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Tanaka K, Minami Y, Tokudome Y, Inoue K, Kuniyoshi Y, Nakajima K. Continuum-Body-Pose Estimation From Partial Sensor Information Using Recurrent Neural Networks. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3199034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Yuna Minami
- Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yuji Tokudome
- Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Katsuma Inoue
- Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yasuo Kuniyoshi
- Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Kohei Nakajima
- Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
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2
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Muacevic A, Adler JR. Robotic Integration in the Field of Opthalmology and Its Prospects in India. Cureus 2022; 14:e30482. [PMID: 36415349 PMCID: PMC9674111 DOI: 10.7759/cureus.30482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022] Open
Abstract
In this paper, an overview of the integration of robotic techniques into surgical fields of ophthalmology is described and the details about the latest advancements and future potentials associated with it are presented. The eye is a small, enclosed space that does not tolerate the misplacement of instruments that general surgery can tolerate. As the retina doesn't regenerate, it is of paramount importance to avoid injury. Furthermore, there are additional limitations of unassisted human hands in terms of dexterity, tremor, and precision in positioning instruments in the eye. Robotics has become a promising solution to these human challenges. The emergence of robotic technology into the domain of rapidly advancing micro-invasive surgery has reduced discomfort in patients and enhanced safety, capabilities, and outcomes. With the arrival of the Femtosecond laser system for robotic cataract surgery in several hospitals in India, the paradigm of robotic surgery has shifted as people started to accept and apply it. Although there is still much to learn in this area, there is growing interest in creating gadgets that perform complete surgical procedures. The fundamental objective of these surgeries would be to increase speed and efficiency without compromising the capacity to increase precision. Major criteria include an acceptable range of motion, the capacity to switch instruments mid-surgery, and simultaneous manipulation of the surgical instrument. Robotic surgery is an already well-established technological advancement employed across the globe by leading surgeons in their fields but its curve in ophthalmology is still under supervision. Just like every other advance, robotics has its own set of disadvantages including but not limited to the costs, limited availability, and long learning curve. Nonetheless, this paper doesn't intend to promote the replacement of surgeons with technology, it's intended to get aware of the utilities of technology to improve care and deliver personal compassionate care. This quest is for the idea of robotics in the ocular field and improvisation of the field.
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Iordachita II, de Smet MD, Naus G, Mitsuishi M, Riviere CN. Robotic Assistance for Intraocular Microsurgery: Challenges and Perspectives. PROCEEDINGS OF THE IEEE. INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS 2022; 110:893-908. [PMID: 36588782 PMCID: PMC9799958 DOI: 10.1109/jproc.2022.3169466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Intraocular surgery, one of the most challenging discipline of microsurgery, requires sensory and motor skills at the limits of human physiological capabilities combined with tremendously difficult requirements for accuracy and steadiness. Nowadays, robotics combined with advanced imaging has opened conspicuous and significant directions in advancing the field of intraocular microsurgery. Having patient treatment with greater safety and efficiency as the final goal, similar to other medical applications, robotics has a real potential to fundamentally change microsurgery by combining human strengths with computer and sensor-based technology in an information-driven environment. Still in its early stages, robotic assistance for intraocular microsurgery has been accepted with precaution in the operating room and successfully tested in a limited number of clinical trials. However, owing to its demonstrated capabilities including hand tremor reduction, haptic feedback, steadiness, enhanced dexterity, micrometer-scale accuracy, and others, microsurgery robotics has evolved as a very promising trend in advancing retinal surgery. This paper will analyze the advances in retinal robotic microsurgery, its current drawbacks and limitations, as well as the possible new directions to expand retinal microsurgery to techniques currently beyond human boundaries or infeasible without robotics.
