Scopes too flexible...and too stiff

Multimodal Sensors Enabled Autonomous Soft Robotic System with Self-Adaptive Manipulation

Human hands are amazingly skilled at recognizing and handling objects of different sizes and shapes. To date, soft robots rarely demonstrate autonomy equivalent to that of humans for fine perception and dexterous operation. Here, an intelligent soft robotic system with autonomous operation and multimodal perception ability is developed by integrating capacitive sensors with triboelectric sensor. With distributed multiple sensors, our robot system can not only sense and memorize multimodal information but also enable an adaptive grasping method for robotic positioning and grasp control, during which the multimodal sensory information can be captured sensitively and fused at feature level for crossmodally recognizing objects, leading to a highly enhanced recognition capability. The proposed system, combining the performance and physical intelligence of biological systems (i.e., self-adaptive behavior and multimodal perception), will greatly advance the integration of soft actuators and robotics in many fields.

MorphGI: A Self-Propelling Soft Robotic Endoscope Through Morphing Shape

Colonoscopy is currently the best method for detecting bowel cancer, but fundamental design and construction have not changed significantly in decades. Conventional colonoscope (CC) is difficult to maneuver and can lead to pain with a risk of damaging the bowel due to its rigidity. We present the MorphGI, a robotic endoscope system that is self-propelling and made of soft material, thus easy to operate and inherently safe to patient. After verifying kinematic control of the distal bending segment, the system was evaluated in: a benchtop colon simulator, using multiple colon configurations; a colon simulator with force sensors; and surgically removed pig colon tissue. In the colon simulator, the MorphGI completed a colonoscopy in an average of 10.84 min. The MorphGI showed an average of 77% and 62% reduction in peak forces compared to a CC in high- and low-stiffness modes, respectively. Self-propulsion was demonstrated in the excised tissue test but not in the live pig test, due to anatomical differences between pig and human colons. This work demonstrates the core features of MorphGI.

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.

Artificial intelligence meets medical robotics

Artificial intelligence (AI) applications in medical robots are bringing a new era to medicine. Advanced medical robots can perform diagnostic and surgical procedures, aid rehabilitation, and provide symbiotic prosthetics to replace limbs. The technology used in these devices, including computer vision, medical image analysis, haptics, navigation, precise manipulation, and machine learning (ML) , could allow autonomous robots to carry out diagnostic imaging, remote surgery, surgical subtasks, or even entire surgical procedures. Moreover, AI in rehabilitation devices and advanced prosthetics can provide individualized support, as well as improved functionality and mobility (see the figure). The combination of extraordinary advances in robotics, medicine, materials science, and computing could bring safer, more efficient, and more widely available patient care in the future. -Gemma K. Alderton.

Intelligent Wireless Capsule Endoscopy for the Diagnosis of Gastrointestinal Diseases

Through a wireless capsule endoscope (WCE) fitted with a miniature camera (about an inch), this study aims to examine the role of wireless capsule endoscopy (WCE) in the diagnosis, monitoring, and evaluation of GI (gastrointestinal) disorders. In a wearable belt recorder, a capsule travels through the digestive tract and takes pictures. It attempts to find tiny components that can be used to enhance the WCE. To accomplish this, we followed the steps below: Researching current capsule endoscopy through databases, designing and simulating the device using computers, implanting the system and finding tiny components compatible with capsule size, testing the system and eliminating noise and other problems, and analyzing the results. In the present study, it was shown that a spherical WCE shaper and a smaller WCE with a size of 13.5 diameter, a high resolution, and a high frame rate (8-32 fps) could help patients with pains due to the traditional capsules and provide more accurate pictures as well as prolong the battery life. In addition, the capsule can also be used to reconstruct 3D images. Simulation experiments showed that spherical endoscopic devices are more advantageous than commercial capsule-shaped endoscopic devices for wireless applications. We found that the sphere's velocity through the fluid was greater than the capsule's.

Bioelectronic devices for light-based diagnostics and therapies

Light has broad applications in medicine as a tool for diagnosis and therapy. Recent advances in optical technology and bioelectronics have opened opportunities for wearable, ingestible, and implantable devices that use light to continuously monitor health and precisely treat diseases. In this review, we discuss recent progress in the development and application of light-based bioelectronic devices. We summarize the key features of the technologies underlying these devices, including light sources, light detectors, energy storage and harvesting, and wireless power and communications. We investigate the current state of bioelectronic devices for the continuous measurement of health and on-demand delivery of therapy. Finally, we highlight major challenges and opportunities associated with light-based bioelectronic devices and discuss their promise for enabling digital forms of health care.

