A review of magnetic actuation systems and magnetically actuated guidewire- and catheter-based microrobots for vascular interventions

Design Optimization of Printed Multi-Layered Electroactive Actuators Used for Steerable Guidewire in Micro-Invasive Surgery

To treat cardiovascular diseases (i.e., a major cause of mortality after cancers), endovascular-technique-based guidewire has been employed for intra-arterial navigation. To date, most commercially available guidewires (e.g., Terumo, Abbott, Cordis, etc.) are non-steerable, which is poorly suited to the human arterial system with numerous bifurcations and angulations. To reach a target artery, surgeons frequently opt for several tools (guidewires with different size integrated into angulated catheters) that might provoke arterial complications such as perforation or dissection. Steerable guidewires would, therefore, be of high interest to reduce surgical morbidity and mortality for patients as well as to simplify procedure for surgeons, thereby saving time and health costs. Regarding these reasons, our research involves the development of a smart steerable guidewire using electroactive polymer (EAP) capable of bending when subjected to an input voltage. The actuation performance of the developed device is assessed through the curvature behavior (i.e., the displacement and the angle of the bending) of a cantilever beam structure, consisting of single- or multi-stack EAP printed on a substrate. Compared to the single-stack architecture, the multi-stack gives rise to a significant increase in curvature, even when subjected to a moderate control voltage. As suggested by the design framework, the intrinsic physical properties (dielectric, electrical, and mechanical) of the EAP layer, together with the nature and thickness of all materials (EAP and substrate), do have strong effect on the bending response of the device. The analyses propose a comprehensive guideline to optimize the actuator performance based on an adequate selection of the relevant materials and geometric parameters. An analytical model together with a finite element model (FEM) are investigated to validate the experimental tests. Finally, the design guideline leads to an innovative structure (composed of a 10-stack active layer screen-printed on a thin substrate) capable of generating a large range of bending angle (up to 190°) under an acceptable input level of 550 V, which perfectly matches the standard of medical tools used for cardiovascular surgery.

Remote magnetic navigation enables precision telesurgery

Medical devices actuated by external magnetic fields can create opportunities for clinical adoption of precision telesurgery.

Magnetic soft microfiberbots for robotic embolization

Cerebral aneurysms and brain tumors are leading life-threatening diseases worldwide. By deliberately occluding the target lesion to reduce the blood supply, embolization has been widely used clinically to treat cerebral aneurysms and brain tumors. Conventional embolization is usually performed by threading a catheter through blood vessels to the target lesion, which is often limited by the poor steerability of the catheter in complex neurovascular networks, especially in submillimeter regions. Here, we propose magnetic soft microfiberbots with high steerability, reliable maneuverability, and multimodal shape reconfigurability to perform robotic embolization in submillimeter regions via a remote, untethered, and magnetically controllable manner. Magnetic soft microfiberbots were fabricated by thermal drawing magnetic soft composite into microfibers, followed by magnetizing and molding procedures to endow a helical magnetic polarity. By controlling magnetic fields, magnetic soft microfiberbots exhibit reversible elongated/aggregated shape morphing and helical propulsion in flow conditions, allowing for controllable navigation through complex vasculature and robotic embolization in submillimeter regions. We performed in vitro embolization of aneurysm and tumor in neurovascular phantoms and in vivo embolization of a rabbit femoral artery model under real-time fluoroscopy. These studies demonstrate the potential clinical value of our work, paving the way for a robotic embolization scheme in robotic settings.

Dexterous helical magnetic robot for improved endovascular access

Treating vascular diseases in the brain requires access to the affected region inside the body. This is usually accomplished through a minimally invasive technique that involves the use of long, thin devices, such as wires and tubes, that are manually maneuvered by a clinician within the bloodstream. By pushing, pulling, and twisting, these devices are navigated through the tortuous pathways of the blood vessels. The outcome of the procedure heavily relies on the clinician's skill and the device's ability to navigate to the affected target region in the bloodstream, which is often inhibited by tortuous blood vessels. Sharp turns require high flexibility, but this flexibility inhibits translation of proximal insertion to distal tip advancement. We present a highly dexterous, magnetically steered continuum robot that overcomes pushability limitations through rotation. A helical protrusion on the device's surface engages with the vessel wall and translates rotation to forward motion at every point of contact. An articulating magnetic tip allows for active steerability, enabling navigation from the aortic arch to millimeter-sized arteries of the brain. The effectiveness of the magnetic continuum robot has been demonstrated through successful navigation in models of the human vasculature and in blood vessels of a live pig.

