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Chatterjee S, Das S, Ganguly K, Mandal D. Advancements in robotic surgery: innovations, challenges and future prospects. J Robot Surg 2024; 18:28. [PMID: 38231455 DOI: 10.1007/s11701-023-01801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/16/2023] [Indexed: 01/18/2024]
Abstract
The use of robots has revolutionized healthcare, wherein further innovations have led to improved precision and accuracy. Conceived in the late 1960s, robot-assisted surgeries have evolved to become an integral part of various surgical specialties. Modern robotic surgical systems are equipped with highly dexterous arms and miniaturized instruments that reduce tremors and enable delicate maneuvers. Implementation of advanced materials and designs along with the integration of imaging and visualization technologies have enhanced surgical accuracy and made robots safer and more adaptable to various procedures. Further, the haptic feedback system allows surgeons to determine the consistency of the tissues they are operating upon, without physical contact, thereby preventing injuries due to the application of excess force. With the implementation of teleoperation, surgeons can now overcome geographical limitations and provide specialized healthcare remotely. The use of artificial intelligence (AI) and machine learning (ML) aids in surgical decision-making by improving the recognition of minute and complex anatomical structures. All these advancements have led to faster recovery and fewer complications in patients. However, the substantial cost of robotic systems, their maintenance, the size of the systems and proper surgeon training pose major challenges. Nevertheless, with future advancements such as AI-driven automation, nanorobots, microscopic incision surgeries, semi-automated telerobotic systems, and the impact of 5G connectivity on remote surgery, the growth curve of robotic surgery points to innovation and stands as a testament to the persistent pursuit of progress in healthcare.
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Affiliation(s)
- Swastika Chatterjee
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | | | - Karabi Ganguly
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | - Dibyendu Mandal
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India.
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Xiao C, Wei D, Zhu Z, Chen H, Zhou W, Tang X, Yuan J, Wang Y, Hu J. Robot-assisted vs traditional percutaneous freehand for the scaphoid fracture treatment: a retrospective study. INTERNATIONAL ORTHOPAEDICS 2023; 47:839-845. [PMID: 35922521 PMCID: PMC9931861 DOI: 10.1007/s00264-022-05532-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE The purpose of this study was to assess the efficiency, safety, and accuracy of cannulated screw fixation using a robot-assisted method compared with a traditional percutaneous freehand method. METHODS This retrospective clinical study included 18 patients with scaphoid fracture who underwent cannulated screw fixation by robot-assisted technique or traditional percutaneous freehand technique from June 2018 to June 2020. All patients were divided into the robot-assisted group (9 patients) or the traditional surgery group (9 patients). The operation time, blood loss, number of intra-operative fluoroscopies, fracture healing time, Mayo wrist function score, and screw implantation accuracy were recorded in the two groups. RESULTS The average age of the robot-assisted group was 37.9 ± 10.6 years (with a range of 30 to 52 years), there were eight males and one female, and there were six cases of scaphoid fracture on the right side and three on the left side. The average pre-operative time was 2.8 ± 0.7 days (ranging from 1 to 3 days). The average age of the traditional surgery group was 31.6 ± 6.8 years (with a range of 20 to 45 years), there were eight males and one female, and there were five cases of scaphoid fracture on the right side and four on the left side. The average pre-operative time was 2.1 ± 0.8 days (with a range of 2 to 4 days). The number of intra-operative fluoroscopies was 24.4 ± 3.5 in the traditional surgery group, whereas it was only 10.1 ± 1.9 in the robot-assisted group, which was significantly lower (P < 0.05). The average operation time of the traditional operation group was 48.4 ± 12.2 min, and that of the robot-assisted group was 32.6 ± 4.2 minutes, which was significantly shorter (P < 0.05). The angles between the actual screw position and the central axis of the scaphoid on both the coronal and sagittal post-operative CT images were 8.3° ± 2.3° and 8.8° ± 1.6° for the traditional operation group and 3.8° ± 0.8° and 4.3° ± 1.2° for the robot-assisted group, so the accuracy of the robot-assisted group was significantly higher (P < 0.05). There were no significant differences between the two groups in wrist function recovery or fracture healing time. CONCLUSION Robot-assisted treatment of scaphoid fracture is more accurate than traditional freehand technology, with shorter operation time and fewer intra-operative fluoroscopies. There is no difference between the two surgical techniques in intra-operative bleeding, post-operative fracture healing, or functional recovery. Robot-assisted surgery is a safe, effective, and accurate method for treating scaphoid fracture.