Electro-mechano responsive elastomers with self-tunable conductivity and stiffness

Materials with programmable conductivity and stiffness offer new design opportunities for next-generation engineered systems in soft robotics and electronic devices. However, existing approaches fail to harness variable electrical and mechanical properties synergistically and lack the ability to self-respond to environmental changes. We report an electro-mechano responsive Field's metal hybrid elastomer exhibiting variable and tunable conductivity, strain sensitivity, and stiffness. By synergistically harnessing these properties, we demonstrate two applications with over an order of magnitude performance improvement compared to state-of-the-art, including a self-triggered multiaxis compliance compensator for robotic manipulators, and a resettable, highly compact, and fast current-limiting fuse with an adjustable fusing current. We envisage that the extraordinary electromechanical properties of our hybrid elastomer will bring substantial advancements in resilient robotic systems, intelligent instruments, and flexible electronics.

Follow-The-Leader Mechanisms in Medical Devices: A Review on Scientific and Patent Literature

Conventional medical instruments are not capable of passing through tortuous anatomy as required for natural orifice transluminal endoscopic surgery due to their rigid shaft designs. Nevertheless, developments in minimally invasive surgery are pushing medical devices to become more dexterous. Amongst devices with controllable flexibility, so-called Follow-The-Leader (FTL) devices possess motion capabilities to pass through confined spaces without interacting with anatomical structures. The goal of this literature study is to provide a comprehensive overview of medical devices with FTL motion. A scientific and patent literature search was performed in five databases (Scopus, PubMed, Web of Science, IEEExplore, Espacenet). Keywords were used to isolate FTL behavior in devices with medical applications. Ultimately, 35 unique devices were reviewed and categorized. Devices were allocated according to their design strategies to obtain the three fundamental sub-functions of FTL motion: steering, (controlling the leader/end-effector orientation), propagation, (advancing the device along a specific path), and conservation (memorizing the shape of the path taken by the device). A comparative analysis of the devices was carried out, showing the commonly used design choices for each sub-function and the different combinations. The advantages and disadvantages of the design aspects and an overview of their performance were provided. Devices that were initially assessed as ineligible were considered in a possible medical context or presented with FTL potential, broadening the classification. This review could aid in the development of a new generation of FTL devices by providing a comprehensive overview of the current solutions and stimulating the search for new ones.

Static Modeling of a Class of Stiffness-Adjustable Snake-Like Robots with Gravity Compensation

Stiffness-adjustable snake-like robots have been proposed for various applications, including minimally invasive surgery. Based on a variable neutral-line mechanism, previous works proposed a class of snake-like robots that can adjust their stiffness by changing the driving cables’ tensions. A constant curvature hypothesis was used to formulate such robots’ kinematics and was further verified by our previous work via rigorous force analysis and ADAMS simulations. However, all these models and analyses have ignored the effect of the robot links’ gravity, resulting in significant errors in real systems. In this paper, a static model considering gravity compensation is proposed for the stiffness-adjustable snake-like robots. The proposed model adopts a nonlinear Gauss–Seidel iteration scheme and consists of two parts: gravity update and pose estimation. In each iteration, the former updates the payload of each link caused by gravity, and the latter estimates the pose of the robot by refreshing the angle and position values. This iteration stops when the change in the tip position is less than a pre-set error ϵ. During the above process, the only dependent information is each cable’s tension. Simulations and experiments are carried out to verify the effectiveness of the proposed model. The impact of gravity is found to increase with growing material densities in the simulations. The experimental results further indicate that compared with a model without gravity compensation, our model reduces the tip estimation error by 91.5% on average.

Multifunctional Fiber-Enabled Intelligent Health Agents

The application of wearable devices is promoting the development toward digitization and intelligence in the field of health. However, the current smart devices centered on human health have disadvantages such as weak perception, high interference degree, and unfriendly interaction. Here, an intelligent health agent based on multifunctional fibers, with the characteristics of autonomy, activeness, intelligence, and perceptibility enabling health services, is proposed. According to the requirements for healthcare in the medical field and daily life, four major aspects driven by intelligent agents, including health monitoring, therapy, protection, and minimally invasive surgery, are summarized from the perspectives of materials science, medicine, and computer science. The function of intelligent health agents is realized through multifunctional fibers as sensing units and artificial intelligence technology as a cognitive engine. The structure, characteristics, and performance of fibers and analysis systems and algorithms are reviewed, while discussing future challenges and opportunities in healthcare and medicine. Finally, based on the above four aspects, future scenarios related to health protection of a person's life are presented. Intelligent health agents will have the potential to accelerate the realization of precision medicine and active health.

