Development and preliminary assessment of a robotic platform for neuroendoscopy based on a lightweight robot

Review of robotic systems for thoracoabdominal puncture interventional surgery

Cancer, with high morbidity and high mortality, is one of the major burdens threatening human health globally. Intervention procedures via percutaneous puncture have been widely used by physicians due to its minimally invasive surgical approach. However, traditional manual puncture intervention depends on personal experience and faces challenges in terms of precisely puncture, learning-curve, safety and efficacy. The development of puncture interventional surgery robotic (PISR) systems could alleviate the aforementioned problems to a certain extent. This paper attempts to review the current status and prospective of PISR systems for thoracic and abdominal application. In this review, the key technologies related to the robotics, including spatial registration, positioning navigation, puncture guidance feedback, respiratory motion compensation, and motion control, are discussed in detail.

Research on spatial motion safety constraints and cooperative control of robot-assisted craniotomy: Beagle model experiment verification

BACKGROUND

Traditional craniotomy depends primarily on the experience of the surgeon. However, the accuracy of manual operation is limited and carries certain surgical risks. The interaction method of current robot-assisted craniotomy is unnatural and inadaptive to the operating style of the surgeon. In this research, we built a hands-on synergistic robotics craniotomy system with human-machine collaboration. Safe isometric surfaces and virtual restraint methods are combined to achieve highly accurate, efficient, minimally invasive and safe craniotomy.

MATERIALS AND METHODS

Fifteen three-dimensional (3D)-printed beagle skull models were used to evaluate the system accuracy and the related image guidance process. It mainly includes the design of the surgical plan, the adopted strategy based on motion constraint and safe isometric surface, and the impedance control method based on the position inner loop via the human-machine collaboration method. The trajectory tracking experiment was performed by applying human-machine collaboration, and completed an experiment on the 3D-printed beagle skull models involving drilling and milling of the skull performed by the robot, and evaluation of accuracy via computed tomographic (CT) scanning verification after the operation.

RESULTS

The 3D-printed beagle skull model experiment shows that the average errors for the top surface and the bottom surface, and the angle error were 0.81 ± 0.15 mm, 0.89 ± 0.12 mm, and 1.74° ± 0.16°, respectively. The average milling position errors for the top and bottom surfaces were 0.87 ± 0.19 and 0.93 ± 0.22 mm, respectively.

CONCLUSION

The performance of the robot system was evaluated and verified using a 3D-printed beagle model experiment. The proposed collaborative surgical robot system is feasible and can complete a craniotomy, with improved accuracy and surgical safety.

A Preliminary Study on Animal Experiments of Robot-Assisted Craniotomy

BACKGROUND

Traditional craniotomy relies on the surgeon's experience and can be complicated owing to excessive skull bone removal, undesirable brain tissue penetration, or severe bleeding. For craniotomy, we developed a robot system based on intraoperative cone-beam computed tomography image guidance and human-robot cooperative interaction, aiming to improve the safety and accuracy of surgery and reduce the labor-intensiveness of the procedure.

METHODS

Intraoperative cone-beam computed tomography image guidance was adopt to improve the accuracy in our experiment. Craniotomy was performed using an interactive method based on human-robot collaboration, which could achieve a natural interactive method in accordance with surgeons' operating habits. The frequency-based method of contact distinction and the method of torque estimation were used to improve the safety of the designed robot.

RESULTS

An animal experiment was conducted to verify the effectiveness of the robot system. During the drilling process, the position error was 0.92 ± 0.17 mm (upper surface) and 0.97 ± 0.11 mm (lower surface), and the angle error was 3.37 ± 1.43°. During the milling process, the position error was 1.06 ± 0.13 mm (upper surface) and 1.09 ± 0.09 mm (lower surface). The results showed that the system had sufficient precision and could better complete craniotomy with human-robot collaboration. In addition, with the feedback of multisensor information, the robot system could achieve a sufficient level of safety.

CONCLUSIONS

The robot system can achieve accurate positioning and safe user-friendly human-robot interaction, which solves problems encountered in the drilling and milling of craniotomy, meets clinical needs, and provides a new method for robot-assisted craniotomy.

Stereotactic Neuro-Navigation Phantom Designs: A Systematic Review

Diverse stereotactic neuro-navigation systems are used daily in neurosurgery and novel systems are continuously being developed. Prior to clinical implementation of new surgical tools, methods or instruments, in vitro experiments on phantoms should be conducted. A stereotactic neuro-navigation phantom denotes a rigid or deformable structure resembling the cranium with the intracranial area. The use of phantoms is essential for the testing of complete procedures and their workflows, as well as for the final validation of the application accuracy. The aim of this study is to provide a systematic review of stereotactic neuro-navigation phantom designs, to identify their most relevant features, and to identify methodologies for measuring the target point error, the entry point error, and the angular error (α). The literature on phantom designs used for evaluating the accuracy of stereotactic neuro-navigation systems, i.e., robotic navigation systems, stereotactic frames, frameless navigation systems, and aiming devices, was searched. Eligible articles among the articles written in English in the period 2000–2020 were identified through the electronic databases PubMed, IEEE, Web of Science, and Scopus. The majority of phantom designs presented in those articles provide a suitable methodology for measuring the target point error, while there is a lack of objective measurements of the entry point error and angular error. We identified the need for a universal phantom design, which would be compatible with most common imaging techniques (e.g., computed tomography and magnetic resonance imaging) and suitable for simultaneous measurement of the target point, entry point, and angular errors.

