A review of recent advancements in soft and flexible robots for medical applications

Design and navigation method of a soft robot for single-port transvesical radical prostatectomy

PURPOSE

Currently, the rigid instruments used for laparoscopic radical resection of prostate cancer not only have the risk of damage to tissues, blood vessels, and nerves, but their limited freedom will also cause surgical blind areas. Soft robots are expected to solve these issues due to inherent flexibility, compliance, and safe interaction with tissues and organs. In addition, to achieve high surgical accuracy and provide precise guidance for surgeons, the navigation method should be studied for the soft robot.

METHODS

A soft robot system for single-port transvesical radical prostatectomy (STRP) is developed, and a navigation method combining fiber Bragg gratings and electromagnetic tracking is proposed for the soft robot. To validate the soft robot design and the effectiveness of the navigation method, different groups of experiments are conducted.

RESULTS

The proposed navigation method can achieve accurate location and shape sensing of the soft manipulator. The experiments show that the maximum tip sensing error is 2.691 mm, which is 5.38 % of the robot length for static configurations, and that the average tip sensing error is 1.966 mm, which corresponds to 3.93 % of the robot length for dynamic scenarios. Additionally, phantom tests demonstrate that the designed soft robot can enter the prostate through navigation guidance in a master-slave control mode and cover the entire prostate space.

CONCLUSIONS

The designed soft robot system, due to its soft structure, good flexibility, and accurate navigation, is expected to improve surgical safety and precision, thereby exhibiting significant potential for STRP.

Untethered Soft Pneumatic Actuators with Embedded Multiple Sensing Capabilities

Pneumatic soft robot attracts extensive attention because of its own characteristics. It has great application potential in medical and other fields. Although the recent improvement of the soft robot shows great potentials for delicate manipulations, the development of completely untethered pneumatic intelligent soft robots remains challenging. This article introduces a novel type of untethered soft pneumatic actuator with embedded multiple sensing capabilities. The untethered drive of the soft pneumatic actuator is achieved by near-infrared-induced liquid-gas phase transition. In addition, a soft conductive resin was developed to make flexible sensors. Embedded flexible sensors enable bending and temperature sensing of soft actuators. With Digital Light Processing three-dimensional printing, the rapid fabrication of soft actuators and flexible sensors was realized. This article demonstrates the potential of the proposed untethered soft actuators with embedded multiple sensing capabilities as an important contribution to the research of completely untethered intelligent soft robots.

Pioneering healthcare with soft robotic devices: A review

Recent advancements in soft robotics have been emerging as an exciting paradigm in engineering due to their inherent compliance, safe human interaction, and ease of adaptation with wearable electronics. Soft robotic devices have the potential to provide innovative solutions and expand the horizons of possibilities for biomedical applications by bringing robots closer to natural creatures. In this review, we survey several promising soft robot technologies, including flexible fluidic actuators, shape memory alloys, cable-driven mechanisms, magnetically driven mechanisms, and soft sensors. Selected applications of soft robotic devices as medical devices are discussed, such as surgical intervention, soft implants, rehabilitation and assistive devices, soft robotic exosuits, and prosthetics. We focus on how soft robotics can improve the effectiveness, safety and patient experience for each use case, and highlight current research and clinical challenges, such as biocompatibility, long-term stability, and durability. Finally, we discuss potential directions and approaches to address these challenges for soft robotic devices to move toward real clinical translations in the future.

A review on model-based and model-free approaches to control soft actuators and their potentials in colonoscopy

Colorectal cancer (CRC) is the third most common cancer worldwide and responsible for approximately 1 million deaths annually. Early screening is essential to increase the chances of survival, and it can also reduce the cost of treatments for healthcare centres. Colonoscopy is the gold standard for CRC screening and treatment, but it has several drawbacks, including difficulty in manoeuvring the device, patient discomfort, and high cost. Soft endorobots, small and compliant devices thatcan reduce the force exerted on the colonic wall, offer a potential solution to these issues. However, controlling these soft robots is challenging due to their deformable materials and the limitations of mathematical models. In this Review, we discuss model-free and model-based approaches for controlling soft robots that can potentially be applied to endorobots for colonoscopy. We highlight the importance of selecting appropriate control methods based on various parameters, such as sensor and actuator solutions. This review aims to contribute to the development of smart control strategies for soft endorobots that can enhance the effectiveness and safety of robotics in colonoscopy. These strategies can be defined based on the available information about the robot and surrounding environment, control demands, mechanical design impact and characterization data based on calibration.

Flexible Magnetic Sensors

With the merits of high sensitivity, high stability, high flexibility, low cost, and simple manufacturing, flexible magnetic field sensors have potential applications in various fields such as geomagnetosensitive E-Skins, magnetoelectric compass, and non-contact interactive platforms. Based on the principles of various magnetic field sensors, this paper introduces the research progress of flexible magnetic field sensors, including the preparation, performance, related applications, etc. In addition, the prospects of flexible magnetic field sensors and their challenges are presented.