Augmented Reality Navigation System for Biliary Interventional Procedures With Dynamic Respiratory Motion Correction

OBJECTIVE

Biliary interventional procedures require physicians to track the interventional instrument tip (Tip) precisely with X-ray image. However, Tip positioning relies heavily on the physicians' experience due to the limitations of X-ray imaging and the respiratory interference, which leads to biliary damage, prolonged operation time, and increased X-ray radiation.

METHODS

We construct an augmented reality (AR) navigation system for biliary interventional procedures. It includes system calibration, respiratory motion correction and fusion navigation. Firstly, the magnetic and 3D computed tomography (CT) coordinates are aligned through system calibration. Secondly, a respiratory motion correction method based on manifold regularization is proposed to correct the misalignment of the two coordinates caused by respiratory motion. Thirdly, the virtual biliary, liver and Tip from CT are overlapped to the corresponding position of the patient for dynamic virtual-real fusion.

RESULTS

Our system is respectively evaluated and achieved an average alignment error of 0.75 ± 0.17 mm and 2.79 ± 0.46 mm on phantoms and patients. The navigation experiments conducted on phantoms achieve an average Tip positioning error of 0.98 ± 0.15 mm and an average fusion error of 1.67 ± 0.34 mm after correction.

CONCLUSION

Our system can automatically register the Tip to the corresponding location in CT, and dynamically overlap the 3D virtual model onto patients to provide accurate and intuitive AR navigation.

SIGNIFICANCE

This study demonstrates the clinical potential of our system by assisting physicians during biliary interventional procedures. Our system enables dynamic visualization of virtual model on patients, reducing the reliance on contrast agents and X-ray usage.

Coupling magnetic torque and force for colloidal microbot assembly and manipulation

For targeted transport in the body, biomedical microbots (μbots) must move effectively in three-dimensional (3D) microenvironments. Swimming μbots translate via asymmetric or screw-like motions while rolling ones use friction with available surfaces to generate propulsive forces. We have previously shown that planar rotating magnetic fields assemble μm-scale superparamagnetic beads into circular μbots that roll along surfaces. In this, gravity is required to pull μbots near the surface; however, this is not necessarily practical in complex geometries. Here we show that rotating magnetic fields, in tandem with directional magnetic gradient forces, can be used to roll μbots on surfaces regardless of orientation. Simplifying implementation, we use a spinning permanent magnet to generate differing ratios of rotating and gradient fields, optimizing control for different environments. This use of a single magnetic actuator sidesteps the need for complex electromagnet or tandem field setups, removes requisite gravitational load forces, and enables μbot targeting in complex 3D biomimetic microenvironments.

Submillimeter Multifunctional Ferromagnetic Fiber Robots for Navigation, Sensing, and Modulation

Small-scale robots capable of remote active steering and navigation offer great potential for biomedical applications. However, the current design and manufacturing procedure impede their miniaturization and integration of various diagnostic and therapeutic functionalities. Herein, submillimeter fiber robots that can integrate navigation, sensing, and modulation functions are presented. These fiber robots are fabricated through a scalable thermal drawing process at a speed of 4 meters per minute, which enables the integration of ferromagnetic, electrical, optical, and microfluidic composite with an overall diameter of as small as 250 µm and a length of as long as 150 m. The fiber tip deflection angle can reach up to 54o under a uniform magnetic field of 45 mT. These fiber robots can navigate through complex and constrained environments, such as artificial vessels and brain phantoms. Moreover, Langendorff mouse hearts model, glioblastoma micro platforms, and in vivo mouse models are utilized to demonstrate the capabilities of sensing electrophysiology signals and performing a localized treatment. Additionally, it is demonstrated that the fiber robots can serve as endoscopes with embedded waveguides. These fiber robots provide a versatile platform for targeted multimodal detection and treatment at hard-to-reach locations in a minimally invasive and remotely controllable manner.

The CathPilot: Performance Validation and Preclinical Safety and Feasibility Assessment

OBJECTIVES

Peripheral endovascular revascularization procedures often fail due to technical limitations of guidewire support, steering, and visualization. The novel CathPilot catheter aims to address these challenges. This study assesses the safety and feasibility of the CathPilot and compares its performance to conventional catheters for peripheral vascular interventions.

METHODS

The study compared the CathPilot to non-steerable and steerable catheters. The success rates and access times for a relevant target inside a tortuous vessel phantom model were assessed. The reachable workspace within the vessel and the guidewire's force delivery capabilities were also evaluated. To validate the technology, chronic total occlusion tissue samples were used ex vivo to compare crossing success rates with conventional catheters. Finally, in vivo experiments in a porcine aorta were conducted to evaluate safety and feasibility.