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Affiliation(s)
- Iulian I Iordachita
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Marc D de Smet
- Microinvasive Ocular Surgery Center (MIOS), Lausanne, Switzerland
| | | | - Mamoru Mitsuishi
- Department of Mechanical Engineering, The University of Tokyo, Japan
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Jinno M, Li G, Patel N, Iordachita I. An Integrated High-dexterity Cooperative Robotic Assistant for Intraocular Micromanipulation. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION : ICRA : [PROCEEDINGS]. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION 2021; 2021. [PMID: 34721938 DOI: 10.1109/icra48506.2021.9562040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Retinal surgeons are required to manipulate multiple surgical instruments in a confined intraocular space, while the instruments are constrained at the small incisions made on the sclera. Furthermore, physiological hand tremor can affect the precision of the instrument motion. The Steady-Hand Eye Robot (SHER), developed in our previous study, enables tremor-free tool manipulation by employing a cooperative control scheme whereby the surgeon and robot can co-manipulate the surgical instruments. Although SHER enables precise and tremor-free manipulation of surgical tools, its straight and rigid structure imposes certain limitations, as it can only approach a target on the retina from one direction. As a result, the instrument could potentially collide with the eye lens when attempting to access the anterior portion of the retina. In addition, it can be difficult to approach a target on the retina from a suitable direction when accessing its anterior portion for procedures such as vein cannulation or membrane peeling. Snake-like robots offer greater dexterity and allow access to a target on the retina from suitable directions, depending on the clinical task at hand. In this study, we present an integrated, high-dexterity, cooperative robotic assistant for intraocular micromanipulation. This robotic assistant comprises an improved integrated robotic intraocular snake (I2RIS) with a user interface (a tactile switch or joystick unit) for the manipulation of the snake-like distal end and the SHER, with a detachable end-effector to which the I2RIS can be attached. The integrated system was evaluated through a set of experiments wherein subjects were requested to touch or insert into randomly-assigned targets. The results indicate that the high-dexterity robotic assistant can touch or insert the tip into the same target from multiple directions, with no significant increase in task completion time for either user interface.
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Affiliation(s)
- Makoto Jinno
- School of Science and Engineering, Mechanical Engineering Course, Kokushikan University, Tokyo, Japan
| | - Gang Li
- Whiting School of Engineering, Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Niravkumar Patel
- Whiting School of Engineering, Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Iulian Iordachita
- Whiting School of Engineering, Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218 USA
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Jinno M, Iordachita I. Improved Integrated Robotic Intraocular Snake. ... INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS. INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS 2021; 2020. [PMID: 34423337 DOI: 10.1109/ismr48331.2020.9312927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Retinal surgery can be performed only by surgeons possessing advanced surgical skills because of the small, confined intraocular space, and the restricted free motion of instruments in contact with the sclera. Snake-like robots could be essential for use in retinal surgery to overcome this problem. Such robots can approach from suitable directions and operate delicate tissues when performing retinal vein cannulation, epiretinal membrane peeling and so on. In this study, we propose an improved integrated robotic intraocular snake (I2RIS), which is a new version of our previous IRIS. This update focuses on the dexterous distal unit design and the drive unit design. The proposed dexterous distal unit consists of small elements with reduced contact stress. The proposed drive unit includes a new wire drive mechanism where the drive pulley is mounted at a right angle relative to the actuation direction (also, relative to the conventional direction). A geometric analysis and mechanical design show that the proposed drive mechanism is simpler and easier to assemble and yields higher accuracy than the conventional drive mechanism. Furthermore, considering clinical use, the instrument of the I2RIS is detachable from the motor unit for cleaning, sterilization, and attachment of various surgical tools. Weighing merely 31.3 g, the proposed mechanism is only one third of the weight of the conventional IRIS. The basic functions and effectiveness of the proposed mechanism are verified by experiments on 5:1 scaled-up models of the dexterous distal unit and actual-size models of the instrument and motor units.
