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Duan Y, Ling J, Feng Z, Ye T, Sun T, Zhu Y. A Survey of Needle Steering Approaches in Minimally Invasive Surgery. Ann Biomed Eng 2024; 52:1492-1517. [PMID: 38530535 DOI: 10.1007/s10439-024-03494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
In virtue of a curved insertion path inside tissues, needle steering techniques have revealed the potential with the assistance of medical robots and images. The superiority of this technique has been preliminarily verified with several maneuvers: target realignment, obstacle circumvention, and multi-target access. However, the momentum of needle steering approaches in the past decade leads to an open question-"How to choose an applicable needle steering approach for a specific clinical application?" This survey discusses this question in terms of design choices and clinical considerations, respectively. In view of design choices, this survey proposes a hierarchical taxonomy of current needle steering approaches. Needle steering approaches of different manipulations and designs are classified to systematically review the design choices and their influences on clinical treatments. In view of clinical consideration, this survey discusses the steerability and acceptability of the current needle steering approaches. On this basis, the pros and cons of the current needle steering approaches are weighed and their suitable applications are summarized. At last, this survey concluded with an outlook of the needle steering techniques, including the potential clinical applications and future developments in mechanical design.
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Affiliation(s)
- Yuzhou Duan
- College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 210016, China
| | - Jie Ling
- College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 210016, China.
| | - Zhao Feng
- School of Power and Mechanical Engineering, Wuhan University, Wuhan, 430072, China
- Wuhan University Shenzhen Research Institute, Shenzhen, 518057, China
| | - Tingting Ye
- Industrial and Systems Engineering Department, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Tairen Sun
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Yuchuan Zhu
- College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 210016, China
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L'Abbate D, Prescott K, Geraghty B, Kearns VR, Steel DHW. Biomechanical considerations for optimising subretinal injections. Surv Ophthalmol 2024:S0039-6257(24)00053-5. [PMID: 38797394 DOI: 10.1016/j.survophthal.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
Subretinal injection is the preferred delivery technique for various novel ocular therapies and is widely used because of its precision and efficient delivery of gene and cell therapies; however, choosing an injection point and defining delivery parameters to target a specified retinal location and area is an inexact science. We provide an overview of the key factors that play important roles during subretinal injections to refine the technique, enhance patient outcomes, and minimise risks. We describe the role of anatomical and physical variables that affect subretinal bleb propagation and shape and their impact on retinal integrity. We highlight the risks associated with subretinal injections and consider strategies to mitigate reflux and retinal trauma. Finally, we explore the emerging field of robotic assistance in improving intraocular manouvrability and precision to facilitate the injection procedure.
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Affiliation(s)
- Dario L'Abbate
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Kia Prescott
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Brendan Geraghty
- Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Victoria R Kearns
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - David H W Steel
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Sunderland Eye Infirmary, Sunderland, UK; Bioscience Institute, Newcastle University, Newcastle Upon Tyne, UK
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Lu M, Zhang Y, Lim CM, Ren H. Flexible Needle Steering with Tethered and Untethered Actuation: Current States, Targeting Errors, Challenges and Opportunities. Ann Biomed Eng 2023; 51:905-924. [PMID: 36943414 DOI: 10.1007/s10439-023-03163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/05/2023] [Indexed: 03/23/2023]
Abstract
Accurate needle targeting is critical for many clinical procedures, such as transcutaneous biopsy or radiofrequency ablation of tumors. However, targeting errors may arise, limiting the widespread adoption of these procedures. Advances in flexible needle (FN) steering are emerging to mitigate these errors. This review summarizes the state-of-the-art developments of FNs and addresses possible targeting errors that can be overcome with steering actuation techniques. FN steering techniques can be classified as passive and active. Passive steering directly results from the needle-tissue interaction forces, whereas active steering requires additional forces to be applied at the needle tip, which enhances needle steerability. Therefore, the corresponding targeting errors of most passive FNs and active FNs are between 1 and 2 mm, and less than 1 mm, respectively. However, the diameters of active FNs range from 1.42 to 12 mm, which is larger than the passive steering needle varying from 0.5 to 1.4 mm. Therefore, the development of active FNs is an area of active research. These active FNs can be steered using tethered internal direct actuation or untethered external actuation. Examples of tethered internal direct actuation include tendon-driven, longitudinal segment transmission and concentric tube transmission. Tendon-driven FNs have various structures, and longitudinal segment transmission needles could be adapted to reduce tissue damage. Additionally, concentric tube needles have immediate advantages and clinical applications in natural orifice surgery. Magnetic actuation enables active FN steering with untethered external actuation and facilitates miniaturization. The challenges faced in the fabrication, sensing, and actuation methods of FN are analyzed. Finally, bio-inspired FNs may offer solutions to address the challenges faced in FN active steering mechanisms.
