Continuum Robots for Medical Interventions

Toward Extending Concentric Tube Robot Kinematics for Large Clearance and Impulse Curvature

Concentric Tube Robots (CTRs) have been proposed to operate within the unstructured environment for minimally invasive surgeries. In this letter, we consider the operation scenario where the tubes travel inside the channels with a large clearance or large curvature, such as aortas or industrial pipes. Accurate kinematic modeling of CTRs is required for the development of motion planning and control within these operation scenarios. To this end, we extended the conventional CTR kinematics model to a more general case with large tube-to-tube clearance and large centerline curvature. Numerical simulations and experimental validations are conducted to compare our model with respect to the conventional CTR kinematic model. In the physical experiments, our proposed model achieved a tip position error of 1.53 mm in the 2D planer case and 3.86 mm in 3D case, outperforming the state-of-the-art model by 71% and 61%, respectively.

A Novel Extensible Continuum Robot with Growing Motion Capability Inspired by Plant Growth for Path-Following in Transoral Laryngeal Surgery

This article presents a novel extensible continuum robot (ECR) with growing motion capability for improved flexible access in transoral laryngeal procedures. The robot uses an extensible continuum joint with a staggered V-shaped notched structure as the backbone, driven by the pushing and pulling of superelastic Nitinol rods. The notched structure is optimized to achieve a wide range of extension/contraction and bending motion for the continuum joint. The successive and uniform deflection of the notches provides the continuum joint with excellent constant curvature bending characteristics. The bidirectional rod-driven approach expands the robot's extension capabilities with both pushing and pulling operations, and the superelasticity of the driving rods preserves the robot's bending performance. The ECR significantly increases motion dexterity and reachability through its variable length, which facilitates collision-free access to deep lesions by following the anatomy. To further exploit the advantages of the ECR in path-following for flexible access, a growing motion approach inspired by the plant growth process has been proposed to minimize the path deviation error. Characterization experiments are conducted to verify the performances of the proposed ECR. The extension ratio achieves up to 225.92%, and the average distal positioning error and hysteresis error values are 2.87% and 0.51% within the ±120° bending range. Compared with the typical continuum robot with a fixed length, the path-following deviation of this robot is reduced by more than 58.30%, effectively reducing the risk of collision during access. Phantom experiments validate the feasibility of the proposed concept in flexible access procedures.

Bioinspired handheld time-share driven robot with expandable DoFs

Handheld robots offer accessible solutions with a short learning curve to enhance operator capabilities. However, their controllable degree-of-freedoms are limited due to scarce space for actuators. Inspired by muscle movements stimulated by nerves, we report a handheld time-share driven robot. It comprises several motion modules, all powered by a single motor. Shape memory alloy (SMA) wires, acting as "nerves", connect to motion modules, enabling the selection of the activated module. The robot contains a 202-gram motor base and a 0.8 cm diameter manipulator comprised of sequentially linked bending modules (BM). The manipulator can be tailored in length and integrated with various instruments in situ, facilitating non-invasive access and high-dexterous operation at remote surgical sites. The applicability was demonstrated in clinical scenarios, where a surgeon held the robot to conduct transluminal experiments on a human stomach model and an ex vivo porcine stomach. The time-share driven mechanism offers a pragmatic approach to build a multi-degree-of-freedom robot for broader applications.