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Affiliation(s)
- Makoto Jinno
- School of Science and Engineering, Mechanical Engineering Course, Kokushikan University, Tokyo, Japan; Whiting School of Engineering, Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, USA
| | - Iulian Iordachita
- Whiting School of Engineering, Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, USA
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Ai X, Gao A, Lin Z, He C, Chen W. A Multi-Contact-Aided Continuum Manipulator With Anisotropic Shapes. IEEE Robot Autom Lett 2021. [DOI: 10.1109/lra.2021.3068648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ahronovich EZ, Simaan N, Joos KM. A Review of Robotic and OCT-Aided Systems for Vitreoretinal Surgery. Adv Ther 2021; 38:2114-2129. [PMID: 33813718 PMCID: PMC8107166 DOI: 10.1007/s12325-021-01692-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/27/2021] [Indexed: 02/08/2023]
Abstract
The introduction of the intraocular vitrectomy instrument by Machemer et al. has led to remarkable advancements in vitreoretinal surgery enabling the limitations of human physiologic capabilities to be reached. To overcome the barriers of perception, tremor, and dexterity, robotic technologies have been investigated with current advancements nearing the feasibility for clinical use. There are four categories of robotic systems that have emerged through the research: (1) handheld instruments with intrinsic robotic assistance, (2) hand-on-hand robotic systems, (3) teleoperated robotic systems, and (4) magnetic guidance robots. This review covers the improvements and the remaining needs for safe, cost-effective clinical deployment of robotic systems in vitreoretinal surgery.
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Affiliation(s)
- Elan Z. Ahronovich
- Advanced Robotics and Mechanism Applications (ARMA) Laboratory, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
| | - Nabil Simaan
- Advanced Robotics and Mechanism Applications (ARMA) Laboratory, Department of Mechanical Engineering, Department of Computer Science, Vanderbilt University, Nashville, TN 37235 USA
| | - Karen M. Joos
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232 USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235 USA
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Jinno M, Iordachita I. Improved Integrated Robotic Intraocular Snake: Analyses of the Kinematics and Drive Mechanism of the Dexterous Distal Unit. JOURNAL OF MEDICAL ROBOTICS RESEARCH 2021; 6:2140001. [PMID: 34722945 PMCID: PMC8553217 DOI: 10.1142/s2424905x21400018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Retinal surgery can be performed only by surgeons possessing advanced surgical skills because of the small, confined intraocular space, and the restricted free motion of the instruments in contact with the sclera. Snake-like robots may be essential for use in retinal surgery to overcome this problem. Such robots can approach the target site from suitable directions and operate on delicate tissues during retinal vein cannulation, epiretinal membrane peeling, and so on. We propose an improved integrated robotic intraocular snake (I2RIS), which is a new version of our previous IRIS. This study focused on the analyses of the kinematics and drive mechanism of the dexterous distal unit. This unit consists of small elements with reduced contact stress achieved by changing wire-hole positions. The kinematic analysis of the dexterous distal unit shows that it is possible to control the bending angle and direction of the unit by using two pairs of drive wires. The proposed drive mechanism includes a new pull-and-release wire mechanism in which the drive pulley is mounted at a right angle relative to the actuation direction (also, relative to the conventional direction). Analysis of the drive mechanism shows that compared to the previous drive mechanism, the proposed mechanism is simpler and easier to assemble and yields higher accuracy and resolution. Furthermore, considering clinical use, the instrument of the I2RIS is detachable from the motor unit easily for cleaning, sterilization, and attachment of various surgical tools. Analyses of the kinematics and drive mechanism and the basic functions of the proposed mechanism were verified experimentally on actual-size prototypes of the instrument and motor units.
