STING: a soft-tissue intervention and neurosurgical guide to access deep brain lesions through curved trajectories

Design and evaluation of a pneumatic actuation unit for a wasp-inspired self-propelled needle

Transperineal laser ablation is a minimally invasive thermo-ablative treatment for prostate cancer that requires the insertion of a needle for accurate optical fiber positioning. Needle insertion in soft tissues may cause tissue motion and deformation, resulting in tissue damage and needle positioning errors. In this study, we present a wasp-inspired self-propelled needle that uses pneumatic actuation to move forward with zero external push force, thus avoiding large tissue motion and deformation. The needle consists of six parallel 0.25-mm diameter Nitinol rods driven by a pneumatic actuation system. The pneumatic actuation system consists of Magnetic Resonance (MR) safe 3D-printed parts and off-the-shelf plastic screws. A self-propelled motion is achieved by advancing the needle segments one by one, followed by retracting them simultaneously. The advancing needle segment has to overcome a cutting and friction force, while the stationary needle segments experience a friction force in the opposite direction. The needle self-propels through the tissue when the friction force of the five stationary needle segments overcomes the sum of the friction and cutting forces of the advancing needle segment. We evaluated the prototype's performance in 10-wt% gelatin phantoms and ex vivo porcine liver tissue inside a preclinical Magnetic Resonance Imaging (MRI) scanner in terms of the slip ratio of the needle with respect to the phantom or liver tissue. Our results demonstrated that the needle was able to self-propel through the phantom and liver tissue with slip ratios of 0.912-0.955 and 0.88, respectively. The prototype is a promising step toward the development of self-propelled needles for MRI-guided transperineal laser ablation as a method to treat prostate cancer.

A Survey of Needle Steering Approaches in Minimally Invasive Surgery

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.

Biomimicry - medical design concepts inspired by nature

Biomimicry is the application of existing features in nature to human technologies, such as the invention of aircraft inspired by bird flight. In the development of medical solutions, biomimicry is a growing field of research, where a holistic understanding of nature can inspire cutting-edge design. The purpose of this study was to create an educational, visual resource exemplifying up-and-coming medical applications of biomimicry. A website was created to present 2D motion graphics (animations) and illustrations. Animation is an established and useful method of communicating health information to the public. This presents an accessible interface for the public to interact with and learn about this area of research, bridging the gap between the two. Increasing public knowledge, engagement, and interest can expand the reach and thereby influence future research. A survey was conducted to assess public engagement and opinions on both the resource and the topic of biomimicry and medical design. The results suggested that participants positively engaged with the resource; 95.7% strongly agreed/agreed that the animations were beneficial for learning. All responding participants agreed that biomimicry could provide useful solutions in medical design. This study suggests that graphic motions are effective at communicating complex ideas for public outreach.

DROD: bio-robotic drill/sampler for planetary subterranean exploration: experiments and challenges

Key features for space exploration equipment, and in particular drills and sampling mechanisms, are low weight, small size, and energy efficiency. These characteristics are substantially required not only in reducing the spaceship flight cost, but also in extending the exploration time on the extraterrestrial bodies. This article experimentally investigates the feasibility of a novel drill bioinspired by wood-wasp and sand-fish lizard as an integrated robotic solution for rover exploration tasks. A new penetration depth of 820 mm in terms of reciprocation drilling technique has been achieved by the proposed dual reciprocation and oscillation drill (DROD), especially with the new enhancements such as miniature sample compartment and toothed stems. Additionally, a first sampling experiment with DROD has been performed and a sample amount of 20 g and size of 30 cm3has been collected successfully. Finally, the article provides developments for integration of DROD with rovers for future exploration missions and potentials for horizontal drilling for subterranean applications.

Design and Experimental Validation of a 3D-Printed Embedded-Sensing Continuum Robot for Neurosurgery

A minimally-invasive manipulator characterized by hyper-redundant kinematics and embedded sensing modules is presented in this work. The bending angles (tilt and pan) of the robot tip are controlled through tendon-driven actuation; the transmission of the actuation forces to the tip is based on a Bowden-cable solution integrating some channels for optical fibers. The viability of the real-time measurement of the feedback control variables, through optoelectronic acquisition, is evaluated for automated bending of the flexible endoscope and trajectory tracking of the tip angles. Indeed, unlike conventional catheters and cannulae adopted in neurosurgery, the proposed robot can extend the actuation and control of snake-like kinematic chains with embedded sensing solutions, enabling real-time measurement, robust and accurate control of curvature, and tip bending of continuum robots for the manipulation of cannulae and microsurgical instruments in neurosurgical procedures. A prototype of the manipulator with a length of 43 mm and a diameter of 5.5 mm has been realized via 3D printing. Moreover, a multiple regression model has been estimated through a novel experimental setup to predict the tip angles from measured outputs of the optoelectronic modules. The sensing and control performance has also been evaluated during tasks involving tip rotations.

Bioinspired medical needles: a review of the scientific literature

Needles are commonly used in medical procedures. However, current needle designs have some disadvantages. Therefore, a new generation of hypodermic needles and microneedle patches drawing inspiration from mechanisms found in nature (i.e. bioinspiration) is being developed. In this systematic review, 80 articles were retrieved from Scopus, Web of Science, and PubMed and classified based on the strategies for needle-tissue interaction and propulsion of the needle. The needle-tissue interaction was modified to reduce grip for smooth needle insertion or enlarge grip to resist needle retraction. The reduction of grip can be achieved passively through form modification and actively through translation and rotation of the needle. To enlarge grip, interlocking with the tissue, sucking the tissue, and adhering to the tissue were identified as strategies. Needle propelling was modified to ensure stable needle insertion, either through external (i.e. applied to the prepuncturing movement of the needle) or internal (i.e. applied to the postpuncturing movement of the needle) strategies. External strategies include free-hand and guided needle insertion, while friction manipulation of the tissue was found to be an internal strategy. Most needles appear to be using friction reduction strategies and are inserted using a free-hand technique. Furthermore, most needle designs were inspired by insects, specifically parasitoid wasps, honeybees, and mosquitoes. The presented overview and description of the different bioinspired interaction and propulsion strategies provide insight into the current state of bioinspired needles and offer opportunities for medical instrument designers to create a new generation of bioinspired needles.

