Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023最新文献

{"title":"Toward Robotic Craniosynostosis Surgery: Development of a Novel Articulated Minimally Invasive Bone Cutting Tool","authors":"Jones Law, Dale J. Podolsky","doi":"10.31256/hsmr2023.7","DOIUrl":"https://doi.org/10.31256/hsmr2023.7","url":null,"abstract":"Craniosynostosis involves premature fusion of the cranial sutures resulting in an abnormal head shape and functional sequelae such as raised intracranial pressure [1]. Surgery is required and can be performed open or endoscopically. Both approaches require osteotomies to either remove the fused suture or to remodel the bone. The endoscopic approach is performed using smaller incisions and has reduced blood loss, operative time and cost in comparison to the open approach [2]. However, with the endoscopic approach, the osteotomy extent is limited due to reduced access using currently available surgical tools [3]. As a result, the patient is required to wear a molding helmet post-operatively and only certain types of craniosynostosis can be treated using this approach. Conventional instruments for craniosynostosis surgery consists of straight rigid tools. They are simple and intuitive to manipulate with open accessibility, but are difficult to use in restricted areas. Furthermore, the unique curvature of the skull limits the reach of the instruments during craniosynostosis surgery. A novel steerable instrument would allow performance of extensive osteotomies on the skull using key-hole incisions. Such a device would eliminate the need for a molding helmet and can be used to treat all types of craniosynostosis. The following paper describes a novel articulating bone cutting device specifically designed for keyhole craniosynostosis surgery that can also be utilized for any procedure requiring a craniotomy. This device would represent a paradigm shift in minimal access cranial surgery.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"56 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116571898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Wrist Ergonomics in Laparoscopy using the HandX®","authors":"Itai Meshorer, Amit Milstein, Oliver Nathan, Lior Soffer, Barak Rattner, Michal Sudak, A. Szold","doi":"10.31256/hsmr2023.33","DOIUrl":"https://doi.org/10.31256/hsmr2023.33","url":null,"abstract":"Laparoscopic surgery has become increasingly popular due to its benefits over open surgery. However, one of the major challenges in laparoscopic surgery is the ergonomics of the surgeon. Ergonomics plays a crucial role in laparoscopic surgery, as surgeons are at risk of developing musculoskeletal disorders (MSDs) due to prolonged and repetitive motions [1,2]. One of the most common areas affected by MSDs in surgeons is the wrist, which can be affected by various factors such as handle design, awkward postures, and high force demands [3]. Laparoscopic surgery requires precise and delicate movements, that can put a significant strain on the wrist. Wrist flexion and deviation refer to the bending of the wrist forward and backward and twisting of the wrist to the left or right, respectively. Optimal wrist posture minimizes the degree of flexion and deviation, allowing for a neutral wrist position. On the other hand, excessive wrist flexion and deviation can lead to musculoskeletal pain, fatigue, and reduced grip strength. Neutral wrist posture with a lower degree of flexion and deviation has been shown to reduce musculoskeletal symptoms, increase dexterity, and improve surgical precision. Additionally, forearm rotation (pronation and supination) also plays a role in wrist ergonomics. Based on the rapid upper limb assessment (RULA), for wrist flexion/extension a range of 0-15° is recommended, and close to neutral position for wrist deviation, whilst pronation or supination of the forearm is considered ergonomic for up to 45° [4], [5]. The HandX® [6] is a hand-held laparoscopic, software-driven, robotic platform, used to manipulate 5mm fully articulating instruments. The HandX has four robotic degree-of-freedom (DoF), here we focus on the two DoF’s for controlling articulation. The HandX’s sphere-like control interface (CI) allows the surgeon to manipulate the articulated instruments' end-effector in all directions, over two axes: pitch and yaw","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122519829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-Time Cognitive Workload States Recognition from Ultra Short-Term ECG Signals on Trainee Surgeons Using 1D Convolutional Neural Networks","authors":"Kaizhe Jin, R. Naik, Adrian Rubio Solis, G. Mylonas","doi":"10.31256/hsmr2023.56","DOIUrl":"https://doi.org/10.31256/hsmr2023.56","url":null,"abstract":"Surgery is a mentally demanding task that is focused on patient safety and requires the precise execution of motor control and decision making in a timely manner. Episodes of high Cognitive Workload (CWL) induced by stressors or distractions have been shown to lead to inferior performance potentially compromising patient safety [1]. We have proposed a promising CWL assess- ment platform utilising a wide range of physiological sensors [2]. However, there are some disadvantages associated with a complex multimodal sensing