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Affiliation(s)
- Makoto Jinno
- School of Science and Engineering, Kokushikan University, Tokyo 154-8515, Japan
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21218, USA
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Roizenblatt M, Dias Gomes Barrios Marin V, Grupenmacher AT, Muralha F, Faber J, Jiramongkolchai K, Gehlbach PL, Farah ME, Belfort R, Maia M. Association of Weight-Adjusted Caffeine and β-Blocker Use With Ophthalmology Fellow Performance During Simulated Vitreoretinal Microsurgery. JAMA Ophthalmol 2021; 138:819-825. [PMID: 32525517 DOI: 10.1001/jamaophthalmol.2020.1971] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Vitreoretinal surgery can be technically challenging and is limited by physiologic characteristics of the surgeon. Factors that improve accuracy and precision of the vitreoretinal surgeon are invaluable to surgical performance. Objectives To establish weight-adjusted cutoffs for caffeine and β-blocker (propranolol) intake and to determine their interactions in association with the performance of novice vitreoretinal microsurgeons. Design, Settings, and Participants This single-blind cross-sectional study of 15 vitreoretinal surgeons who had less than 2 years of surgical experience was conducted from September 19, 2018, to September 25, 2019, at a dry-laboratory setting. Five simulations were performed daily for 2 days. On day 1, performance was assessed after sequential exposure to placebo, low-dose caffeine (2.5 mg/kg), high-dose caffeine (5.0 mg/kg), and high-dose propranolol (0.6 mg/kg). On day 2, performance was assessed after sequential exposure to placebo, low-dose propranolol (0.2 mg/kg), high-dose propranolol (0.6 mg/kg), and high-dose caffeine (5.0 mg/kg). Interventions Surgical simulation tasks were repeated 30 minutes after masked ingestion of placebo, caffeine, or propranolol pills during the 2 days. Main Outcomes and Measures An Eyesi surgical simulator was used to assess surgical performance, which included surgical score (range, 0 [worst] to 700 [best]), task completion time, intraocular trajectory, and tremor rate (range, 0 [worst] to 100 [best]). The nonparametric Friedman test followed by Dunn-Bonferroni post hoc test was applied for multiple comparisons. Results Of 15 vitreoretinal surgeons, 9 (60%) were male, with a mean (SD) age of 29.6 (1.4) years and mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 23.15 (2.9). Compared with low-dose propranolol, low-dose caffeine was associated with a worse total surgical score (557.0 vs 617.0; difference, -53.0; 95% CI, -99.3 to -6.7; P = .009), a lower antitremor maneuver score (55.0 vs 75.0; difference, -12.0; 95% CI, -21.2 to -2.8; P = .009), longer intraocular trajectory (2298.6 vs 2080.7 mm; difference, 179.3 mm; 95% CI, 1.2-357.3 mm; P = .048), and increased task completion time (14.9 minutes vs 12.7 minutes; difference, 2.3 minutes; 95% CI, 0.8-3.8 minutes; P = .048). Postcaffeine treatment with propranolol was associated with performance improvement; however, surgical performance remained inferior compared with low-dose propranolol alone for total surgical score (570.0 vs 617.0; difference, -51.0; 95% CI, -77.6 to -24.4; P = .01), tremor-specific score (50.0 vs 75.0; difference, -16.0; 95% CI, -31.8 to -0.2; P = .03), and intraocular trajectory (2265.9 mm vs 2080.7 mm; difference, 166.8 mm; 95% CI, 64.1-269.6 mm; P = .03). Conclusions and Relevance The findings suggest that performance of novice vitreoretinal surgeons was worse after receiving low-dose caffeine alone but improved after receiving low-dose propranolol alone. Their performance after receiving propranolol alone was better than after the combination of propranolol and caffeine. These results may be helpful for novice vitreoretinal surgeons to improve microsurgical performance.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.,Vision Institute, Universidade Federal de São Paulo, São Paulo, Brazil.,Johns Hopkins University School of Medicine, The Wilmer Eye Institute, Baltimore, Maryland
| | | | | | - Felipe Muralha
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jean Faber
- Department of Neurology and Neurosurgery, Neuroengineering and Neurocognition Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kim Jiramongkolchai
- Johns Hopkins University School of Medicine, The Wilmer Eye Institute, Baltimore, Maryland
| | - Peter Louis Gehlbach
- Johns Hopkins University School of Medicine, The Wilmer Eye Institute, Baltimore, Maryland
| | - Michel Eid Farah
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.,Vision Institute, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.,Vision Institute, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.,Vision Institute, Universidade Federal de São Paulo, São Paulo, Brazil
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He C, Patel N, Shahbazi M, Yang Y, Gehlbach P, Kobilarov M, Iordachita I. Toward Safe Retinal Microsurgery: Development and Evaluation of an RNN-Based Active Interventional Control Framework. IEEE Trans Biomed Eng 2019; 67:966-977. [PMID: 31265381 DOI: 10.1109/tbme.2019.2926060] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Robotics-assisted retinal microsurgery provides several benefits including improvement of manipulation precision. The assistance provided to the surgeons by current robotic frameworks is, however, a "passive" support, e.g., by damping hand tremor. Intelligent assistance and active guidance are, however, lacking in the existing robotic frameworks. In this paper, an active interventional control framework (AICF) has been presented to increase operation safety by actively intervening the operation to avoid exertion of excessive forces to the sclera. METHODS AICF consists of the following four components: first, the steady-hand eye robot as the robotic module; second, a sensorized tool to measure tool-to-sclera forces; third, a recurrent neural network to predict occurrence of undesired events based on a short history of time series of sensor measurements; and finally, a variable admittance controller to command the robot away from the undesired instances. RESULTS A set of user studies were conducted involving 14 participants (with four surgeons). The users were asked to perform a vessel-following task on an eyeball phantom with the assistance of AICF as well as other two benchmark approaches, i.e., auditory feedback (AF) and real-time force feedback (RF). Statistical analysis shows that AICF results in a significant reduction of proportion of undesired instances to about 2.5%, compared with 38.4% and 26.2% using AF and RF, respectively. CONCLUSION AICF can effectively predict excessive-force instances and augment performance of the user to avoid undesired events during robot-assisted microsurgical tasks. SIGNIFICANCE The proposed system may be extended to other fields of microsurgery and may potentially reduce tissue injury.