A multi-module soft robotic arm with soft actuator for minimally invasive surgery

BACKGROUND

Compared to traditional rigid robotic arms, soft robotic arms are flexible, environmentally adaptable and biocompatible. Recently, most minimally invasive cardiac procedures still rely on traditional rigid surgical tools. However, rigid tools lack sufficient bending angles, which are high-risk in terms of contact with tissues and organs.

METHODS

A soft robotic arm with multiple degrees of freedom was designed to repair atrial septal defects in cardiac surgery. The developed multi-module soft robotic arm consists of four different units, including a bending unit, a turning unit, a stretching unit and gripper units. The three movement units can reach the specified position, and the gripper units can hold a surgical tool stably, such as a suture needle in cardiac surgery.

RESULTS

A cardiac surgery to repair an atrial septal defect has been completed, validating the reliability and functionality of the developed multi-module soft robotic arm.

CONCLUSIONS

The multi-module flexible soft robotic arm for minimally invasive surgery proposed in this paper can reach the designated surgical area during surgery to repair Atrial Septal Defects. Meanwhile, the design of the actuator of the robot arm was used a completely soft silicone material replacing the rigid material, which releases the contact trauma of the organs during the surgery.

The Use of Modern Technologies in Post-COVID-19 Cardiopulmonary Rehabilitation

Managing cardiopulmonary rehabilitation in patients with COVID-19 remains a global challenge due to the facets of this virus. The technologies used in the rehabilitation of post-COVID-19 patients fail to keep pace with the global epidemiological developments. The purpose of this article is to review the medical technologies used in post-COVID-19 cardiopulmonary rehabilitation and the innovations that have allowed us to adapt and care for our patients. The pandemic highlighted the need for seismic changes in diagnostic and rehabilitation paradigms. We discuss advances in telemedicine and telemedicine-based rehabilitation, remote patient monitoring and emerging technologies used in cardiopulmonary rehabilitation. The rapid adoption of modern technologies in the practice of post-COVID-19 cardiopulmonary rehabilitation is promising and can improve patients’ access to complex rehabilitation programs with outstanding results.

Visual servoing of continuum robots: Methods, challenges, and prospects

BACKGROUND

Recent advancements in continuum robotics have accentuated developing efficient and stable controllers to handle shape deformation and compliance. The control of continuum robots (CRs) using physical sensors attached to the robot, particularly in confined spaces, is difficult due to their limited accuracy in three-dimensional deflections and challenging localisation. Therefore, using non-contact imaging sensors finds noticeable importance, particularly in medical scenarios. Accordingly, given the need for direct control of the robot tip and notable uncertainties in the kinematics and dynamics of CRs, many papers have focussed on the visual servoing (VS) of CRs in recent years.

METHODS

The significance of this research towards safe human-robot interaction has fuelled our survey on the previous methods, current challenges, and future opportunities.

RESULTS

Beginning with actuation modalities and modelling approaches, the paper investigates VS methods in medical and non-medical scenarios.

CONCLUSIONS

Finally, challenges and prospects of VS for CRs are discussed, followed by concluding remarks.

Pneumatic System Capable of Supplying Programmable Pressure States for Soft Robots

Pneumatic soft robots are of great interest in varieties of potential applications due to their unique capabilities compared with rigid structures. As a part of the soft robotic system, the pneumatic system plays a very important role as all motion performance is ultimately related to the pressure control in air chambers. With the increasing flexibility and complexity of robotic tasks, diverse pneumatic robots driven by positive, negative, or even hybrid pressure are developed, and this comes with higher requirements of pneumatic system and air pressure control precision. In this study, we aim to propose a simplified pneumatic design capable of generating programmable pressure states ranging from negative to positive pressure in each air branch. Based on the design concept and system configuration, special inflation and deflation strategies and closed-loop feedback control strategy are proposed to achieve precise pressure control. Then, a prototype of the pneumatic system with six independent air supply branches is designed and fabricated. Experimental results show that the pneumatic system can achieve a wide range of pressure from -59 to 112 kPa. The speed of inflation and deflation is controllable. Finally, we demonstrate three robotic applications and design the related algorithms to verify the feasibility and practicability of the pneumatic system. Our proposed pneumatic design can satisfy the pressure control requirements of a variety of soft robots driven by both positive and negative pressure. It can be used as a universal pneumatic platform, which is inspiring for actuation and control in the soft robotic field.

Fully Soft Pressure Sensor Based on Bionic Spine-Pillar Structure for Robotics Motion Monitoring

Soft and stretchable sensors are essential to the development of electronic skin, especially their potential applications in health care and intelligent robots, which have increasingly attracted attentions. Herein, inspired by the epidermal tissue hierarchy, we propose a high-sensitivity fully soft capacitive pressure sensor with bionic spine-pillar microstructure. Benefiting from the combination of the random microscale spines and the millimeter-sized pillar array prepared based on polydimethylsiloxane, the proposed sensor exhibits a well deformability, a high sensitivity up to 2.87 k/Pa at low-pressure range, and a broad linear pressure dynamic range from 5 Pa to 100 kPa. A simple equivalent circuit model was established to demonstrate the sensing mechanism and geometric effect. For practical application demonstrations, the sensor was utilized to monitor local subtle and large movements of the skin, such as finger bending, wrist bending, swallowing, and facial muscle movements. The sensor shows a conformality with human skin to follow the skin extension closely. Furthermore, the proposed sensing strategy can provide a distinguishable tactile feedback for controlling robot arm and soft claw in various tasks, illustrating its potential applications in robotics.