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Affiliation(s)
- Chengwei Xiao
- Orthopaedic Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072 China ,grid.410646.10000 0004 1808 0950Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072 China
| | - Dan Wei
- Orthopaedic Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072 China ,grid.410646.10000 0004 1808 0950Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072 China
| | - Zongdong Zhu
- Orthopaedic Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072 China ,grid.410646.10000 0004 1808 0950Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072 China
| | - Hui Chen
- Orthopaedic Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072 China ,grid.410646.10000 0004 1808 0950Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072 China
| | - Weijun Zhou
- Orthopaedic Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072 China ,grid.410646.10000 0004 1808 0950Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072 China
| | - Xiaoming Tang
- Orthopaedic Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072 China ,grid.410646.10000 0004 1808 0950Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072 China
| | - Jiabin Yuan
- Orthopaedic Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072 China ,grid.410646.10000 0004 1808 0950Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072 China
| | - Yue Wang
- Orthopaedic Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072 China ,grid.410646.10000 0004 1808 0950Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072 China
| | - Jiang Hu
- Orthopaedic Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072, China. .,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
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Zhao C, Cao Q, Sun X, Wu X, Zhu G, Wang Y. Intelligent robot-assisted minimally invasive reduction system for reduction of unstable pelvic fractures. Injury 2023; 54:604-614. [PMID: 36371315 DOI: 10.1016/j.injury.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/15/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Currently, minimally invasive internal fixation is recommended for the surgical treatment of unstable pelvic fractures. The premise and difficulty of minimally invasive internal fixation are minimally invasive reduction of fractures. This review aimed to investigate the indications, surgical strategy and techniques, safety, and efficacy of intelligent robot-assisted fracture reduction (RAFR) system of pelvic ring injuries. METHODS This retrospective study reviewed a case series from March 2021 to November 2021. A total of 22 patients with unstable pelvic fracture injuries underwent minimally invasive internal fixations. All pelvic ring fractures were reduced with our intelligent RAFR system. The robot system intelligently designs the optimal position and reduction path based on the patient's preoperative 3D CT. During the operation, the three-dimensional visualization of the fracture is realized through image registration, and the Robot completes the automatic reduction of the fracture. The global 3D point cloud error between the preoperative planning results and the actual postoperative reduction results was calculated. The postoperative reduction results of residual displacement were graded by the Matta Criteria. RESULTS Minimally invasive closed reduction procedures were completed in all 22 cases with our RAFR system. The average global 3D point cloud reduction error between the preoperative planning results and the actual postoperative reduction results was 3.41mm±1.83mm. The mean residual displacement was 4.61mm±3.29mm. Given the Matta criteria, 16 cases were excellent, five were good, and one was fair, with an excellent and good rate of 95.5%. CONCLUSION Our new pelvic fracture reduction robot system can complete intelligent and minimally invasive fracture reduction for most patients with unstable pelvic fractures. The system has intelligent reduction position and path planning and realizes stable pelvis control through a unique holding arm and a robotic arm. The operation process will not cause additional damage to the patient, which fully meets the clinical requirements. Our study demonstrated the safety and effectiveness of our robotic reduction system and its applicability and usability in clinical practice, thus paving the way towards Robot minimally invasive pelvic fracture surgeries.
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Affiliation(s)
- Chunpeng Zhao
- Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Qiyong Cao
- Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xu Sun
- Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xinbao Wu
- Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Beijing 100035, China.
| | - Gang Zhu
- Rossum Robot Co., Ltd., Beijing 100083, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China; Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100083, China
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Cai C, Zheng X, Shi M, Bi J, Zhang Q. Bone collision detection method for robot assisted fracture reduction based on vibration excitation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 229:107317. [PMID: 36563649 DOI: 10.1016/j.cmpb.2022.107317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE In the process of robotic fracture reduction, there is a risk of unintended collision of broken bones, which is not conducive to ensuring the safety of the reduction system. In order to solve this problem, this paper proposed a vibration-based collision detection method for fracture reduction process. METHODS Based on the two degree-of-freedom vibration response model, the factors affecting the respond of the vibration, including the excitation voltage, the clamping length at the proximal and distal ends, the mass and tensile force of the soft tissue, were obtained. The effects of these factors on the vibration transfer performance of broken bones and soft tissue were investigated by single factor experiments. RESULTS The results showed that, in terms of peak value, the increase of excitation voltage would make the vibration amplitude increase linearly, and the increase of soft tissue mass and tension increased the vibration transmission capacity of soft tissue in the frequency range of 500-1000 Hz. In terms of peak frequency, the clamping length at the distal end had the greatest influence, which reached 74 Hz, followed by 45 Hz at the proximal end. While the influence of other factors was little. According to single factor experiments, the excitation frequency in the verification experiments was determined as 677 Hz. Under the vibration interference with the acceleration amplitude of 1.2 G, this method achieved correct detection. CONCLUSION This research developed a broken bone collision detection method based on vibration excitation. The method can correctly detect the collision of broken bones with strong anti-interference ability. It is of great significance to improve the safety of fracture reduction process.
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Affiliation(s)
- Chenxu Cai
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture (Ministry of Education), School of Mechanical Engineering, Shandong University, Jinan 250061, China; National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan 250061, China
| | - Xuran Zheng
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture (Ministry of Education), School of Mechanical Engineering, Shandong University, Jinan 250061, China; National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan 250061, China
| | - Mingyang Shi
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture (Ministry of Education), School of Mechanical Engineering, Shandong University, Jinan 250061, China; National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan 250061, China
| | - Jianping Bi
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, China
| | - Qinhe Zhang
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture (Ministry of Education), School of Mechanical Engineering, Shandong University, Jinan 250061, China; National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan 250061, China.