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Farooq MU, Xu B, Ko SY. A concentric tube-based 4-DOF puncturing needle with a novel miniaturized actuation system for vitrectomy. Biomed Eng Online 2019; 18:46. [PMID: 30999918 PMCID: PMC6472096 DOI: 10.1186/s12938-019-0666-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 04/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vitreoretinal surgeries require precise, dexterous, and steady instruments for operation in delicate parts of the eye. Robotics has presented solutions for many vitreoretinal surgical problems, but, in a few operations, the available tools are still not dexterous enough to carry out procedures with minimum trauma to patients. Vitrectomy is one of those procedures and requires some dexterous instruments to replace straight ones for better navigation to affected sides inside the eyeball. METHOD In this paper, we propose a new vein puncturing solution with a 4-DOF motion to increase the workspace inside the eye. A two-member concentric tube-based 25G needle is proposed whose shape is optimized. To operate the concentric tube needle, a novel and miniaturized actuation system is proposed that uses hollow shaft motors for the first time. The presented prototype of actuation system has a stroke of 100 mm in a small size of 148 × 25 × 65 mm (L × W × H), suitable for approaching distant positions inside the eyeball. RESULTS Experimental results validate that the targeting accuracy of the needle is less than one millimeter and the needle tip can apply a force of 23.51 mN which is enough to perform puncturing. Furthermore, the proposed needle covers maximum workspace of around 128.5° inside the eyeball. For the actuation system, experiments show that it can produce repeatable motions with accuracy in submillimeter. CONCLUSION The proposed needle system can navigate to the sites which are difficult to approach by currently available straight tools requiring reinsertions. Along with the miniaturized actuation system, this work is expected to improve the outcome of vitrectomy with safe and accurate navigation.
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Affiliation(s)
- Muhammad Umar Farooq
- Department of Mechanical Engineering, Chonnam National University, Gwangju, 61186, South Korea
| | - Binxiang Xu
- Department of Mechanical Engineering, Chonnam National University, Gwangju, 61186, South Korea
| | - Seong Young Ko
- Department of Mechanical Engineering, Chonnam National University, Gwangju, 61186, South Korea.
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Zanaty M, Fussinger T, Rogg A, Lovera A, Lambelet D, Vardi I, Wolfensberger TJ, Baur C, Henein S. Programmable Multistable Mechanisms for Safe Surgical Puncturing. J Med Device 2019. [DOI: 10.1115/1.4043016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We present novel medical devices for safe surgical puncturing, in particular a cannula for the treatment of retinal vein occlusion (RVO). This passive mechanical device has an adjustable stroke and exerts a puncturing force independent of operator applied displacement. The innovative feature of this tool is that puncturing stroke is decoupled from operator input thereby minimizing the possibility of overpuncturing. This is achieved using our concept of stability programming, where the user modifies the mechanism strain energy as opposed to imposing direct displacement which is the case for standard bistable mechanisms. Ultra-fast laser three-dimensional (3D) printing is used to manufacture the needle in glass. A microfluidic channel is integrated into the needle tip for drug injection. Numerical simulations and experimental measurements validate the mechanical stability behavior of the puncture mechanism and characterize its puncturing stroke and force.