Design and evaluation of an MRI-ready, self-propelled needle for prostate interventions

Prostate cancer diagnosis and focal laser ablation treatment both require the insertion of a needle for biopsy and optical fibre positioning. Needle insertion in soft tissues may cause tissue motion and deformation, which can, in turn, result in tissue damage and needle positioning errors. In this study, we present a prototype system making use of a wasp-inspired (bioinspired) self-propelled needle, which is able to move forward with zero external push force, thereby avoiding large tissue motion and deformation. Additionally, the actuation system solely consists of 3D printed parts and is therefore safe to use inside a magnetic resonance imaging (MRI) system. The needle consists of six parallel 0.25-mm diameter Nitinol rods driven by the actuation system. In the prototype, the self-propelled motion is achieved by advancing one needle segment while retracting the others. The advancing needle segment has to overcome a cutting and friction force while the retracting needle segments experience a friction force in the opposite direction. The needle self-propels through the tissue when the friction force of the five retracting needle segments overcomes the sum of the friction and cutting forces of the advancing needle segment. We tested the performance of the prototype in ex vivo human prostate tissue inside a preclinical MRI system in terms of the slip ratio of the needle with respect to the prostate tissue. The results showed that the needle was visible in MR images and that the needle was able to self-propel through the tissue with a slip ratio in the range of 0.78-0.95. The prototype is a step toward self-propelled needles for MRI-guided transperineal laser ablation as a method to treat prostate cancer.

A Continuum Robotic Cannula with Tip Following Capability and Distal Dexterity for Intracerebral Hemorrhage Evacuation

OBJECTIVE

This paper aims to investigate a new continuum robot design and its motion implementation methods appropriate for a minimally invasive intracerebral hemorrhage (ICH) evacuation.

METHODS

We propose a continuum robotic cannula, consisting of a precurved body and a 2-degree-of-freedom (DoF) flexible tip, monolithically fabricated. Kinematics model with cable elongation model, and a dedicated design optimization and motion planning algorithm were developed to enable the follow-the-leader (FTL) motion of the cannula. A task-dependent Jacobian-based closed loop control was also designed to track the cannula motion during the insertion and its independent tip motion.

RESULTS

Comprehensive experiments were conducted to verify the kinematic model and submillimeter motion coupling between the cannula precurved body and its flexible tip. The cannula was also capable of achieving FTL motion within around 2.5 mm shape deviation and control performance within submillimeter errors. It was finally demonstrated to be capable of the nonlinear insertion and tip manipulation in the brain phantom.

CONCLUSION

The new cannula design, together with the proposed algorithms, provides the unique ability to access ICH in a nonlinear trajectory and dexterous tip motion.

SIGNIFICANCE

These motion capabilities of the robot in such a slender form factor will lead to more complete ICH evacuation and reduced trauma to the healthy brain tissues.

Design of a Flexible Wasp-Inspired Tissue Transport Mechanism

Tissue transport is a challenge during Minimally Invasive Surgery (MIS) with the current suction-based instruments as the increasing length and miniaturisation of the outer diameter requires a higher pressure. Inspired by the wasp ovipositor, a slender and bendable organ through which eggs can be transported, a flexible transport mechanism for tissue was developed that does not require a pressure gradient. The flexible shaft of the mechanism consists of ring magnets and cables that can translate in a similar manner as the valves in the wasp ovipositor. The designed transport mechanism was able to transport 10wt% gelatine tissue phantoms with the shaft in straight and curved positions and in vertical orientation against gravity. The transport rate can be increased by increasing the rotational velocity of the cam. A rotational velocity of 25 RPM resulted in a transport rate of 0.8 mm/s and increasing the rotation velocity of the cam to 80 RPM increased the transport rate to 2.3 mm/s though the stroke efficiency decreased by increasing the rotational velocity of the cam. The transport performance of the flexible transport mechanism is promising. This means of transportation could in the future be an alternative for tissue transport during MIS.

Path Replanning for Orientation-Constrained Needle Steering

INTRODUCTION

Needle-based neurosurgical procedures require high accuracy in catheter positioning to achieve high clinical efficacy. Significant challenges for achieving accurate targeting are (i) tissue deformation (ii) clinical obstacles along the insertion path (iii) catheter control.

OBJECTIVE

We propose a novel path-replanner able to generate an obstacle-free and curvature bounded three-dimensional (3D) path at each time step during insertion, accounting for a constrained target pose and intraoperative anatomical deformation. Additionally, our solution is sufficiently fast to be used in a closed-loop system: needle tip tracking via electromagnetic sensors is used by the path-replanner to automatically guide the programmable bevel-tip needle (PBN) while surgical constraints on sensitive structures avoidance are met.

METHODS

The generated path is achieved by combining the "Bubble Bending" method for online path deformation and a 3D extension of a convex optimisation method for path smoothing.

RESULTS

Simulation results performed on a realistic dataset show that our replanning method can guide a PBN with bounded curvature to a predefined target pose with an average targeting error of 0.65  ± 0.46 mm in position and 3.25  ± 5.23 degrees in orientation under a deformable simulated environment. The proposed algorithm was also assessed in-vitro on a brain-like gelatin phantom, achieving a target error of 1.81  ± 0.51 mm in position and 5.9  ± 1.42 degrees in orientation.

CONCLUSION

The presented work assessed the performance of a new online steerable needle path-planner able to avoid anatomical obstacles while optimizing surgical criteria.

SIGNIFICANCE

This method is particularly suited for surgical procedures demanding high accuracy on the desired goal pose under tissue deformations and real-world inaccuracies.