Variable Stiffness Conductive Composites by 4D Printing Dual Materials Alternately

Materials that can be designed with programmable properties and which change in response to external stimuli are of great importance in numerous fields of soft actuators, involving robotics, drug delivery and aerospace applications. In order to improve the interaction of human and robots, materials with variable stiffness are introduced to develop their compliance. A variable stiffness composite has been investigated in this paper, which is composed of liquid metals (LMs) and silicone elastomers. The phase changing materials (LMs) have been encapsulated into silicone elastomer by printing the dual materials alternately with three-dimensional direct ink writing. Such composites enable the control over their own stiffness between soft and rigid states through LM effective phase transition. The tested splines demonstrated that the stiffness changes approximately exceeded 1900%, and the storage modulus is 4.75 MPa and 0.2 MPa when LM is rigid and soft, respectively. In the process of heating up, the stretching strain can be enlarged by at least three times, but the load capacity is weakened. At a high temperature, the resistance of the conductive composites changes with the deformation degree, which is expected to be applied in the field of soft sensing actuators.

Hyper-Redundant Manipulator Capable of Adjusting Its Non-Uniform Curvature with Discrete Stiffness Distribution

Hyper-redundant manipulators are widely used in minimally invasive surgery because they can navigate through narrow passages in passive compliance with the human body. Although their stability and dexterity have been significantly improved over the years, we need manipulators that can bend with appropriate curvatures and adapt to complex environments. This paper proposes a design principle for a manipulator capable of adjusting its non-uniform curvature and predicting the bending shape. Rigid segments were serially stacked, and elastic fixtures in the form of flat springs were arranged between hinged-slide joint segments. A manipulator with a diameter of 4.5 mm and a length of 28 mm had been fabricated. A model was established to predict the bending shape through minimum potential energy theory, kinematics, and measured stiffnesses of the flat springs. A comparison of the simulation and experimental results indicated an average position error of 3.82% of the endpoints when compared to the total length. With this modification, the manipulator is expected to be widely used in various fields such as small endoscope systems and single-port robot systems.

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.

A Soft Robot for Peripheral Lung Cancer Diagnosis and Therapy

Lung cancer is one of the deadliest forms of cancers and is often diagnosed by performing biopsies with the use of a bronchoscope. However, this diagnostic procedure is limited in ability to explore deep into the periphery of the lung where cancer can remain undetected. In this study, we present design, modeling, fabrication, and testing of a one degree of freedom soft robot with integrated diagnostic and interventional capabilities as well as vision sensing. The robot can be deployed through the working channel of commercial bronchoscopes or used as a stand-alone system as it integrates a micro camera to provide vision sensing and controls to the periphery of the lung. The small diameter (2.4 mm) of the device allows navigation in branches deeper in the lung, where current devices have limited reachability. We have performed mechanical characterizations of the robotic platform, including blocked force, maximum bending angle, maximum angular velocity, and workspace, and assessed its performance in in vitro and ex vivo experiments. We have developed a computer vision algorithm, and validated it in in vitro conditions, to autonomously align the robot to a selected branch of the lung and aid the clinician (by means of a graphical user interface) during navigation tasks and to perform robot-assisted stabilization in front of a lesion, with automated tracking and alignment.

A Soft Robotic Sleeve for Safer Colonoscopy Procedures

Colonoscopy is the gold standard for colorectal cancer diagnosis; however, limited instrument dexterity and no sensor feedback can hamper procedure safety and acceptance. We propose a soft robotic sleeve to provide sensor feedback and additional actuation capabilities to improve safety during navigation in colonoscopy. The robot can be mounted around current endoscopic instrumentation as a disposable "add-on", avoiding the need for dedicated or customized instruments and without disrupting current surgical workflow. We focus on design, finite element analysis, fabrication, and experimental characterization and validation of the soft robotic sleeve. The device integrates soft optical sensors to monitor contact interaction forces between the colon and the colonoscope and soft robotic actuators that can be automatically deployed if excessive force is detected, to guarantee pressure redistribution on a larger contact area of the colon. The system can be operated by a surgeon via a graphic user interface that displays contact force values and enables independent or coordinated pressurization of the soft actuators upon demand, in case deemed necessary to aid navigation or distend colon tissue.

Flexible Manipulator with Low-Melting-Point Alloy Actuation and Variable Stiffness

Flexible manipulators offer significant advantages over traditional rigid manipulators in minimally invasive surgery, because they can flexibly navigate around obstacles and pass cramped or tortuous paths. However, due to the inherent low stiffness, the ability to control/obtain higher stiffness when required remains to be further explored. In this article, we propose a flexible manipulator that exploits the phase transformation property of low-melting-point alloy to hydraulically drive and change the stiffness by heating and cooling. A prototype was fabricated, and experiments were conducted to evaluate the motion characteristics, stiffness performance, and rigid-flexible transition efficiency. The experimental results demonstrate that the proposed manipulator can freely adjust heading direction in the three-dimensional space. The experimental results also indicate that it took 9.2-10.3 s for the manipulator to transform from a rigid state to a flexible state and 15.4 s to transform from a flexible state to a rigid state. The lateral stiffness and flexural stiffness of the manipulator were 95.54 and 372.1 Ncm² in the rigid state and 7.26 and 0.78 Ncm² in the flexible state. The gain of the lateral stiffness and flexural stiffness was 13.15 and 477.05, respectively. In the rigid state, the ultimate force without shape deformation was more than 0.98 N in the straight condition (0°) and 1.36 N in the bending condition (90°). By assembling flexible surgical tools, the manipulator can enrich the diagnosis or treatment functions, which demonstrated the potential clinical value of the proposed manipulator.