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Affiliation(s)
- Mohamed Zanaty
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | - Thomas Fussinger
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | - Arno Rogg
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | | | - David Lambelet
- Galatea-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | - Ilan Vardi
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | - Thomas J. Wolfensberger
- Department of Ophthalmology, University of Lausanne, Hôpital Ophtalmique Jules-Gonin, Lausanne 1004, Switzerland e-mail:
| | - Charles Baur
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | - Simon Henein
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
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He C, Ebrahimi A, Roizenblatt M, Patel N, Yang Y, Gehlbach PL, Iordachita I. User Behavior Evaluation in Robot-Assisted Retinal Surgery. RO-MAN ... : THE ... IEEE INTERNATIONAL SYMPOSIUM ON ROBOT AND HUMAN INTERACTIVE COMMUNICATION : PROCEEDINGS. IEEE INTERNATIONAL SYMPOSIUM ON ROBOT AND HUMAN INTERACTIVE COMMUNICATION 2018; 2018:174-179. [PMID: 30906505 DOI: 10.1109/roman.2018.8525638] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Retinal microsurgery is technically demanding and requires high surgical skill with very little room for manipulation error. The introduction of robotic assistance has the potential to enhance and expand a surgeon's manipulation capabilities during retinal surgery, i.e., improve precision, cancel physiological hand tremor, and provide sensing information. However, surgeon performance may also be negatively impacted by robotic assistance due to robot structural stiffness and nonintuitive controls. In complying with robotic constraints, the surgeon loses the dexterity of the human hand. In this paper, we present a preliminary experimental study to evaluate user behavior when affected by robotic assistance during mock retinal surgery. In these experiments user behavior is characterized by measuring the forces applied by the user to the sclera, the tool insertion/retraction speed, the tool insertion depth relative to the scleral entry point, and the duration of surgery. The users' behavior data is collected during three mock retinal surgery tasks with four users. Each task is conducted using both freehand and robot-assisted techniques. The univariate user behavior and the correlations of multiple parameters of user behavior are analyzed. The results show that robot assistance prolongs the duration of the surgery and increases the manipulation forces applied to sclera, but refines the insertion velocity and eliminates hand tremor.
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Affiliation(s)
- Changyan He
- School of Mechanical Engineering and Automation at Beihang University, Beijing, 100191 China, and also with LCSR at the Johns Hopkins University, Baltimore, MD 21218 USA
| | - Ali Ebrahimi
- LCSR at the Johns Hopkins University, Baltimore, MD 21218 USA
| | - Marina Roizenblatt
- Wilmer Eye Institute at the Johns Hopkins Hospital, Baltimore, MD 21287 USA .,Federal University of Sao Paulo, São Paulo, 04023-062 Brazil
| | | | - Yang Yang
- School of Mechanical Engineering and Automation at Beihang University, Beijing, 100191 China
| | - Peter L Gehlbach
- Wilmer Eye Institute at the Johns Hopkins Hospital, Baltimore, MD 21287 USA
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Dahroug B, Tamadazte B, Weber S, Tavernier L, Andreff N. Review on Otological Robotic Systems: Toward Microrobot-Assisted Cholesteatoma Surgery. IEEE Rev Biomed Eng 2018; 11:125-142. [PMID: 29994589 DOI: 10.1109/rbme.2018.2810605] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Otologic surgical procedures over time have become minimally invasive due to the development of medicine, microtechniques, and robotics. This trend then provides an expected reduction in the patient's recovery time and improvement in the accuracy of diagnosis and treatment. One of the most challenging difficulties that such techniques face are precise control of the instrument and supply of an ergonomic system to the surgeon. The objective of this literature review is to present requirements and guidelines for a surgical robotic system dedicated to middle ear surgery. This review is particularly focused on cholesteatoma surgery (diagnosis and surgical tools), which is one of the most frequent pathologies that urge for an enhanced treatment. This review also presents the current robotic systems that are implemented for otologic applications.
