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

{"title":"Valvuloplasty Balloon Catheter Sizing Approach for Calcified Aortic Valve with Different Annulus Ratios","authors":"Junke Yao, G. Bosi, G. Burriesci, H. Wurdemann","doi":"10.31256/hsmr2023.19","DOIUrl":"https://doi.org/10.31256/hsmr2023.19","url":null,"abstract":"Transcatheter aortic valve implantation (TAVI) is re- garded as the option of preference minimally invasive intervention to treat high-risk patients with aortic steno- sis, which is a common heart valve disease charac- terized by the narrowing of the valve opening due to the thickening of the valve leaflets. During TAVI, a prosthetic aortic valve, replacing the diseased native valve with its function, is inserted and expanded by a balloon catheter if it is a balloon-expandable device. As a result, the correct size of the prosthetic device is vital due to its association with potential complications such as paravalvular regurgitation and aortic annulus rupture [1]. Pre-operative annulus size measurement based on imaging techniques is commonly applied be- fore TAVI procedure including transthoracic echocar- diography, transesophageal echocardiography and multi- detector computed tomography [2], [3]. However, these techniques face two major limitations: heavy dependence on the operator’s experience and the influence of the optimum instant in the cardiac cycle for evaluation. In addition, the potential changes in the annular geometry caused by balloon aortic valvuloplasty, which uses a balloon catheter to dilate the calcified aortic leaflets as a bridge treatment to TAVI, are not considered. There- fore, intraoperative assessments based on valvuloplasty balloon catheters were introduced, which measure the annulus size by the balloon when it is inflated for dilatation [4]. They do, however, only provide limited compatibility for a limited number of devices. This study proposes an intra-operative method for mea- suring the aortic annulus that account for compliance and elliptical geometries using balloon internal pressure and volume data. The valvuloplasty balloon catheter from a commercially available source was used to obtain the intra-balloon pressure-volume curves by an inflation device. A characterized analytical model and a numeri- cal model for balloon free-inflation were used to develop a sizing algorithm for estimating annulus dimensions.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"28 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":"134052314","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":"Global versus local kinematic skills assessment on robotic assisted hysterectomies","authors":"A. Huaulmé, Krystel Nyango Timoh, V. Jan, S. Guerin, P. Jannin","doi":"10.31256/hsmr2023.41","DOIUrl":"https://doi.org/10.31256/hsmr2023.41","url":null,"abstract":"Surgical skills assessment is a crucial step to help understanding surgical expertise and to provide technical knowledge to beginners. Scores, such as GOALS [1], have been designed to assess surgical skills. However, these scores are subjective and need experts to compute them. With the advent of robotic surgery, it is possible to compute Automated Performance Metrics (APMs) based on the motion of robotic arms to assess surgical skills. Several studies have demonstrated statistically significant differences between APMs from different levels of expertise [2], [3]. The majority of these studies performed a global analysis, i.e., studying the surgical procedure or training task as a whole. By using the Surgical Process Model (SPM) methodology [4], it is possible to describe the surgery at different levels of granularity and break it down into a sequence of elements. Riffaud et al. [5], decomposed Lumbar Disc herniation surgery by phases and demonstrated that the main expertise differences in terms of duration are due to specific phases or actions. In this paper, we will combine SPM and APMs to study global and local kinematic skills during robotic-assisted hysterectomies.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"65 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":"134296223","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":"Miniaturisation, Modularization and Evaluation of the SoftSCREEN System","authors":"Vanni Consumi, D. Stoyanov, A. Stilli","doi":"10.31256/hsmr2023.74","DOIUrl":"https://doi.org/10.31256/hsmr2023.74","url":null,"abstract":"Early detection of precancerous forms in the intestine, e.g. adenomatous polyps, can be achieved with regular screening programmes of the lower gastro-intestinal tract (GI) by means of flexible sigmoidoscopy and colonoscopy. Screening of the GI tract is of paramount importance to reduce the high death rate of patients affected by colon cancer worldwide. Nonetheless, colonoscopy typi- cally causes discomfort and often