Design of 3-D Printed Concentric Tube Robots

Non-Metallic MR-Guided Concentric Tube Robot for Intracerebral Hemorrhage Evacuation

OBJECTIVE

We aim to develop and evaluate an MR-conditional concentric tube robot for intracerebral hemorrhage (ICH) evacuation.

METHODS

We fabricated the concentric tube robot hardware with plastic tubes and customized pneumatic motors. The robot kinematic model was developed using a discretized piece-wise constant curvature (D-PCC) approach to account for variable curvature along the tube shape, and tube mechanics model was used to compensate torsional deflection of the inner tube. The MR-safe pneumatic motors were controlled using a variable gain PID algorithm. The robot hardware was validated in a series of bench-top and MRI experiments, and the robot's evacuation efficacy was tested in MR-guided phantom trials.

RESULTS

The pneumatic motor was able to achieve a rotational accuracy of 0.32°±0.30° with the proposed variable gain PID control algorithm. The kinematic model provided a positional accuracy of the tube tip of 1.39 ± 0.54 mm. The robot was able to evacuate an initial 38.36 mL clot, leaving a residual hematoma of 8.14 mL after 5 minutes, well below the 15 mL guideline suggesting good post-ICH evacuation clinical outcomes.

CONCLUSION

This robotic platform provides an effective method for MR-guided ICH evacuation.

SIGNIFICANCE

ICH evacuation is feasible under MRI guidance using a plastic concentric tube, indicating potential feasibility in future live animal studies.

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.

A Survey on Design, Actuation, Modeling, and Control of Continuum Robot

In this paper, we describe the advances in the design, actuation, modeling, and control field of continuum robots. After decades of pioneering research, many innovative structural design and actuation methods have arisen. Untethered magnetic robots are a good example; its external actuation characteristic allows for miniaturization, and they have gotten a lot of interest from academics. Furthermore, continuum robots with proprioceptive abilities are also studied. In modeling, modeling approaches based on continuum mechanics and geometric shaping hypothesis have made significant progress after years of research. Geometric exact continuum mechanics yields apparent computing efficiency via discrete modeling when combined with numerical analytic methods such that many effective model-based control methods have been realized. In the control, closed-loop and hybrid control methods offer great accuracy and resilience of motion control when combined with sensor feedback information. On the other hand, the advancement of machine learning has made modeling and control of continuum robots easier. The data-driven modeling technique simplifies modeling and improves anti-interference and generalization abilities. This paper discusses the current development and challenges of continuum robots in the above fields and provides prospects for the future.

Branching Vine Robots for Unmapped Environments

While exploring complex unmapped spaces is a persistent challenge for robots, plants are able to reliably accomplish this task. In this work we develop branching robots that deploy through an eversion process that mimics key features of plant growth (i.e., apical extension, branching). We show that by optimizing the design of these robots, we can successfully traverse complex terrain even in unseen instances of an environment. By simulating robot growth through a set of known training maps and evaluating performance with a reward heuristic specific to the intended application (i.e., exploration, anchoring), we optimized robot designs with a particle swarm algorithm. We show these optimization efforts transfer from training on known maps to performance on unseen maps in the same type of environment, and that the resulting designs are specialized to the environment used in training. Furthermore, we fabricated several optimized branching everting robot designs and demonstrated key aspects of their performance in hardware. Our branching designs replicated three properties found in nature: anchoring, coverage, and reachability. The branching designs were able to reach 25% more of a given space than non-branching robots, improved anchoring forces by 12.55×, and were able to hold greater than 100× their own mass (i.e., a device weighing 5 g held 575 g). We also demonstrated anchoring with a robot that held a load of over 66.7 N at an internal pressure of 50 kPa. These results show the promise of using branching vine robots for traversing complex and unmapped terrain.