design, including high device cost, long set up time and the dis- comfort caused by wearing multiple wearable sensors for long periods during surgery. To address this problem, the proposed one-dimensional convolutional neural network (1D-CNN) model discussed here, offers an alternative solution to recognising CWL states, achieving satisfac- tory performance (91.3% accuracy) with the use of a wireless ECG sensor alone, showing great potential for widespread deployment in the operating room (OR). MATERIALS AND METHODS","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132302405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surface-Enhanced Raman Spectroscopy and Transfer Learning Toward Accurate Reconstruction of the Surgical Zone","authors":"Ashutosh Raman, Ren A. Odion, Ken Yamamoto, Weston A. Ross, P. Codd, T. Vo‐Dinh","doi":"10.31256/hsmr2023.75","DOIUrl":"https://doi.org/10.31256/hsmr2023.75","url":null,"abstract":"Raman spectroscopy is a photonic modality defined as the inelastic backscattering of excitation coherent laser light. It is particularly beneficial for rapid tissue diagnosis in sensitive intraoperative environments like those involving the brain, due to its nonionizing potential, point-scanning capability, and highly-specific spectral fingerprint signatures that can characterize tissue pathology [1]. While Raman scattering is an inherently weak process, Surface-Enhanced Raman Spectroscopy (SERS), which is based on the use of metal nanostructure surfaces to amplify Raman signals, has become a compelling method for achieving highly specific Raman spectra with detection sensitivity comparable to conventional modalities such as fluorescence [2]. A unique plasmonics-active nanoplatform, SERS gold nanostars (GNS) have previously been designed in our group to accumulate preferentially in brain tumors [2]. Raman detection, when combined with machine learning and robotics, stands to enhance the diagnosis of ambiguous tissue during tumor resection surgery, with the potential to improve extent-of-resection and rapidly reconstruct the dynamic surgical field. Here we demonstrate preliminary results from the use of a SERS-based robotics platform to efficiently recreate a tumor embedded in healthy tissue, which is modeled here as a GNS-infused phantom. Transfer learning, specifically through use of the open-source RRUFF mineral database, is employed here to address the dearth of collected biomedical Raman data [3].","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134457033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Fluidic Actuated Soft Robot for Improving Bronchoscopic Biopsy","authors":"Daniel Van Lewen, Taylor Janke, Harin Lee, Ryan Austin, E. Billatos, S. Russo","doi":"10.31256/hsmr2023.48","DOIUrl":"https://doi.org/10.31256/hsmr2023.48","url":null,"abstract":"Lung cancer has long been one of the deadliest forms of cancer in large part due to the difficulty in diagnosis when at its earlier stages [1]. Because of their large diameter (i.e., ≈ 6 mm) preventing them from navigating in the peripheral lung, traditional bronchoscopes used in minimally invasive biopsy encounter difficulty when trying to reach smaller, deep-seated lesions [2]. Robotic solutions have been developed to address these limitations in surgical navigation. Commercial robotic bronchoscopy systems, like the Auris Monarch™ and Intuitive Ion™ , con- sist of tendon-actuated continuum robots which focus on navigation and biopsy deeper into the lung periphery [3]. Soft robots present a promising alternative to these commercial robotic systems due to their scalability, in- herent flexibility, and potential for safer interactions with biological tissue, making them well-suited for procedures in the peripheral lung [4]. Furthermore, the materials used in soft robotics are generally more economical and allow seamless integration of soft robotic actuation and sensing mechanisms. Exploration of various actuation methods, such as magnetic and fluidic, have demonstrated navigation capabilities in hard-to-reach areas of the lung and the ability to integrate useful tools, such as needles and cameras [5], [6]. However, with miniaturization, the ability of soft robots to transmit forces and interact with the surrounding biological tissue diminishes. We propose a 3.5 mm diameter soft robot with em- bedded degrees of freedom (DOFs) for tip steering, tip stabilization, and needle deployment for tissue biopsy in bronchoscopy procedures (Fig. 1). Via soft actuators embedded in its continuum body, the robot can navigate through the lung branches to the target lesion and anchor itself within an anatomical channel. After anchoring, a needle may be deployed from the robot tip using an origami-inspired soft actuator to puncture the target lesion and take a biopsy. The fluidic actuated DOFs embedded in the proposed robot seek to reach deeper into the lungs, actively increase force transmission at the millimeter scale, and distally control the biopsy needle laying the framework for enhanced surgical capabilities in minimally invasive bronchoscopy procedures.