Computer Assisted Planning for Curved Laser Interstitial Thermal Therapy

Laser interstitial thermal therapy (LiTT) is a minimally invasive alternative to conventional open surgery for drug-resistant focal mesial temporal lobe epilepsy (MTLE). Recent studies suggest that higher seizure freedom rates are correlated with maximal ablation of the mesial hippocampal head, whilst sparing of the parahippocampal gyrus (PHG) may reduce neuropsychological sequelae. Current commercially available laser catheters are inserted following manually planned straight-line trajectories, which cannot conform to curved brain structures, such as the hippocampus, without causing collateral damage or requiring multiple insertions. The clinical feasibility and potential of curved LiTT trajectories through steerable needles has yet to be investigated. This is the focus of our work. We propose a GPU-accelerated computer-assisted planning (CAP) algorithm for steerable needle insertions that generates optimized curved 3D trajectories with maximal ablation of the amygdalohippocampal complex and minimal collateral damage to nearby structures, while accounting for a variable ablation diameter ( 5-15mm). Simulated trajectories and ablations were performed on 5 patients with mesial temporal sclerosis (MTS), which were identified from a prospectively managed database. The algorithm generated obstacle-free paths with significantly greater target area ablation coverage and lower PHG ablation variance compared to straight line trajectories. The presented CAP algorithm returns increased ablation of the amygdalohippocampal complex, with lower patient risk scores compared to straight-line trajectories. This is the first clinical application of preoperative planning for steerable needle based LiTT. This study suggests that steerable needles have the potential to improve LiTT procedure efficacy whilst improving the safety and should thus be investigated further.

Making the cut: mechanics of cutting and steering of insect probes

Many insects forage, oviposit or inject venom in their prey by penetrating or cutting through substrates. From a physical perspective, cutting involves creation of new free surfaces. The cutting parts of insects, such as their mandibles or ovipositor tips, are often zinc-enriched and hardened as compared to the other cuticular regions. Whereas tip hardening is key to their ability to penetrate surfaces, it is often also important for probes to be maneuverable through substrates. How do insect probes negotiate the trade-off between cutting and steering through substrates of diverse stiffness? To address this question, we review the morphology, mechanics, and adaptations in the cutting parts of various insects. Understanding these mechanisms will allow us to develop biomimetic tools, including agricultural and surgical tools, that can both cut and steer through diverse substrates.

Gels, jets, mosquitoes, and magnets: a review of implantation strategies for soft neural probes

Implantable neuroelectronic interfaces have enabled breakthrough advances in the clinical diagnosis and treatment of neurological disorders, as well as in fundamental studies of brain function, behavior, and disease. Intracranial electroencephalography (EEG) mapping with stereo-EEG (sEEG) depth electrodes is routinely adopted for precise epilepsy diagnostics and surgical treatment, while deep brain stimulation has become the standard of care for managing movement disorders. Intracortical microelectrode arrays for high-fidelity recordings of neural spiking activity have led to impressive demonstrations of the power of brain-machine interfaces for motor and sensory functional recovery. Yet, despite the rapid pace of technology development, the issue of establishing a safe, long-term, stable, and functional interface between neuroelectronic devices and the host brain tissue still remains largely unresolved. A body of work spanning at least the last 15 years suggests that safe, chronic integration between invasive electrodes and the brain requires a close match between the mechanical properties of man-made components and the neural tissue. In other words, the next generation of invasive electrodes should be soft and compliant, without sacrificing biological and chemical stability. Soft neuroelectronic interfaces, however, pose a new and significant surgical challenge: bending and buckling during implantation that can preclude accurate and safe device placement. In this topical review, we describe the next generation of soft electrodes and the surgical implantation methods for safe and precise insertion into brain structures. We provide an overview of the most recent innovations in the field of insertion strategies for flexible neural electrodes such as dissolvable or biodegradable carriers, microactuators, biologically-inspired support structures, and electromagnetic drives. In our analysis, we also highlight approaches developed in different fields, such as robotic surgery, which could be potentially adapted and translated to the insertion of flexible neural probes.

Development of the Third Generation of the Dual-Reciprocating Drill

The dual-reciprocating drill (DRD) is a low-mass alternative to traditional drilling techniques biologically inspired by the wood wasp ovipositor, which is used to drill into wood in order to lay its eggs. The DRD reciprocates two halves lined with backwards-facing teeth, enabling it to generate traction forces that reduce the required overhead penetration force. While previous research has focused on experimental testing of the drill’s operational and design parameters, numerical simulation techniques are being developed to allow the rapid testing of multiple designs, complementing and informing experimental testing campaigns. The latest DRD design iteration integrated a novel internal actuation mechanism and demonstrated the benefits of adding controlled lateral movements. This paper presents an exploration of how bit morphology affects drilling performance and a preliminary study of discrete element method (DEM) simulations for modelling DRD interactions in regolith. These have shown how regolith grain size and microscopic behaviour significantly affects the performance of different drill designs, and demonstrated how customisable drills can exploit the properties of various substrates. Two system prototypes are also being developed for the DRD’s third generation, each utilising novel actuation and sampling mechanisms. A final drill design will then be deployed from a planetary rover and perform the first DRD drilling and sampling operation.

An adaptive finite element model for steerable needles

Penetration of a flexible and steerable needle into a soft target material is a complex problem to be modelled, involving several mechanical challenges. In the present paper, an adaptive finite element algorithm is developed to simulate the penetration of a steerable needle in brain-like gelatine material, where the penetration path is not predetermined. The geometry of the needle tip induces asymmetric tractions along the tool–substrate frictional interfaces, generating a bending action on the needle in addition to combined normal and shear loading in the region where fracture takes place during penetration. The fracture process is described by a cohesive zone model, and the direction of crack propagation is determined by the distribution of strain energy density in the tissue surrounding the tip. Simulation results of deep needle penetration for a programmable bevel-tip needle design, where steering can be controlled by changing the offset between interlocked needle segments, are mainly discussed in terms of penetration force versus displacement along with a detailed description of the needle tip trajectories. It is shown that such results are strongly dependent on the relative stiffness of needle and tissue and on the tip offset. The simulated relationship between programmable bevel offset and needle curvature is found to be approximately linear, confirming empirical results derived experimentally in a previous work. The proposed model enables a detailed analysis of the tool–tissue interactions during needle penetration, providing a reliable means to optimise the design of surgical catheters and aid pre-operative planning.