RESULTS

The success rates for reaching the set targets were 31%, 69%, and 100% with the non-steerable catheter, the steerable catheter, and the CathPilot, respectively. CathPilot had a significantly larger reachable workspace, and allowed for up to four times higher force delivery and pushability. In crossing of chronic total occlusion samples, the CathPilot achieved a success rate of 83% and 100%, for fresh and fixed lesions respectively, which was also significantly higher than conventional catheters. The device was fully functional in the in vivo study, and there were no signs of coagulation or damage to the vessel wall.

CONCLUSION

This study shows the safety and feasibility of the CathPilot system and its potential to reduce failure and complication rates in peripheral vascular interventions. The novel catheter outperformed conventional catheters in all defined metrics. This technology can potentially improve the success rate and outcome of peripheral endovascular revascularization procedures.

Modeling and motion control of helical microrobots using the dual quaternion framework and adaptive sliding mode strategy

This study investigates the tracking control problem of helical microrobots (HMRs) in complicated blood environments. The integrated relative motion model of HMRs is established by resorting to the dual quaternion method, which can describe the coupling effect between the rotational and translational motions. Subsequently, an original apparent weight compensator (AWC) is designed to alleviate the adverse effects of the HMR sinking and drifting owing to its own weight and buoyancy. An adaptive sliding mode control based on the developed AWC (AWC-ASMC) is constructed to guarantee the fast convergence of the relative motion tracking errors in the presence of model uncertainties and unknown perturbations. The chattering phenomenon of the classical SMC is significantly reduced using the developed control strategy. Furthermore, the stability of the closed-loop system under the constructed control framework is demonstrated by the Lyapunov theory. Finally, numerical simulations are performed to demonstrate the validity and superiority of the developed control scheme.

Kirchhoff rod-based three-dimensional dynamical model and real-time simulation for medical-magnetic guidewires

BACKGROUND AND OBJECTIVE

Magnetic guidewire, fabricated from hard-magnetic soft composites, has recently emerged as an appropriate candidate for magnetic actuation systems to perform intravascular surgical navigation, owing to its elastic, magnetically steerable properties and good interphase with biological tissues. A suitable and efficient mathematical model for the magnetic guidewire is essential in the system to execute remote manipulation and active control.

METHODS

This paper presents a real-time Kirchhoff rod-based dynamical modeling approach, the magneto-elastic rod model, to simulate magnetic guidewire, which provides accurate simulations for two- and three-dimensional dynamic deflections induced by external magnetic fields and obtains deformed guidewire shapes in quasi-static status.

RESULTS

The proposed model is capable of describing the intrinsic principles of elastic body actuation by torques generated from the hard-magnetic soft matrix. The effectiveness of the developed model is validated, and the real-time simulation application is conducted via the semi-implicit numerical integration method.

CONCLUSIONS

It has been shown that the presented dynamical model captures large nonlinear deformations and transient responses of the magnetic guidewire in an imitated human blood environment, which could offer robust support for the construction of a simulated magnetically driven surgical system.

Toward a novel soft robotic system for minimally invasive interventions

PURPOSE

During minimally invasive surgery, surgeons maneuver tools through complex anatomies, which is difficult without the ability to control the position of the tools inside the body. A potential solution for a substantial portion of these procedures is the efficient design and control of a pneumatically actuated soft robot system.

METHODS

We designed and evaluated a system to control a steerable catheter tip. A macroscale 3D printed catheter tip was designed to have two separately pressurized channels to induce bending in two directions. A motorized hand controller was developed to allow users to control the bending angle while manually inserting the steerable tip. Preliminary characterization of two catheter tip prototypes was performed and used to map desired angle inputs into pressure commands.

RESULTS

The integrated robotic system allowed both a novice and a skilled surgeon to position the steerable catheter tip at the location of cylindrical targets with sub-millimeter accuracy. The novice was able to reach each target within ten seconds and the skilled surgeon within five seconds on average.

CONCLUSION

This soft robotic system enables its user to simultaneously insert and bend the pneumatically actuated catheter tip with high accuracy and in a short amount of time. These results show promise concerning the development of a soft robotic system that can improve outcomes in minimally invasive interventions.

Current State of Robotics in Interventional Radiology

As a relatively new specialty with a minimally invasive nature, the field of interventional radiology is rapidly growing. Although the application of robotic systems in this field shows great promise, such as with increased precision, accuracy, and safety, as well as reduced radiation dose and potential for teleoperated procedures, the progression of these technologies has been slow. This is partly due to the complex equipment with complicated setup procedures, the disruption to theatre flow, the high costs, as well as some device limitations, such as lack of haptic feedback. To further assess these robotic technologies, more evidence of their performance and cost-effectiveness is needed before their widespread adoption within the field. In this review, we summarise the current progress of robotic systems that have been investigated for use in vascular and non-vascular interventions.