A Novel Design of Water-Activated Variable Stiffness Endoscopic Manipulator with Safe Thermal Insulation

In natural orifice transluminal endoscopic surgery (NOTES), an ideal endoscope platform should be flexible and dexterous enough to go through the natural orifices to access the lesion site inside the human body, and meanwhile provide sufficient rigidity to serve as a base for the end-effectors to operate during the surgical tasks. However, the conventional endoscope has limited ability for maintaining high rigidity over the length of the body. This paper presents a novel design of a variable stiffness endoscopic manipulator. By using a new bioplastic named FORMcard, whose stiffness can be thermally adjusted, water at different temperatures is employed to switch the manipulator between rigid mode and flexible mode. A biocompatible microencapsulated phase change material (MEPCM) with latent heat storage properties is adopted as the thermal insulation for better safety. Experiments are conducted to test the concept design, and the validated advantages of our proposed variable stiffness endoscopic manipulator include: shorter mode activation time (25 s), significantly improved stiffness in rigid mode (547.9–926.3 N·cm2) and larger stiffness-adjusting ratio (23.9–25.1 times).

Honeycomb Jamming: An Enabling Technology of Variable Stiffness Reconfiguration

Jamming technologies are one of the promising approaches of variable stiffness mechanisms. However, there are problems limiting the broad application of jamming-based approaches such as a limited stiffening capacity and restricted stiffening position. This article presents a variable stiffness mechanism to achieve a rapid flexible to rigid state transition with biocompatibility, fail-safe design, and enhanced stiffening capacity. A novel strategy of reconfiguration of stiffening regions, which is entitled variable stiffness reconfiguration, is exploited to control not only the stiffnesses but also the positions and areas of the stiffening regions. At first, this article provides a new approach to the variable stiffness soft robotics community to enable both stiffness control and stiffening region adjustment. In this way, additional functions of the variable stiffness mechanisms including reproducing complex manipulator postures or customizing the soft gripper, through delivering functional units into or out of the devices, are demonstrated. Through reconfiguration, our design provides a generally applicable solution for a wide range of complex manipulator postures reproduced and objects grasped by reconfiguration of the stiffening regions. The variable stiffness mechanism is empirically evaluated with a comparison with other variable stiffness strategies in which the proposed solution shows greater stiffening capability, and an experimental search of optimal parameters of the honeycomb structure is presented. Finite element models, which have shown reasonable agreement with the empirical results, are constructed to model the stiffnesses, and an analytic model of the manipulator is derived to predict the posture.

Programmable Stimuli-Responsive Actuators for Complex Motions in Soft Robotics: Concept, Design and Challenges

During the last years, great progress was made in material science in terms of concept, design and fabrication of new composite materials with conferred properties and desired functionalities. The scientific community paid particular interest to active soft materials, such as soft actuators, for their potential as transducers responding to various stimuli aiming to produce mechanical work. Inspired by this, materials engineers today are developing multidisciplinary approaches to produce new active matters, focusing on the kinematics allowed by the material itself more than on the possibilities offered by its design. Traditionally, more complex motions beyond pure elongation and bending are addressed by the robotics community. The present review targets encompassing and rationalizing a framework which will help a wider scientific audience to understand, sort and design future soft actuators and methods enabling complex motions. Special attention is devoted to recent progress in developing innovative stimulus-responsive materials and approaches for complex motion programming for soft robotics. In this context, a challenging overview of the new materials as well as their classification and comparison (performances and characteristics) are proposed. In addition, the great potential of soft transducers are outlined in terms of kinematic capabilities, illustrated by the related application. Guidelines are provided to design actuators and to integrate asymmetry enabling motions along any of the six basic degrees of freedom (translations and rotations), and strategies towards the programming of more complex motions are discussed. As a final note, a series of manufacturing methods are described and compared, from molding to 3D and 4D printing. The review ends with a Perspectives section, from material science and microrobotic points of view, on the soft materials’ future and close future challenges to be overcome.