Experimental evaluation of a self-propelling bio-inspired needle in single- and multi-layered phantoms

In percutaneous interventions, reaching targets located deep inside the body with minimal tissue damage and patient pain requires the use of long and thin needles. However, when pushed through a solid substrate, a structure with a high aspect ratio is prone to buckle. We developed a series of multi-element needles with a diameter smaller than 1 mm and a length larger than 200 mm, and we experimentally evaluated the performance of a bio-inspired insertion mechanism that prevents needle buckling of such slender structures. The needles consisted of Nitinol wires and advance into a substrate by pushing the wires forward one after the other, followed by pulling all the wires simultaneously backward. The resulting net push force is low, allowing the needles to self-propel through the substrate. We investigated the effect of the needle design parameters (number of wires and their diameter) and substrate characteristics (stiffness and number of layers) on the needle motion. Three needle prototypes (consisting of six 0.25-mm wires, six 0.125-mm wires, and three 0.25-mm wires, respectively) were inserted into single- and multi-layered tissue-mimicking phantoms. The prototypes were able to move forward in all phantoms without buckling. The amount of needle slip with respect to the phantom was used to assess the performance of the prototypes. The six-wire 0.25-mm prototype exhibited the least slip among the three prototypes. Summarizing, we showed that a bio-inspired motion mechanism prevents buckling in very thin (diameter <1 mm), long (length >200 mm) needles, allowing deep insertion into tissue-mimicking phantoms.

The Adaptive Hermite Fractal Tree (AHFT): a novel surgical 3D path planning approach with curvature and heading constraints

PURPOSE

In the context of minimally invasive neurosurgery, steerable needles such as the one developed within the Horizon2020-funded EDEN2020 project (Frasson et al. in Proc Inst Mech Eng Part H J Eng Med 224(6):775-88, 2010. https://doi.org/10.1243/09544119JEIM663 ; Secoli and y Baena in IEEE international conference on robotics and automation, 2013) aspire to address the clinical challenge of better treatment for cancer patients. The direct, precise infusion of drugs in the proximity of a tumor has been shown to enhance its effectiveness and diffusion in the surrounding tissue (Vogelbaum and Aghi in Neuro-Oncology 17(suppl 2):ii3-ii8, 2015. https://doi.org/10.1093/neuonc/nou354 ). However, planning for an appropriate insertion trajectory for needles such as the one proposed by EDEN2020 is challenging due to factors like kinematic constraints, the presence of complex anatomical structures such as brain vessels, and constraints on the required start and target poses.

METHODS

We propose a new parallelizable three-dimensional (3D) path planning approach called Adaptive Hermite Fractal Tree (AHFT), which is able to generate 3D obstacle-free trajectories that satisfy curvature constraints given a specified start and target pose. The AHFT combines the Adaptive Fractal Tree algorithm's efficiency (Liu et al. in IEEE Robot Autom Lett 1(2):601-608, 2016. https://doi.org/10.1109/LRA.2016.2528292 ) with optimized geometric Hermite (Yong and Cheng in Comput Aided Geom Des 21(3):281-301, 2004. https://doi.org/10.1016/j.cagd.2003.08.003 ) curves, which are able to handle heading constraints.

RESULTS

Simulated results demonstrate the robustness of the AHFT to perturbations of the target position and target heading. Additionally, a simulated preoperative environment, where the surgeon is able to select a desired entry pose on the patient's skull, confirms the ability of the method to generate multiple feasible trajectories for a patient-specific case.

CONCLUSIONS

The AHFT method can be adopted in any field of application where a 3D path planner with kinematic and heading constraints on both start and end poses is required.

The Adaptive Hermite Fractal Tree (AHFT): a novel surgical 3D path planning approach with curvature and heading constraints

Purpose

In the context of minimally invasive neurosurgery, steerable needles such as the one developed within the Horizon2020-funded EDEN2020 project (Frasson et al. in Proc Inst Mech Eng Part H J Eng Med 224(6):775–88, 2010. 10.1243/09544119JEIM663; Secoli and y Baena in IEEE international conference on robotics and automation, 2013) aspire to address the clinical challenge of better treatment for cancer patients. The direct, precise infusion of drugs in the proximity of a tumor has been shown to enhance its effectiveness and diffusion in the surrounding tissue (Vogelbaum and Aghi in Neuro-Oncology 17(suppl 2):ii3–ii8, 2015. 10.1093/neuonc/nou354). However, planning for an appropriate insertion trajectory for needles such as the one proposed by EDEN2020 is challenging due to factors like kinematic constraints, the presence of complex anatomical structures such as brain vessels, and constraints on the required start and target poses.

Methods

We propose a new parallelizable three-dimensional (3D) path planning approach called Adaptive Hermite Fractal Tree (AHFT), which is able to generate 3D obstacle-free trajectories that satisfy curvature constraints given a specified start and target pose. The AHFT combines the Adaptive Fractal Tree algorithm’s efficiency (Liu et al. in IEEE Robot Autom Lett 1(2):601–608, 2016. 10.1109/LRA.2016.2528292) with optimized geometric Hermite (Yong and Cheng in Comput Aided Geom Des 21(3):281–301, 2004. 10.1016/j.cagd.2003.08.003) curves, which are able to handle heading constraints.

Results

Simulated results demonstrate the robustness of the AHFT to perturbations of the target position and target heading. Additionally, a simulated preoperative environment, where the surgeon is able to select a desired entry pose on the patient’s skull, confirms the ability of the method to generate multiple feasible trajectories for a patient-specific case.

Conclusions

The AHFT method can be adopted in any field of application where a 3D path planner with kinematic and heading constraints on both start and end poses is required.