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130390922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an Untethered Inflatable Capsule Robot for Stricture Dilation - a Preliminary Study","authors":"Kaan Esendag, M. McAlindon, D. Rus, S. Miyashita, Dana D. Damian","doi":"10.31256/hsmr2023.53","DOIUrl":"https://doi.org/10.31256/hsmr2023.53","url":null,"abstract":"Capsule robots have the potential to provide untethered access to the gastrointestinal tract and perform simple tasks that could reduce invasiveness and provide a better alternative method of access than an endoscopy or colonoscopy. Current state-of-the-art for capsule robots already fulfil the need for inspection, but there is a gap that exists between the capabilities of current capsule robots when compared with those of endoscopic surgical robots [1]. For example, strictures occurring throughout the gastrointestinal tract due to inflammation or Crohn’s disease needs a source of pressure to break the strained organ and unblock the stenosis. Additionally, access to the distal parts of the small intestine remains difficult even for Endoscopic Balloon Dilation (EBD). A capsule robot with an actuator that can provide volumetric expansion could fulfil both of these needs, i.e., opening the lumen at a stricture site, anchoring for surgical procedures in difficult-to-access GI areas. This paper presents a capsule robot prototype, of 14 mm diameter and 28 mm length, with a soft internal actuator capable of providing wireless volumetric expansion as seen in Fig. 1. The inflation of the capsule is based on the chemical reaction between NaHCO3 and C6 H8 O7 , which releases carbon dioxide (CO2 ) gas. The inflation of the internal actuator is wirelessly controlled through magnetic induction which generates thermal energy. The capsule also deflates over time due to the CO2 being slowly reabsorbed into water as carbonic acid (H2 CO3 ). Mechanisms that can provide wireless expansion, such as using a wireless electronic module with a pump to inflate and deflate a balloon, using liquid-to-gas transition of chemicals as the source of expansion, or using chemical reactions that release gas as a source of pressure have been previously presented [2]–[4]. However, the method of actuation should not require operating at temperatures that can cause permanent tissue damage [5]. In the current work the generated thermal energy is below limits of hyperthermia [5].The chemicals and the dissolution medium used are all safe for ingestion, making them suitable for gastroin- testinal applications, and the capsule design provides a novel and promising alternative for ballooning operations without using electronics or a battery.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115492993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proof of Concept of a Novel Growing Soft Robot for Colonoscopy","authors":"C. Tutcu, S. K. Talas, O. Kocaturk, N. Tozun, Evren Samur","doi":"10.31256/hsmr2023.54","DOIUrl":"https://doi.org/10.31256/hsmr2023.54","url":null,"abstract":"Colonoscopy is considered to be the gold standard for the detection of colorectal polyps and other colonic disease. In this study, a novel growing soft-continuum robot is presented as a proof of concept for a potential colonoscopy application. Compared to the state-of-the- art systems such as the ColonoSight system [1] using an inflated balloon attached over the colonoscope shaft, or Neoguide [2] actuated via electromechanical actu- ators, the proposed architecture utilizes the advantage of pneumatic propulsion as well as allowing control in three degrees of freedom. The growing robot concept pushes the end effector from the tip and prevents loss in propulsion force at the tip that results a lower mechanical forcing on the colon. Since the actuation is performed pneumatically and controlled via electromechanical in- terface, there is no need for users to apply high forces for pushing/pulling to progress and maneuver the robot.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"403 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122721345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-local Dependencies and Contextual Information in the Interpretation of Procedural Surgical Text","authors":"M. Fiazza","doi":"10.31256/hsmr2023.73","DOIUrl":"https://doi.org/10.31256/hsmr2023.73","url":null,"abstract":"Efforts to automate mining of procedural information from surgical texts are enabling technology for future autonomous surgical robots. In building their knowledge base (or seeking to augment it if they encounter un- expected circumstances), these robots need to interface with surgical resources so far intended for human use— such as textbooks, case reports, published medical lit- erature. Knowledge mined from surgical texts forms the backbone of higher cognition mechanisms that support surgical situation awareness and autonomous decision- making, as well as verbal interaction with humans. Great progress in natural language understanding is required. Regardless of whether the information is in- tended to support monitoring processes, surgeon or performance evaluation, or (in the future) autonomous decision-making, the safety-critical nature of the domain requires a careful study of the information landscape. Surgical textbooks contain descriptions of surgical pro- cedures that are presented semi-algorithmically, often organized