A Layer Jamming Actuator for Tunable Stiffness and Shape-Changing Devices

Changing the shape and the stiffness of a device in a dynamic and controlled way enables important advancements in the field of robotics and wearable robotics. Variable stiffness materials and technologies can be used to address this challenge. In particular, layer jamming actuation is a very promising technology, featured by high efficiency and low cost. In this article, a stiffness- and shape-changing device based on a novel mechanism including a multiple-chamber structure is proposed. It allows to effectively modulate the shape and stiffness of a device, by activating two jamming chambers while pressurizing/depressurizing one or more interposed inflatable chambers. Prototypes with a size of 45 × 270 mm² and an average thickness ranging from 4.4 to 13 mm were developed and their ability to undergo a stiffness change over two orders of magnitude was demonstrated. The prototypes were also able to change their shape according to the position and inflation level of the interposed inflatable chambers, thus resulting in an overall deflection >10 mm. The possibility to wear the system as an orthotic brace was also demonstrated: this technology increased the patient comfort in static positions, yet keeping a supportive function when needed (e.g., in dynamic conditions). The device working principle highlighted in this article could also be exploited in other domains, for example, to build walking soft robots, prostheses, or grippers, as demonstrated through additional tests.

Development of a Rigidity Tunable Flexible Joint Using Magneto-Rheological Compounds-Toward a Multijoint Manipulator for Laparoscopic Surgery

Laparoscopic surgery is a representative operative method of minimally invasive surgery. However, most laparoscopic hand instruments consist of rigid and straight structures, which have serious limitations such as interference by the instruments and limited field of view of the endoscope. To improve the flexibility and dexterity of these instruments, we propose a new concept of a multijoint manipulator using a variable stiffness mechanism. The manipulator uses a magneto-rheological compound (MRC) whose rheological properties can be tuned by an external magnetic field. In this study, we changed the shape of the electromagnet and MRC to improve the performance of the variable stiffness joint we previously fabricated; further, we fabricated a prototype and performed basic evaluation of the joint using this prototype. The MRC was fabricated by mixing carbonyl iron particles and glycerol. The prototype single joint was assembled by combining MRC and electromagnets. The configuration of the joint indicates that it has a closed magnetic circuit. To examine the basic properties of the joint, we conducted preliminary experiments such as elastic modulus measurement and rigidity evaluation. We confirmed that the elastic modulus increased when a magnetic field was applied. The rigidity of the joint was also verified under bending conditions. Our results confirmed that the stiffness of the new joint changed significantly compared with the old joint depending on the presence or absence of a magnetic field, and the performance of the new joint also improved.

A review of recent advancements in soft and flexible robots for medical applications

BACKGROUND

Soft and flexible robots for medical applications are needed to change their flexibility over a wide range to perform tasks adequately. The mechanism and theory of flexibility has been a scientific issue and is of interest to the community.

METHODS

Recent advancements of bionics, flexible actuation, sensing, and intelligent control algorithms as well as tunable stiffness have been referenced when soft and flexible robots are developed. The benefits and limitations of these relevant studies and how they affect the flexibility are discussed, and possible research directions are explored.

RESULTS

The bionic materials and structures that demonstrate the potential capabilities of the soft medical robot flexibility are the fundamental guarantee for clinical medical applications. Flexible actuation that used to provide power, intelligent control algorithms which are the exact executors, and the wide range stiffness of the soft materials are the three important influence factors for soft medical robots.

CONCLUSION

Some reasonable suggestions and possible solutions for soft and flexible medical robots are proposed, including novel materials, flexible actuation concepts with a built-in source of energy or power, programmable flexibility, and adjustable stiffness.

A review on recent advances in soft surgical robots for endoscopic applications

BACKGROUND

Soft materials, with their compliant properties, enable conformity and safe interaction with human body. With the advance in actuation and sensing of soft materials, new paradigm in robotics called "soft robotics" emerges. Soft robotics has become a new approach in designing medical devices such as wearable robotic gloves and exoskeleton. However, application of soft robotics in surgical instrument inside human body is still in its infancy.

AIMS

In this paper, current application and design of soft robots specifically applied for endoscopy are reviewed.

MATERIALS & METHODS

Different aspects in the implementation of soft robotics in endoscope design were reviewed. The key studies about MIS and NOTES were reviewed to establish the clinical background and extract the limitations of current endoscopic device in the last decade.

RESULTS AND DISCUSSION

In this review study, the implementation of soft robotics concepts in endoscopic application, with highlights on different features of several soft endoscopes, were evaluated. The progress in different aspects of soft robotics endoscope, current state, and future perspectives were also discussed.

CONCLUSION

Based on the survey on the structural specification, actuation, sensing, and stiffening the future soft surgical endoscopes are recommended to fulfil the following specifications: safe especially from pressure leakage, fully biocompatible materials, MR-compatible, capable for large bending in at least two antagonistic directions, modularity, adjustable stiffness.