Deep CNN-Based Static Modeling of Soft Robots Utilizing Absolute Nodal Coordinate Formulation

Soft continuum robots, inspired by the adaptability and agility of natural soft-bodied organisms like octopuses and elephant trunks, present a frontier in robotics research. However, exploiting their full potential necessitates precise modeling and control for specific motion and manipulation tasks. This study introduces an innovative approach using Deep Convolutional Neural Networks (CNN) for the inverse quasi-static modeling of these robots within the Absolute Nodal Coordinate Formulation (ANCF) framework. The ANCF effectively represents the complex non-linear behavior of soft continuum robots, while the CNN-based models are optimized for computational efficiency and precision. This combination is crucial for addressing the complex inverse statics problems associated with ANCF-modeled robots. Extensive numerical experiments were conducted to assess the performance of these Deep CNN-based models, demonstrating their suitability for real-time simulation and control in statics modeling. Additionally, this study includes a detailed cross-validation experiment to identify the most effective model architecture, taking into account factors such as the number of layers, activation functions, and unit configurations. The results highlight the significant benefits of integrating Deep CNN with ANCF models, paving the way for advanced statics modeling in soft continuum robotics.

Separable Tendon-Driven Robotic Manipulator with a Long, Flexible, Passive Proximal Section

This work tackles practical issues which arise when using a tendon-driven robotic manipulator (TDRM) with a long, flexible, passive proximal section in medical applications. Tendon-driven devices are preferred in medicine for their improved outcomes via minimally invasive procedures, but TDRMs come with unique challenges such as sterilization and reuse, simultaneous control of tendons, hysteresis in the tendon-sheath mechanism, and unmodeled effects of the proximal section shape. A separable TDRM which overcomes difficulties in actuation and sterilization is introduced, in which the body containing the electronics is reusable and the remainder is disposable. An open-loop redundant controller which resolves the redundancy in the kinematics is developed. Simple linear hysteresis compensation and re-tension compensation based on the physical properties of the device are proposed. The controller and compensation methods are evaluated on a testbed for a straight proximal section, a curved proximal section at various static angles, and a proximal section which dynamically changes angles; and overall, distal tip error was reduced.

A Concentric Tube Steerable Drilling Robot for Minimally Invasive Spinal Fixation of Osteoporotic Vertebrae

Spinal fixation with rigid pedicle screws have shown to be an effective treatment for many patients. However, this surgical option has been proved to be insufficient and will eventually fail for patients experiencing osteoporosis. This failure is mainly attributed to the lack of dexterity in the existing rigid drilling instruments and the complex anatomy of vertebrae, forcing surgeons to implant rigid pedicle screws within the osteoporotic regions of anatomy. To address this problem, in this article, we present the design, fabrication, and evaluation of a unique flexible yet structurally strong concentric tube steerable drilling robot (CT-SDR). The CT-SDR is capable of drilling smooth and accurate curved trajectories through hard tissues without experiencing buckling and failure; thus enabling the use of novel flexible pedicle screws for the next generation of spinal fixation procedures. Particularly, by decoupling the control of bending and insertion degrees of freedom (DoF) of the CT-SDR, we present a robotic system that (i) is intuitive to steer as it does not require an on-the-fly control algorithm for the bending DoF, and (ii) is able to address the contradictory requirements of structural stiffness and dexterity of a flexible robot interacting with the hard tissue. The robust and repeatable performance of the proposed CT-SDR have been experimentally evaluated by conducting various drilling procedures on simulated bone materials and animal bone samples. Experimental results indicate drilling times as low as 35 seconds for curved trajectories with 41 mm length and remarkable steering accuracy with a maximum 2% deviation error.

Hybrid Tendon and Ball Chain Continuum Robots for Enhanced Dexterity in Medical Interventions

A hybrid continuum robot design is introduced that combines a proximal tendon-actuated section with a distal telescoping section comprised of permanent-magnet spheres actuated using an external magnet. While, individually, each section can approach a point in its workspace from one or at most several orientations, the two-section combination possesses a dexterous workspace. The paper describes kinematic modeling of the hybrid design and provides a description of the dexterous workspace. We present experimental validation which shows that a simplified kinematic model produces tip position mean and maximum errors of 3% and 7% of total robot length, respectively.

