Virtual remote center of motion control for needle placement robots

Real Time Estimator to Perform Targeted Biopsies With a Free-Wrist Robot Despite Large Deformations of the Insertion Orifice

In the context of keyhole surgery, and more particularly of uterine biopsy, the fine automatic movements of a surgical instrument held by a robot with 3 active DOF’s require an exact knowledge of the point of rotation of the instrument. However, this center of rotation is not fixed and moves during an examination. This paper deals with a new method of detecting and updating the interaction matrix linking the movements of the robot with the surgical instrument. This is based on the method of updating the Jacobian matrix which is named the “Broyden method”. It is able to take into account body tissue deformations in real time in order to improve the pointing task for automatic movements of a surgical instrument in an unknown environment.

Design and Experiment of Assistive Mechanism for Adjustment of Transrectal Ultrasound Probe

Transrectal ultrasound prostate biopsy is the most commonly used method for the diagnosis of prostate cancer. During the operation, the doctor needs to manually adjust the ultrasound probe for repeated adjustments, which is difficult to ensure the efficiency, accuracy, and safety of the operation. This paper presents a passive posture adjusting mechanism of transrectal ultrasound probe. The overall mechanism has 7 degrees of freedom, consisting of a position adjustment module, a posture adjustment module, and an ultrasonic probe rotation and feed module. In order to achieve the centering function, the posture adjustment module is designed based on the double parallelogram. Centering performance is verified based on SimMechanics, and remote center point error of physical prototypes is evaluated. The maximum error of the azimuth remote center point motion and the maximum error of the remote center point motion of the ultrasonic probe are 4 mm and 3.4 mm, respectively, which are less than the anus that can withstand 6 mm. Meanwhile, the analysis of measurement error shows that the random error correlation is weak in different directions, the systematic error confidence intervals of azimuth and elevation angle are less than 2.5 mm, and the maximum relative fixed point error and the maximum relative standard error are 14.73% and 14.98%, respectively. The simulation and testing results have shown the effectiveness and reliability of the propose mechanism.

Magnetic resonance and ultrasound image-guided navigation system using a needle manipulator

PURPOSE

Image guidance is crucial for percutaneous tumor ablations, enabling accurate needle-like applicator placement into target tumors while avoiding tissues that are sensitive to injury and/or correcting needle deflection. Although ultrasound (US) is widely used for image guidance, magnetic resonance (MR) is preferable due to its superior soft tissue contrast. The objective of this study was to develop and evaluate an MR and US multi-modal image-guided navigation system with a needle manipulator to enable US-guided applicator placement during MR imaging (MRI)-guided percutaneous tumor ablation.

METHODS

The MRI-compatible needle manipulator with US probe was installed adjacent to a 3 Tesla MRI scanner patient table. Coordinate systems for the MR image, patient table, manipulator, and US probe were all registered using an optical tracking sensor. The patient was initially scanned in the MRI scanner bore for planning and then moved outside the bore for treatment. Needle insertion was guided by real-time US imaging fused with the reformatted static MR image to enhance soft tissue contrast. Feasibility, targeting accuracy, and MR compatibility of the system were evaluated using a bovine liver and agar phantoms.

RESULTS

Targeting error for 50 needle insertions was 1.6 ± 0.6 mm (mean ± standard deviation). The experiment confirmed that fused MR and US images provided real-time needle localization against static MR images with soft tissue contrast.

CONCLUSIONS

The proposed MR and US multi-modal image-guided navigation system using a needle manipulator enabled accurate needle insertion by taking advantage of static MR and real-time US images simultaneously. Real-time visualization helped determine needle depth, tissue monitoring surrounding the needle path, target organ shifts, and needle deviation from the path.

Precisely positioning the tip of an instrument inserted through an orifice with a free wrist robot: application to prostate biopsies

PURPOSE

Robots with a spherical unactuated wrist can be used for minimally invasive surgery. With such a robot, positioning the wrist center controls the instrument tip position when assuming that the insertion site behaves like a lever with a fixed and known fulcrum. In practice, this assumption is not always respected. In this paper we first study the practical consequences of this problem in terms of tip precision positioning. We then propose a robotic control scheme that improves the precision compared to the fixed point assumption approach.

METHODS

In the first part of the paper, data recorded during robot-assisted transrectal needle positioning for prostate biopsies (nine patients) are exploited to quantify the positioning error induced by the use of a fixed point hypothesis in the positioning process. In the second part of the paper advanced control techniques allow for the online identification of a locally linear system that describes a model characterized by anisotropy and center displacement. A laboratory apparatus is used to demonstrate the resulting improvement on tip positioning precision.

RESULTS

Errors obtained by processing the clinical data reach 7.5 mm at the tip in average. Errors obtained with the laboratory apparatus drop from 2.4 mm in average to 0.8 mm when using real-time model update.

MRI-compatible manipulator with remote-center-of-motion control

PURPOSE

To develop and assess a needle-guiding manipulator for MRI-guided therapy that allows a physician to freely select the needle insertion path while maintaining remote center of motion (RCM) at the tumor site.

MATERIALS AND METHODS

The manipulator consists of a three-degrees-of-freedom (DOF) base stage and passive needle holder with unconstrained two-DOF rotation. The synergistic control keeps the Virtual RCM at the preplanned target using encoder outputs from the needle holder as input to motorize the base stage.

RESULTS

The manipulator assists in searching for an optimal needle insertion path which is a complex and time-consuming task in MRI-guided ablation therapy for liver tumors. The assessment study showed that accuracy of keeping the virtual RCM to predefined position is 3.0 mm. In a phantom test, the physicians found the needle insertion path faster with than without the manipulator (number of physicians = 3, P = 0.001). However, the alignment time with the virtual RCM was not shorter when imaging time for planning were considered.

CONCLUSION

The study indicated that the robot holds promise as a tool for accurately and interactively selecting the optimal needle insertion path in liver ablation therapy guided by open-configuration MRI.

Three-dimensional ultrasound-guided robotic needle placement: an experimental evaluation

BACKGROUND

Clinical use of image-guided needle placement robots has lagged behind laboratory-demonstrated robotic capability. Bridging this gap requires reliable and easy-to-use robotic systems.

METHODS

Our system for image-guided needle placement requires only simple, low-cost components and minimal, entirely off-line calibration. It rapidly aligns needles to planned entry paths using 3D ultrasound (US) reconstructed from freehand 2D scans. We compare system accuracy against clinical standard manual needle placement.

RESULTS

The US-guided robotic system is significantly more accurate than single manual insertions. When several manual withdrawals and reinsertions are allowed, accuracy becomes equivalent. In ex vivo experiments, robotic repeatability was 1.56 mm, compared to 3.19 and 4.63 mm for two sets of manual insertions. In an in vivo experiment with heartbeat and respiratory effects, robotic system accuracy was 5.5 mm.

CONCLUSIONS

A 3D US-guided robot can eliminate error bias and reduce invasiveness (the number of insertions required) compared to manual needle insertion. Remaining future challenges include target motion compensation.