Design and Development of Surgeon Augmented Endovascular Robotic System

Improved precise guidewire delivery of a cardiovascular interventional surgery robot based on admittance control

PURPOSE

The development of cardiovascular interventional surgery robots can realize master-slave interventional operations, which will effectively solve the problem of surgeons being injured by X-ray radiation. The delivery accuracy and safety of interventional instruments such as guidewire are the most important issues in the development of robotic systems. Most of the current control methods are position control or force feedback control, which cannot take into account delivery accuracy and safety.

METHODS

A cardiovascular interventional surgery robotic system integrated force sensors is developed. A novel force/position controller, which includes a radial basis function neural networks-based inner loop position controller and a force-based admittance outer loop controller, is proposed. Furthermore, a series of simulations and vascular model experiments are carried out to demonstrate the feasibility and accuracy of the proposed controller.

RESULTS

The designed cardiovascular interventional robot is flexible to enter the target vessel branch. Experimental results indicate that the proposed controller can effectively improve the delivery accuracy of the guidewire and reduce the contact force with the vessel wall.

CONCLUSIONS

The proposed controller based on radial basis function neural network and admittance control is effective in improving delivery accuracy and reducing contact force. The algorithm needs to be further validated in vivo experiments.

Learning-Based Multimodal Information Fusion and Behavior Recognition of Vascular Interventionists' Operating Skills

The operating skills of vascular interventionists have an important impact on the effect of surgery. However, current research on behavior recognition and skills learning of interventionists' operating skills is limited. In this study, an innovative deep learning-based multimodal information fusion architecture is proposed for recognizing and analyzing eight common operating behaviors of interventionists. An experimental platform integrating four modal sensors is used to collect multimodal data from interventionists. The ANOVA and Manner-Whitney tests is used for relevance analysis of the data. The analysis results demonstrate that there is almost no significant difference ( p <0.001) between the actions related to the unimodal data, which cannot be used for accurate behavior recognition. Therefore, a study of the fusion architecture based on the existing machine learning classifier and the proposed deep learning fusion architecture is carried out. The research findings indicate that the proposed deep learning-based fusion architecture achieves an impressive overall accuracy of 98.5%, surpassing both the machine learning classifier (93.51%) and the unimodal data (90.05%). The deep learning-based multimodal information fusion architecture proves the feasibility of behavior recognition and skills learning of interventionist's operating skills. Furthermore, the application of deep learning-based multimodal fusion technology of surgeon's operating skills will help to improve the autonomy and intelligence of surgical robotic systems.

A novel catheter interaction simulating method for virtual reality interventional training systems

Endovascular robotic systems have been applied in robot-assisted interventional surgery to improve surgical safety and reduce radiation to surgeons. However, this surgery requires surgeons to be highly skilled at operating vascular interventional surgical robot. Virtual reality (VR) interventional training systems for robot-assisted interventional surgical training have many advantages over traditional training methods. For virtual interventional radiology, simulation of the behaviors of surgical tools (here mainly refers to catheter and guidewire) is a challenging work. In this paper, we developed a novel virtual reality interventional training system. This system is an extension of the endovascular robotic system. Because the master side of this system can be used for both the endovascular robotic system and the VR interventional training system, the proposed system improves training and reduces the cost of education. Moreover, we proposed a novel method to solve catheterization modeling during the interventional simulation. Our method discretizes the catheter by the collision points. The catheter between two adjacent collision points is treated as thin torsion-free elastic rods. The deformation of the rod is mainly affected by the force applied at the collision points. Meanwhile, the virtual contact force is determined by the collision points. This simplification makes the model more stable and reduces the computational complexity, and the behavior of the surgical tools can be approximated. Therefore, we realized the catheter interaction simulation and virtual force feedback for the proposed VR interventional training system. The performance of our method is experimentally validated.

Design, development and evaluation of an ergonomically designed dual-use mechanism for robot-assisted cardiovascular intervention

PURPOSE

Robot-assisted cardiovascular intervention has been recently developed, which enables interventionists to avoid x-ray radiation and improve their comfort. However, there are still some challenges in the robotic design, such as the inability of the interventionist to freely perform natural clinical techniques and the limited motion travel of the interventional tool. To overcome these challenges, this paper proposes an ergonomically designed dual-use mechanism for cardiovascular intervention (DMCI).

METHODS

DMCI can work as an ergonomic interface or a compact slave robot with unlimited motion travel. Our kinematic analysis of DMCI includes motion decoupling and coupling. Motion decoupling decomposes the translation and rotation from the interventionist's natural clinical actions at the master side. Motion coupling can calculate the input pulses of motors according to the desired rotation and translation, thus composing the motion of the intervention tool at the slave side.

RESULTS

Our kinematic analysis of DMCI has been experimentally verified, where the overall mean rotational errors are all less than 1° and translational errors are all less than 1 mm. We also evaluated the performance of the DMCI-based master-slave system, where the overall rotational and translational errors are 0.821 ± 0.753° and 0.608 ± 0.512 mm. Moreover, operators were found to be generally more efficient when using the DMCI-based interface compared to the conventional joystick.

CONCLUSION

We have validated our kinematic analysis of DMCI. The master-slave teleoperation experiment demonstrated that operators can freely perform natural clinical techniques through the DMCI-based interface, and the slave robot can replicate the operators' manipulation at the master side well.