Using robotics to move a neurosurgeon's hands to the tip of their endoscope

A major advantage of surgical robots is that they can reduce the invasiveness of a procedure by enabling the clinician to manipulate tools as they would in open surgery but through small incisions in the body. Neurosurgery has yet to benefit from this advantage. Although clinical robots are available for the least invasive neurosurgical procedures, such as guiding electrode insertion, the most invasive brain surgeries, such as tumor resection, are still performed as open manual procedures. To investigate whether robotics could reduce the invasiveness of major brain surgeries while still providing the manipulation capabilities of open surgery, we created a two-armed joystick-controlled endoscopic robot. To evaluate the efficacy of this robot, we developed a set of neurosurgical skill tasks patterned after the steps of brain tumor resection. We also created a patient-derived brain model for pineal tumors, which are located in the center of the brain and are normally removed by open surgery. In comparison, testing with existing manual endoscopic instrumentation, we found that the robot provided access to a much larger working volume at the trocar tip and enabled bimanual tasks without compression of brain tissue adjacent to the trocar. Furthermore, many tasks could be completed faster with the robot. These results suggest that robotics has the potential to substantially reduce the invasiveness of brain surgery by enabling certain procedures currently performed as open surgery to be converted to endoscopic interventions.

Coupling Analysis of Compound Continuum Robots for Surgery: Another Line of Thought

The compound continuum robot employs both concentric tube components and cable-driven continuum components to achieve its complex motions. Nevertheless, the interaction between these components causes coupling, which inevitably leads to reduced accuracy. Consequently, researchers have been striving to mitigate and compensate for this coupling-induced error in order to enhance the overall performance of the robot. This paper leverages the coupling between the components of the compound continuum robot to accomplish specific surgical procedures. Specifically, the internal concentric tube component is utilized to induce motion in the cable-driven external component, which generates coupled motion under the constraints of the cable. This approach enables the realization of high-precision surgical operations. Specifically, a kinematic model for the proposed robot is established, and an inverse kinematic algorithm is developed. In this inverse kinematic algorithm, the solution of a highly nonlinear system of equations is simplified into the solution of a single nonlinear equation. To demonstrate the effectiveness of the proposed approach, simulations are conducted to evaluate the efficiency of the algorithm. The simulations conducted in this study indicate that the proposed inverse kinematic (IK) algorithm improves computational speed by a significant margin. Specifically, it achieves a speedup of 2.8 × 10³ over the Levenberg-Marquardt (LM) method. In addition, experimental results demonstrate that the coupled-motion system achieves high levels of accuracy. Specifically, the repetitive positioning accuracy is measured to be 0.9 mm, and the tracking accuracy is 1.5 mm. This paper is significant for dealing with the coupling of the compound continuum robot.

Workspace Characterization for Hybrid Tendon and Ball Chain Continuum Robots

Continuum robots have attracted considerable attention for applications in minimally invasive diagnostics and therapeutics over the past decade [1]. The primary reason is their ability to navigate narrow and tortuous anatomical passageways, while guaranteeing safe inter- action with the anatomy. In designing such robots, an important goal is create a robot with a workspace appropriate for the clinical task. A significant limitation of many continuum designs re- lates to the minimum radius of curvature that a particular design can achieve. While multiple bending sections can be concatenated to provide more degrees of freedom, the orientations by which a point in the workspace can be approached are often limited. To overcome this limitation, this paper investigates a hybrid design that combines the advantages of tendon- actuated [2] and magnetic ball chain robots [3] as shown in Fig. 1. In this hybrid design, a proximal tendon- actuated section positions the robot with respect to the goal tip location while a distal ball chain section orients the robot tip with respect to the goal location. This abstract describes how the hybrid kinematics can be modeled and illustrates how the hybrid design possesses a dextrous workspace of finite extent.

