Magnetic Soft Catheter Robot System for Minimally Invasive Treatments of Articular Cartilage Defects

Articular cartilage defects are among the most common orthopedic diseases, which seriously affect patients' health and daily activities, without prompt treatment. The repair biocarrier-based treatment has shown great promise. Total joint injection and open surgery are two main methods to deliver functional repair biocarriers into the knee joint. However, the exhibited drawbacks of these methods hinder their utility. The repair effect of total joint injection is unstable due to the low targeting rate of the repair biocarriers, whereas open surgery causes serious trauma to patients, thereby prolonging the postoperative healing time. In this study, we develop a magnetic soft catheter robot (MSCR) system to perform precise in situ repair of articular cartilage defects with minimal incision. The MSCR processes a size of millimeters, allowing it to enter the joint cavity through a tiny skin incision to reduce postoperative trauma. Meanwhile, a hybrid control strategy combining neural network and visual servo is applied to sequentially complete the coarse and fine positioning of the MSCR on the cartilage defect sites. After reaching the target, the photosensitive hydrogel is injected and anchored into the defect sites through the MSCR, ultimately completing the in situ cartilage repair. The in vitro and ex vivo experiments were conducted on a 3D printed human femur model and an isolated porcine femur, respectively, to demonstrate the potential of our system for the articular cartilage repair.

Self-folding soft-robotic chains with reconfigurable shapes and functionalities

Magnetic continuum soft robots can actively steer their tip under an external magnetic field, enabling them to effectively navigate in complex in vivo environments and perform minimally invasive interventions. However, the geometries and functionalities of these robotic tools are limited by the inner diameter of the supporting catheter as well as the natural orifices and access ports of the human body. Here, we present a class of magnetic soft-robotic chains (MaSoChains) that can self-fold into large assemblies with stable configurations using a combination of elastic and magnetic energies. By pushing and pulling the MaSoChain relative to its catheter sheath, repeated assembly and disassembly with programmable shapes and functions are achieved. MaSoChains are compatible with state-of-the-art magnetic navigation technologies and provide many desirable features and functions that are difficult to realize through existing surgical tools. This strategy can be further customized and implemented for a wide spectrum of tools for minimally invasive interventions.

Multi-Degree-of-Freedom Robots Powered and Controlled by Microwaves

Microwaves have become a promising wireless driving strategy due to the advantages of transmissivity through obstacles, fast energy targeting, and selective heating. Although there are some studies on microwave powered artificial muscles based on different structures, the lack of studies on microwave control has limited the development of microwave-driven (MWD) robots. Here, a far-field MWD parallel robot controlled by adjusting energy distribution via changing the polarization direction of microwaves at 2.47 GHz is first reported. The parallel robot is based on three double-layer bending actuators composed of wave-absorbing sheets and bimetallic sheets, and it can implement circular and triangular path at a distance of 0.4 m under 700 W transmitting power. The thermal response rate of the actuator under microwaves is studied, and it is found that the electric-field components can provide a faster thermal response at the optimal length of actuator than magnetic-field components. The work of the parallel robot is demonstrated in an enclosed space composed of microwave-transparent materials. This developed method demonstrates the multi-degree-of-freedom controllability for robots using microwaves and offers potential solutions for some engineering cases, such as pipeline/reactors inspection and medical applications.

Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: A systematic review and meta-analysis

Introduction

Catheter placement and stability are well-known challenges in atrial fibrillation (AF) ablation. As a result, steerable sheaths (SS) were developed to improve catheter stabilization and maintain proper catheter-tissue contact. The purpose of this systematic review and meta-analysis is to see if employing a SS influences procedure outcome.

Method

We performed a comprehensive literature search for studies that evaluated the efficacy and safety of SS compared to nonsteerable sheaths (NSS) in AF ablation. The primary outcome was the rate of atrial arrhythmia (AA) freedom by the time of the last follow-up. The secondary outcomes were the procedure-related complications and procedural characteristics. Risk ratio (RR) or the mean difference (MD) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model.

Results

A total of 10 studies, including 967 AF patients (mean age: 59.2 ± 11.1 years, 516 patients managed with SS vs. 454 with NSS), were included. SS group showed a higher rate of freedom of AA compared to NSS (RR: 1.19; 95% CI 1.09-1.29; p < .001). Both techniques had similar rate for procedural-related complication (RR: 1.09, 95% CI 0.50-2.39; p = .83). The SS strategy had a shorter procedure time (MD -10.6 [min], 95% CI -20.97, -0.20; p = .05) but comparable fluoroscopic and radiofrequency application times to the NSS group.

Conclusions

The SS for AF catheter ablation not only reduced the total procedure time but also significantly increased the rate of successful ablation while maintaining a similar safety profile when compared to the traditional NSS.

Continuum Robots for Medical Interventions

Continuum robots are not constructed with discrete joints but, instead, change shape and position their tip by flexing along their entire length. Their narrow curvilinear shape makes them well suited to passing through body lumens, natural orifices, or small surgical incisions to perform minimally invasive procedures. Modeling and controlling these robots are, however, substantially more complex than traditional robots comprised of rigid links connected by discrete joints. Furthermore, there are many approaches to achieving robot flexure. Each presents its own design and modeling challenges, and to date, each has been pursued largely independently of the others. This article attempts to provide a unified summary of the state of the art of continuum robot architectures with respect to design for specific clinical applications. It also describes a unifying framework for modeling and controlling these systems while additionally explaining the elements unique to each architecture. The major research accomplishments are described for each topic and directions for the future progress needed to achieve widespread clinical use are identified.

