Technical and Clinical Progress on Robot-Assisted Endovascular Interventions: A Review

Prior methods of patient care have changed in recent years due to the availability of minimally invasive surgical platforms for endovascular interventions. These platforms have demonstrated the ability to improve patients' vascular intervention outcomes, and global morbidities and mortalities from vascular disease are decreasing. Nonetheless, there are still concerns about the long-term effects of exposing interventionalists and patients to the operational hazards in the cath lab, and the perioperative risks that patients undergo. For these reasons, robot-assisted vascular interventions were developed to provide interventionalists with the ability to perform minimally invasive procedures with improved surgical workflow. We conducted a thorough literature search and presented a review of 130 studies published within the last 20 years that focused on robot-assisted endovascular interventions and are closely related to the current gains and obstacles of vascular interventional robots published up to 2022. We assessed both the research-based prototypes and commercial products, with an emphasis on their technical characteristics and application domains. Furthermore, we outlined how the robotic platforms enhanced both surgeons' and patients' perioperative experiences of robot-assisted vascular interventions. Finally, we summarized our findings and proposed three key milestones that could improve the development of the next-generation vascular interventional robots.

Position-based dynamics simulator of vessel deformations for path planning in robotic endovascular catheterization

A major challenge during autonomous navigation in endovascular interventions is the complexity of operating in a deformable but constrained workspace with an instrument. Simulation of deformations for it can provide a cost-effective training platform for path planning. Aim of this study is to develop a realistic, auto-adaptive, and visually plausible simulator to predict vessels' global deformation induced by the robotic catheter's contact and cyclic heartbeat motion. Based on a Position-based Dynamics (PBD) approach for vessel modeling, Particle Swarm Optimization (PSO) algorithm is employed for an auto-adaptive calibration of PBD deformation parameters and of the vessels movement due to a heartbeat. In-vitro experiments were conducted and compared with in-silico results. The end-user evaluation results were reported through quantitative performance metrics and a 5-Point Likert Scale questionnaire. Compared with literature, this simulator has an error of 0.23±0.13% for deformation and 0.30±0.85mm for the aortic root displacement. In-vitro experiments show an error of 1.35±1.38mm for deformation prediction. The end-user evaluation results show that novices are more accustomed to using joystick controllers, and cardiologists are more satisfied with the visual authenticity. The real-time and accurate performance of the simulator make this framework suitable for creating a dynamic environment for autonomous navigation of robotic catheters.

The Radiographic Changes of Catheter Tip in Different Positions of Arm Infusion Port

In order to investigate the influence of patient position change on the position of catheter tip in arm infusion port, the clinical data of 324 patients undergoing arm infusion port implantation in a hospital were retrospectively analyzed. It could be obtained that TIVAP was successfully implanted in 324 patients with malignant tumors. In 171 cases, the TIVAP catheter tip shifted to the foot side when the position was changed from upright to decubitus, with an average displacement of (12.29 ± 7.48) mm; 149 cases had cephalic displacement with an average of (5.00 ± 3.79) mm; and 5 cases had no change. The position of the TIVAP catheter tip tended to shift to the foot side when the vertical position changed to the decubitus position, with an average displacement of (−9.32 ± 9.36) mm, and the difference had statistical significance (P < 0.0001), while there were no significant differences in gender, age, height, weight, body mass index, and catheter tip position (P > 0.05). It could be analyzed from the data that from decubitus to upright position, the tip of the arm infusion port tended to shift to the foot side, and the moving distance was related to the patient's gender, sebum thickness, and indwelling catheter length. Preoperative understanding of relevant information is helpful to determine the location and length of catheterization and reduce catheter-related complications.

On the Mathematical Modeling of Slender Biomedical Continuum Robots

The passive, mechanical adaptation of slender, deformable robots to their environment, whether the robot be made of hard materials or soft ones, makes them desirable as tools for medical procedures. Their reduced physical compliance can provide a form of embodied intelligence that allows the natural dynamics of interaction between the robot and its environment to guide the evolution of the combined robot-environment system. To design these systems, the problems of analysis, design optimization, control, and motion planning remain of great importance because, in general, the advantages afforded by increased mechanical compliance must be balanced against penalties such as slower dynamics, increased difficulty in the design of control systems, and greater kinematic uncertainty. The models that form the basis of these problems should be reasonably accurate yet not prohibitively expensive to formulate and solve. In this article, the state-of-the-art modeling techniques for continuum robots are reviewed and cast in a common language. Classical theories of mechanics are used to outline formal guidelines for the selection of appropriate degrees of freedom in models of continuum robots, both in terms of number and of quality, for geometrically nonlinear models built from the general family of one-dimensional rod models of continuum mechanics. Consideration is also given to the variety of actuators found in existing designs, the types of interaction that occur between continuum robots and their biomedical environments, the imposition of constraints on degrees of freedom, and to the numerical solution of the family of models under study. Finally, some open problems of modeling are discussed and future challenges are identified.