Magnetic Ball Chain Robots for Endoluminal Interventions

This paper introduces a novel class of hyperredundant robots comprised of chains of permanently magnetized spheres enclosed in a cylindrical polymer skin. With their shape controlled using an externally-applied magnetic field, the spherical joints of these robots enable them to bend to very small radii of curvature. These robots can be used as steerable tips for endoluminal instruments. A kinematic model is derived based on minimizing magnetic and elastic potential energy. Simulation is used to demonstrate the enhanced steerability of these robots in comparison to magnetic soft continuum robots designed using either distributed or lumped magnetic material. Experiments are included to validate the model and to demonstrate the steering capability of ball chain robots in bifurcating channels.

Hyperelastic Modeling and Validation of Hybrid-Actuated Soft Robot with Pressure-Stiffening

Soft robots have gained popularity, especially in intraluminal applications, because their soft bodies make them safer for surgical interventions than flexures with rigid backbones. This study investigates a pressure-regulating stiffness tendon-driven soft robot and provides a continuum mechanics model for it towards using that in adaptive stiffness applications. To this end, first, a central single-chamber pneumatic and tri-tendon-driven soft robot was designed and fabricated. Afterward, the classic Cosserat's rod model was adopted and augmented with the hyperelastic material model. The model was then formulated as a boundary-value problem and was solved using the shooting method. To identify the pressure-stiffening effect, a parameter-identification problem was formulated to identify the relationship between the flexural rigidity of the soft robot and internal pressure. The flexural rigidity of the robot at various pressures was optimized to match theoretical deformation and experiments. The theoretical findings of arbitrary pressures were then compared with the experiment for validation. The internal chamber pressure was in the range of 0 to 40 kPa and the tendon tensions were in the range of 0 to 3 N. The theoretical and experimental findings were in fair agreement for tip displacement with a maximum error of 6.40% of the flexure's length.

Continuum Robots: From Conventional to Customized Performance Indicators

Continuum robots have often been compared with rigid-link designs through conventional performance metrics (e.g., precision and Jacobian-based indicators). However, these metrics were developed to suit rigid-link robots and are tuned to capture specific facets of performance, in which continuum robots do not excel. Furthermore, conventional metrics either fail to capture the key advantages of continuum designs, such as their capability to operate in complex environments thanks to their slender shape and flexibility, or see them as detrimental (e.g., compliance). Previous work has rarely addressed this issue, and never in a systematic way. Therefore, this paper discusses the facets of a continuum robot performance that cannot be characterized by existing indicator and aims at defining a tailored framework of geometrical specifications and kinetostatic indicators. The proposed framework combines the geometric requirements dictated by the target environment and a methodology to obtain bioinspired reference metrics from a biological equivalent of the continuum robot (e.g., a snake, a tentacle, or a trunk). A numerical example is then reported for a swimming snake robot use case.

Modeling of and Experimenting with Concentric Tube Robots: Considering Clearance, Friction and Torsion

Concentric tube robots (CTRs) are a promising prospect for minimally invasive surgery due to their inherent compliance and ability to navigate in constrained environments. Existing mechanics-based kinematic models typically neglect friction, clearance, and torsion between each pair of contacting tubes, leading to large positioning errors in medical applications. In this paper, an improved kinematic modeling method is developed. The effect of clearance on tip position during concentric tube assembly is compensated by the database method. The new kinematic model is mechanic-based, and the impact of friction moment and torsion on tubes is considered. Integrating the infinitesimal torsion of the concentric tube robots eliminates the errors caused by the interaction force between the tubes. A prototype is built, and several experiments with kinematic models are designed. The results indicate that the error of tube rotations is less than 2 mm. The maximum error of the feeding experiment does not exceed 0.4 mm. The error of the new modeling method is lower than that of the previous kinematic model. This paper has substantial implications for the high-precision and real-time control of concentric tube robots.

Closed-form Kinematic Model and Workspace Characterization for Magnetic Ball Chain Robots

Magnetic ball chains are well suited to serve as the steerable tips of endoluminal robots. While it has been demonstrated that these robots produce a larger reachable workspace than magnetic soft continuum robots designed using either distributed or lumped magnetic material, here we investigate the orientational capabilities of these robots. To increase the range of orientations that can be produced at each point in the workspace, we introduce a comparatively-stiff outer sheath from which the steerable ball chain is extended. We present an energy-based kinematic model and also derive an approximate expression for the range of achievable orientations at each point in the workspace. Experiments are used to validate these results.