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Fan X, Zhu Q, Tu P, Joskowicz L, Chen X. A review of advances in image-guided orthopedic surgery. Phys Med Biol 2023; 68. [PMID: 36595258 DOI: 10.1088/1361-6560/acaae9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
Orthopedic surgery remains technically demanding due to the complex anatomical structures and cumbersome surgical procedures. The introduction of image-guided orthopedic surgery (IGOS) has significantly decreased the surgical risk and improved the operation results. This review focuses on the application of recent advances in artificial intelligence (AI), deep learning (DL), augmented reality (AR) and robotics in image-guided spine surgery, joint arthroplasty, fracture reduction and bone tumor resection. For the pre-operative stage, key technologies of AI and DL based medical image segmentation, 3D visualization and surgical planning procedures are systematically reviewed. For the intra-operative stage, the development of novel image registration, surgical tool calibration and real-time navigation are reviewed. Furthermore, the combination of the surgical navigation system with AR and robotic technology is also discussed. Finally, the current issues and prospects of the IGOS system are discussed, with the goal of establishing a reference and providing guidance for surgeons, engineers, and researchers involved in the research and development of this area.
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Affiliation(s)
- Xingqi Fan
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Qiyang Zhu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Puxun Tu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Ha HG, Han G, Lee S, Nam K, Joung S, Park I, Hong J. Robot-patient registration for optical tracker-free robotic fracture reduction surgery. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 228:107239. [PMID: 36410266 DOI: 10.1016/j.cmpb.2022.107239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Image-guided robotic surgery for fracture reduction is a medical procedure in which surgeons control a surgical robot to align the fractured bones by using a navigation system that shows the rotation and distance of bone movement. In such robotic surgeries, it is necessary to estimate the relationship between the robot and patient (bone), a task known as robot-patient registration, to realize the navigation. Through the registration, a fracture state in real-world can be simulated in virtual space of the navigation system. METHODS This paper proposes an approach to realize robot-patient registration for an optical-tracker-free robotic fracture-reduction system. Instead of the optical tracker which is a three-dimensional position localizer, X-ray images are used to realize the robot-patient registration, combining the relationship of both the robot and patient with regards to C-arm. The proposed method consists of two steps of registration, where initial registration is followed by refined registration which adopts particle swarm optimization with the minimum cross-reprojection error based on bidirectional X-ray images. To address the unrecognizable features due to interference between the robot and bone, we also developed attachable robot features. The allocated robot features could be clearly extracted from the X-ray images, and precise registration could be realized through the particle swarm optimization. RESULTS The proposed method was evaluated in phantom and ex-vivo experiments involving a caprine cadaver. For the phantom experiments, the average translational and rotational errors were 1.88 mm and 2.45°, respectively, and the corresponding errors in the ex vivo experiments were 2.64 mm and 3.32° The results demonstrated the effectiveness of the proposed robot-patient registration. CONCLUSIONS The proposed method enable to estimate the three-dimensional relationship between fractured bones in real-world by using only two-dimensional images, and the relationship is accurately simulated in virtual reality for the navigation. Therefore, a reduction procedure for successful treatment of bone fractures in image-guided robotic surgery can be expected with the aid of the proposed registration method.
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Affiliation(s)
- Ho-Gun Ha
- Division of Intelligent Robot, DGIST, 333 Techno Jungang-daero, Hyeonpung-myeon, Dalseong-Gun, Daegu 42988, Republic of Korea.
| | - Gukyeong Han
- Department of Robotics and Mechatronics Engineering, DGIST, 333 Techno Jungang-daero, Hyeonpung-myeon, Dalseong-gun, Daegu 42988, Republic of Korea
| | - Seongpung Lee
- R&D Center, Curexo Inc., 4-5, Yanghyeon-ro 405 Beon-gil, Jungwon-gu, Seongnam-si, Gyeonggi-do 13438, Republic of Korea
| | - Kwonsun Nam
- R&D Center, SAMICK THK Co., Ltd., Jinwi2sandan-ro, Jinwi-myeon, Pyeongtaek-si, Gyeonggi-do 17708, Republic of Korea
| | - Sanghyun Joung
- Medical Device and Robot Institute of Park, Kyungpook National University, Global plaza 1006, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea
| | - Ilhyung Park
- Medical Device and Robot Institute of Park, Kyungpook National University, Global plaza 1006, 80, Daehak-ro, Buk-gu, Daegu 41566, Republic of Korea; Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Republic of Korea
| | - Jaesung Hong
- Department of Robotics and Mechatronics Engineering, DGIST, 333 Techno Jungang-daero, Hyeonpung-myeon, Dalseong-gun, Daegu 42988, Republic of Korea
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A Computer-Assisted Preoperative Path Planning Method for the Parallel Orthopedic Robot. MACHINES 2022. [DOI: 10.3390/machines10060480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Trajectory planning is the premise of the control of orthopedic robots, which is directly related to the safety of the human body. However, to date, the trajectory of orthopedic robots has been restricted to lines and spline curves. This limits the flexibility of the robot and leads to unsatisfactory performance. In this paper, a trajectory planning method based on improved RRT* and B-spline curve is proposed in order to improve the control accuracy and flexibility. Method: Firstly, combined with the shortcomings of current trajectory planning methods and bone docking task analysis, the characteristics of the trajectory for orthopedic robot are illustrated, and the problem is described. Secondly, a sampling strategy and an extension strategy are proposed to solve the optimal problem of the RRT* algorithm. Meanwhile, B-spline curve is selected for path smoothing. Thirdly, based on our orthopedic robot, kinematics analysis is introduced briefly, and hypotonic polynomial is used to fit the joint variables. Finally, a comparative study of the improved RRT*, RRT*, and other algorithms are completed, and the feasibility of the robot’s trajectory is verified by algorithm simulation and platform simulation. Results: Compared with RRT*, shorter path and high node utilization are shown in the improved RRT*, which cut down about 1mm in the average path length and increased about half in the average node utilization. In the meantime, the fitting results are accepted, and the results of algorithm simulation and platform simulation showed good consistency and feasibility. Conclusions: This study revealed that the improved RRT* was superior to RRT*, and the proposed method could be used for the trajectory planning of parallel orthopedic robots, which has some significance for bone fracture and deformity correction.