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Affiliation(s)
- Mingyue Lu
- The Key Laboratory of Advanced Manufacturing and Intelligent Technology, Harbin University of Science and Technology, Harbin, China
- Duke-NUS Graduate Medical School, Singapore, Singapore
- The Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Yongde Zhang
- The Key Laboratory of Advanced Manufacturing and Intelligent Technology, Harbin University of Science and Technology, Harbin, China
| | - Chwee Ming Lim
- The Department of Otolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Hongliang Ren
- The Department of Electronic Engineering and the Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong, Hong Kong, China.
- The Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.
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Axially rigid steerable needle with compliant active tip control. PLoS One 2021; 16:e0261089. [PMID: 34914777 PMCID: PMC8675730 DOI: 10.1371/journal.pone.0261089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
Steerable instruments allow for precise access to deeply-seated targets while sparing sensitive tissues and avoiding anatomical structures. In this study we present a novel omnidirectional steerable instrument for prostate high-dose-rate (HDR) brachytherapy (BT). The instrument utilizes a needle with internal compliant mechanism, which enables distal tip steering through proximal instrument bending while retaining high axial and flexural rigidity. Finite element analysis evaluated the design and the prototype was validated in experiments involving tissue simulants and ex-vivo bovine tissue. Ultrasound (US) images were used to provide visualization and shape-reconstruction of the instrument during the insertions. In the experiments lateral tip steering up to 20 mm was found. Manually controlled active needle tip steering in inhomogeneous tissue simulants and ex-vivo tissue resulted in mean targeting errors of 1.4 mm and 2 mm in 3D position, respectively. The experiments show that steering response of the instrument is history-independent. The results indicate that the endpoint accuracy of the steerable instrument is similar to that of the conventional rigid HDR BT needle while adding the ability to steer along curved paths. Due to the design of the steerable needle sufficient axial and flexural rigidity is preserved to enable puncturing and path control within various heterogeneous tissues. The developed instrument has the potential to overcome problems currently unavoidable with conventional instruments, such as pubic arch interference in HDR BT, without major changes to the clinical workflow.
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Girerd C, Morimoto TK. Design and Control of a Hand-Held Concentric Tube Robot for Minimally Invasive Surgery. IEEE T ROBOT 2021. [DOI: 10.1109/tro.2020.3043668] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Alfalahi H, Renda F, Stefanini C. Concentric Tube Robots for Minimally Invasive Surgery: Current Applications and Future Opportunities. ACTA ACUST UNITED AC 2020. [DOI: 10.1109/tmrb.2020.3000899] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mitros Z, Sadati S, Seneci C, Bloch E, Leibrandt K, Khadem M, da Cruz L, Bergeles C. Optic Nerve Sheath Fenestration With a Multi-Arm Continuum Robot. IEEE Robot Autom Lett 2020; 5:4874-4881. [PMID: 34109274 DOI: 10.1109/lra.2020.3005129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article presents a medical robotic system for deep orbital interventions, with a focus on Optic Nerve Sheath Fenestration (ONSF). ONSF is a currently invasive ophthalmic surgical approach that can reduce potentially blinding elevated hydrostatic intracranial pressure on the optic disc via an incision on the optic nerve. The prototype is a multi-arm system capable of dexterous manipulation and visualization of the optic nerve area, allowing for a minimally invasive approach. Each arm is an independently controlled concentric tube robot collimated by a bespoke guide that is secured on the eye sclera via sutures. In this article, we consider the robot's end-effector design in order to reach/navigate the optic nerve according to the clinical requirements of ONSF. A prototype of the robot was engineered, and its ability to penetrate the optic nerve was analysed by conducting ex vivo experiments on porcine optic nerves and comparing their stiffness to human ones. The robot was successfully deployed in a custom-made realistic eye phantom. Our simulation studies and experimental results demonstrate that the robot can successfully navigate to the operation site and carry out the intervention.
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Affiliation(s)
- Zisos Mitros
- Robotics and Vision in Medicine (RViM) Lab, School of Biomedical Engineering & Imaging Sciences, King's College London, London E14 3WF, U.K.; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London WC1E 6BT, U.K
| | - Seyedmohammadhadi Sadati
- Robotics and Vision in Medicine (RViM) Lab, School of Biomedical Engineering & Imaging Sciences, King's College London, London E14 3WF, U.K
| | - Carlo Seneci
- Robotics and Vision in Medicine (RViM) Lab, School of Biomedical Engineering & Imaging Sciences, King's College London, London E14 3WF, U.K
| | - Edward Bloch
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London WC1E 6BT, U.K.; Moorfields Eye Hospital, London EC1V 2PD, U.K
| | - Konrad Leibrandt
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London WC1E 6BT, U.K
| | - Mohsen Khadem
- School of Informatics, University of Edinburgh, Edinburgh EH8 9AB, U.K
| | - Lyndon da Cruz
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London WC1E 6BT, U.K.; Moorfields Eye Hospital, London EC1V 2PD, U.K
| | - Christos Bergeles
- Robotics and Vision in Medicine (RViM) Lab, School of Biomedical Engineering & Imaging Sciences, King's College London, London E14 3WF, U.K
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