Continuum robots for endoscopic sinus surgery: Recent advances, challenges, and prospects

PURPOSE

Endoscopic sinus surgery (ESS) has been recognized as an effective treatment modality for paranasal sinus diseases. Over the past decade, continuum robots (CRs) for ESS have been studied, but there are still some challenges. This paper presents a review on the scientific studies of CRs for ESS.

METHODS

Based on the analysis of the anatomical structure of the paranasal sinus, the requirements of CRs for ESS are discussed. Recent studies on rigid robots, handheld flexible robots, and CRs for ESS are presented. Surgical path planning, navigation, and control are also included.

RESULTS

Concentric tube CRs and cable-driven CRs have great potential for applications in ESS. The CRs incorporated with multiple replaceable arms with different functions are preferable in ESS.

CONCLUSION

Further study on navigation and control is required to improve the performance of CRs for ESS.

Modeling Tendon-actuated Concentric Tube Robots

Mechanics-based models have been developed to describe the shape of tendon-actuated continuum robots. Models have also been developed to describe the shape of concentric tube robots, i.e., nested combinations of precurved superelastic tubes. While an important class of continuum robots used in endoscopic and intracardiac medical applications combines these two designs, existing models do not cover this combination. Tendon-actuated models are limited to a single tube while concentric tube models do not include tendon-produced forces and moments. This paper derives a mechanics-based model for this hybrid design and assesses it using numerical and physical experiments involving a pair of tendon-actuated tubes. It is demonstrated that, similar to concentric tube robots, relative twisting between the tendon-actuated tubes is an important factor in determining overall robot shape.

Design of a Novel Haptic Joystick for the Teleoperation of Continuum-Mechanism-Based Medical Robots

Continuum robots are increasingly used in medical applications and the master–slave-based architectures are still the most important mode of operation in human–machine interaction. However, the existing master control devices are not fully suitable for either the mechanical mechanism or the control method. This study proposes a brand-new, four-degree-of-freedom haptic joystick whose main control stick could rotate around a fixed point. The rotational inertia is reduced by mounting all powertrain components on the base plane. Based on the design, kinematic and static models are proposed for position perception and force output analysis, while at the same time gravity compensation is also performed to calibrate the system. Using a continuum-mechanism-based trans-esophageal ultrasound robot as the test platform, a master–slave teleoperation scheme with position–velocity mapping and variable impedance control is proposed to integrate the speed regulation on the master side and the force perception on the slave side. The experimental results show that the main accuracy of the design is within 1.6°. The workspace of the control sticks is −60° to 110° in pitch angle, −40° to 40° in yaw angle, −180° to 180° in roll angle, and −90° to 90° in translation angle. The standard deviation of force output is within 8% of the full range, and the mean absolute error is 1.36°/s for speed control and 0.055 N for force feedback. Based on this evidence, it is believed that the proposed haptic joystick is a good addition to the existing work in the field with well-developed and effective features to enable the teleoperation of continuum robots for medical applications.

Teleoperated and Automated Control of a Robotic Tool for Targeted Prostate Biopsy

This work presents a robotic tool with bidirectional manipulation and control capabilities for targeted prostate biopsy interventions. Targeted prostate biopsy is an effective image-guided technique that results in detection of significant cancer with fewer cores and lower number of unnecessary biopsies compared to systematic biopsy. The robotic tool comprises of a compliant flexure section fabricated on a nitinol tube that enables bidirectional bending via actuation of two internal tendons, and a biopsy mechanism for extraction of tissue samples. The kinematic and static models of the compliant flexure section, as well as teleoperated and automated control of the robotic tool are presented and validated with experiments. It was shown that the controller can force the tip of the robotic tool to follow sinusoidal set-point positions with reasonable accuracy in air and inside a phantom tissue. Finally, the capability of the robotic tool to bend, reach targeted positions inside a phantom tissue, and extract a biopsy sample is evaluated.