requires sedation for the patient because of its invasiveness and abdominal pain as- sociated with it. Research on robotic-assisted colonoscopy is advancing in the design of minimally invasive devices aimed at the inspection of the GI, with the goal of reducing the discomfort caused to the patient while resulting in a safer and more successful procedure [1]. Multiple loco- motion strategies have been explored to enable front-head locomotion of endoscopes, to minimise the interaction forces between the scope and the intestine wall, as these forces are typically the first cause of discomfort for the patient. Extensive studies have been conducted in the context of track-based miniaturised robots such as [2] and [3]. However, due to the fixed geometry of these systems, adapting to the variable and irregular lumen of the colon to enable full body track-based navigation is not possible. Furthermore, as per many of the robotic solution presented to date for GI screening, there is also a need to drag a tether, the frictional resistance of which grows the more the robot advances in the intestine. Soft materials properties have inspired research of mechanism to accomplish a compliant interaction with the tissue, such as the use of inflatable balloons for double balloon endoscopy. In our previous work [4], we have presented a novel robotic system for colonoscopy called SoftSCREEN. The proposed system relies on track-based locomotion and shape reconfiguration enabled by two inflatable chambers capable of displacing the elastic tracks to conform to the local geometry of the lumen, enabling full-body track navigation. In this seminal paper we have validated the proposed desing in a 2:1 scale system and demonstrated that not only is possible to reconfigure our system to always match the lumen navigated, but also to control the force applied on the walls by means of pressure regulation, and, as a result, fine tuning the traction force of our system. In this work, we present the first miniaturised and modularised prototype of the SoftSCREEN system, designed to create a sterilisable reusable expensive compo- nent and a cheap disposable component. We then evaluate this first prototype in a 1:1 scale phantom.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"246 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":"122130558","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":"Usability study of human-computer interfaces for 3D model manual registration in augmented reality application for surgery","authors":"A. Neri, V. Penza, L. Mattos","doi":"10.31256/hsmr2023.59","DOIUrl":"https://doi.org/10.31256/hsmr2023.59","url":null,"abstract":"Augmented reality (AR) is becoming essential in several surgical specialities [1]. Fusing patient-specific preoper- ative information, typically 3D models extracted from CT scans or MRI, on the real-time surgical images allows the surgeon to have detailed information on the anatomical structure of the surgical target intra- operatively. As stated in [2] and [3], an AR system’s first step consists of an initial rigid registration of the 3D models on the surgical image. Most of the approaches are manual or semi-automatic. While the latter exploits physical landmarks on the tissue or 3D surface features, the manual approach requires Human- Computer Interfaces (HCI) to manipulate the models. The choice of the HCI is fundamental to develop an easy-to-use application with a short learning curve. In fact, the way the manual registration is performed can impact the users’ physical and mental stress, influencing their final performances. This paper presents a human-centred usability study that aims to evaluate two modern HCI devices com- monly proposed for 3D model manipulation in surgical augmented reality applications, i.e., the SpaceMouse® and UltraLeap® . Accordingly, a software interface was developed to allow the manipulation of 3D models in a minimally invasive partial nephrectomy scenario. Subjects were asked to perform a rigid manual registration of a kidney’s 3D model on the image of the real kidney. Quantitative and qualitative evaluation was performed to assess the cognitive and physical load imposed on the operators, which can support an informed selection of HCI to maximize system usability and operator perfor- mance. These trials were performed under study protocol 229/2019 - ID 4621, approved by the Regional Ethics Committee of Liguria (Italy).","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"27 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":"126086269","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":"Augmented Reality-assisted Epidural Needle Insertion: User Experience and Performance","authors":"Negar Kazemipour, A. Sayadi, R. Cecere, J. Barralet, Amir Amir","doi":"10.31256/hsmr2023.13","DOIUrl":"https://doi.org/10.31256/hsmr2023.13","url":null,"abstract":"The