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Lee S, Joung S, Ha HG, Lee JH, Park KH, Kim S, Nam K, Lee J, Lee HJ, Oh CW, Park I, Hong J. 3D Image-Guided Robotic System for Bone Fracture Reduction. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3150880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Xu H, Lei J, Hu L, Zhang L. Constraint of musculoskeletal tissue and path planning of robot-assisted fracture reduction with collision avoidance. Int J Med Robot 2021; 18:e2361. [PMID: 34969160 DOI: 10.1002/rcs.2361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND For the robot-assisted fracture reduction, due to the complex fracture musculoskeletal environment, it is necessary to consider the influence of soft tissue traction on preoperative reduction path planning. METHOD An improved 3D A* algorithm is adopted to plan the fracture reduction path. The distal fragment point clouds are updated to avoid the collision, and the end point coordinates of the muscles are updated to calculate muscular lengths during the path search. RESULTS 3D reduction path of long-bone fracture is planned, effectively avoiding the fracture fragments collision and ensuring the length of the corresponding muscle is always less than the allowable maximum muscle length after elongation. CONCLUSION The proposed method can effectively avoid the collision between the distal fragment and the proximal fragment during the fracture reduction, can avoid secondary injury of the muscles around the femoral bone caused by over-distraction, and effectively improve the safety of robot reduction operation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Haifei Xu
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Jingtao Lei
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Lei Hu
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Lihai Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China
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Zhao C, Guan M, Shi C, Zhu G, Gao X, Zhao X, Wang Y, Wu X. Automatic reduction planning of pelvic fracture based on symmetry. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2021. [DOI: 10.1080/21681163.2021.2012830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Chunpeng Zhao
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing China
| | - Mingjun Guan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Chao Shi
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Gang Zhu
- Beijing TINAVI Medical Technology Co., Ltd, 5Rossum Robot Co., Ltd, Beijing, China
| | - Xiangyang Gao
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing China
| | - Xiangrui Zhao
- Beijing TINAVI Medical Technology Co., Ltd, 5Rossum Robot Co., Ltd, Beijing, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing China
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A Marker-Free 2D Image-Guided Method for Robot-Assisted Fracture Reduction Surgery. J INTELL ROBOT SYST 2021. [DOI: 10.1007/s10846-021-01453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vijayan RC, Han R, Wu P, Sheth NM, Ketcha MD, Vagdargi P, Vogt S, Kleinszig G, Osgood GM, Siewerdsen JH, Uneri A. Development of a fluoroscopically guided robotic assistant for instrument placement in pelvic trauma surgery. J Med Imaging (Bellingham) 2021; 8:035001. [PMID: 34124283 PMCID: PMC8189698 DOI: 10.1117/1.jmi.8.3.035001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/21/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: A method for fluoroscopic guidance of a robotic assistant is presented for instrument placement in pelvic trauma surgery. The solution uses fluoroscopic images acquired in standard clinical workflow and helps avoid repeat fluoroscopy commonly performed during implant guidance. Approach: Images acquired from a mobile C-arm are used to perform 3D-2D registration of both the patient (via patient CT) and the robot (via CAD model of a surgical instrument attached to its end effector, e.g; a drill guide), guiding the robot to target trajectories defined in the patient CT. The proposed approach avoids C-arm gantry motion, instead manipulating the robot to acquire disparate views of the instrument. Phantom and cadaver studies were performed to determine operating parameters and assess the accuracy of the proposed approach in aligning a standard drill guide instrument. Results: The proposed approach achieved average drill guide tip placement accuracy of 1.57 ± 0.47 mm and angular alignment of 0.35 ± 0.32 deg in phantom studies. The errors remained within 2 mm and 1 deg in cadaver experiments, comparable to the margins of errors provided by surgical trackers (but operating without the need for external tracking). Conclusions: By operating at a fixed fluoroscopic perspective and eliminating the need for encoded C-arm gantry movement, the proposed approach simplifies and expedites the registration of image-guided robotic assistants and can be used with simple, non-calibrated, non-encoded, and non-isocentric C-arm systems to accurately guide a robotic device in a manner that is compatible with the surgical workflow.
