A robotic indenter for minimally invasive characterization of soft tissues

A Minimally Invasive Robotic Tissue Palpation Device

OBJECTIVE

Robot-assisted minimally invasive surgery remains limited by the absence of haptic feedback, which surgeons routinely rely on to assess tissue stiffness. This limitation hinders surgeons' ability to identify and treat abnormal tissues, such as tumors, during robotic surgery.

METHODS

To address this challenge, we developed a robotic tissue palpation device capable of rapidly and non-invasively quantifying the stiffness of soft tissues, allowing surgeons to make objective and data-driven decisions during minimally invasive procedures. We evaluated the effectiveness of our device by measuring the stiffness of phantoms as well as lung, heart, liver, and skin tissues obtained from both rats and swine.

RESULTS

Results demonstrated that our device can accurately determine tissue stiffness and identify tumor mimics. Specifically, in swine lung, we determined elastic modulus (E) values of 9.1 ± 2.3, 16.8 ± 1.8, and 26.0 ± 3.6 kPa under different internal pressure of the lungs (PIP) of 2, 25, and 45 cmH2O, respectively. Using our device, we successfully located a 2-cm tumor mimic embedded at a depth of 5 mm in the lung subpleural region. Additionally, we measured E values of 33.0 ± 5.4, 19.2 ± 2.2, 33.5 ± 8.2, and 22.6 ± 6.0 kPa for swine heart, liver, abdominal skin, and muscle, respectively, which closely matched existing literature data.

CONCLUSION/SIGNIFICANCE

Results suggest that our robotic palpation device can be utilized during surgery, either as a stand-alone or additional tool integrated into existing robotic surgical systems, to enhance treatment outcomes by enabling accurate intraoperative identification of abnormal tissue.

Synthesis and characterisation of a cancerous liver for presurgical planning and training applications

OBJECTIVES

Oncology surgeons use animals and cadavers in training because of a lack of alternatives. The aim of this work was to develop a design methodology to create synthetic liver models familiar to surgeons, and to help plan, teach and rehearse patient-specific cancerous liver resection surgery.

DESIGN

Synthetic gels were selected and processed to recreate accurate anthropomorphic qualities. Organic and synthetic materials were mechanically tested with the same equipment and standards to determine physical properties like hardness, elastic modulus and viscoelasticity. Collected data were compared with published data on the human liver. Patient-specific CT data were segmented and reconstructed and additive manufactured models were made of the liver vasculature, parenchyma and lesion. Using toolmaking and dissolvable scaffolds, models were transformed into tactile duplicates that could mimic liver tissue behaviour.

RESULTS

Porcine liver tissue hardness was found to be 23 H00 (±0.1) and synthetic liver was 10 H00 (±2.3), while human parenchyma was reported as 15.06 H00 (±2.64). Average elastic Young's modulus of human liver was reported as 0.012 MPa, and synthetic liver was 0.012 MPa, but warmed porcine parenchyma was 0.28 MPa. The final liver model demonstrated a time-dependant viscoelastic response to cyclic loading.

CONCLUSION

Synthetic liver was better than porcine liver at recreating the mechanical properties of living human liver. Warmed porcine liver was more brittle, less extensible and stiffer than both human and synthetic tissues. Qualitative surgical assessment of the model by a consultant liver surgeon showed vasculature was explorable and that bimanual palpation, organ delivery, transposition and organ slumping were analogous to human liver behaviour.

In vitro compressive properties of skeletal muscles and inverse finite element analysis: Comparison of human versus animals

Virtual finite element human body models have been widely used in biomedical engineering, traffic safety injury analysis, etc. Soft tissue modeling like skeletal muscle accounts for a large portion of a human body model establishment, and its modeling method is not enough explored. The present study aims to investigate the compressive properties of skeletal muscles due to different species, loading rates and fiber orientations, in order to obtain available parameters of specific material laws as references for building or improving the human body model concerning both modeling accuracy and computational cost. A series of compressive experiments of skeletal muscles were implemented for human gastrocnemius muscle, bovine and porcine hind leg muscle. To avoid long-time preservation effects, all experimental tests were carried out in 24 h after that the samples were harvested. Considering computational cost and generally used in the previous human body models, one-order hyperelastic Ogden model and three-term simplified viscoelastic quasi-linear viscoelastic (QLV) were selected for numerical analysis. Inverse finite element analysis was employed to obtain corresponding material parameters. With good fitting records, the simulation results presented available material parameters for human body model establishment, and also indicated significant differences of muscle compressive properties due to species, loading rates and fiber orientations. When considering one-order Ogden law, it is worthy of noting that the inversed material parameters of the porcine muscles are similar to those of the human gastrocnemius regardless of fiber orientations. In conclusion, the obtained material parameters in the present study can be references for global human body and body segment modeling.

An Economic, Modular, and Portable Skin Viscoelasticity Measurement Device for In Situ Longitudinal Studies

A indentation-based device to measure tissue mechanical property was designed and built using over-the-counter and 3D-printed parts. The device costs less than 100 USD and is capable of measuring samples of various geometry because of its modular design. The device is light-weight, thus portable, for measurements that can be performed at different sites. It was demonstrated that the measurement results obtained using our device are comparable to previous observations. The elastic shear modulus of the human skin was in the range of 2 kPa to 8 kPa, and skin tissues in old mice were stiffer than young mice. Mechanical properties of the skin tissues belonging to the same test subject varied depending on the location of the measurement. In conclusion, because our device is economic, modular, portable, and robust, it is suitable to serve as a standard measurement platform for studying tissue mechanics.

