Towards a Closed-loop Neuro-Robotic Approach to DBS Electrode Implantation based on Real-Time Wrist Rigidity Evaluation

The iHandU system is a wearable device that quantitatively evaluates changes in wrist rigidity during Deep Brain Stimulation (DBS) surgery, allowing clinicians to find optimal stimulation settings that reduce patient symptoms. Robotic accuracy is also especially relevant in DBS surgery, as accurate electrode placement is required to increase effectiveness and reduce side effects. The main goal of this work is to integrate the advantages of each system in a closed-loop system between an industrial robot and the iHandU system. For this purpose, a comparative analysis of a Leksell stereotactic frame and neuro-robotic system accuracies was performed using a lab-made phantom. The neuro-robotic system reached 90% of trajectories, while the stereotactic frame reached all trajectories. There are significant differences in accuracy errors between these trajectories (p < 0.0001), which can be explained by the high correlation between the neuro-robotic system errors and the distance from the trajectory to the origin of the Leksell coordinate system (ρ = 0.72). Overall accuracy is comparable to existing neuro-robotic systems, achieving a deviation of (1.0 ± 0.5) mm at the target point. The accuracy of DBS electrode positioning and stimulation parameters choice leads to better long-term clinical outcomes in Parkinson's disease patients. Our neuro-robotic system combines real-time feedback assessment of the patient's symptomatic response and automatic positioning of the DBS electrode in a specific brain area.

A Brief Insight on Magnetic Resonance Conditional Neurosurgery Robots

The brain is a delicate organ in the human body that requires extreme care. Brain-related diseases are unavoidable. Perse, neurosurgery is a complicated procedure that demands high precision and accuracy. Developing a surgical robot is a complex task. To date, there are only a handful of neurosurgery robots in the market that distinctly undergo clinical procedures. These robots have exorbitant cost that hinders the utmost care progress in the area as they are unaffordable. This paper looked at the historical perspective and presented insight literature of the magnetic resonance conditional stereotactic neurosurgery robots that find their ways in clinics, abandoning research projects and promising research yet to undergo clinical use. In addition, the study also gives a thorough insight into the advantage of magnetic resonance imaging modalities and magnetic resonance conditional robots and the future challenges in automation use. Image compatibility test data and accuracy results are also examined because they guarantee that these systems work correctly in particular imaging settings. The primary differences between these systems include actuation and control technologies, construction materials, and the degree of freedom. Thus, one system has an advantage over the other.

Investigation of Micro-motion Kinematics of Continuum Robots for Volumetric OCT and OCT-guided Visual Servoing

Continuum robots (CR) have been recently shown capable of micron-scale motion resolutions. Such motions are achieved through equilibrium modulation using indirect actuation for altering either internal preload forces or changing the cross-sectional stiffness along the length of a continuum robot. Previously reported, but unexplained, turning point behavior is modeled using two approaches. An energy minimization approach is first used to explain the source of this behavior. Subsequently, a kinematic model using internal constraints in multi-backbone CRs is used to replicate this turning point behavior. An approach for modeling the micro-motion differential kinematics is presented using experimental data based on the solution of a system of linear matrix equations. This approach provides a closed-form approximation of the empirical micro-motion kinematics and could be easily used for real-time control. A motivating application of image-based biopsy using 3D optical coherence tomography (OCT) is envisioned and demonstrated in this paper. A system integration for generating OCT volumes by sweeping a custom B-mode OCT probe is presented. Results showing high accuracy in obtaining 3D OCT measurements are shown using a commercial OCT probe. Qualitative results using a miniature probe integrated within the robot are also shown. Finally, closed-loop visual servoing using OCT data is demonstrated for guiding a needle into an agar channel. Results of this paper present what we believe is the first embodiment of a continuum robot capable of micro and macro motion control for 3D OCT imaging. This approach can support the development of new technologies for CRs capable of surgical intervention and micro-motion for ultra-precision tasks.