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Roizenblatt M, Edwards TL, Gehlbach PL. Robot-assisted vitreoretinal surgery: current perspectives. ROBOTIC SURGERY (AUCKLAND) 2018; 5:1-11. [PMID: 29527537 PMCID: PMC5842029 DOI: 10.2147/rsrr.s122301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vitreoretinal microsurgery is among the most technically challenging of the minimally invasive surgical techniques. Exceptional precision is required to operate on micron scale targets presented by the retina while also maneuvering in a tightly constrained and fragile workspace. These challenges are compounded by inherent limitations of the unassisted human hand with regard to dexterity, tremor and precision in positioning instruments. The limited human ability to visually resolve targets on the single-digit micron scale is a further limitation. The inherent attributes of robotic approaches therefore, provide logical, strategic and promising solutions to the numerous challenges associated with retinal microsurgery. Robotic retinal surgery is a rapidly emerging technology that has witnessed an exponential growth in capabilities and applications over the last decade. There is now a worldwide movement toward evaluating robotic systems in an expanding number of clinical applications. Coincident with this expanding application is growth in the number of laboratories committed to "robotic medicine". Recent technological advances in conventional retina surgery have also led to tremendous progress in the surgeon's capabilities, enhanced outcomes, a reduction of patient discomfort, limited hospitalization and improved safety. The emergence of robotic technology into this rapidly advancing domain is expected to further enhance important aspects of the retinal surgery experience for the patients, surgeons and society.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil,
| | - Thomas L Edwards
- Department of Clinical Neurosciences, University of Oxford, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Peter L Gehlbach
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil,
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Nuzzi R, Brusasco L. State of the art of robotic surgery related to vision: brain and eye applications of newly available devices. Eye Brain 2018; 10:13-24. [PMID: 29440943 PMCID: PMC5798758 DOI: 10.2147/eb.s148644] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Robot-assisted surgery has revolutionized many surgical subspecialties, mainly where procedures have to be performed in confined, difficult to visualize spaces. Despite advances in general surgery and neurosurgery, in vivo application of robotics to ocular surgery is still in its infancy, owing to the particular complexities of microsurgery. The use of robotic assistance and feedback guidance on surgical maneuvers could improve the technical performance of expert surgeons during the initial phase of the learning curve. Evidence acquisition We analyzed the advantages and disadvantages of surgical robots, as well as the present applications and future outlook of robotics in neurosurgery in brain areas related to vision and ophthalmology. Discussion Limitations to robotic assistance remain, that need to be overcome before it can be more widely applied in ocular surgery. Conclusion There is heightened interest in studies documenting computerized systems that filter out hand tremor and optimize speed of movement, control of force, and direction and range of movement. Further research is still needed to validate robot-assisted procedures.
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Affiliation(s)
- Raffaele Nuzzi
- Department of Surgical Sciences, Eye Clinic, University of Torino, Turin, Italy
| | - Luca Brusasco
- Department of Surgical Sciences, Eye Clinic, University of Torino, Turin, Italy
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Song J, Gonenc B, Guo J, Iordachita I. Intraocular Snake Integrated with the Steady-Hand Eye Robot for Assisted Retinal Microsurgery. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION : ICRA : [PROCEEDINGS]. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION 2017; 2017:6724-6729. [PMID: 30135744 DOI: 10.1109/icra.2017.7989796] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Due to the confined intraocular space and physical constraints in tool manipulation, snake-like robots have a significant potential for use in retinal microsurgery. By enhancing the dexterity at the tool tip, not only the operable space on the retina can be enlarged, but also the delicate target tissues can be reached at an optimal angle minimizing the damage and making the operation much easier. In this study, we present an improved version of our earlier integrated intraocular snake (IRIS) robot, and combine it with another robotic assistant: the cooperatively controlled Steady-Hand Eye Robot (SHER). SHER is used to drive IRIS close to the retina with precision, while IRIS makes omnidirectional bends by combining its yaw and pitch motions and provides a significantly enhanced intraocular dexterity while holding the sclerotomy port fixed. For precise control of IRIS, its snake-like tip actuation has been characterized through experiments considering both a free tool tip and external loading at the tool tip. The workspace analysis showed ±45° yaw and pitch with excellent repeatability (±1°) despite the highly miniaturized articulated segment length (3 mm) and very thin shaft (Ø 0.9 mm). Our preliminary experiments in an artificial eye model have shown feasibility in reaching targets requiring bends up to 55° accurately.