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.

Kinetics Analysis and ADRC-Based Controller for a String-Driven Vascular Intervention Surgical Robotic System

Vascular interventional surgery is a typical method for diagnosing and treating cardio-cerebrovascular diseases. However, a surgeon is exposed to significant X-radiation exposure when the operation is conducted for a long period of time. A vascular intervention surgical robotic system for assisting the surgeon is a promising approach to address the aforementioned issue. When developing the robotic system, a high displacement accuracy is crucial, and this can aid in enhancing operating efficiency and safety. In this study, a novel kinetics analysis and active disturbance rejection control (ADRC)-based controller is proposed to provide high accuracy for a string-driven robotic system. In this controller, kinetics analysis is initially used to improve the accuracy affected by the inner factors of the slave manipulator. Then, the ADRC controller is used to further improve the operating accuracy of the robotic system. Finally, the proposed controller is evaluated by conducting experiments on a vascular model. The results indicate maximum steady errors of 0.45 mm and 6.67°. The experimental results demonstrate that the proposed controller can satisfy the safety requirements of the string-driven robotic system.

Remote vascular interventional surgery robotics: a literature review

Vascular interventional doctors are exposed to radiation hazards during surgery and endure high work intensity. Remote vascular interventional surgery robotics is a hot research field, in which researchers aim to not only protect the health of interventional doctors, but to also improve surgical accuracy and efficiency. However, the current vascular interventional robots have numerous shortcomings, such as poor haptic feedback, few compatible surgeries and instruments, and cumbersome maintenance and operational procedures. Nevertheless, vascular interventional surgery combined with robotics provides more cutting-edge directions, such as Internet remote surgery combined with 5G network technology and the application of artificial intelligence in surgical procedures. To summarize the developmental status and key technical points of intravascular interventional surgical robotics research, we performed a systematic literature search to retrieve original articles related to remote vascular interventional surgery robotics published up to December 2020. This review, which includes 113 articles published in English, introduces the mechanical and structural characteristics of various aspects of vascular interventional surgical robotics, discusses the current key features of vascular interventional surgical robotics in force sensing, haptic feedback, and control methods, and summarizes current frontiers in autonomous surgery, long-distance robotic telesurgery, and magnetic resonance imaging (MRI)-compatible structures. On the basis of summarizing the current research status of remote vascular interventional surgery robotics, we aim to propose a variety of prospects for future robotic systems.

An Endovascular Catheterization Robotic System Using Collaborative Operation with Magnetically Controlled Haptic Force Feedback

Robot-assisted technology is often used to perform endovascular catheterization surgeries, which generally depend on the flexible operability and the accurate force feedback of a robotic system. In this paper, an endovascular catheterization robotic system (ECRS) was developed to improve collaborative operation and haptic force feedback. A couple of operating handles were designed to maximize the use of the natural operations of surgeons on the master side, which is a flexible and ergonomic device. A magnetically controlled haptic force feedback structure is proposed based on hydrogel and solid magnetorheological (MR) fluid to offer a sense of haptic feedback to operators; this has potential influence on the field of force feedback. In addition, a unique tremor-reduction structure is introduced to enhance operating safety. Tracking performance experiments and in vitro experiments were conducted to evaluate the performance of the developed ECRS. According to these experimental results, the average translation-tracking error is 0.94 mm, and the average error of rotation is 0.89 degrees. Moreover, in vitro experiments demonstrated that haptic feedback has the advantage of reducing workload and shortening surgery completion time. The developed ECRS also has the benefits of inspiring other researchers to study collaborative robots and magnetically controlled feedback.

A generalized predictive control for remote cardiovascular surgical systems

Robot-assisted cardiovascular surgery is used to avoid surgeon suffering from X-ray radiation and relieve fatigue caused by long-time standing wearing protective clothing. Its remote surgery can alleviate the lack of experienced doctors in remote areas. Due to the existence of time-delay phenomena, flexible deformation and nonlinearity of interventional instruments, it is difficult to ensure system transparency. This paper analyzes the evaluation index of system transparency. A generalized predictive control (GPC) is developed to suppress the effect of time-varying delay and parameter identification error. Moreover, a terminal sliding mode controller (SMC) is designed to improve the robustness of the system under consideration. Simulation results are provided to show that the proposed control strategy can improve transparency of the remote vascular interventional surgery system.

Force calibration for an endovascular robotic system with proximal force measurement

Surgeons, while performing manual endovascular procedures with conventional surgical tools (catheters and guidewires), experience forces on the tool outside the patient's body that are proximal to the point of actuation. Currently, most of the robotic systems for endovascular procedures use active catheters to navigate vasculature and to measure the contact forces at the distal end (tool tip). These tools are more expensive than the conventional surgical tools used in endovascular procedures. To avoid dependence on specialized devices like active catheters, we have developed a novel endovascular robotic system (ERS) that uses conventional surgical tools. Our robot can indirectly measure proximal forces and provide haptic feedback to surgeons. This paper discusses the theory, methodology, and calibration of indirect proximal force measurement. This new calibration technique is presented as a nested optimization problem that is solved using bi-level optimization. The results of experimental validation of the new force calibration methodology are also discussed. The results show that unbiasing of the indirect force measurement by means of force calibration will allow the use of conventional tools in robotic endovascular procedures.