A Novel Master-Slave Interventional Surgery Robot with Force Feedback and Collaborative Operation

In recent years, master-slave vascular robots have been developed to address the problem of radiation exposure during vascular interventions for surgeons. However, the single visual feedback reduces surgeon immersion and transparency of the system. In this work, we have developed a haptic interface based on the magnetorheological fluid (MRF) on the master side. The haptic interface can provide passive feedback force with high force fidelity and low inertia. Additionally, the manipulation of the master device does not change the operating posture of traditional surgery, which allows the surgeon to better adapt to the robotic system. For the slave robot, the catheter and guidewire can be navigated simultaneously which allows the two degrees of action on the catheter and axial action of a guidewire. The resistance force of the catheter navigation is measured and reflected to the user through the master haptic interface. To verify the proposed master-slave robotic system, the evaluation experiments are carried out in vitro, and the effectiveness of the system was demonstrated experimentally.

Identification of the Position of a Tethered Delivery Catheter to Retrieve an Untethered Magnetic Robot in a Vascular Environment

In this paper, we propose a method of identifying the position of a tethered delivery catheter in a vascular environment, recombining an untethered magnetic robot (UMR) to the tethered delivery catheter, and safely retrieving them from the vascular environment in an endovascular intervention by utilizing a separable and recombinable magnetic robot (SRMR) and a magnetic navigation system (MNS). From images of a blood vessel and a tethered delivery catheter taken from two different angles, we developed a method of extracting the position of the delivery catheter in the blood vessel by introducing dimensionless cross-sectional coordinates. Then, we propose a retrieval method for the UMR by using the magnetic force considering the delivery catheter's position, suction force, and rotating magnetic field. We used thane MNS and feeding robot to simultaneously apply magnetic force and suction force to the UMR. In this process, we determined a current solution for generating magnetic force by using a linear optimization method. Finally, we conducted in vitro and in vivo experiments to verify the proposed method. In the in vitro experiment, which was in a glass tube environment, by using an RGB camera, we confirmed that the location of the delivery catheter in the glass tube could be recognized within an average error of 0.05 mm in each of the X- and Z-coordinates and that the retrieval success rate was greatly improved in comparison with that in the case without the use of magnetic force. In an in vivo experiment, we successfully retrieved the UMR in the femoral arteries of pigs.

A review on microrobots driven by optical and magnetic fields

Due to their small sizes, microrobots are advantageous for accessing hard-to-reach spaces for delivery and measurement. However, their small sizes also bring challenges in on-board powering, thus usually requiring actuation by external energy. Microrobots actuated by external energy have been applied to the fields of physics, biology, medical science, and engineering. Among these actuation sources, light and magnetic fields show advantages in high precision and high biocompatibility. This paper reviews the recent advances in the design, actuation, and applications of microrobots driven by light and magnetic fields. For light-driven microrobots, we summarized the uses of optical tweezers, optoelectronic tweezers, and heat-mediated optical manipulation techniques. For magnetically driven microrobots, we summarized the uses of torque-driven microrobots, force-driven microrobots, and shape-deformable microrobots. Then, we compared the two types of field-driven microrobots and reviewed their advantages and disadvantages. The paper concludes with an outlook for the joint use of optical and magnetic field actuation in microrobots.

Medical microrobots in reproductive medicine from the bench to the clinic

Medical microrobotics is an emerging field that aims at non-invasive diagnosis and therapy inside the human body through miniaturized sensors and actuators. Such microrobots can be tethered (e.g., smart microcatheters, microendoscopes) or untethered (e.g., cell-based drug delivery systems). Active motion and multiple functionalities, distinguishing microrobots from mere passive carriers and conventional nanomedicines, can be achieved through external control with physical fields such as magnetism or ultrasound. Here we give an overview of the key challenges in the field of assisted reproduction and how these new technologies could, in the future, enable assisted fertilization in vivo and enhance embryo implantation. As a case study, we describe a potential intervention in the case of recurrent embryo implantation failure, which involves the non-invasive delivery of an early embryo back to the fertilization site using magnetically-controlled microrobots. As the embryo will be in contact with the secretory oviduct fluid, it can develop under natural conditions and in synchrony with the endometrium preparation. We discuss the potential microrobot designs, including a proper selection of materials and processes, envisioning their translation from bench to animal studies and human medicine. Finally, we highlight regulatory and ethical considerations for bringing this technology to the clinic.