Friction Prediction and Validation of a Variable Stiffness Lower Limb Exosuit Based on Finite Element Analysis

The variable stiffness exosuit has great potential for human augmentation and medical applications. However, the model of the variable stiffness mechanism in exosuits is far from satisfactory for the accurate prediction and control of friction force. This paper presents a friction prediction model of a variable stiffness lower limb exosuit, verifies its prediction performance, and identifies its applicability. The friction force model was established by the Coulomb friction hypothesis. The equivalent coefficient, which is the core parameter of the model, was determined based on friction and squeezing force data obtained by tests and an ANSYS simulation. Experiments show that the prediction error of the proposed model can reach 15% with a proper structural dimension change constraint. The friction force control test showed that the achieved model can shorten the settling time of the step response by 26% and eliminate the steady-state error. Verifications indicate that the proposed method can provide guidance to the modeling of other friction/stiffness structures, especially friction-based wearable robot structure models and predictions.

Brainware Computing: Concepts, Scopes and Challenges

Over the decades, robotics technology has acquired sufficient advancement through the progression of 5G Internet, Artificial Intelligence (AI), Internet of Things (IoT), Cloud, and Edge Computing. Though nowadays, Cobot and Service Oriented Architecture (SOA) supported robots with edge computing paradigms have achieved remarkable performances in diverse applications, the existing SOA robotics technology fails to develop a multi-domain expert with high performing robots and demands improvement to Service-Oriented Brain, SOB (including AI model, driving service application and metadata) enabling robot for deploying brain and a new computing model with more scalability and flexibility. In this paper, instead of focusing on SOA and Robot as a Service (RaaS) model, we propose a novel computing architecture, addressed as Brainware Computing, for driving multiple domain-specific brains one-at-a-time in a single hardware robot according to the service, addressed as Brain as a Service (BaaS). In Brainware Computing, each robot can install and remove the virtual machine, which contains SOB and operating applications from the nearest edge cloud. Secondly, we provide an extensive explanation of the scope and possibilities of Brainware Computing. Finally, we demonstrate several challenges and opportunities and then concluded with future research directions in the field of Brainware Computing.

Guidance for Acupuncture Robot with Potentially Utilizing Medical Robotic Technologies

Acupuncture is gaining increasing attention and recognition all over the world. However, a lot of physical labor is paid by acupuncturists. It is natural to resort to a robot which can improve the accuracy as well as the efficacy of therapy. Several teams have separately developed real acupuncture robots or related technologies and even went to the stage of clinical trial and then achieved success commercially. A completed clinical practical acupuncture robot is not far from reach with the combination of existing mature medical robotic technologies. A hand-eye-brain coordination framework is proposed in this review to integrate the potential utilizing technologies including force feedback, binocular vision, and automatic prescription. We should take acupuncture prescription with artificial intelligence and future development trends into account and make a feasible choice in development of modern acupuncture.

Recent Advances in Design and Actuation of Continuum Robots for Medical Applications

Traditional rigid robot application in the medical field is limited due to the limited degrees of freedom caused by their material and structure. Inspired by trunk, tentacles, and snakes, continuum robot (CR) could traverse confined space, manipulate objects in complex environment, and conform to curvilinear paths in space. The continuum robot has broad prospect in surgery due to its high dexterity, which can reach circuitous areas of the body and perform precision surgery. Recently, many efforts have been done by researchers to improve the design and actuation methods of continuum robots. Several continuum robots have been applied in clinic surgical interventions and demonstrated superiorities to conventional rigid-link robots. In this paper, we provide an overview of the current development of continuum robots, including the design principles, actuation methods, application prospect, limitations, and challenge. And we also provide perspective for the future development. We hope that with the development of material science, Engineering ethics, and manufacture technology, new methods can be applied to manufacture continuum robots for specific surgical procedures.

Robotics Utilization for Healthcare Digitization in Global COVID-19 Management

This paper describes the evolving role of robotics in healthcare and allied areas with special concerns relating to the management and control of the spread of the novel coronavirus disease 2019 (COVID-19). The prime utilization of such robots is to minimize person-to-person contact and to ensure cleaning, sterilization and support in hospitals and similar facilities such as quarantine. This will result in minimizing the life threat to medical staff and doctors taking an active role in the management of theCOVID-19 pandemic. The intention of the present research is to highlight the importance of medical robotics in general and then to connect its utilization with the perspective of COVID-19 management so that the hospital management can direct themselves to maximize the use of medical robots for various medical procedures. This is despite the popularity of telemedicine, which is also effective in similar situations. In essence, the recent achievement of the Korean and Chinese health sectors in obtaining active control of the COVID-19 pandemic was not possible without the use of state of the art medical technology.