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

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

Stretchable and Compliant Sensing of Strain, Pressure and Vibration of Soft Deformable Structures

Soft robotic and medical devices will greatly benefit from stretchable and compliant pressure sensors that can detect deformation and contact forces for control and task safety. In addition to traditional 2D buckling via planar substrates, 3D buckling via curved substrates has emerged as an alternative approach to generate tunable and highly convoluted hierarchical wrinkle morphologies. Such wrinkles may provide advantages in pressure sensing, such as increased sensitivity, ultra-stretchability, and detecting changing curvatures. In this work, we fabricated stretchable sensors using wrinkled MXene electrodes obtained from 3D buckling. We then characterized the sensors’ performance in detecting strain, pressure, and vibrations. The fabricated wrinkled MXene electrode exhibited high stretchability of up to 250% and has a strain sensitivity of 0.1 between 0 and 80%. The fabricated bilayer MXene pressure sensor exhibited a pressure sensitivity of 0.935 kPa−1 and 0.188 kPa−1 at the lower (<0.25 kPa) and higher-pressure regimes (0.25 kPa–2.0 kPa), respectively. The recovery and response timing of the wrinkled MXene pressure sensor was found to be 250 ms and 400 ms, respectively. The sensor was also capable of detecting changing curvatures upon mounting onto an inflating balloon.

Design and Modeling of a Bio-Inspired Compound Continuum Robot for Minimally Invasive Surgery

The continuum robot is a new type of bionic robot which is widely used in the medical field. However, the current structure of the continuum robot limits its application in the field of minimally invasive surgery. In this paper, a bio-inspired compound continuum robot (CCR) combining the concentric tube continuum robot (CTR) and the notched continuum robot is proposed to design a high-dexterity minimally invasive surgical instrument. Then, a kinematic model, considering the stability of the CTR part, was established. The unstable operation of the CCR is avoided. The simulation of the workspace shows that the introduction of the notched continuum robot expands the workspace of CTR. The dexterity indexes of the robots are proposed. The simulation shows that the dexterity of the CCR is 1.472 times that of the CTR. At last, the length distribution of the CCR is optimized based on the dexterity index by using a fruit fly optimization algorithm. The simulations show that the optimized CCR is more dexterous than before. The dexterity of the CCR is increased by 1.069 times. This paper is critical for the development of high-dexterity minimally invasive surgical instruments such as those for the brain, blood vessels, heart and lungs.

Snake Robots for Surgical Applications: A Review

Although substantial advancements have been achieved in robot-assisted surgery, the blueprint to existing snake robotics predominantly focuses on the preliminary structural design, control, and human–robot interfaces, with features which have not been particularly explored in the literature. This paper aims to conduct a review of planning and operation concepts of hyper-redundant serpentine robots for surgical use, as well as any future challenges and solutions for better manipulation. Current researchers in the field of the manufacture and navigation of snake robots have faced issues, such as a low dexterity of the end-effectors around delicate organs, state estimation and the lack of depth perception on two-dimensional screens. A wide range of robots have been analysed, such as the i²Snake robot, inspiring the use of force and position feedback, visual servoing and augmented reality (AR). We present the types of actuation methods, robot kinematics, dynamics, sensing, and prospects of AR integration in snake robots, whilst addressing their shortcomings to facilitate the surgeon’s task. For a smoother gait control, validation and optimization algorithms such as deep learning databases are examined to mitigate redundancy in module linkage backlash and accidental self-collision. In essence, we aim to provide an outlook on robot configurations during motion by enhancing their material compositions within anatomical biocompatibility standards.