Multifunctional ferromagnetic fiber robots for navigation, sensing, and treatment in minimally invasive surgery

Small-scale robots capable of remote active steering and navigation offer great potential for biomedical applications. However, the current design and manufacturing procedure impede their miniaturization and integration of various diagnostic and therapeutic functionalities. Here, we present a robotic fiber platform for integrating navigation, sensing, and therapeutic functions at a submillimeter scale. These fiber robots consist of ferromagnetic, electrical, optical, and microfluidic components, fabricated with a thermal drawing process. Under magnetic actuation, they can navigate through complex and constrained environments, such as artificial vessels and brain phantoms. Moreover, we utilize Langendorff mouse hearts model, glioblastoma microplatforms, and in vivo mouse models to demonstrate the capabilities of sensing electrophysiology signals and performing localized treatment. Additionally, we demonstrate that the fiber robots can serve as endoscopes with embedded waveguides. These fiber robots provide a versatile platform for targeted multimodal detection and treatment at hard-to-reach locations in a minimally invasive and remotely controllable manner.

Magnetically steerable catheters: State of the art review

Magnetically steerable catheters (MSCs) have caught the interest of researchers due to their various potential uses in clinical applications, for example, minimally invasive surgery. Many significant advances in the design, implementation and analysis of MSCs have been accomplished in the last decade. This review concentrates on the configurations of current MSCs with an in depth look at control of the device and the specific workspace. This review also evaluates MSCs and references possible future system designs and difficulties. The concept of magnetic manipulation is briefly presented. Then, by category, the MSC is introduced. Following that, a discussion of future works and challenges of the review systems is provided. The conclusions are finally addressed.

Magnetic Soft Helical Manipulators with Local Dipole Interactions for Flexibility and Forces

Magnetic continuum manipulators (MCMs) are a class of continuum robots that can be actuated without direct contact by an external magnetic field. MCMs operating in confined workspaces, such as those targeting medical applications, require flexible magnetic structures that contain combinations of magnetic components and polymers to navigate long and tortuous paths. In cylindrical MCM designs, a significant trade-off exists between magnetic moment and bending flexibility as the ratio between length and diameter decreases. In this study, we propose a new MCM design framework that enables increasing diameter without compromising on flexibility and magnetic moment. Magnetic soft composite helices constitute bending regions of the MCM and are separated by permanent ring magnets. Local dipole interactions between the permanent magnets can reduce bending stiffness, depending on their size and spacing. For the particular segment geometry presented herein, the local dipole interactions result in a 31% increase in angular deflection of composite helices inside an external magnetic field, compared to helices without local interactions. In addition, we demonstrate fabrication, maneuverability, and example applications of a multisegment MCM in a phantom of the abdominal aorta, such as passing contrast dye and guidewires.

Multiphysical Analytical Modeling and Design of A Magnetically Steerable Robotic Catheter for Treatment of Peripheral Artery Disease

This article presents a unique multiphysical analytical modeling framework and solution algorithm to provide an effective tool for design of magnetically steerable robotic catheters (MSRCs) experiencing external interaction loads. Particularly, in this study, we are interested in design and fabrication of a MSRC with flexural patterns for treatment of peripheral artery disease (PAD). Aside from the parameters involved in the magnetic actuation system and the external interaction loads acting on the MSRC, the considered flexural patterns have a critical role on the deformation behavior and steerability of the proposed MSRC. Therefore, to optimally design such MSRC, we utilized the proposed multiphysical modeling approach and thoroughly evaluated the influence of involved parameters on the performance of the MSRC via two simulations studies. We also conducted experimental studies in a free bending condition and in the presence of different external interaction loads on two custom-designed MSRCs to thoroughly evaluate the efficacy of the proposed multiphysical model and solution algorithm. Our analysis demonstrates the accuracy of the proposed approach and necessity of utilizing such models to optimally design a MSRC before fabrication procedure.

An introductory review of robotically assisted surgical systems

Purpose

The scope of the work is to present the state of the art of robotically assisted surgical systems and to give a general idea about how technology can help today and tomorrow robotic surgery. The road to innovation passes through research and on field trials; for this reason, not only commercial surgery robots, but also innovative prototype robots, proposed by the Academic world, are presented.

Design/methodology/approach

Following a short introduction, robotically assisted surgery systems are introduced discussing their architectures and main peculiarities. A further section is dedicated to the key enabling technologies that will make possible to improve current systems and that will lead to a new generation of surgical robotic systems able to meet the patient's needs and facilitate the surgeon's task. Finally, brief concluding comments are given.

Findings

The idea of using robots for surgery was born many years ago and in a short time a market demand was created. Today the market is very dynamic, and several new products are updated and created for the execution of both traditional and new procedures. The article provides a guide for the reader who has an interest in this area.

Originality/value

This paper provides an insight into the commercial robotic surgical systems and a look on research prototypes from academic and industrial worlds.