Magnetic concentric tube robots: introduction and analysis

In this paper, we propose a new type of continuum robot, referred to as a magnetic concentric tube robot (M-CTR), for performing minimally invasive surgery in narrow and difficult-to-access areas. The robot combines concentric tubes and magnetic actuation to benefit from the ‘follow the leader’ behaviour, the dexterity and stability of existing robots, while targeting millimetre-sized external diameters. These three kinematic properties are assessed through numerical and experimental studies performed on a prototype of a M-CTR. They are performed with general forward and inverse kineto-static models of the robot, continuation and bifurcation analysis, and a specific experimental setup. The prototype presents unique capabilities in terms of deployment and active stability management, while its dexterity in terms of tip orientability is also among the best reported for other robots at its scale.

Thermoset Shape Memory Polymer Variable Stiffness 4D Robotic Catheters

Variable stiffness catheters are typically composed of an encapsulated core. The core is usually composed of a low melting point alloy (LMPA) or a thermoplastic polymer (TP). In both cases, there is a need to encapsulate the core with an elastic material. This imposes a limit to the volume of variable stiffness (VS) material and limits miniaturization. This paper proposes a new approach that relies on the use of thermosetting materials. The variable stiffness catheter (VSC) proposed in this work eliminates the necessity for an encapsulation layer and is made of a unique biocompatible thermoset polymer with an embedded heating system. This significantly reduces the final diameter, improves manufacturability, and increases safety in the event of complications. The device can be scaled to sub-millimeter dimensions, while maintaining a high stiffness change. In addition, integration into a magnetic actuation system allows for precise actuation of one or multiple tools.

Evolutionary design of magnetic soft continuum robots

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

Electrothermally Driven Hydrogel-on-Flex-Circuit Actuator for Smart Steerable Catheters

This paper reports an active catheter-tip device functionalized by integrating a temperature-responsive smart polymer onto a microfabricated flexible heater strip, targeting at enabling the controlled steering of catheters through complex vascular networks. A bimorph-like strip structure is enabled by photo-polymerizing a layer of poly(N-isopropylacrylamide) hydrogel (PNIPAM), on top of a 20 × 3.5 mm² flexible polyimide film that embeds a micropatterned heater fabricated using a low-cost flex-circuit manufacturing process. The heater activation stimulates the PNIPAM layer to shrink and bend the tip structure. The bending angle is shown to be adjustable with the amount of power fed to the device, proving the device’s feasibility to provide the integrated catheter with a controlled steering ability for a wide range of navigation angles. The powered device exhibits uniform heat distribution across the entire PNIPAM layer, with a temperature variation of <2 °C. The operation of fabricated prototypes assembled on commercial catheter tubes demonstrates their bending angles of up to 200°, significantly larger than those reported with other smart-material-based steerable catheters. The temporal responses and bending forces of their actuations are also characterized to reveal consistent and reproducible behaviors. This proof-of-concept study verifies the promising features of the prototyped approach to the targeted application area.

Magnetically Active Cardiac Patches as an Untethered, Non-Blood Contacting Ventricular Assist Device

Patients suffering from heart failure often require circulatory support using ventricular assist devices (VADs). However, most existing VADs provide nonpulsatile flow, involve direct contact between the blood flow and the device's lumen and moving components, and require a driveline to connect to an external power source. These design features often lead to complications such as gastrointestinal bleeding, device thrombosis, and driveline infections. Here, a concept of magnetically active cardiac patches (MACPs) that can potentially function as non-blood contacting, untethered pulsatile VADs inside a magnetic actuationsystem is reported. The MACPs, which are composed of permanent magnets and 3D-printed patches, are attached to the epicardial surfaces, thus avoiding direct contact with the blood flow. They provide powerful actuation assisting native heart pumping inside a magnetic actuation system. In ex vivo experiments on a healthy pig's heart, it is shown that the ventricular ejection fractions are as high as 37% in the left ventricle and 63% in the right ventricle. Non-blood contacting, untethered VADs can eliminate the risk of serious complications associated with existing devices, and provide an alternative solution for myocardial training and therapy for patients with heart failure.

Ferromagnetic soft continuum robots

Small-scale soft continuum robots capable of active steering and navigation in a remotely controllable manner hold great promise in diverse areas, particularly in medical applications. Existing continuum robots, however, are often limited to millimeter or centimeter scales due to miniaturization challenges inherent in conventional actuation mechanisms, such as pulling mechanical wires, inflating pneumatic or hydraulic chambers, or embedding rigid magnets for manipulation. In addition, the friction experienced by the continuum robots during navigation poses another challenge for their applications. Here, we present a submillimeter-scale, self-lubricating soft continuum robot with omnidirectional steering and navigating capabilities based on magnetic actuation, which are enabled by programming ferromagnetic domains in its soft body while growing hydrogel skin on its surface. The robot’s body, composed of a homogeneous continuum of a soft polymer matrix with uniformly dispersed ferromagnetic microparticles, can be miniaturized below a few hundreds of micrometers in diameter, and the hydrogel skin reduces the friction by more than 10 times. We demonstrate the capability of navigating through complex and constrained environments, such as a tortuous cerebrovascular phantom with multiple aneurysms. We further demonstrate additional functionalities, such as steerable laser delivery through a functional core incorporated in the robot’s body. Given their compact, self-contained actuation and intuitive manipulation, our ferromagnetic soft continuum robots may open avenues to minimally invasive robotic surgery for previously inaccessible lesions, thereby addressing challenges and unmet needs in healthcare.