Functional principles of steerable multi-element probes in insects

Hemipterans, mosquitoes, and parasitic wasps probe in a variety of substrates to find hosts for their larvae or food sources. Probes capable of sensing and precise steering enable insects to navigate through solid substrates without visual information and to reach targets that are hidden deep inside the substrate. The probes belong to non‐related taxa and originate from abdominal structures (wasps) or mouthparts (hemipterans and mosquitoes), but nevertheless share several morphological characteristics. Although the transport function clearly differs (egg laying and acquisition of liquid food), the functional demands on the mechanical behaviour of the probe within the substrate tend to be similar. The probe needs to be thin to limit substrate deformation, and long, in order to attain substantial path lengths or depths. We linked the morphology across taxa to the different functional requirements, to provide insights into the biology of probing insects and the evolution of their probes.

Current knowledge of insect probes is spread over many taxa, which offers the possibility to derive general characteristics of insect probing. Buckling during initial puncturing is limited by external support mechanisms. The probe itself consist of multiple (3–6) parts capable of sliding along one another. This multi‐part construction presumably enables advancement and precise three‐dimensional steering of the probe through the substrate with very low net external pushing forces, preventing buckling during substrate penetration. From a mechanical viewpoint, a minimum of three elements is required for 3D steering and volumetric exploration, as realised in the ovipositors of wasps. More elements, such as in six‐element probes of mosquitoes, may enhance friction in soft substrates. Alternatively, additional elements can have functions other than ‘drilling’, such as saliva injection in mosquitoes.

Despite the gross similarities, probes show differences in their cross sections, tip morphologies, relative lengths of their elements, and the shape of their interconnections. The hypothesis is that the probe morphology is influenced by the substrate properties, which are mostly unknown. Correlating the observed diversity to substrate‐specific functional demands is therefore currently impossible.

We conclude that a multipart probe with sliding elements is highly effective for volumetric substrate probing. Shared functional demands have led to an evolutionary convergence of slender multi‐element probes in disparate insect taxa. To fully understand 3D probing, it is necessary to study the sensory and material properties, as well as the detailed kinematics and dynamics of the various probes in relation to the nature of the selective pressure originating from the species‐specific substrates. Such knowledge will deepen our understanding of probing mechanisms and may support the development of slender, bio‐inspired probes.

Ovipositor-inspired steerable needle: design and preliminary experimental evaluation

Flexible steerable needles have the potential to allow surgeons to reach deep targets inside the human body with higher accuracy than rigid needles do. Furthermore, by maneuvering around critical anatomical structures, steerable needles could limit the risk of tissue damage. However, the design of a thin needle (e.g. diameter under 2 mm) with a multi-direction steering mechanism is challenging. The goal of this paper is to outline the design and experimental evaluation of a biologically inspired needle with a diameter under 2 mm that advances through straight and curved trajectories in a soft substrate without being pushed, without buckling, and without the need of axial rotation. The needle design, inspired by the ovipositor of parasitoid wasps, consisted of seven nickel titanium wires and had a total diameter of 1.2 mm. The motion of the needle was tested in gelatin phantoms. Forward motion of the needle was evaluated based on the lag between the actual and the desired insertion depth of the needle. Steering was evaluated based on the radius of curvature of a circle fitted to the needle centerline and on the ratio of the needle deflection from the straight path to the insertion depth. The needle moved forward inside the gelatin with a lag of 0.21 (single wire actuation) and 0.34 (double wire actuation) and achieved a maximum curvature of 0.0184 cm^-1and a deflection-to-insertion ratio of 0.0778. The proposed biologically inspired needle design is a relevant step towards the development of thin needles for percutaneous interventions.

Tip Design for Safety of Steerable Needles for Robot-Controlled Brain Insertion

Background

Current practice in neurosurgical needle insertion is limited by the straight trajectories inherent with rigid probes. One technique allowing curvilinear trajectories involves flexible bevel-tipped needles, which bend during insertion due to their asymmetry. In the brain, safety will require avoidance of the sharp tips often used in laboratory studies, in favor of a more rounded profile. Steering performance, on the other hand, requires maximal asymmetry. Design of safe bevel-tipped brain needles thus involves management of this tradeoff by adjusting needle gauge, bevel angle, and fillet (or tip) radius to arrive at a design that is suitably asymmetrical while producing strain, strain rate, and stress below the levels that would damage brain tissue.

Methods

Designs with a variety of values of needle radius, bevel angle, and fillet radius were evaluated in finite-element simulations of simultaneous insertion and rotation. Brain tissue was modeled as a hyperelastic, linear viscoelastic material. Based on the literature available, safety thresholds of 0.19 strain, 10 s^-1 strain rate, and 120 kPa stress were used. Safe values of needle radius, bevel angle, and fillet radius were selected, along with an appropriate velocity envelope for safe operation. The resulting needle was fabricated and compared with a Sedan side-cutting brain biopsy needle in a study in the porcine model in vivo (N=3).

Results

The prototype needle selected was 1.66 mm in diameter, with bevel angle of 10° and fillet radius of 0.25 mm. Upon examination of postoperative CT and histological images, no differences in tissue trauma or hemorrhage were noted between the prototype needle and the Sedan needle.

Conclusions

The study indicates a general design technique for safe bevel-tipped brain needles based on comparison with relevant damage thresholds for strain, strain rate, and stress. The full potential of the technique awaits the determination of more exact safety thresholds.

Mechanisms of ovipositor insertion and steering of a parasitic wasp

Drilling into solid substrates with slender beam-like structures is a mechanical challenge, but is regularly done by female parasitic wasps. The wasp inserts her ovipositor into solid substrates to deposit eggs in hosts, and even seems capable of steering the ovipositor while drilling. The ovipositor generally consists of three longitudinally connected valves that can slide along each other. Alternative valve movements have been hypothesized to be involved in ovipositor damage avoidance and steering during drilling. However, none of the hypotheses have been tested in vivo. We used 3D and 2D motion analysis to quantify the probing behavior of the fruit-fly parasitoid Diachasmimorpha longicaudata (Braconidae) at the levels of the ovipositor and its individual valves. We show that the wasps can steer and curve their ovipositors in any direction relative to their body axis. In a soft substrate, the ovipositors can be inserted without reciprocal motion of the valves. In a stiff substrate, such motions were always observed. This is in agreement with the damage avoidance hypothesis of insertion, as they presumably limit the overall net pushing force. Steering can be achieved by varying the asymmetry of the distal part of the ovipositor by protracting one valve set with respect to the other. Tip asymmetry is enhanced by curving of ventral elements in the absence of an opposing force, possibly due to pretension. Our findings deepen the knowledge of the functioning and evolution of the ovipositor in hymenopterans and may help to improve man-made steerable probes.