Mechanical Follow-the-Leader motion of a hyper-redundant surgical instrument: Proof-of-concept prototype and first tests

One of the most prominent drivers in the development of surgical procedures is the will to reduce their invasiveness, attested by minimally invasive surgery being the gold standards in many surgical procedures and natural orifices transluminal endoscopic surgery gaining acceptance. A logical next step in this pursuit is the introduction of hyper-redundant instruments that can insert themselves along multi-curved paths referred to as Follow-the-Leader motion. In the current state of the art, two different types of Follow-the-Leader instruments can be distinguished. One type of instrument is robotized; the movements of the shaft are controlled from outside the patient by actuators, for example, electric motors, and a controller storing a virtual track of the desired path. The other type of instrument is more mechanical; the movements of the shaft are controlled from inside the patient by a physical track that guides the shaft along the desired path. While in the robotized approach all degrees of freedom of the shaft require an individual actuator, the mechanical approach makes the number of degrees of freedom independent from the number of actuators. A desirable feature as an increasing number of actuators will inevitably drive up costs and increase the footprint of an instrument. Building the physical track inside the body does, however, impede miniaturization of the shaft’s diameter. This article introduces a new fully mechanical approach for Follow-the-Leader motion using a pre-determined physical track that is placed outside the body. This new approach was validated with a prototype called MemoFlex, which supports a Ø5 mm shaft (standard size in minimally invasive surgery) that contains 28-degrees-of-freedom and utilizes a simple steel rod as its physical track. Even though the performance of the MemoFlex leaves room for improvement, especially when following multiple curves, it does validate the proposed concept for Follow-the-Leader motion in three-dimensional space.

Soft Robotics in Minimally Invasive Surgery

Soft robotic devices have desirable traits for applications in minimally invasive surgery (MIS), but many interdisciplinary challenges remain unsolved. To understand current technologies, we carried out a keyword search using the Web of Science and Scopus databases, applied inclusion and exclusion criteria, and compared several characteristics of the soft robotic devices for MIS in the resulting articles. There was low diversity in the device designs and a wide-ranging level of detail regarding their capabilities. We propose a standardized comparison methodology to characterize soft robotics for various MIS applications, which will aid designers producing the next generation of devices.

MR-Conditional SMA-Based Origami Joint

Foldable origami structures have been implemented into robotics as a way of compacting joints and circuitry into smaller structures. This technique is especially useful in minimally invasive surgical instruments, where the goal is to create slimline devices that can be inserted through small incisions. Origami also has the potential to cut costs by reducing the amount of material required for assembly. Origami devices are especially suitable for MRI-guided procedures, where instruments must be nonmagnetic because origami is more suitable for flexible, non-metallic materials. MR conditional surgical instruments enable intraoperative MRI procedures that provide superior imaging capabilities to physicians to allow for safer procedures. This work presents an MR conditional joint developed using origami techniques that reduces costs by eliminating assembly of various components and has potential applications in endoscopy. The joint is a compliant rolling-contact element that employs curved-folding origami techniques. A chain of these joints can be constructed from a single sheet of material, eliminating assembly of numerous materials to produce a final product, which is specifically advantageous for constructing low-cost, disposable surgical devices. The prototype contains a degree of bending of ±9 degrees per joint, a response time of less than 4 seconds and an actuation force of 0.5 N using a 1.25 A current. The MRI results showed a minimal artifact of less than 1 mm measured from the boundary of the joint chain and a SNR reduction of less than 10%.

Stiffening Sheaths for Continuum Robots

Added to their high dexterity and ability to conform to complex shapes, continuum robots can be further improved to provide safer interaction with their environment. Indeed, controlling their stiffness is one of the most challenging yet promising research topics. We propose a tubular stiffening sheath as a replaceable cover for small-diameter continuum robots to temporarily increase the stiffness in a certain configuration. In this article, we assess and compare performances of two different stiffening modalities: granular and layer jamming, provide arguments for material selection and experimental results for stiffness with respect to lateral and axial applied forces. Furthermore, we detected empirically additional effects relating sheath stiffness to material parameters and added to recent investigations in the state of the art, which are based exclusively on material roughness. Finally, we integrated the selected layer jamming material in a miniaturized sheath (13 mm outer diameter, 2.5 mm wall thickness) and covered a tendon-actuated continuum robot with it. Experimental characterization of the behavior with respect to applied external forces was performed via stiffness measurements and proved that the initial tendon-actuated continuum robot stiffness can be improved by a factor up to 24.

Active Stiffness Tuning of a Spring-based Continuum Robot for MRI-Guided Neurosurgery

Deep intracranial tumor removal can be achieved if the neurosurgical robot has sufficient flexibility and stability. Towards achieving this goal, we have developed a spring-based continuum robot, namely a Minimally Invasive Neurosurgical Intracranial Robot (MINIR-II) with novel tendon routing and tunable stiffness for use in a magnetic resonance imaging (MRI) environment. The robot consists of a pair of springs in parallel, i.e., an inner inter-connected spring that promotes flexibility with decoupled segment motion and an outer spring that maintains its smooth curved shape during its interaction with the tissue. We propose a shape memory alloy (SMA) spring backbone that provides local stiffness control and a tendon routing configuration that enables independent segment locking. In this work, we also present a detailed local stiffness analysis of the SMA backbone and model the relationship between the resistive force at the robot tip and the tension in the tendon. We also demonstrate through experiments, the validity of our local stiffness model of the SMA backbone and the correlation between the tendon tension and the resistive force. We also performed MRI compatibility studies of the 3-segment MINIR-II robot by attaching it to a robotic platform that consists of SMA spring actuators with integrated water cooling modules.