A Survey on Design, Actuation, Modeling, and Control of Continuum Robot

In this paper, we describe the advances in the design, actuation, modeling, and control field of continuum robots. After decades of pioneering research, many innovative structural design and actuation methods have arisen. Untethered magnetic robots are a good example; its external actuation characteristic allows for miniaturization, and they have gotten a lot of interest from academics. Furthermore, continuum robots with proprioceptive abilities are also studied. In modeling, modeling approaches based on continuum mechanics and geometric shaping hypothesis have made significant progress after years of research. Geometric exact continuum mechanics yields apparent computing efficiency via discrete modeling when combined with numerical analytic methods such that many effective model-based control methods have been realized. In the control, closed-loop and hybrid control methods offer great accuracy and resilience of motion control when combined with sensor feedback information. On the other hand, the advancement of machine learning has made modeling and control of continuum robots easier. The data-driven modeling technique simplifies modeling and improves anti-interference and generalization abilities. This paper discusses the current development and challenges of continuum robots in the above fields and provides prospects for the future.

An Electromagnetically Controllable Microrobotic Interventional System for Targeted, Real-Time Cardiovascular Intervention

Robotic magnetic manipulation systems offer a wide range of potential benefits in medical fields, such as precise and selective manipulation of magnetically responsive instruments in difficult-to-reach vessels and tissues. However, more preclinical/clinical studies are necessary before robotic magnetic interventional systems can be widely adopted. In this study, a clinically translatable, electromagnetically controllable microrobotic interventional system (ECMIS) that assists a physician in remotely manipulating and controlling microdiameter guidewires in real time, is reported. The ECMIS comprises a microrobotic guidewire capable of active magnetic steering under low-strength magnetic fields, a human-scale electromagnetic actuation (EMA) system, a biplane X-ray imaging system, and a remote guidewire/catheter advancer unit. The proposed ECMIS demonstrates targeted real-time cardiovascular interventions in vascular phantoms through precise and rapid control of the microrobotic guidewire under EMA. Further, the potential clinical effectiveness of the ECMIS for real-time cardiovascular interventions is investigated through preclinical studies in coronary, iliac, and renal arteries of swine models in vivo, where the magnetic steering of the microrobotic guidewire and control of other ECMIS modules are teleoperated by operators in a separate control booth with X-ray shielding. The proposed ECMIS can help medical physicians optimally manipulate interventional devices such as guidewires under minimal radiation exposure.

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.

Dual-Resonance (16/32 MHz) Piezoelectric Transducer With a Single Electrical Connection for Forward-Viewing Robotic Guidewire

Peripheral artery disease (PAD) affects more than 200 million people globally. Minimally invasive endovascular procedures can provide relief and salvage limbs while reducing injury rates and recovery times. Unfortunately, when a calcified chronic total occlusion is encountered, ~25% of endovascular procedures fail due to the inability to advance a guidewire using the view provided by fluoroscopy. To enable a sub-millimeter, robotically steerable guidewire to cross these occlusions, a novel single-element, dual-band transducer is developed that provides simultaneous multifrequency, forward-viewing imaging with high penetration depth and high spatial resolution while requiring only a single electrical connection. The design, fabrication, and acoustic characterization of this device are described, and proof-of-concept imaging is demonstrated in an ex vivo porcine artery after integration with a robotically steered guidewire. Measured center frequencies of the developed transducer were 16 and 32 MHz, with -6 dB fractional bandwidths of 73% and 23%, respectively. When imaging a 0.2-mm wire target at a depth of 5 mm, measured -6 dB target widths were 0.498 ± 0.02 and 0.268 ± 0.01 mm for images formed at 16 and 32 MHz, respectively. Measured SNR values were 33.3 and 21.3 dB, respectively. The 3-D images of the ex vivo artery demonstrate high penetration for visualizing vessel morphology at 16 MHz and ability to resolve small features close to the transducer at 32 MHz. Using images acquired simultaneously at both frequencies as part of an integrated forward-viewing, guidewire-based imaging system, an interventionalist could visualize the best path for advancing the guidewire to improve outcomes for patients with PAD.

Physics-Informed Modeling and Control of Multi-Actuator Soft Catheter Robots

Catheter-based endovascular interventional procedures have become increasingly popular in recent years as they are less invasive and patients spend less time in the hospital with less recovery time and less pain. These advantages have led to a significant growth in the number of procedures that are performed annually. However, it is still challenging to position a catheter in a target vessel branch within the highly complicated and delicate vascular structure. In fact, vessel tortuosity and angulation, which cause difficulties in catheterization and reaching the target site, have been reported as the main causes of failure in endovascular procedures. Maneuverability of a catheter for intravascular navigation is a key to reaching the target area; ability of a catheter to move within the target vessel during trajectory tracking thus affects to a great extent the length and success of the procedure. To address this issue, this paper models soft catheter robots with multiple actuators and provides a time-dependent model for characterizing the dynamics of multi-actuator soft catheter robots. Built on this model, an efficient and scalable optimization-based framework is developed for guiding the catheter to pass through arteries and reach the target where an aneurysm is located. The proposed framework models the deflection of the multi-actuator soft catheter robot and develops a control strategy for movement of catheter along a desired trajectory. This provides a simulation-based framework for selection of catheters prior to endovascular catheterization procedures, assuring that given a fixed design, the catheter is able to reach the target location. The results demonstrate the benefits that can be achieved by design and control of catheters with multiple number of actuators for navigation into small vessels.