Influencing Factors Analysis of Facial Nerve Function after the Microsurgical Resection of Acoustic Neuroma

Objective

To explore and analyze the influencing factors of facial nerve function retainment after microsurgery resection of acoustic neurinoma.

Methods

Retrospective analysis of our hospital 105 acoustic neuroma cases from October, 2006 to January 2012, in the group all patients were treated with suboccipital sigmoid sinus approach to acoustic neuroma microsurgery resection. We adopted researching individual patient data, outpatient review and telephone followed up and the House-Brackmann grading system to evaluate and analyze the facial nerve function.

Results

Among 105 patients in this study group, complete surgical resection rate was 80.9% (85/105), subtotal resection rate was 14.3% (15/105), and partial resection rate 4.8% (5/105). The rate of facial nerve retainment on neuroanatomy was 95.3% (100/105) and the mortality rate was 2.1% (2/105). Facial nerve function when the patient is discharged from the hospital, also known as immediate facial nerve function which was graded in House-Brackmann: excellent facial nerve function (House-Brackmann I–II level) cases accounted for 75.2% (79/105), facial nerve function III–IV level cases accounted for 22.9% (24/105), and V–VI cases accounted for 1.9% (2/105). Patients were followed up for more than one year, with excellent facial nerve function retention rate (H-B I–II level) was 74.4% (58/78).

Conclusion

Acoustic neuroma patients after surgery, the long-term (≥1 year) facial nerve function excellent retaining rate was closely related with surgical proficiency, post-operative immediate facial nerve function, diameter of tumor and whether to use electrophysiological monitoring techniques; while there was no significant correlation with the patient’s age, surgical approach, whether to stripping the internal auditory canal, whether there was cystic degeneration, tumor recurrence, whether to merge with obstructive hydrocephalus and the length of the duration of symptoms.

Design, Fabrication, and Testing of a Needle-Sized Wrist for Surgical Instruments

This paper presents a miniature wrist that can be integrated into needle-sized surgical instruments. The wrist consists of a nitinol tube with asymmetric cutouts that is actuated by a single tendon to provide high distal curvature. We derive and experimentally validate kinematic and static models for the wrist and describe several prototype wrists, illustrating the straightforward fabrication and scalability of the design. We experimentally investigate fatigue life, the concept of tip-first bending, and practical use of the wrist with a concentric tube robot in an endonasal surgical scenario.

Minimally disruptive needle insertion: a biologically inspired solution

The mobility of soft tissue can cause inaccurate needle insertions. Particularly in steering applications that employ thin and flexible needles, large deviations can occur between pre-operative images of the patient, from which a procedure is planned, and the intra-operative scene, where a procedure is executed. Although many approaches for reducing tissue motion focus on external constraining or manipulation, little attention has been paid to the way the needle is inserted and actuated within soft tissue. Using our biologically inspired steerable needle, we present a method of reducing the disruptiveness of insertions by mimicking the burrowing mechanism of ovipositing wasps. Internal displacements and strains in three dimensions within a soft tissue phantom are measured at the needle interface, using a scanning laser-based image correlation technique. Compared to a conventional insertion method with an equally sized needle, overall displacements and strains in the needle vicinity are reduced by 30% and 41%, respectively. The results show that, for a given net speed, needle insertion can be made significantly less disruptive with respect to its surroundings by employing our biologically inspired solution. This will have significant impact on both the safety and targeting accuracy of percutaneous interventions along both straight and curved trajectories.

Buckling prevention strategies in nature as inspiration for improving percutaneous instruments: a review

A typical mechanical failure mode observed in slender percutaneous instruments, such as needles and guidewires, is buckling. Buckling is observed when the axial compressive force that is required to penetrate certain tissue types exceeds the critical load of the instrument and manifests itself by sudden lateral deflection of the instrument. In nature, several organisms are able to penetrate substrates without buckling while using apparatuses with diameters smaller than those of off-the-shelf available percutaneous needles and guidewires. In this study we reviewed the apparatuses and buckling prevention strategies employed by biological organisms to penetrate substrates such as wood and skin. A subdivision is made between buckling prevention strategies that focus on increasing the critical load of the penetration tool and strategies that focus on decreasing the penetration load of the substrate. In total, 28 buckling prevention strategies were identified and categorized. Most organisms appear to be using a combination of buckling prevention strategies simultaneously. Integration and combination of these biological buckling prevention strategies in percutaneous instruments may contribute to increasing the success rate of percutaneous interventions.

A low-cost, high-field-strength magnetic resonance imaging-compatible actuator

To perform minimally invasive surgical interventions with the aid of robotic systems within a magnetic resonance imaging scanner offers significant advantages compared to conventional surgery. However, despite the numerous exciting potential applications of this technology, the introduction of magnetic resonance imaging-compatible robotics has been hampered by safety, reliability and cost concerns: the robots should not be attracted by the strong magnetic field of the scanner and should operate reliably in the field without causing distortion to the scan data. Development of non-conventional sensors and/or actuators is thus required to meet these strict operational and safety requirements. These demands commonly result in expensive actuators, which mean that cost effectiveness remains a major challenge for such robotic systems. This work presents a low-cost, high-field-strength magnetic resonance imaging-compatible actuator: a pneumatic stepper motor which is controllable in open loop or closed loop, along with a rotary encoder, both fully manufactured in plastic, which are shown to perform reliably via a set of in vitro trials while generating negligible artifacts when imaged within a standard clinical scanner.