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Affiliation(s)
- Rohan C. Vijayan
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Runze Han
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Pengwei Wu
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Niral M. Sheth
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Michael D. Ketcha
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Prasad Vagdargi
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | | | | | - Greg M. Osgood
- Johns Hopkins Medicine, Department of Orthopaedic Surgery, Baltimore, Maryland, United States
| | - Jeffrey H. Siewerdsen
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | - Ali Uneri
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
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Han R, Uneri A, Vijayan RC, Wu P, Vagdargi P, Sheth N, Vogt S, Kleinszig G, Osgood GM, Siewerdsen JH. Fracture reduction planning and guidance in orthopaedic trauma surgery via multi-body image registration. Med Image Anal 2020; 68:101917. [PMID: 33341493 DOI: 10.1016/j.media.2020.101917] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
PURPOSES Surgical reduction of pelvic fracture is a challenging procedure, and accurate restoration of natural morphology is essential to obtaining positive functional outcome. The procedure often requires extensive preoperative planning, long fluoroscopic exposure time, and trial-and-error to achieve accurate reduction. We report a multi-body registration framework for reduction planning using preoperative CT and intraoperative guidance using routine 2D fluoroscopy that could help address such challenges. METHOD The framework starts with semi-automatic segmentation of fractured bone fragments in preoperative CT using continuous max-flow. For reduction planning, a multi-to-one registration is performed to register bone fragments to an adaptive template that adjusts to patient-specific bone shapes and poses. The framework further registers bone fragments to intraoperative fluoroscopy to provide 2D fluoroscopy guidance and/or 3D navigation relative to the reduction plan. The framework was investigated in three studies: (1) a simulation study of 40 CT images simulating three fracture categories (unilateral two-body, unilateral three-body, and bilateral two-body); (2) a proof-of-concept cadaver study to mimic clinical scenario; and (3) a retrospective clinical study investigating feasibility in three cases of increasing severity and accuracy requirement. RESULTS Segmentation of simulated pelvic fracture demonstrated Dice coefficient of 0.92±0.06. Reduction planning using the adaptive template achieved 2-3 mm and 2-3° error for the three fracture categories, significantly better than planning based on mirroring of contralateral anatomy. 3D-2D registration yielded ~2 mm and 0.5° accuracy, providing accurate guidance with respect to the preoperative reduction plan. The cadaver study and retrospective clinical study demonstrated comparable accuracy: ~0.90 Dice coefficient in segmentation, ~3 mm accuracy in reduction planning, and ~2 mm accuracy in 3D-2D registration. CONCLUSION The registration framework demonstrated planning and guidance accuracy within clinical requirements in both simulation and clinical feasibility studies for a broad range of fracture-dislocation patterns. Using routinely acquired preoperative CT and intraoperative fluoroscopy, the framework could improve the accuracy of pelvic fracture reduction, reduce radiation dose, and could integrate well with common clinical workflow without the need for additional navigation systems.
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Affiliation(s)
- R Han
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - A Uneri
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - R C Vijayan
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - P Wu
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - P Vagdargi
- Department of Computer Science, The Johns Hopkins University, BaltimoreMD, United States
| | - N Sheth
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States
| | - S Vogt
- Siemens Healthineers, ErlangenGermany
| | | | - G M Osgood
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, BaltimoreMD, United States
| | - J H Siewerdsen
- Department of Biomedical Engineering, The Johns Hopkins University, BaltimoreMD, United States.
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14
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Fu Z, Sun H, Dong X, Chen J, Rong H, Guo Y, Lin S. Indirect visual guided fracture reduction robot based on external markers. Int J Med Robot 2020; 17:1-11. [PMID: 32881221 DOI: 10.1002/rcs.2162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Zhuoxin Fu
- School of Artificial Intelligence and Data Science Hebei University of Technology Tiajin China
| | - Hao Sun
- School of Artificial Intelligence and Data Science Hebei University of Technology Tiajin China
| | - Xinyu Dong
- Navigation and Inertia Division Shanghai Aerospace Control Technology Institute Shanghai China
- Shanghai Engineering Research Center of Inertia Shanghai China
| | - Jianwen Chen
- Orthopedics Rehabilitation Hospital of National Research Center for Rehabilitation Technical Aids Beijing China
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs Beijing China
| | - Hongtao Rong
- Recovery unit Tianjin Medical University General Hospital Tianjin China
| | - Yue Guo
- Orthopedics Rehabilitation Hospital of National Research Center for Rehabilitation Technical Aids Beijing China
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs Beijing China
| | - Shengxin Lin
- School of Artificial Intelligence and Data Science Hebei University of Technology Tiajin China
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15
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Abstract
With the development of computer-assisted surgery, preoperational design is detailed in software. However, it is still a challenge for surgeons to realize the surgical plan in the craniofacial surgery. Robot-assisted surgery has advantages of high accuracy and stability. It is suitable for the high-stress procedures like drilling, milling, and cutting. This study aims to verify the feasibility for automatic drilling without soft tissues in model test based on an industrial robot platform.This study chose the data from digital laboratory in Shanghai 9th People's Hospital. The mandibular was reconstructed in software and surgical plan was also designed. Then, the coordinate data was input to the robot's software and matrix conversion was calculated by 4 marked points. The trajectory generation was calculated by inverse kinematics for target coordinates and robot coordinates. The model was fixed and calibrated for automatic drilling. At last, the accuracy was calculated by optic scanning instrument.The installment and preparation cost 10 minutes, the drilling procedure cost 12 minutes. The outside position error was (1.71 ± 0.16) mm, the inside position error was (1.37 ± 0.28) mm, the orientation error was (3.04 ± 1.02)°. Additionally, a total of 5 beagles were tested, with an accuracy error of (2.78 ± 1.52) mm. No postoperative complications occurred.This is the first study reported for robot-assisted automatic surgery in craniofacial surgery. The result shows it is possible to realize the automatic drilling procedure under the condition of no interference like soft tissues. With the development of artificial intelligence and machine vision, robot-assisted surgery may help surgeons to fulfill more automatic procedures for craniofacial surgery.
