Hand-Held Instrument with Integrated Parallel Mechanism for Active Tremor Compensation During Microsurgery

Developments and Challenges of Miniature Piezoelectric Robots: A Review

Miniature robots have been widely studied and applied in the fields of search and rescue, reconnaissance, micromanipulation, and even the interior of the human body benefiting from their highlight features of small size, light weight, and agile movement. With the development of new smart materials, many functional actuating elements have been proposed to construct miniature robots. Compared with other actuating elements, piezoelectric actuating elements have the advantages of compact structure, high power density, fast response, high resolution, and no electromagnetic interference, which make them greatly suitable for actuating miniature robots, and capture the attentions and favor of numerous scholars. In this paper, a comprehensive review of recent developments in miniature piezoelectric robots (MPRs) is provided. The MPRs are classified and summarized in detail from three aspects of operating environment, structure of piezoelectric actuating element, and working principle. In addition, new manufacturing methods and piezoelectric materials in MPRs, as well as the application situations, are sorted out and outlined. Finally, the challenges and future trends of MPRs are evaluated and discussed. It is hoped that this review will be of great assistance for determining appropriate designs and guiding future developments of MPRs, and provide a destination board to the researchers interested in MPRs.

Overcoming the impact of physiologic tremors in ophthalmology

PURPOSE

Ophthalmic surgery involves the manipulation of micron-level sized structures such as the internal limiting membrane where tactile sensation is practically absent. All humans have physiologic tremors that are of low amplitude and not discernible to the naked eye; they do not adversely affect the majority of the population's daily functioning. However, during microsurgery, such tremors can be problematic. In this review, we focus on the impact of physiological tremors on ophthalmic microsurgery and offer a comparative discussion on the impact of such tremors on other surgical specialties.

METHODS

A single investigator used the MEDLINE database (via PubMed) to search for and identify articles for inclusion in this systematic review. Ten key factors were identified as potentially having an impact on tremor amplitude: beta-blockers, muscle fatigue, robotic systems, handheld tools/micromanipulators, armrests/wrist supports, caffeine, diet, sleep deprivation, consuming alcohol, and workouts (exercise). These key terms were then searched using the advanced Boolean search tool and operators (i.e., AND, OR) available on PubMed: (*keyword*) AND (surgeon tremor OR microsurgery tremor OR hand steadiness OR simulator score).

RESULTS

Ten studies attempted to quantify the baseline severity of operator physiologic tremor. Approximately 89% of studies accessing the impact of tremors on performance in regards to surgical metrics reported an improvement in performance compared to 57% of studies concluding that tremor elimination was of benefit when considering procedural outcomes.

CONCLUSIONS

Robotic technology, new instruments, exoskeletons, technique modifications, and lifestyle factors have all demonstrated the potential to assist in overcoming tremors in ophthalmology.

Data analytics interrogates robotic surgical performance using a microsurgery-specific haptic device

OBJECTIVES

With the increase in robot-assisted cases, recording the quantifiable dexterity of surgeons is essential for proficiency evaluations. The present study employs sensor-based kinematics and recorded surgeon experience for evaluating a new haptic device.

METHODS

Thirty surgeons performed a task simulating micromanipulation with neuroArmPLUS^HD and two commercially available hand-controllers. The surgical performance was evaluated based on subjective measures obtained from survey and objective features derived from the sensors. Statistical analyses were performed to assess the hand-controllers and regression analysis was used to identify the key features and develop a machine learning model for surgical skill assessment.

FINDINGS

MANCOVA tests on objective features demonstrated significance (α = 0.05) for time (p = 0.02), errors (p = 0.01), distance (p = 0.03), clutch incidents (p = 0.03), and forces (p = 0.00). The majority of metrics were in favor of neuroArmPLUS^HD. The surgeons found it smoother, more comfortable, less tiring, and easier to maneuver with more realistic force feedback. The ensemble machine learning model trained with 5-fold cross-validation showed an accuracy (SD) of 0.78 (0.15) in surgeon skill classification.

CONCLUSIONS

This study validates the importance of incorporating a superior haptic device in telerobotic surgery for standardization of surgical education and patient care.

Hybrid Robot-assisted Frameworks for Endomicroscopy Scanning in Retinal Surgeries

High-resolution real-time intraocular imaging of retina at the cellular level is very challenging due to the vulnerable and confined space within the eyeball as well as the limited availability of appropriate modalities. A probe-based confocal laser endomicroscopy (pCLE) system, can be a potential imaging modality for improved diagnosis. The ability to visualize the retina at the cellular level could provide information that may predict surgical outcomes. The adoption of intraocular pCLE scanning is currently limited due to the narrow field of view and the micron-scale range of focus. In the absence of motion compensation, physiological tremors of the surgeons' hand and patient movements also contribute to the deterioration of the image quality. Therefore, an image-based hybrid control strategy is proposed to mitigate the above challenges. The proposed hybrid control strategy enables a shared control of the pCLE probe between surgeons and robots to scan the retina precisely, with the absence of hand tremors and with the advantages of an image-based auto-focus algorithm that optimizes the quality of pCLE images. The hybrid control strategy is deployed on two frameworks - cooperative and teleoperated. Better image quality, smoother motion, and reduced workload are all achieved in a statistically significant manner with the hybrid control frameworks.