Magnetically Guided Catheters, Micro- and Nanorobots for Spinal Cord Stimulation

Spinal cord stimulation (SCS) is an established treatment for refractory pain syndromes and has recently been applied to improve locomotion. Several technical challenges are faced by surgeons during SCS lead implantation, particularly in the confined dorsal epidural spaces in patients with spinal degenerative disease, scarring and while targeting challenging structures such as the dorsal root ganglion. Magnetic navigation systems (MNS) represent a novel technology that uses externally placed magnets to precisely steer tethered and untethered devices. This innovation offers several benefits for SCS electrode placement, including enhanced navigation control during tip placement, and the ability to position and reposition the lead in an outpatient setting. Here, we describe the challenges of SCS implant surgery and how MNS can be used to overcome these hurdles. In addition to tethered electrode steering, we discuss the navigation of untethered micro- and nanorobots for wireless and remote neuromodulation. The use of these small-scale devices can potentially change the current standard of practice by omitting the need for electrode and pulse generator implantation or replacement. Open questions include whether small-scale robots can generate an electrical field sufficient to activate neuronal tissue, as well as testing precise navigation, placement, anchoring, and biodegradation of micro- and nanorobots in the in vivo environment.

Textiles in soft robots: Current progress and future trends

Soft robotics have substantial benefits of safety, adaptability, and cost efficiency compared to conventional rigid robotics. Textiles have applications in soft robotics either as an auxiliary material to reinforce the conventional soft material or as an active soft material. Textiles of various types and configurations have been fabricated into key components of soft robotics in adaptable formats. Despite significant advancements, the efficiency and characteristics of textile actuators in practical applications remain unsatisfactory. To address these issues, novel structural and material designs as well as new textile technologies have been introduced. Herein, we aim at giving an insight into the current state of the art in textile technology for soft robotic manufacturing. We firstly discuss the fundamental actuation mechanisms for soft robotics. We then provide a critical review on the recently developed functional textiles as reinforcements, sensors, and actuators in soft robotics. Finally, the future trends and current strategies that can be employed in textile-based actuator manufacturing process have been explored to address the critical challenges in soft robotics.

Light-driven untethered soft actuators based on biomimetic microstructure arrays

Soft actuators based on smart materials and structures that can perform more diverse tasks skillfully, are being intensively sought. Despite the good progress made in the past few years, locomotion and transportation functionalities of the untethered soft-bodied devices for various natural terrains remain challenging. Inspired by a gecko crawling system, an untethered soft actuator with the abilities of picking up, transporting, and delivering objects controlled by NIR light is proposed. The soft actuator consisting of photo-responsive MWCNTs units and mushroom shaped microstructures, was fabricated by an integrative soft-lithography method with inking and imprinting processes. The integrated MWCNTs unit can convert NIR light irradiation into thermal energy, which can make the body of the soft actuator generate a strong shape deformation intrinsically in a self-contained way, leading to a combined discontinuous and continuous locomotion. Moreover, the integrated mushroom shaped microstructures can also realize grasping and manipulation of the object that was not constrained by the object's shapes and sizes, which was further addressed from experimental and theoretical perspectives. Thus, the combined use of smart materials and structures opens up new research avenues and represents a step forward toward future applications of light-driven untethered soft actuators.

A Magnetically Powered Stem Cell-Based Microrobot for Minimally Invasive Stem Cell Delivery via the Intranasal Pathway in a Mouse Brain

Targeted stem cell delivery with microrobots has emerged as a potential alternative therapeutic strategy in regenerative medicine, and intranasal administration is an effective approach for minimally invasive delivery of therapeutic agents into the brain. In this study, a magnetically powered stem cell-based microrobot ("Cellbot") is used for minimally invasive targeted stem cell delivery to the brain through the intranasal passage. The Cellbot is developed by internalizing superparamagnetic iron oxide nanoparticles (SPIONs) into human nasal turbinate stem cells. The SPIONs have no influence on hNTSC characteristics, including morphology, cell viability, and neuronal differentiation. The Cellbots are capable of proliferation and differentiation into neurons, neural precursor cells, and neurogliocytes. The Cellbots in the microfluidic channel can be reliably manipulated by an external magnetic field for orientation and position control. Using an ex vivo model based on brain organoids, it is determined that the Cellbots can be transplanted into brain tissue. Using a murine model, it is demonstrated that the Cellbots can be intranasally administered and magnetically guided to the target tissue in vivo. This approach has the potential to effectively treat central nervous system disorders in a minimally invasive manner.