Smart handheld device with flexible wrist and electrical bioimpedance sensor for tissue inspection

With the evolving demands of surgical intervention, there is a strong need for smaller and functionally augmented instruments to improve surgical outcomes, operational convenience, and diagnostic safety. Owing to the narrow and complicated anatomy, the probe head of the medical instrument is required to possess both good maneuverability and compact size. In addition, the development of medical instrument is moving toward patient-specialized, of which the articulation positions can be customized to reach the target position. To fulfill these requirements, this study presents the design of a smart handheld device which equips with a low cost, easy control, disposable flexible wrist, and an electrical bioimpedance sensor for medical diagnosis. Prototype of the device is made and tested. The experimental results demonstrate that the proposed device can provide accurate manipulation and effective tissue detection, showing a great potential in various medical applications.

Cruciate-Ligament-Inspired Compliant Joints: Application to 3D-Printed Continuum Surgical Robots

The rapid development of additive manufacturing technology makes it possible to fabricate a patient-specific surgical robot in a short time. To simplify the assembly process of the printed robotic system, compliant-joint-based monolithic structures are often used as substitutes for rigid-link mechanisms to realize flexible bending. In this paper, we introduce a cruciate-ligament-inspired compliant joint (CLCJ) to improve the bending stability of the 3D-printed continuum surgical robots. The basic structure of the tendon-driven CLCJ mechanism and its kinematic model were described in detail. The bending performance of CLCJ was also successfully evaluated by FEM simulation and experimental tests. Besides, a prototype of CLCJ-based surgical robotic system was presented to demonstrate its application in 3D-printed continuum surgical robots.

Real-Time Shape Estimation for Concentric Tube Continuum Robots with a Single Force/Torque Sensor

Shape-sensing in real-time is a key requirement for the development of advanced algorithms for concentric tube continuum robots when safe interaction with the environment is important e.g., for path planning, advanced control, and human-machine interaction. We propose a real-time shape-estimation algorithm for concentric tube continuum robots based on the force-torque information measured at the tubes' basis. It extends a shape estimation algorithm for elastic rods based on discrete Kirchhoff rod theory. For simplicity and efficiency of calculation, we combine it with a model under piece-wise constant curvature assumption, in which we model a concentric tube continuum robot as a combination of segments of planar constant curvatures lying on different equilibrium planes. We evaluate our approach for a single and two combined additively manufactured tubes and achieve an estimation frequency of 333 Hz for two combined tubes with a mean deviation along the backbone of the tubes of 1.91-5.22 mm.

Current Trends and Prospects in Compliant Continuum Robots: A Survey

Compliant continuum robots (CCRs) have slender and elastic bodies. Compared with a traditional serial robot, they have more degrees of freedom and can deform their flexible bodies to go through a constrained environment. In this paper, we classify CCRs according to basic transmission units. The merits, materials and potential drawbacks of each type of CCR are described. Drive systems depend on the basic transmission units significantly, and their advantages and disadvantages are reviewed and summarized. Variable stiffness and intrinsic sensing are desired characteristics of CCRs, and the methods of obtaining the two characteristics are discussed. Finally, we discuss the friction, buckling, singularity and twisting problems of CCRs, and emphasise the ways to reduce their effects, followed by several proposing perspectives, such as the collaborative CCRs.

A Dynamic Model for Concentric Tube Robots

Existing static and kinematic models of concentric tube robots are based on the ordinary differential equations of a static Cosserat rod. In this paper, we provide the first dynamic model for concentric tube continuum robots by adapting the partial differential equations of a dynamic Cosserat rod to describe the coupled inertial dynamics of precurved concentric tubes. This generates an initial-boundary-value problem that can capture robot vibrations over time. We solve this model numerically at high time resolutions using implicit finite differences in time and arc length. This approach is capable of resolving the high-frequency torsional dynamics that occur during unstable "snapping" motions and provides a simulation tool that can track the true robot configuration through such transitions. Further, it can track slower oscillations associated with bending and torsion as a robot interacts with tissue at real-time speeds. Experimental verification of the model shows that this wide range of effects is captured efficiently and accurately.