Stereotactic Neuro-Navigation Phantom Designs: A Systematic Review

Diverse stereotactic neuro-navigation systems are used daily in neurosurgery and novel systems are continuously being developed. Prior to clinical implementation of new surgical tools, methods or instruments, in vitro experiments on phantoms should be conducted. A stereotactic neuro-navigation phantom denotes a rigid or deformable structure resembling the cranium with the intracranial area. The use of phantoms is essential for the testing of complete procedures and their workflows, as well as for the final validation of the application accuracy. The aim of this study is to provide a systematic review of stereotactic neuro-navigation phantom designs, to identify their most relevant features, and to identify methodologies for measuring the target point error, the entry point error, and the angular error (α). The literature on phantom designs used for evaluating the accuracy of stereotactic neuro-navigation systems, i.e., robotic navigation systems, stereotactic frames, frameless navigation systems, and aiming devices, was searched. Eligible articles among the articles written in English in the period 2000-2020 were identified through the electronic databases PubMed, IEEE, Web of Science, and Scopus. The majority of phantom designs presented in those articles provide a suitable methodology for measuring the target point error, while there is a lack of objective measurements of the entry point error and angular error. We identified the need for a universal phantom design, which would be compatible with most common imaging techniques (e.g., computed tomography and magnetic resonance imaging) and suitable for simultaneous measurement of the target point, entry point, and angular errors.

Prevalence of haptic feedback in robot-mediated surgery: a systematic review of literature

With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.

Technique, Results, and Complications Related to Robot-Assisted Stereoelectroencephalography

BACKGROUND:

Robot-assisted stereoelectroencephalography (SEEG) may represent a simplified, precise, and safe alternative to the more traditional SEEG techniques.

OBJECTIVE:

To report our clinical experience with robotic SEEG implantation and to define its utility in the management of patients with medically refractory epilepsy.

METHODS:

The prospective observational analyses included all patients with medically refractory focal epilepsy who underwent robot-assisted stereotactic placement of depth electrodes for extraoperative brain monitoring between November 2009 and May 2013. Technical nuances of the robotic implantation technique are presented, as well as an analysis of demographics, time of planning and procedure, seizure outcome, in vivo accuracy, and procedure-related complications.

RESULTS:

One hundred patients underwent 101 robot-assisted SEEG procedures. Their mean age was 33.2 years. In total, 1245 depth electrodes were implanted. On average, 12.5 electrodes were implanted per patient. The time of implantation planning was 30 minutes on average (range, 15-60 minutes). The average operative time was 130 minutes (range, 45-160 minutes). In vivo accuracy (calculated in 500 trajectories) demonstrated a median entry point error of 1.2 mm (interquartile range, 0.78-1.83 mm) and a median target point error of 1.7 mm (interquartile range, 1.20-2.30 mm). Of the group of patients who underwent resective surgery (68 patients), 45 (66.2%) gained seizure freedom status. Mean follow-up was 18 months. The total complication rate was 4%.

CONCLUSION:

The robotic SEEG technique and method were demonstrated to be safe, accurate, and efficient in anatomically defining the epileptogenic zone and subsequently promoting sustained seizure freedom status in patients with difficult-to-localize seizures.

Convergence Analysis of an Iterative Targeting Method for Keyhole Robotic Surgery

In surgical procedures, robots can accurately position and orient surgical instruments. Intraoperatively, external sensors can localize the instrument and compute the targeting movement of the robot, based on the transformation between the coordinate frame of the robot and the sensor.

This paper addresses the assessment of the robustness of an iterative targeting algorithm in perturbed conditions. Numerical simulations and experiments (with a robot with seven degrees of freedom and an optical tracking system) were performed for computing the maximum error of the rotational part of the calibration matrix, which allows for convergence, as well as the number of required iterations.

The algorithm converges up to 50 degrees of error within a large working space.

The study confirms the clinical relevance of the method because it can be applied on commercially available robots without modifying the internal controller, thus improving the targeting accuracy and meeting surgical accuracy requirements.