recording both the forces applied directly by the surgeon at the instrument handle and the reaction forces on the access port. The measuring system was used to measure the forces necessary for appropriate surgical manipulation of tissues during transanal endoscopic microsurgery (TEM). Ex-vivo and in-vivo measurements were performed, reported and discussed. The obtained data can be used for developing and appropriately dimensioning novel dedicated instrumentation for TEM procedures.

Microfluidic Thermally Activated Materials for Rapid Control of Macroscopic Compliance

Macroscopic structures that undergo rapid and reversible stiffness transitions can serve as functional polymeric materials for many applications in robotics and medical devices. Thermomechanical phase transitions can provide a suitable mechanism for transient control of mechanical properties. However, the characteristic time scale for actuation is large and dictated by the dimensions of the structure. Embedding vascular networks within bulk polymers can reduce the characteristic length scale of the material and permit rapid and reversible thermomechanical transitions. Here we report perfusable bulk materials with embedded microvascular networks that can undergo rapid and reversible stiffness transitions. Acrylate-based thermoplastic structures exhibit storage moduli with a dynamic range between E' = 1.02 ± 0.07 GPa and E' = 13.5 ± 0.7 MPa over time scales as small as 2.4 ± 0.5 s using an aqueous thermal perfusate. The spatiotemporal evolutions of temperature profiles were accurately predicted using finite element simulation and compared to experimental values. Rigid-compliant transitions were leveraged in a demonstration in which a microvascularized device was used to grasp an external object without the aid of moving parts.

Mechanical analysis of insertion problems and pain during colonoscopy: why highly skill-dependent colonoscopy routines are necessary in the first place... and how they may be avoided

BACKGROUND

Colonoscopy requires highly skill-dependent manoeuvres that demand a significant amount of training, and can cause considerable discomfort to patients, which increases the use of sedatives. Understanding the underlying fundamental mechanics behind insertion difficulties and pain during colonoscopy may help to simplify colonoscopy and reduce the required extent of training and reliance on sedatives.

METHODS

A literature search, anatomical studies, models of the colon and colonoscope, and bench tests were used to qualitatively analyze the fundamental mechanical causes of insertion difficulties and pain. A categorized review resulted in an overview of potential alternatives to current colonoscopes.

RESULTS

To advance a colonoscope through the colon, the colon wall, ligaments and peritoneum must be stretched, thus creating tension in the colon wall, which resists further wall deformation. This resistance forces the colonoscope to bend and follow the curves of the colon. The deformations that cause insertion difficulties and pain (necessitating the use of complex conventional manoeuvres) are the stretching of ligaments, and stretching of colon wall in the transverse and longitudinal directions, and the peritoneum.

CONCLUSIONS

Four fundamental mechanical solutions to prevent these deformations were extracted from the analysis. The current results may help in the development of new colonoscopy devices that reduce - or eliminate - the necessity of using highly skill-dependent manoeuvres, facilitate training and reduce the use of sedatives.

Advanced endoscopic technologies for colorectal cancer screening

Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide. Diagnosing colorectal has been increasingly successful due to advances in technology. Flexible endoscopy is considered to be an effective method for early diagnosis and treatment of gastrointestinal cancer, making it a popular choice for screening programs. However, millions of people who may benefit from endoscopic colorectal cancer screening fail to have the procedure performed. Main reasons include psychological barriers due to the indignity of the procedure, fear of procedure related pain, bowel preparation discomfort, and potential need for sedation. Therefore, an urgent need for new technologies addressing these issues clearly exists. In this review, we discuss a set of advanced endoscopic technologies for colorectal cancer screening that are either already available or close to clinical trial. In particular, we focus on visual-inspection-only advanced flexible colonoscopes, interventional colonoscopes with alternative propulsion mechanisms, wireless capsule colonoscopy, and technologies for intraprocedural bowel cleansing. Many of these devices have the potential to reduce exam related patient discomfort, obviate the need for sedation, increase diagnostic yield, reduce learning curves, improve access to screening, and possibly avert the need for a bowel preparation.

A modular magnetic platform for Natural Orifice Transluminal Endoscopic Surgery

Modern surgery is currently developing NOTES (Natural Orifice Translumenal Endoscopic Surgery) robotic approaches to enable scarless surgical procedures. Despite of the variegated devices proposed, they still have several limitations. In this work, we propose a surgical platform composed of specialized modules, in order to provide the overall system with adequate stability, dexterity and force generation. The concept behind the platform, the main modules and their performance are described to highlight the system potential to outperform current NOTES procedures.