Are Current Advances of Compression Algorithms for Capsule Endoscopy Enough? A Technical Review

The recent technological advances in capsule endoscopy system have revolutionized the healthcare system by introducing new techniques and functionalities to diagnose gastrointestinal tract. These techniques improve diagnostic accuracy and reduce the risk of hospitalization. Although many benefits of capsule endoscopy are known, there are still limitations including lower battery life, higher bandwidth, poor image quality and lower frame rate, which have restricted its wide use. In order to solve these limitations, the importance of a low-cost compression algorithm, that produces higher frame rate with better image quality and yet consumes lower bandwidth and transmission power, is paramount. While several review papers have been published describing the capability of capsule endoscope in terms of its functionality and emerging features, an extensive review on the compression algorithms from past and for future applications is still of great interest. Hence, in this review, we aim to address the issue by exploring the characteristics of endoscopic images, analyzing the strengths and weaknesses of useful compression techniques, and making suggestions for possible future adaptation.

A soft multi-module manipulator with variable stiffness for minimally invasive surgery

This work presents a soft manipulator for minimally invasive surgery inspired by the biological capabilities of the octopus arm. The multi-module arm is composed of three identical units, which are able to move thanks to embedded fluidic actuators that allow omnidirectional bending and elongation, typical movements of the octopus. The use of soft materials makes the arm safe, adaptable and compliant with tissues. In addition, a granular jamming-based stiffening mechanism is integrated in each module with the aim of tuning the stiffness of the manipulator and controlling the interactions with biological structures. A miniaturized camera and a pneumatic gripper have been purposely designed and integrated on the tip of the manipulator making it usable in real working conditions. This work reports the design and the fabrication process of the manipulator, the theoretical and experimental evaluation of the stiffness and the analysis of the motion workspace. Finally, pick and place tests with the fully integrated system are shown.

Stimuli-Responsive Soft Untethered Grippers for Drug Delivery and Robotic Surgery

Untethered microtools that can be precisely navigated into deep in vivo locations are important for clinical procedures pertinent to minimally invasive surgery and targeted drug delivery. In this mini-review, untethered soft grippers are discussed, with an emphasis on a class of autonomous stimuli-responsive gripping soft tools that can be used to excise tissues and release drugs in a controlled manner. The grippers are composed of polymers and hydrogels and are thus compliant to soft tissues. They can be navigated using magnetic fields and controlled by robotic path-planning strategies to carry out tasks like pick-and-place of microspheres and biological materials either with user assistance, or in a fully autonomous manner. It is envisioned that the use of these untethered soft grippers will translate from laboratory experiments to clinical scenarios and the challenges that need to be overcome to make this transition are discussed.

Ingestible Sensors

Ingestible sensing capsules are fast emerging as a critical technology that has the ability to greatly impact health, nutrition, and clinical areas. These ingestible devices are noninvasive and hence are very attractive for customers. With widespread access to smart phones connected to the Internet, the data produced by this technology can be readily seen and reviewed online, and accessed by both users and physicians. The outputs provide invaluable information to reveal the state of gut health and disorders as well as the impact of food, medical supplements, and environmental changes on the gastrointestinal tract. One unique feature of such ingestible sensors is that their passage through the gut lumen gives them access to each individual organ of the gastrointestinal tract. Therefore, ingestible sensors offer the ability to gather images and monitor luminal fluid and the contents of each gut segment including electrolytes, enzymes, metabolites, hormones, and the microbial communities. As such, an incredible wealth of knowledge regarding the functionality and state of health of individuals through key gut biomarkers can be obtained. This Review presents an overview of the gut structure and discusses current and emerging digestible technologies. The text is an effort to provide a comprehensive overview of ingestible sensing capsules, from both a body physiology point of view as well as a technological view, and to detail the potential information that they can generate.