Flexure-Based Active Needle for Enhanced Steering Within Soft Tissue

Flexible needles with enhanced steerability are desired in minimally invasive surgeries to reach target locations precisely and to bypass critical organs lying in the planned path. We have proposed a flexure-based active needle that enhances steerability by using a flexure element near the needle tip. Needle curvature is controlled by attached shape memory alloy (SMA) wires that apply actuator forces to bend the needle. Using actuator forces rather than axial rotation to control needle curvature minimizes placement errors due to torsional rigidity that is compromised by the flexure element. A prototype of the proposed needle was developed and was demonstrated in air, in tissue-mimicking gel, and in pig liver. Needle insertion studies with the prototype showed that increasing the wire diameter from 0.15 to 0.24 mm insignificantly affected the maximum needle tip deflection (19.4±0.3 mm for 150 mm insertion), but significantly increased the actuation current (from 0.60 to 1.04 A).

Structures, properties, and functions of the stings of honey bees and paper wasps: a comparative study

Through natural selection, many animal organs with similar functions have evolved different macroscopic morphologies and microscopic structures. Here, we comparatively investigate the structures, properties and functions of honey bee stings and paper wasp stings. Their elegant structures were systematically observed. To examine their behaviors of penetrating into different materials, we performed penetration-extraction tests and slow motion analyses of their insertion process. In comparison, the barbed stings of honey bees are relatively difficult to be withdrawn from fibrous tissues (e.g. skin), while the removal of paper wasp stings is easier due to their different structures and insertion skills. The similarities and differences of the two kinds of stings are summarized on the basis of the experiments and observations.

Biomechanics of substrate boring by fig wasps

Female insects of diverse orders bore into substrates to deposit their eggs. Such insects must overcome several biomechanical challenges to successfully oviposit, which include the selection of suitable substrates through which the ovipositor can penetrate without itself fracturing. In many cases, the insect may also need to steer and manipulate the ovipositor within the substrate to deliver eggs at desired locations before rapidly retracting her ovipositor to avoid predation. In the case of female parasitoid ichneumonid wasps, this process is repeated multiple times during her lifetime, thus testing the ability of the ovipositioning apparatus to endure fracture and fatigue. What specific adaptations does the ovipositioning apparatus of a female ichneumonoid wasp possess to withstand these challenges? We addressed this question using a model system composed of parasitoid and pollinator fig wasps. First, we show that parasitoid ovipositor tips have teeth-like structures, preferentially enriched with zinc, unlike the smooth morphology of pollinator ovipositors. We describe sensillae present on the parasitoid ovipositor tip that are likely to aid in the detection of chemical species and mechanical deformations and sample microenvironments within the substrate. Second, using atomic force microscopy, we show that parasitoid tip regions have a higher modulus compared with regions proximal to the abdomen in parasitoid and pollinator ovipositors. Finally, we use videography to film wasps during substrate boring and analyse buckling of the ovipositor to estimate the forces required for substrate boring. Together, these results allow us to describe the biomechanical principles underlying substrate boring in parasitoid ichneumonid wasps. Such studies may be useful for the biomimetic design of surgical tools and in the use of novel mechanisms to bore through hard substrates.

Robotics in keyhole transcranial endoscope-assisted microsurgery: a critical review of existing systems and proposed specifications for new robotic platforms

BACKGROUND

Over the past decade, advances in image guidance, endoscopy, and tube-shaft instruments have allowed for the further development of keyhole transcranial endoscope-assisted microsurgery, utilizing smaller craniotomies and minimizing exposure and manipulation of unaffected brain tissue. Although such approaches offer the possibility of shorter operating times, reduced morbidity and mortality, and improved long-term outcomes, the technical skills required to perform such surgery are inevitably greater than for traditional open surgical techniques, and they have not been widely adopted by neurosurgeons. Surgical robotics, which has the ability to improve visualization and increase dexterity, therefore has the potential to enhance surgical performance.

OBJECTIVE

To evaluate the role of surgical robots in keyhole transcranial endoscope-assisted microsurgery.

METHODS

The technical challenges faced by surgeons utilizing keyhole craniotomies were reviewed, and a thorough appraisal of presently available robotic systems was performed.

RESULTS

Surgical robotic systems have the potential to incorporate advances in augmented reality, stereoendoscopy, and jointed-wrist instruments, and therefore to significantly impact the field of keyhole neurosurgery. To date, over 30 robotic systems have been applied to neurosurgical procedures. The vast majority of these robots are best described as supervisory controlled, and are designed for stereotactic or image-guided surgery. Few telesurgical robots are suitable for keyhole neurosurgical approaches, and none are in widespread clinical use in the field.

CONCLUSION

New robotic platforms in minimally invasive neurosurgery must possess clear and unambiguous advantages over conventional approaches if they are to achieve significant clinical penetration.

Barbs facilitate the helical penetration of honeybee (Apis mellifera ligustica) stingers

The stinger is a very small and efficient device that allows honeybees to perform two main physiological activities: repelling enemies and laying eggs for reproduction. In this study, we explored the specific characteristics of stinger penetration, where we focused on its movements and the effects of it microstructure. The stingers of Italian honeybees (Apis mellifera ligustica) were grouped and fixed onto four types of cubic substrates, before pressing into different substrates. The morphological characteristics of the stinger cross-sections were analyzed before and after penetration by microscopy. Our findings suggest that the honeybee stinger undergoes helical and clockwise rotation during penetration. We also found that the helical penetration of the stinger is associated directly with the spiral distribution of the barbs, thereby confirming that stinger penetration involves an advanced microstructure rather than a simple needle-like apparatus. These results provide new insights into the mechanism of honeybee stinger penetration.