Numerical simulation and identification of macroscopic vascularised liver behaviour: Case of indentation tests

Mini-invasive surgery restricts the surgeon information to two-dimensional digital representation without the corresponding physical information obtained in previous open surgery. To overcome these drawbacks, real time augmented reality interfaces including the true mechanical behaviour of organs depending on their internal microstructure need to be developed. For the case of tumour resection, we present here a finite element numerical study of the liver mechanical behaviour including the effects of its own vascularisation through numerical indentation tests in order extract the corresponding macroscopic behaviour. The obtained numerical results show excellent correlation of the corresponding force-displacement curves when compared with macroscopic experimental data available in the literature.

Estimation of the elastic parameters of human liver biomechanical models by means of medical images and evolutionary computation

This paper presents a method to computationally estimate the elastic parameters of two biomechanical models proposed for the human liver. The method is aimed at avoiding the invasive measurement of its mechanical response. The chosen models are a second order Mooney-Rivlin model and an Ogden model. A novel error function, the geometric similarity function (GSF), is formulated using similarity coefficients widely applied in the field of medical imaging (Jaccard coefficient and Hausdorff coefficient). This function is used to compare two 3D images. One of them corresponds to a reference deformation carried out over a finite element (FE) mesh of a human liver from a computer tomography image, whilst the other one corresponds to the FE simulation of that deformation in which variations in the values of the model parameters are introduced. Several search strategies, based on GSF as cost function, are developed to accurately find the elastics parameters of the models, namely: two evolutionary algorithms (scatter search and genetic algorithm) and an iterative local optimization. The results show that GSF is a very appropriate function to estimate the elastic parameters of the biomechanical models since the mean of the relative mean absolute errors committed by the three algorithms is lower than 4%.

Analysis of several biomechanical models for the simulation of lamb liver behaviour using similarity coefficients from medical image

In this study, six biomechanical models for simulating lamb liver behaviour are presented. They are validated using similarity coefficients from Medical Image on reconstructed volumes from computerised tomography images. In particular, the Jaccard and Hausdorff coefficients are used. Loads of 20 and 40 g are applied to the livers and their deformation is simulated by means of the finite element method. The models used are a linear elastic model, a neo-Hookean model, a Mooney-Rivlin model, an Ogden model, a linear viscoelastic model and a viscohyperelastic model. The model that provided a behaviour that is closest to reality was the viscohyperelastic model, where the hyperelastic part was modelled with an Ogden model.

Mechanical analysis of end-to-end silk-sutured anastomosis for robot-assisted surgery

BACKGROUND

Robot-assisted anastomosis holds great promise for the future. To secure surgery quality, some key process factors, such as the force arrangement of sutures, should be provided because of the lack of haptic feedback in robotics systems

METHODS

A model of anastomosis is presented to establish the mechanical relationship between vessel and sutures. Stress distribution of the vessel loaded by the suture was then achieved through finite-element simulations, based on the material property test results. Further, experiments were performed to validate the reliability of the FEM simulation of the anastomosis process.

RESULTS

To avoid blood osmosis, the allowable lower limit of the suture tension was 0.05 N. To keep the tissue free from injury, the allowable upper limit of tension on the suture was 0.4 N.

CONCLUSIONS

The study provided meaningful results for directing the robot-assisted anastomosis procedure and design of the surgical tools.

Data-Driven Haptic Rendering-From Viscous Fluids to Visco-Elastic Solids

In this article we present extensions of our earlier work on data-driven haptic rendering. Haptic feedback is generated directly by interpolating measured data. The selection of appropriate data dimensions is guided by the structure of the generalized Maxwell model. Material elasticity and viscosity are reproduced, including transient material effects like stress relaxation. All these properties can be nonlinear and mutually dependent. Besides visco-elastic bodies, we also apply our method to viscous fluids. We present results for several materials and compare the errors of the interpolated forces with perceptual thresholds reported in the literature. Moreover, we examine how these errors behave if different subjects perform the recordings on which the data-driven haptic feedback is based.

A real time hyperelastic tissue model

Real-time soft tissue modeling has a potential application in medical training, procedure planning and image-guided therapy. This paper characterizes the mechanical properties of organ tissue using a hyperelastic material model, an approach which is then incorporated into a real-time finite element framework. While generalizable, in this paper we use the published mechanical properties of pig liver to characterize an example application. Specifically, we calibrate the parameters of an exponential model, with a least-squares method (LSM) using the assumption that the material is isotropic and incompressible in a uniaxial compression test. From the parameters obtained, the stress-strain curves generated from the LSM are compared to those from the corresponding computational model solved by ABAQUS and also to experimental data, resulting in mean errors of 1.9 and 4.8%, respectively, which are considerably better than those obtained when employing the Neo-Hookean model. We demonstrate our approach through the simulation of a biopsy procedure, employing a tetrahedral mesh representation of human liver generated from a CT image. Using the material properties along with the geometric model, we develop a nonlinear finite element framework to simulate the behaviour of liver during an interventional procedure with a real-time performance achieved through the use of an interpolation approach.

Real-time finite-element simulation of linear viscoelastic tissue behavior based on experimental data

The lack of experimental data on the viscoelastic material properties of live organ tissues has been a significant obstacle in the development of realistic models. A real-time and realisti finite-element simulation of viscoelastic tissue behavior using experimental data collected by a robotic indenter offers one solution.