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16
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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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17
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Öztürk AM, Süer O, Şirintürk S, Aktuğlu K, Govsa F, Özer MA. A retrospective comparison of the conventional versus three-dimensional printed model-assisted surgery in the treatment of acetabular fractures. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:385-393. [PMID: 32490835 DOI: 10.5152/j.aott.2020.19054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to compare the clinical and radiological outcomes of the conventional versus individualized three-dimensional (3D) printing model-assisted pre-contoured plate fixation in the treatment of patients with acetabular fractures. METHODS The data from 18 consecutive patients who underwent surgery for the acetabular fractures were retrospectively analyzed. The patients were divided into two groups (9 in each): conventional and 3D printed model-assisted. The groups were then compared in terms of the duration of surgery, time of instrumentation, time of intraoperative fluoroscopy, and volume of blood loss. The quality of the fracture reduction was also evaluated postoperatively by radiography and computed tomography in both the groups. The quality of the fracture reduction was defined as good (<2 mm) or fair (>2 mm) based on the amount of displacement in the acetabulum. RESULTS The conventional group included 9 patients (9 males; mean age=41.7 years; age range=16-70) with a mean follow-up of 11.9 months (range=8-15); the 3D printed model-assisted group consisted of 9 patients (9 males; mean age=46.2 years; age range=30-66) with a mean follow-up of 10.33 months (range=7-17). The average duration of surgery, mean time of instrumentation, time of intraoperative fluoroscopy, and mean volume of blood loss were 180.5±9 minutes, 36.2±3.6 minutes, 6±1 times, and 403.3±52.7 mL in the 3D printed model-assisted group, and 220±15.6 minutes, 57.4±10.65 minutes, 10.4±2.2 times, and 606.6±52.7 mL in the conventional group, respectively. Procedurally, the average duration of surgery, mean time of instrumentation, and mean time of fluoroscopy were significantly shorter, and the mean volume of blood loss was significantly lower in the 3D printed model-assisted group (p<0.05). The quality of the fracture reduction was good in 7 patients (78%) in the conventional group and 8 patients (89%) in the 3D printed model-assisted group. CONCLUSION As compared with the conventional surgery, the 3D printing model-assisted pre-contoured plate fixation technique can improve the clinical and radiological outcomes of the acetabular fractures, with shorter surgery, instrumentation, intraoperative fluoroscopy times, and blood loss. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Anıl Murat Öztürk
- Department of Orthopaedic Surgery, Ege University, School of Medicine, İzmir, Turkey
| | - Onur Süer
- Department of Orthopaedic Surgery, Ege University, School of Medicine, İzmir, Turkey
| | - Suzan Şirintürk
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Ege University, School of Medicine, İzmir, Turkey
| | - Kemal Aktuğlu
- Department of Orthopaedic Surgery, Ege University, School of Medicine, İzmir, Turkey
| | - Figen Govsa
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Ege University, School of Medicine, İzmir, Turkey
| | - Mehmet Asım Özer
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Ege University, School of Medicine, İzmir, Turkey
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18
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Chen L, Zhang F, Zhan W, Gan M, Sun L. Research on the accuracy of three‐dimensional localization and navigation in robot‐assisted spine surgery. Int J Med Robot 2020; 16:e2071. [PMID: 31875428 DOI: 10.1002/rcs.2071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Long Chen
- School of Mechanical and Electrical EngineeringSoochow University Suzhou China
| | - Fengfeng Zhang
- School of Mechanical and Electrical EngineeringSoochow University Suzhou China
- Collaborative Innovation Center of Suzhou Nano Science and TechnologySoochow University Suzhou
| | - Wei Zhan
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University Suzhou China
| | - Minfeng Gan
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University Suzhou China
| | - Lining Sun
- School of Mechanical and Electrical EngineeringSoochow University Suzhou China
- Collaborative Innovation Center of Suzhou Nano Science and TechnologySoochow University Suzhou
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19
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Usevitch DE, Sperry AJ, Abbott JJ. Translational and Rotational Arrow Cues (TRAC) Navigation Method for Manual Alignment Tasks. ACM TRANSACTIONS ON APPLIED PERCEPTION 2020; 17:1-19. [PMID: 34113222 PMCID: PMC8188900 DOI: 10.1145/3375001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/01/2019] [Indexed: 06/12/2023]
Abstract
Many tasks in image-guided surgery require a clinician to manually position an instrument in space, with respect to a patient, with five or six degrees of freedom (DOF). Displaying the current and desired pose of the object on a 2D display such as a computer monitor is straightforward. However, providing guidance to accurately and rapidly navigate the object in 5-DOF or 6-DOF is challenging. Guidance is typically accomplished by showing distinct orthogonal viewpoints of the workspace, requiring simultaneous alignment in all views. Although such methods are commonly used, they can be quite unintuitive, and it can take a long time to perform an accurate 5-DOF or 6-DOF alignment task. In this article, we describe a method of visually communicating navigation instructions using translational and rotational arrow cues (TRAC) defined in an object-centric frame, while displaying a single principal view that approximates the human's egocentric view of the physical object. The target pose of the object is provided but typically is used only for the initial gross alignment. During the accurate-alignment stage, the user follows the unambiguous arrow commands. In a series of human-subject studies, we show that the TRAC method outperforms two common orthogonal-view methods-the triplanar display, and a sight-alignment method that closely approximates the Acrobot Navigation System-in terms of time to complete 5-DOF and 6-DOF navigation tasks. We also find that subjects can achieve 1 mm and 1° accuracy using the TRAC method with a median completion time of less than 20 seconds.