Rate dependency during needle insertions with a biologically inspired steering system: an experimental study

Percutaneous intervention is a common Minimally Invasive (MI) surgical procedure for the treatment of various disorders. It generally involves the insertion of slender needles deep within tissue, as lesions can be several centimetres below skin level. Consequently, deviations might occur which need to be accounted for and corrected by steering the needle tip during the insertion process. Needle steering systems, however, are necessarily disruptive to the substrate, with the potential to cause larger migrations of deep-seated targets, as well as potentially increasing the extent of tissue trauma at the needle interface, when compared to straight needles. This study aims to investigate different insertion modalities for a biologically inspired multi-segment needle, which is able to steer along three-dimensional trajectories by exploiting a quasi-linear relationship between the relative displacement of the needle segments and the curvature magnitude and direction plane at the tip. We demonstrate that different segment insertion speeds do not affect this relationship during experiments in gelatine, and thus a new steering approach is proposed to steer the needle into the substrate which substantially improves upon the manoeuvrability (i.e. the rate of change of steering angle) of the needle.

How ticks get under your skin: insertion mechanics of the feeding apparatus of Ixodes ricinus ticks

The tick Ixodes ricinus uses its mouthparts to penetrate the skin of its host and to remain attached for about a week, during which time Lyme disease spirochaetes may pass from the tick to the host. To understand how the tick achieves both tasks, penetration and attachment, with the same set of implements, we recorded the insertion events by cinematography, interpreted the mouthparts' function by scanning electron microscopy and identified their points of articulation by confocal microscopy. Our structural dynamic observations suggest that the process of insertion and attachment occurs via a ratchet-like mechanism with two distinct stages. Initially, the two telescoping chelicerae pierce the skin and, by moving alternately, generate a toehold. Subsequently, a breaststroke-like motion, effected by simultaneous flexure and retraction of both chelicerae, pulls in the barbed hypostome. This combination of a flexible, dynamic mechanical ratchet and a static holdfast thus allows the tick to solve the problem of how to penetrate skin and also remain stuck for long periods of time.

Automatic Steering of Manually Inserted Needles

Bevel-tipped flexible needles can be robotically steered to reach clinical targets along curvilinear paths in 3D. Manual needle insertion allows the clinician to control the insertion speed, ensuring patient safety. This paper presents a control law for automatic 3D steering of manually inserted flexible needles, enabling path-following control. A look-ahead proportional controller for position and orientation is presented. The look-ahead distance is a linear function of insertion speed. Simulations in a 3D brain-like environment demonstrate the performance of the proposed controller. Experimental results also show the feasibility of this technique in 2D and 3D environments.

A flexure-based steerable needle: high curvature with reduced tissue damage

In the quest to design higher curvature bevel-steered needles, kinked bevel-tips have been one of the most successful approaches yet proposed. However, the price to be paid for enhancing steerability in this way has been increased tissue damage, since the prebent tip cuts a local helical path into tissue when axially rotated. This is problematic when closed-loop control is desired, because the controller will typically require the needle to rotate rapidly, and it is particularly problematic when duty cycling (i.e., continual needle spinning) is used to adjust curvature. In this paper, we propose a new flexure-based needle tip design that provides the enhanced steerability of kinked bevel-tip needles, while simultaneously minimizing tissue damage.

Smooth path planning for a biologically-inspired neurosurgical probe

Percutaneous intervention involves the insertion of needles to specific locations inside the human body, to perform a variety of surgical procedures. Percutaneous procedures are becoming the preferred choice for many neurosurgeons, due to the additional benefits they provide over conventional open neurosurgery. A neurosurgical flexible and steerable probe named STING is currently being developed for accessing deep brain lesions following curvilinear paths. In this paper, we present a path planning method for generating pre-operative paths for this neurosurgical flexible probe. Since the flexible probe is modeled as a nonholonomic system, a deterministic continuous curvature path planning scheme capable of avoiding obstacles is developed for smooth steering of its tip. Multiple paths are generated by varying arrival angle at the targeted lesion and a path optimization approach is then formulated, with the aim to minimize damage to the tissue (i.e. shortest path) and the risk to the patient (obstacle avoidance). Simulation results are reported using the risk-map generated for a coronal slice of the brain, which confirms the successful design of a path planning scheme that satisfies the nonholonomic constraints of the neurosurgical probe.

Development and validation of a numerical model for cross-section optimization of a multi-part probe for soft tissue intervention

The popularity of minimally invasive surgical procedures is driving the development of novel, safer and more accurate surgical tools. In this context a multi-part probe for soft tissue surgery is being developed in the Mechatronics in Medicine Laboratory at Imperial College, London. This study reports an optimization procedure using finite element methods, for the identification of an interlock geometry able to limit the separation of the segments composing the multi-part probe. An optimal geometry was obtained and the corresponding three-dimensional finite element model validated experimentally. Simulation results are shown to be consistent with the physical experiments. The outcome of this study is an important step in the provision of a novel miniature steerable probe for surgery.

Detailed finite element simulations of probe insertion into solid elastic material using a cohesive zone approach

In this paper a method is presented for detailed finite element modelling of probe insertion into an elastic material. This is part of an ongoing investigation into the mechanics of a novel, biomimetic, soft-tissue probe currently under development at Imperial College, London. Analysis is performed using a 'cohesive zone' approach by integrating multiple cohesive elements into a finite element mesh using Abaqus software. Cohesive zones with variable crack paths, generated by both remote tensile and contact loading, and substantial probe penetration along an arbitrarily curved crack path are demonstrated. These advances are critical to understanding probe interactions for the development of an existing prototype and control strategy.

Insertion experiments of a biologically inspired microtextured and multi-part probe based on reciprocal motion

While there have been significant advances in minimally invasive surgical instrumentation, the majority of tools still rely on a push from the back to aid insertion into the tissue, whether the process is manual or servo assisted. In this work, a novel approach to tool insertion is proposed which is based on the concept of a multi-part probe with at least three interlocking segments. By means of a sequential insertion process, where each segment is pushed further into the tissue while stabilized by the remaining stationary parts, the multi-part probe concept is shown to successfully "insinuate itself" within a synthetic soft tissue specimen without the need for an overall forward push. The presence of an anisotropic microtextured outer probe surface is also shown to affect the overall speed of insertion and can thus be used to optimize the interaction forces at the probe-tissue interface. A measured reduction in the force transferred to the back of the specimen also suggests that this approach to tool insertion may result in reduced tissue disruption, a result which could lead to less tissue damage and a reduction in target displacement.