Recent Advances in Design and Actuation of Continuum Robots for Medical Applications

Traditional rigid robot application in the medical field is limited due to the limited degrees of freedom caused by their material and structure. Inspired by trunk, tentacles, and snakes, continuum robot (CR) could traverse confined space, manipulate objects in complex environment, and conform to curvilinear paths in space. The continuum robot has broad prospect in surgery due to its high dexterity, which can reach circuitous areas of the body and perform precision surgery. Recently, many efforts have been done by researchers to improve the design and actuation methods of continuum robots. Several continuum robots have been applied in clinic surgical interventions and demonstrated superiorities to conventional rigid-link robots. In this paper, we provide an overview of the current development of continuum robots, including the design principles, actuation methods, application prospect, limitations, and challenge. And we also provide perspective for the future development. We hope that with the development of material science, Engineering ethics, and manufacture technology, new methods can be applied to manufacture continuum robots for specific surgical procedures.

Exploring non-assembly 3D printing for novel compliant surgical devices

In minimally invasive surgery, maneuverability is usually limited and a large number of degrees of freedom (DOF) is highly demanded. However, increasing the DOF usually means increasing the complexity of the surgical instrument leading to long fabrication and assembly times. In this work, we propose the first fully 3D printed handheld, multi-steerable device. The proposed device is mechanically actuated, and possesses five serially controlled segments. We designed a new compliant segment providing high torsion and axial stiffness as well as a low bending stiffness by merging the functions of four helicoids and a continuum backbone. Compliant segments were combined to form the compliant shaft of the new device. In order to control this compliant shaft, a control handle was designed that mimics the shaft structure. A prototype called the HelicoFlex was built using only three 3D printed parts. HelicoFlex, with its 10 degrees of freedom, showed a fluid motion in performing single and multi-curved paths. The multi-steerable instrument was 3D printed without any support material in the compliant shaft itself. This work contributes to enlarge the body of knowledge regarding how additive manufacturing could be used in the production of multi-steerable surgical instruments for personalized medicine.

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.

Towards Patient-Specific 3D-Printed Robotic Systems for Surgical Interventions

Surgical robots have been extensively researched for a wide range of surgical procedures due to the advantages of improved precision, sensing capabilities, motion scaling, and tremor reduction, to name a few. Though the underlying disease condition or pathology may be the same across patients, the intervention approach to treat the condition can vary significantly across patients. This is especially true for endovascular interventions, where each case brings forth its own challenges. Hence it is critical to develop patient-specific surgical robotic systems to maximize the benefits of robot-assisted surgery. Manufacturing patient-specific robots can be challenging for complex procedures and furthermore the time required to build them can be a challenge. To overcome this challenge, additive manufacturing, namely 3D-printing, is a promising solution. 3D-printing enables fabrication of complex parts precisely and efficiently. Although 3D-printing techniques have been researched for general medical applications, patient-specific surgical robots are currently in their infancy. After reviewing the state-of-the-art in 3D-printed surgical robots, this paper discusses 3D-printing techniques that could potentially satisfy the stringent requirements for surgical interventions. We also present the accomplishments in our group in developing 3D-printed surgical robots for neurosurgical and cardiovascular interventions. Finally, we discuss the challenges in developing 3D-printed surgical robots and provide our perspectives on future research directions.

Asymptotically Optimal Kinematic Design of Robots using Motion Planning

In highly constrained settings, e.g., a tentaclelike medical robot maneuvering through narrow cavities in the body for minimally invasive surgery, it may be difficult or impossible for a robot with a generic kinematic design to reach all desirable targets while avoiding obstacles. We introduce a design optimization method to compute kinematic design parameters that enable a single robot to reach as many desirable goal regions as possible while avoiding obstacles in an environment. Our method appropriately integrates sampling based motion planning in configuration space into stochastic optimization in design space so that, over time, our evaluation of a design's ability to reach goals increases in accuracy and our selected designs approach global optimality. We prove the asymptotic optimality of our method and demonstrate performance in simulation for (i) a serial manipulator and (ii) a concentric tube robot, a tentacle-like medical robot that can bend around anatomical obstacles to safely reach clinically- relevant goal regions.