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20
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Georgilas I, Dagnino G, Alves Martins B, Tarassoli P, Morad S, Georgilas K, Koehler P, Atkins R, Dogramadzi S. Design and Evaluation of a Percutaneous Fragment Manipulation Device for Minimally Invasive Fracture Surgery. Front Robot AI 2019; 6:103. [PMID: 33501118 PMCID: PMC7805645 DOI: 10.3389/frobt.2019.00103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022] Open
Abstract
Reduction of fractures in the minimally invasive (MI) manner can avoid risks associated with open fracture surgery. The MI approach requires specialized tools called percutaneous fragment manipulation devices (PFMD) to enable surgeons to safely grasp and manipulate fragments. PFMDs developed for long-bone manipulation are not suitable for intra-articular fractures where small bone fragments are involved. With this study, we offer a solution to potentially move the current fracture management practice closer to the use of a MI approach. We investigate the design and testing of a new PFMD design for manual as well as robot-assisted manipulation of small bone fragments. This new PFMD design is simulated using FEA in three loading scenarios (force/torque: 0 N/2.6 Nm, 75.7 N/3.5 N, 147 N/6.8 Nm) assessing structural properties, breaking points, and maximum bending deformations. The PFMD is tested in a laboratory setting on Sawbones models (0 N/2.6 Nm), and on ex-vivo swine samples (F = 80 N ± 8 N, F = 150 ± 15 N). A commercial optical tracking system was used for measuring PFMD deformations under external loading and the results were verified with an electromagnetic tracking system. The average error difference between the tracking systems was 0.5 mm, being within their accuracy limits. Final results from reduction maneuvers performed both manually and with the robot assistance are obtained from 7 human cadavers with reduction forces in the range of (F = 80 N ± 8 N, F = 150 ± 15 N, respectively). The results show that structurally, the system performs as predicted by the simulation results. The PFMD did not break during ex-vivo and cadaveric trials. Simulation, laboratory, and cadaveric tests produced similar results regarding the PFMD bending. Specifically, for forces applied perpendicularly to the axis of the PFMD of 80 N ± 8 N deformations of 2.8, 2.97, and 3.06 mm are measured on the PFMD, while forces of 150 ± 15 N produced deformations of 5.8, 4.44, and 5.19 mm. This study has demonstrated that the proposed PFMD undergoes predictable deformations under typical bone manipulation loads. Testing of the device on human cadavers proved that these deformations do not affect the anatomic reduction quality. The PFMD is, therefore, suitable to reliably achieve and maintain fracture reductions, and to, consequently, allow external fracture fixation.
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Affiliation(s)
- Ioannis Georgilas
- Department of Mechanical Engineering, University of Bath, Bath, United Kingdom
| | - Giulio Dagnino
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Beatriz Alves Martins
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal
| | - Payam Tarassoli
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Samir Morad
- School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
| | | | - Paul Koehler
- Bristol Robotics Laboratory, University of the West of England, Bristol, United Kingdom
| | - Roger Atkins
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Sanja Dogramadzi
- Bristol Robotics Laboratory, University of the West of England, Bristol, United Kingdom
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21
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Zhao JX, Li C, Ren H, Hao M, Zhang LC, Tang PF. Evolution and Current Applications of Robot-Assisted Fracture Reduction: A Comprehensive Review. Ann Biomed Eng 2019; 48:203-224. [DOI: 10.1007/s10439-019-02332-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/20/2019] [Indexed: 11/28/2022]
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22
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Troccaz J, Dagnino G, Yang GZ. Frontiers of Medical Robotics: From Concept to Systems to Clinical Translation. Annu Rev Biomed Eng 2019; 21:193-218. [DOI: 10.1146/annurev-bioeng-060418-052502] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Medical robotics is poised to transform all aspects of medicine—from surgical intervention to targeted therapy, rehabilitation, and hospital automation. A key area is the development of robots for minimally invasive interventions. This review provides a detailed analysis of the evolution of interventional robots and discusses how the integration of imaging, sensing, and robotics can influence the patient care pathway toward precision intervention and patient-specific treatment. It outlines how closer coupling of perception, decision, and action can lead to enhanced dexterity, greater precision, and reduced invasiveness. It provides a critical analysis of some of the key interventional robot platforms developed over the years and their relative merit and intrinsic limitations. The review also presents a future outlook for robotic interventions and emerging trends in making them easier to use, lightweight, ergonomic, and intelligent, and thus smarter, safer, and more accessible for clinical use.