in phases and occasionally also in steps. Sur- geons can understand and execute the procedure from the description, so it is possible at least in principle to derive a high-level executable representation of the procedure, one which could be suitable for an autonomous robot. However, even assuming that the robot already have executable routines corresponding to elementary surgical instructions such as incising an anatomical structure, placing an object in an anatomical location (and so on), not all information necessary to parametrize a surgical action is found directly in the text, and when it is, it is not always local to where the instruction is mentioned. Some parameters that cannot be found in the text are not missing per se; rather, they are patient-specific and thus available only when the abstract procedure is instantiated. Their values can only be determined from the direct perception of the surgical scene or from patient-specific imaging.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"371 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126711302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel stereoscopic thermal endoscope for tissue damage prevention","authors":"Dumitru Scutelnic, Giacomo De Rossi, Nicola Piccinelli, C. Daffara, Salvatore Siracusano, R. Muradore","doi":"10.31256/hsmr2023.25","DOIUrl":"https://doi.org/10.31256/hsmr2023.25","url":null,"abstract":"Multi-spectral imaging systems, namely thermal and visible spectrum imaging systems, are recently being employed successfully in multiple civilian applications, such as civil engineering , precision agriculture, and cultural heritage preservation [1], due to the more general availability of high-performing, compact sen- sors. The same success can not yet be appreciated in medical or surgical applications, with most examples of thermography in medicine being applied on the epidermis [2] or specialized applications with limited measurements [3]. Nevertheless, direct thermal tissue measurements could prove invaluable in laparoscopy and laparo-assisted robotic surgery, where bipolar electroco- agulation or ultrasonic energy are often used to achieve haemostasis to maximise a clear view of the surgical field. The temperatures exceed 45 ◦ C where disruption in the neurovascular bundles (NVB) functions was observed in vivo , with protein denaturation and subsequent cellular death occurring between 57 ◦ C and 65 ◦ C [4]. Coagulation by thermal energy can be considered responsible for the damage to the NVB that are intimately located on the lateral, posterolateral and posterior surface of the prostate during nerve-sparing robotic-assisted radical prostatec- tomy (RARP) [5]. This damage can decrease the chance of a full recovery of physiological functions after the procedure, namely the erection and urinary continence, which is estimated to be at 50% [6]. For this reason, cautery-free procedures have been evaluated to reduce the amount of induced thermal damage by using clips [7], but they introduce risk of unintentional neural bundle dissection. We present a novel endoscope prototype for minimal invasive surgery: it integrates full stereoscopic vision with 3D-mapped, direct thermal measurements to evaluate the heat propagation over the surface target tissue during bipolar coagulation. The precise mapping of the multi-spectral images would allow clinicians to quickly assess the risk of damage to sensitive tissues intra- operatively.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116928840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Assistant for Image-Guided Treatment of Ankle Joint Dislocations: A Feasibility Study","authors":"Gang Li, R. Vijayan, A. Uneri, B. Shafiq, J. Siewerdsen, K. Cleary","doi":"10.31256/hsmr2023.8","DOIUrl":"https://doi.org/10.31256/hsmr2023.8","url":null,"abstract":"Trauma to the ankle is an increasingly common injury and is a major source of long-term debility [1]. Over two million ankle injuries occur each year in the United States alone [2]. Over half a million ankle injuries require surgeries [1]. Multiple studies have demon- strated accurate reduction of the distal tibiofibular joint (syndesmosis) as a critical predictor of good clinical outcome [3], [4]. Surgical manipulation of the tibia and fibula is necessary to properly align and reduce the syndesmosis space in ankle fractures involving sprains of the syndesmosis. However, current techniques of manual reduction utilizing open or percutaneous approaches have been shown to result in inaccurate reduction of the syndesmosis [3], [4]. We propose a novel system that combines intraoperative imaging based on low- dose cone-beam computed tomography (CBCT) and 3D- 2D image registration with robotic manipulation of the fibula to precisely restore its anatomical relationship with the tibial incisura. Our long-term goal is to de- velop robotic assistance with intraoperative imaging for precise reduction of the syndesmosis, while minimizing radiation exposure to the patient and the surgical staff. The focus of this study is to investigate the feasibility of the robot design and the potential clinical workflow.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117246319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}