Toward the Design of Personalized Continuum Surgical Robots

Robot-assisted minimally invasive surgical systems enable procedures with reduced pain, recovery time, and scarring compared to traditional surgery. While these improvements benefit a large number of patients, safe access to diseased sites is not always possible for specialized patient groups, including pediatric patients, due to their anatomical differences. We propose a patient-specific design paradigm that leverages the surgeon's expertise to design and fabricate robots based on preoperative medical images. The components of the patient-specific robot design process are a virtual reality design interface enabling the surgeon to design patient-specific tools, 3-D printing of these tools with a biodegradable polyester, and an actuation and control system for deployment. The designed robot is a concentric tube robot, a type of continuum robot constructed from precurved, elastic, nesting tubes. We demonstrate the overall patient-specific design workflow, from preoperative images to physical implementation, for an example clinical scenario: nonlinear renal access to a pediatric kidney. We also measure the system's behavior as it is deployed through real and artificial tissue. System integration and successful benchtop experiments in ex vivo liver and in a phantom patient model demonstrate the feasibility of using a patient-specific design workflow to plan, fabricate, and deploy personalized, flexible continuum robots.

Design of patient-specific concentric tube robots using path planning from 3-D ultrasound

Percutaneous techniques and robot-assisted surgical systems have enabled minimally invasive procedures that offer reduced scarring, recovery time, and complications compared to traditional open surgeries. Despite these improvements, access to diseased sites using the standard, straight needle-based percutaneous techniques is still limited for certain procedures due to intervening tissues. These limitations can be further exacerbated in specific patient groups, particularly pediatric patients, whose anatomy does not fit the traditional tools and systems. We therefore propose a patient-specific paradigm to design and fabricate dexterous, robotic tools based on the patient's preoperative images. In this paper, we present the main steps of our proposed paradigm - image-based path planning, robot design, and fabrication - along with an example case that focuses on a class of dexterous, snake-like tools called concentric tube robots. We demonstrate planning a safe path using a patient's preoperative ultrasound images. We then determine the concentric tube robot parameters needed to achieve this path, and finally, we use 3-D printing to fabricate the patient-specific robot.

Design of a Compact Actuation and Control System for Flexible Medical Robots

Flexible medical robots can improve surgical procedures by decreasing invasiveness and increasing accessibility within the body. Using preoperative images, these robots can be designed to optimize a procedure for a particular patient. To minimize invasiveness and maximize biocompatibility, the actuation units of flexible medical robots should be placed fully outside the patient's body. In this letter, we present a novel, compact, lightweight, modular actuation, and control system for driving a class of these flexible robots, known as concentric tube robots. A key feature of the design is the use of three-dimensional printed waffle gears to enable compact control of two degrees of freedom within each module. We measure the precision and accuracy of a single actuation module and demonstrate the ability of an integrated set of three actuation modules to control six degrees of freedom. The integrated system drives a three-tube concentric tube robot to reach a final tip position that is on average less than 2 mm from a given target. In addition, we show a handheld manifestation of the device and present its potential applications.

Surgeon Design Interface for Patient-Specific Concentric Tube Robots

Concentric tube robots have potential for use in a wide variety of surgical procedures due to their small size, dexterity, and ability to move in highly curved paths. Unlike most existing clinical robots, the design of these robots can be developed and manufactured on a patient- and procedure-specific basis. The design of concentric tube robots typically requires significant computation and optimization, and it remains unclear how the surgeon should be involved. We propose to use a virtual reality-based design environment for surgeons to easily and intuitively visualize and design a set of concentric tube robots for a specific patient and procedure. In this paper, we describe a novel patient-specific design process in the context of the virtual reality interface. We also show a resulting concentric tube robot design, created by a pediatric urologist to access a kidney stone in a pediatric patient.