Review of manual control methods for handheld maneuverable instruments

By the introduction of new technologies, surgical procedures have been varying from free access in open surgery towards limited access in minimal access surgery. Improving access to difficult-to-reach anatomic sites, e.g. in neurosurgery or percutaneous interventions, needs advanced maneuverable instrumentation. Advances in maneuverable technology require the development of dedicated methods enabling surgeons to stay in direct, manual control of these complex instruments. This article gives an overview of the state-of-the-art in the development of manual control methods for handheld maneuverable instruments. It categorizes the manual control methods in three levels: a) number of steerable segments, b) number of Degrees Of Freedom (DOF), and c) coupling between control motion of the handle and steering motion of the tip. The literature research was completed by using Web of Science, Scopus and PubMed. The study shows that in controlling single steerable segments, direct as well as indirect control methods have been developed, whereas in controlling multiple steerable segments, a gradual shift can be noticed from parallel and serial control to integrated control. The development of multi-segmented maneuverable instruments is still at an early stage, and an intuitive and effective method to control them has to become a primary focus in the domain of minimal access surgery.

Capsule endoscopy: from current achievements to open challenges

Wireless capsule endoscopy (WCE) can be considered an example of disruptive technology since it represents an appealing alternative to traditional diagnostic techniques. This technology enables inspection of the digestive system without discomfort or need for sedation, thus preventing the risks of conventional endoscopy, and has the potential of encouraging patients to undergo gastrointestinal (GI) tract examinations. However, currently available clinical products are passive devices whose locomotion is driven by natural peristalsis, with the drawback of failing to capture the images of important GI tract regions, since the doctor is unable to control the capsule's motion and orientation. To address these limitations, many research groups are working to develop active locomotion devices that allow capsule endoscopy to be performed in a totally controlled manner. This would enable the doctor to steer the capsule towards interesting pathological areas and to accomplish medical tasks. This review presents a research update on WCE and describes the state of the art of the basic modules of current swallowable devices, together with a perspective on WCE potential for screening, diagnostic, and therapeutic endoscopic procedures.

Advanced technologies for gastrointestinal endoscopy

The gastrointestinal tract is home to some of the most deadly human diseases. Exacerbating the problem is the difficulty of accessing it for diagnosis or intervention and the concomitant patient discomfort. Flexible endoscopy has established itself as the method of choice and its diagnostic accuracy is high, but there remain technical limitations in modern scopes, and the procedure is poorly tolerated by patients, leading to low rates of compliance with screening guidelines. Although advancement in clinical endoscope design has been slow in recent years, a critical mass of enabling technologies is now paving the way for the next generation of gastrointestinal endoscopes. This review describes current endoscopes and provides an overview of innovative flexible scopes and wireless capsules that can enable painless endoscopy and/or enhanced diagnostic and therapeutic capabilities. We provide a perspective on the potential of these new technologies to address the limitations of current endoscopes in mass cancer screening and other contexts and thus to save many lives.

Magnetic air capsule robotic system: proof of concept of a novel approach for painless colonoscopy

BACKGROUND

Despite being considered the most effective method for colorectal cancer diagnosis, colonoscopy take-up as a mass-screening procedure is limited mainly due to invasiveness, patient discomfort, fear of pain, and the need for sedation. In an effort to mitigate some of the disadvantages associated with colonoscopy, this work provides a preliminary assessment of a novel endoscopic device consisting in a softly tethered capsule for painless colonoscopy under robotic magnetic steering.

METHODS

The proposed platform consists of the endoscopic device, a robotic unit, and a control box. In contrast to the traditional insertion method (i.e., pushing from behind), a "front-wheel" propulsion approach is proposed. A compliant tether connecting the device to an external box is used to provide insufflation, passing a flexible operative tool, enabling lens cleaning, and operating the vision module. To assess the diagnostic and treatment ability of the platform, 12 users were asked to find and remove artificially implanted beads as polyp surrogates in an ex vivo model. In vivo testing consisted of a qualitative study of the platform in pigs, focusing on active locomotion, diagnostic and therapeutic capabilities, safety, and usability.

RESULTS

The mean percentage of beads identified by each user during ex vivo trials was 85 ± 11%. All the identified beads were removed successfully using the polypectomy loop. The mean completion time for accomplishing the entire procedure was 678 ± 179 s. No immediate mucosal damage, acute complications such as perforation, or delayed adverse consequences were observed following application of the proposed method in vivo.

CONCLUSIONS

Use of the proposed platform in ex vivo and preliminary animal studies indicates that it is safe and operates effectively in a manner similar to a standard colonoscope. These studies served to demonstrate the platform's added advantages of reduced size, front-wheel drive strategy, and robotic control over locomotion and orientation.