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Affiliation(s)
- Jocelyne Troccaz
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France
| | - Giulio Dagnino
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, United Kingdom;,
| | - Guang-Zhong Yang
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, United Kingdom;,
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23
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Chen AF, Kazarian GS, Jessop GW, Makhdom A. Robotic Technology in Orthopaedic Surgery. J Bone Joint Surg Am 2018; 100:1984-1992. [PMID: 30480604 DOI: 10.2106/jbjs.17.01397] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory S Kazarian
- Department of Orthopaedic Surgery, Rothman Institute, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Galen W Jessop
- Department of Orthopaedic Surgery, Rothman Institute, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Asim Makhdom
- Department of Orthopaedic Surgery, Rothman Institute, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
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24
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Abstract
Recent advances and review of literature
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Affiliation(s)
| | - Joydeep Sinha
- King's College Hospital , London ; Joint CAG Leader, King's Health Partners, King's College London
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25
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Abstract
The design of medical devices is a complex and crucial process to ensure patient safety. It has been shown that improperly designed devices lead to errors and associated accidents and costs. A key element for a successful design is incorporating the views of the primary and secondary stakeholders early in the development process. They provide insights into current practice and point out specific issues with the current processes and equipment in use. This work presents how information from a user-study conducted in the early stages of the RAFS (Robot Assisted Fracture Surgery) project informed the subsequent development and testing of the system. The user needs were captured using qualitative methods and converted to operational, functional, and non-functional requirements based on the methods derived from product design and development. This work presents how the requirements inform a new workflow for intra-articular joint fracture reduction using a robotic system. It is also shown how the various elements of the system are developed to explicitly address one or more of the requirements identified, and how intermediate verification tests are conducted to ensure conformity. Finally, a validation test in the form of a cadaveric trial confirms the ability of the designed system to satisfy the aims set by the original research question and the needs of the users.
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26
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Image-Guided Surgical Robotic System for Percutaneous Reduction of Joint Fractures. Ann Biomed Eng 2017; 45:2648-2662. [PMID: 28815387 PMCID: PMC5663813 DOI: 10.1007/s10439-017-1901-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 08/09/2017] [Indexed: 11/03/2022]
Abstract
Complex joint fractures often require an open surgical procedure, which is associated with extensive soft tissue damages and longer hospitalization and rehabilitation time. Percutaneous techniques can potentially mitigate these risks but their application to joint fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces involved in the fragment manipulation (due to the presence of soft tissue, e.g., muscles) which might result in fracture malreduction. Integration of robotic assistance and 3D image guidance can potentially overcome these issues. The authors propose an image-guided surgical robotic system for the percutaneous treatment of knee joint fractures, i.e., the robot-assisted fracture surgery (RAFS) system. It allows simultaneous manipulation of two bone fragments, safer robot-bone fixation system, and a traction performing robotic manipulator. This system has led to a novel clinical workflow and has been tested both in laboratory and in clinically relevant cadaveric trials. The RAFS system was tested on 9 cadaver specimens and was able to reduce 7 out of 9 distal femur fractures (T- and Y-shape 33-C1) with acceptable accuracy (≈1 mm, ≈5°), demonstrating its applicability to fix knee joint fractures. This study paved the way to develop novel technologies for percutaneous treatment of complex fractures including hip, ankle, and shoulder, thus representing a step toward minimally-invasive fracture surgeries.
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27
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Dagnino G, Georgilas I, Morad S, Gibbons P, Tarassoli P, Atkins R, Dogramadzi S. Intra-operative fiducial-based CT/fluoroscope image registration framework for image-guided robot-assisted joint fracture surgery. Int J Comput Assist Radiol Surg 2017; 12:1383-1397. [PMID: 28474269 PMCID: PMC5541125 DOI: 10.1007/s11548-017-1602-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022]
Abstract
Purpose Joint fractures must be accurately reduced minimising soft tissue damages to avoid negative surgical outcomes. To this regard, we have developed the RAFS surgical system, which allows the percutaneous reduction of intra-articular fractures and provides intra-operative real-time 3D image guidance to the surgeon. Earlier experiments showed the effectiveness of the RAFS system on phantoms, but also key issues which precluded its use in a clinical application. This work proposes a redesign of the RAFS’s navigation system overcoming the earlier version’s issues, aiming to move the RAFS system into a surgical environment. Methods The navigation system is improved through an image registration framework allowing the intra-operative registration between pre-operative CT images and intra-operative fluoroscopic images of a fractured bone using a custom-made fiducial marker. The objective of the registration is to estimate the relative pose between a bone fragment and an orthopaedic manipulation pin inserted into it intra-operatively. The actual pose of the bone fragment can be updated in real time using an optical tracker, enabling the image guidance. Results Experiments on phantom and cadavers demonstrated the accuracy and reliability of the registration framework, showing a reduction accuracy (sTRE) of about \documentclass[12pt]{minimal}
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\begin{document}$$1.15\pm 0.8\,\hbox {mm}$$\end{document}1.15±0.8mm (cadavers). Four distal femur fractures were successfully reduced in cadaveric specimens using the improved navigation system and the RAFS system following the new clinical workflow (reduction error \documentclass[12pt]{minimal}
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\begin{document}$$2\pm 1{^{\circ }})$$\end{document}2±1∘). Conclusion Experiments showed the feasibility of the image registration framework. It was successfully integrated into the navigation system, allowing the use of the RAFS system in a realistic surgical application.
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Affiliation(s)
- Giulio Dagnino
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK.
| | - Ioannis Georgilas
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK
| | - Samir Morad
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK.,Aston University, B47ET, Birmingham, UK
| | - Peter Gibbons
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK
| | - Payam Tarassoli
- University Hospitals Bristol, Upper Maudlin Street, BS28HW, Bristol, UK
| | - Roger Atkins
- University Hospitals Bristol, Upper Maudlin Street, BS28HW, Bristol, UK
| | - Sanja Dogramadzi
- Bristol Robotics Laboratory, University of the West of England, Coldharbour Lane, BS161QY, Bristol, UK
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