Management of pineal region tumors in a pediatric case series

Pineal region tumors commonly present with non-communicating hydrocephalus. These heterogeneous histological entities require different therapeutic regimens. We evaluated our surgical experience concerning procurance of a histological diagnosis, management of hydrocephalus, and choice of antitumoral treatment. We analyzed the efficacy of neuroendoscopic biopsy and endoscopic third ventriculocisternostomy (ETV) in patients with pineal region tumors between 2006 and 2019 in a single-center retrospective cross-sectional study with regard to diagnostic yield, hydrocephalus treatment, as well as impact on further antitumoral management. Out of 28 identified patients, 23 patients presented with untreated hydrocephalus and 25 without histological diagnosis. One patient underwent open biopsy, and 24 received a neuroendoscopic biopsy with concomitant hydrocephalus treatment if necessary. Eighteen primary ETVs, 2 secondary ETVs, and 2 ventriculoperitoneal shunts (VPSs) were performed. Endoscopic biopsy had a diagnostic yield of 95.8% (23/24) and complication rates of 12.5% (transient) and 4.2% (permanent), respectively. ETV for hydrocephalus management was successful in 89.5% (17/19) with a median follow-up of more than 3 years. Following histological diagnosis, 8 patients (28.6%) underwent primary resection of their tumor. Another 9 patients underwent later-stage resection after either adjuvant treatment (n = 5) or for progressive disease during observation (n = 4). Eventually, 20 patients received adjuvant treatment and 7 were observed after primary management. One patient was lost to follow-up. Heterogeneity of pineal region tumor requires histological confirmation. Primary biopsy of pineal lesions should precede surgical resection since less than a third of patients needed primary surgical resection according to the German pediatric brain tumor protocols. Interdisciplinary decision making upfront any treatment is warranted in order to adequately guide treatment.

SmartArm: Integration and validation of a versatile surgical robotic system for constrained workspaces

BACKGROUND

With the increasing presence of surgical robots minimally invasive surgery, there is a growing necessity of a versatile surgical system for deep and narrow workspaces.

METHODS

We developed a versatile system for constrained workspaces called SmartArm. It has two industrial-type robotic arms with flexible tools attached to its distal tip, with a total of nine active degrees-of-freedom. The system has a control algorithm based on constrained optimization that allows the safe generation of task constraints and intuitive teleoperation.

RESULTS

The SmartArm system is evaluated in a master-slave experiment in which a medically untrained user operates the robot to suture the dura mater membrane at the skull base of a realistic head phantom. Our results show that the user could accomplish the task proficiently, with speed and accuracy comparable to manual suturing by surgeons. Conclusions We demonstrated the integration and validation of the SmartArm.

Haptic feedback in the da Vinci Research Kit (dVRK): A user study based on grasping, palpation, and incision tasks

BACKGROUND

It was suggested that the lack of haptic feedback, formerly considered a limitation for the da Vinci robotic system, does not affect robotic surgeons because of training and compensation based on visual feedback. However, conclusive studies are still missing, and the interest in force reflection is rising again.

METHODS

We integrated a seven-DoF master into the da Vinci Research Kit. We designed tissue grasping, palpation, and incision tasks with robotic surgeons, to be performed by three groups of users (expert surgeons, medical residents, and nonsurgeons, five users/group), either with or without haptic feedback. Task-specific quantitative metrics and a questionnaire were used for assessment.

RESULTS

Force reflection made a statistically significant difference for both palpation (improved inclusion detection rate) and incision (decreased tissue damage).

CONCLUSIONS

Haptic feedback can improve key surgical outcomes for tasks requiring a pronounced cognitive burden for the surgeon, to be possibly negotiated with longer completion times.

Robot Integrated User Interface for Physical Interaction with the DLR MIRO in Versatile Medical Procedures

To enhance the capability of the DLR MIRO for physical human robot interaction (pHRI), six buttons were integrated as additional input interface along the robot structure. A ring of eight RGB-LEDs at the instrument interface informs the user as additional output interface about the robot’s state. The mechatronic design, which is transferable to other robots, adapts to the existing communication infrastructure of the robot and therefore offers real-time capability. Besides the interaction with the robot itself, it also allows the control of third party devices connected to its communication network. Both interfaces can be flexibly programmed e.g. in C++ or Simulink.

Recent technological advances in pediatric brain tumor surgery

X-rays and ventriculograms were the first imaging modalities used to localize intracranial lesions including brain tumors as far back as the 1880s. Subsequent advances in preoperative radiological localization included computed tomography (CT; 1971) and MRI (1977). Since then, other imaging modalities have been developed for clinical application although none as pivotal as CT and MRI. Intraoperative technological advances include the microscope, which has allowed precise surgery under magnification and improved lighting, and the endoscope, which has improved the treatment of hydrocephalus and allowed biopsy and complete resection of intraventricular, pituitary and pineal region tumors through a minimally invasive approach. Neuronavigation, intraoperative MRI, CT and ultrasound have increased the ability of the neurosurgeon to perform safe and maximal tumor resection. This may be facilitated by the use of fluorescing agents, which help define the tumor margin, and intraoperative neurophysiological monitoring, which helps identify and protect eloquent brain.