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Affiliation(s)
- Jingzhou Song
- Automation School, Beijing University of Posts and Telecommunications, Beijing, 100876, China
| | - Berk Gonenc
- CISST ERC at Johns Hopkins University, Baltimore, MD 21218 USA
| | - Jiangzhen Guo
- CISST ERC at Johns Hopkins University, Baltimore, MD 21218 USA
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Swaney PJ, York PA, Gilbert HB, Burgner-Kahrs J, Webster RJ. Design, Fabrication, and Testing of a Needle-Sized Wrist for Surgical Instruments. J Med Device 2016; 11:0145011-145019. [PMID: 28070228 DOI: 10.1115/1.4034575] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/26/2016] [Indexed: 11/08/2022] Open
Abstract
This paper presents a miniature wrist that can be integrated into needle-sized surgical instruments. The wrist consists of a nitinol tube with asymmetric cutouts that is actuated by a single tendon to provide high distal curvature. We derive and experimentally validate kinematic and static models for the wrist and describe several prototype wrists, illustrating the straightforward fabrication and scalability of the design. We experimentally investigate fatigue life, the concept of tip-first bending, and practical use of the wrist with a concentric tube robot in an endonasal surgical scenario.
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Affiliation(s)
- Philip J Swaney
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212 e-mail:
| | - Peter A York
- Department of Mechanical Engineering, Harvard University, Cambridge, MA 02138
| | - Hunter B Gilbert
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212
| | - Jessica Burgner-Kahrs
- Associate Professor Center of Mechatronics, Leibniz Universität Hannover, Hannover 30167, Germany
| | - Robert J Webster
- Associate Professor Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212 e-mail:
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Srivastava S, Kao PC, Reisman DS, Scholz JP, Agrawal SK, Higginson JS. Robotic Assist-As-Needed as an Alternative to Therapist-Assisted Gait Rehabilitation. ACTA ACUST UNITED AC 2016; 4. [PMID: 28580370 DOI: 10.4172/2329-9096.1000370] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Body Weight Supported Treadmill Training (BWSTT) with therapists' assistance is often used for gait rehabilitation post-stroke. However, this training method is labor-intensive, requiring at least one or as many as three therapists at once for manual assistance. Previously, we demonstrated that providing movement guidance using a performance-based robot-aided gait training (RAGT) that applies a compliant, assist-as-needed force-field improves gait pattern and functional walking ability in people post-stroke. In the current study, we compared the effects of assist-as-needed RAGT combined with functional electrical stimulation and visual feedback with BWSTT to determine if RAGT could serve as an alternative for locomotor training. METHODS Twelve stroke survivors were randomly assigned to one of the two groups, either receiving BWSTT with manual assistance or RAGT with functional electrical stimulation and visual feedback. All subjects received fifteen 40-minutes training sessions. RESULTS Clinical measures, kinematic data, and EMG data were collected before and immediately after the training for fifteen sessions. Subjects receiving RAGT demonstrated significant improvements in their self-selected over-ground walking speed, Functional Gait Assessment, Timed Up and Go scores, swing-phase peak knee flexion angle, and muscle coordination pattern. Subjects receiving BWSTT demonstrated significant improvements in the Six-minute walk test. However, there was an overall trend toward improvement in most measures with both interventions, thus there were no significant between-group differences in the improvements following training. CONCLUSION The current findings suggest that RAGT worked at least as well as BWSTT and thus may be used as an alternative rehabilitation method to improve gait pattern post-stroke as it requires less physical effort from the therapists compared to BWSTT.
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Affiliation(s)
- Shraddha Srivastava
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Pei Chun Kao
- Department of Physical Therapy, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA
| | - John P Scholz
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA
| | - Sunil K Agrawal
- Department of Mechanical Engineering, Columbia University, USA
| | - Jill S Higginson
- Department of Mechanical Engineering, University of Delaware, USA
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