Towards the development of a soft manipulator as an assistive robot for personal care of elderly people

Manipulators based on soft robotic technologies exhibit compliance and dexterity which ensures safe human–robot interaction. This article is a novel attempt at exploiting these desirable properties to develop a manipulator for an assistive application, in particular, a shower arm to assist the elderly in the bathing task. The overall vision for the soft manipulator is to concatenate three modules in a serial manner such that (i) the proximal segment is made up of cable-based actuation to compensate for gravitational effects and (ii) the central and distal segments are made up of hybrid actuation to autonomously reach delicate body parts to perform the main tasks related to bathing. The role of the latter modules is crucial to the application of the system in the bathing task; however, it is a nontrivial challenge to develop a robust and controllable hybrid actuated system with advanced manipulation capabilities and hence, the focus of this article. We first introduce our design and experimentally characterize its functionalities, which include elongation, shortening, omnidirectional bending. Next, we propose a control concept capable of solving the inverse kinetics problem using multiagent reinforcement learning to exploit these functionalities despite high dimensionality and redundancy. We demonstrate the effectiveness of the design and control of this module by demonstrating an open-loop task space control where it successfully moves through an asymmetric 3-D trajectory sampled at 12 points with an average reaching accuracy of 0.79 cm ± 0.18 cm. Our quantitative experimental results present a promising step toward the development of the soft manipulator eventually contributing to the advancement of soft robotics.

Design and preliminary evaluation of a self-steering, pneumatically driven colonoscopy robot

Colonoscopy is a diagnostic procedure to detect pre-cancerous polyps and tumours in the colon, and is performed by inserting a long tube equipped with a camera and biopsy tools. Despite the medical benefits, patients undergoing this procedure often complain about the associated pain and discomfort. This discomfort is mostly due to the rough handling of the tube and the creation of loops during the insertion. The overall goal of this work is to minimise the invasiveness of traditional colonoscopy. In pursuit of this goal, this work presents the development of a semi-autonomous colonoscopic robot with minimally invasive locomotion. The proposed robotic approach allows physicians to concentrate mainly on the diagnosis rather than the mechanics of the procedure. In this paper, an innovative locomotion approach for robotic colonoscopy is addressed. Our locomotion approach takes advantage of longitudinal expansion of a latex tube to propel the robot's tip along the colon. This soft and compliant propulsion mechanism, in contrast to minimally invasive mechanisms used in, for example, inchworm-like robots, has shown promising potential. In the preliminary ex vivo experiments, the robot successfully advanced 1.5 metres inside an excised curvilinear porcine colon with average speed of 28 mm/s, and was capable of traversing bends up to 150 degrees. The robot creates less than 6 N of normal force at its tip when it is pressurised with 90 kPa. This maximum force generates pressure of 44.17 mmHg at the tip, which is significantly lower than safe intraluminal human colonic pressure of 80 mmHg. The robot design inherently prevents loop formation in the colon, which is recognised as the main cause of post procedural pain in patients. Overall, the robot has shown great promise in an ex vivo experimental setup. The design of an autonomous control system and in vivo experiments are left as future work.

Variable Stiffness Fiber with Self-Healing Capability

A variable stiffness fiber made of silicone and low melting point alloys quickly becomes >700 times softer and >400 times more deformable when heated above 62 °C. It shows remarkable self-healing properties and can be clamped, knitted, and bonded, as shown in a foldable multi-purpose drone, a wearable cast for bone injuries, and a soft multi-directional actuator.

Development of a Variable Stiffness Over Tube Based on Low-Melting-Point-Alloy for Endoscopic Surgery

Instruments used in endoscopic surgery (colonoscopy surgery or natural orifice transluminal endoscopic surgery (NOTES)) are flexible to be advanced in human body. However, when the end of the instrument reaches the target, the instrument should be rigid enough to hold its shape against external forces for better surgical accuracy. In order to obtain these two properties, a variable stiffness over tube based on low-melting-point-alloy (LMPA) is proposed in this paper. The structure exploits the phase transformation property of the LMPA which enables the stiffness change of the over tube by heating and cooling. A prototype was fabricated using a special molding method, and experiments were carried out to evaluate its variable stiffness property and response characteristics. According to experimental results, it costs 17 s to make the over tube transform from rigid state to flexible state and 18 s to make the over tube transform from flexible state to rigid state. The experimental results also indicated that the over tube is very rigid in rigid state and flexible in compliant state. A heat insulation layer was assembled to prevent human tissue from thermal damage. The temperature of the outer wall of the over tube was 42.5 °C when hot water of 80 °C was pumped into the over tube continually with the help of the heat insulation layer.

Frontiers of robotic endoscopic capsules: a review

Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd., is an example of disruptive technology and represents an attractive alternative to traditional diagnostic techniques. WCE overcomes conventional endoscopy enabling inspection of the digestive system without discomfort or the need for sedation. Thus, it has the advantage of encouraging patients to undergo gastrointestinal (GI) tract examinations and of facilitating mass screening programmes. With the integration of further capabilities based on microrobotics, e.g. active locomotion and embedded therapeutic modules, WCE could become the key-technology for GI diagnosis and treatment. This review presents a research update on WCE and describes the state-of-the-art of current endoscopic devices with a focus on research-oriented robotic capsule endoscopes enabled by microsystem technologies. The article also presents a visionary perspective on WCE potential for screening, diagnostic and therapeutic endoscopic procedures.