Evolutionary design of magnetic soft continuum robots

Worldwide cardiovascular diseases such as stroke and heart disease are the leading cause of mortality. While guidewire/catheter-based minimally invasive surgery is used to treat a variety of cardiovascular disorders, existing passive guidewires and catheters suffer from several limitations such as low steerability and vessel access through complex geometry of vasculatures and imaging-related accumulation of radiation to both patients and operating surgeons. To address these limitations, magnetic soft continuum robots (MSCRs) in the form of magnetic field-controllable elastomeric fibers have recently demonstrated enhanced steerability under remotely applied magnetic fields. While the steerability of an MSCR largely relies on its workspace-the set of attainable points by its end effector-existing MSCRs based on embedding permanent magnets or uniformly dispersing magnetic particles in polymer matrices still cannot give optimal workspaces. The design and optimization of MSCRs have been challenging because of the lack of efficient tools. Here, we report a systematic set of model-based evolutionary design, fabrication, and experimental validation of an MSCR with a counterintuitive nonuniform distribution of magnetic particles to achieve an unprecedented workspace. The proposed MSCR design is enabled by integrating a theoretical model and the genetic algorithm. The current work not only achieves the optimal workspace for MSCRs but also provides a powerful tool for the efficient design and optimization of future magnetic soft robots and actuators.

Recent Progress in Magnetically Actuated Microrobots for Targeted Delivery of Therapeutic Agents

Therapeutic agents, such as drugs and cells, play an essential role in virtually every treatment of injury, illness, or disease. However, the conventional practices of drug delivery often result in undesirable side effects caused by drug overdose and off-target delivery. In the case of cell delivery, the survival rate of the transplanted cells is extremely low and difficulties with the administration route of cells remain a problem. Recently, magnetically actuated microrobots have started offering unique opportunities in targeted therapeutic delivery due to their tiny size and ability to access hard-to-reach lesions in a minimally invasive manner; considerable advances in this regard have been made over the past decade. Here, recent progress in magnetically actuated microrobots, developed for targeted drug/cell delivery, is presented, with a focus on their design features and mechanisms for controlled therapeutic release. Additionally, the practical challenges faced by the microrobots, and future research directions toward the swift bench-to-bedside translation of the microrobots are addressed.

Flow driven robotic navigation of microengineered endovascular probes

Minimally invasive medical procedures, such as endovascular catheterization, have considerably reduced procedure time and associated complications. However, many regions inside the body, such as in the brain vasculature, still remain inaccessible due to the lack of appropriate guidance technologies. Here, experimentally and through numerical simulations, we show that tethered ultra-flexible endovascular microscopic probes can be transported through tortuous vascular networks with minimal external intervention by harnessing hydrokinetic energy. Dynamic steering at bifurcations is performed by deformation of the probe head using magnetic actuation. We developed an endovascular microrobotic toolkit with a cross-sectional area that is orders of magnitude smaller than the smallest catheter currently available. Our technology has the potential to improve state-of-the-art practices as it enhances the reachability, reduces the risk of iatrogenic damage, significantly increases the speed of robot-assisted interventions, and enables the deployment of multiple leads simultaneously through a standard needle injection and saline perfusion.

The navigation of catheters through blood vessels requires flexible guiding wires that are pushable and tractable at the same time. Pancaldi et al. rely on hydrodynamic forces and magnetic torque in order to access even rather small capillaries with an ultraflexible magnetomechanical probe.

Micro/nanoscale magnetic robots for biomedical applications

Magnetic small-scale robots are devices of great potential for the biomedical field because of the several benefits of this method of actuation. Recent work on the development of these devices has seen tremendous innovation and refinement toward ​improved performance for potential clinical applications. This review briefly details recent advancements in small-scale robots used for biomedical applications, covering their design, fabrication, applications, and demonstration of ability, and identifies the gap in studies and the difficulties that have persisted in the optimization of the use of these devices. In addition, alternative biomedical applications are also suggested for some of the technologies that show potential for other functions. This study concludes that although the field of small-scale robot research is highly innovative ​there is need for more concerted efforts to improve functionality and reliability of these devices particularly in clinical applications. Finally, further suggestions are made toward ​the achievement of commercialization for these devices.