epidural injection is a medical intervention to inject therapeutics directly in the vicinity of the spinal cord and the nerves branching from it. Epidural needle insertion is a blind procedure that relies merely on the physician’s tactile feedback. Nevertheless, tactile feedback can be polluted with needle-tissue friction and may vary from patient to patient. In order to achieve sub-millimetre accuracy, preempt neurological damage, and reduce the radiation exposure time for patients and physicians, new technologies have been used. Most recently, augmented reality (AR)-based methods have shown promising results in reducing the need for intraoperative X-ray imaging, especially in spine surgery. AR navigation is based on displaying images directly on a wearable device or screen visualizing surgical instruments and patients’ anatomy. Combined with robotic precision, AR shows an excellent prospect for increasing accuracy for spinal injection similar to that of spine surgery [1]. Studies have shown that the AR navigation systems, when compared to the free- hand methods, resulted in increased precision of pedicle screw placement without intraoperative fluoroscopy [1], [2] and decreased radiation [3]. Inspired by the recent de- velopments in spine surgery, in this study we have studied the user experience who used our robot-assisted needle insertion system for epidural space localization and needle insertion. In addition, the accuracy and repeatability of augmented reality-assisted epidural needle insertion were compared to that of non-assisted robotic needle insertion. For user experience assessment, NASA Task Load Index (TLX) [4] was used and analyzed.","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":"129548337","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":"Simulating Mesh Cutting with the dVRK in Unity","authors":"Kanishkan Senthilkumar, R. Gondokaryono, Mustafa Haiderbhai, L. Kahrs","doi":"10.31256/hsmr2023.70","DOIUrl":"https://doi.org/10.31256/hsmr2023.70","url":null,"abstract":"Research in surgical robotics and automation has made remarkable advancements in recent years thanks to new methods in computer vision, control, and deep learning. Autonomous end-effector manipulation is a challenging task in surgical robotics, and cutting with scissor tools is largely unexplored. A concurrent work explored path and trajectory generation for cutting deformable materials using the da Vinci Research Kit (dVRK) [1]. However, an efficient and realistic simulation is necessary for methods such as reinforcement learning (RL) or learned trajectory planning. Our previous work built a simulation for the dVRK in Unity for training RL algorithms on rigid body tasks [2]. To our knowledge, there is no dVRK simulation available that includes the cutting of deformable materials. This paper introduces a cutting simulation of a deformable mesh, which can represent a tissue layer, built onto our Unity dVRK simulation.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"47 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":"127877848","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 Soft Laparoscopic Grasper for Retraction of the Small Intestine","authors":"Lorenzo Kinnicutt, Jungjae Lee, Janae Oden, Leah T Gaeta, S. Carroll, Anushka Rathi, Zi Heng Lim, Megan Lee, Chisom Orakwue, Kevin McDonald, Donald Hess, Tommaso Ranzani","doi":"10.31256/hsmr2023.51","DOIUrl":"https://doi.org/10.31256/hsmr2023.51","url":null,"abstract":"Laparoscopy can improve outcomes and patient re- covery times compared to open surgery. However, the minimally-invasive nature of these procedures deprives clinicians of tactile feedback which, when coupled with pinching graspers that deliver high-stress concentrations, increases the likelihood of inflicting iatrogenic trauma upon tissues, especially the small intestine [1]–[4]. Retraction of the small intestine is often necessary to vi- sualize and access nearby tissues [5], [6]. Commercially- available devices rely on passive structures to hold intestinal segments and do not embed compliance [7]. Prior research on surgical retractors has focused on granular jamming [5], pneumatic balloons [6], and either cable-driven [8] or vacuum [9] graspers. However, these devices are challenging to integrate into surgical work- flows, require auxiliary instruments, and do not provide feedback regarding tissue interaction forces. We introduce a laparoscopic grasper capable of passing through an 18 mm trocar, expanding to a controllable width once inside the abdominal cavity, and safely enveloping the small intestine to enable retraction. Upon entry into the abdominal cavity, the grasper estab- lishes an initial hold on a target intestinal segment by pulling vacuum through the suction unit on its distal tip (Fig. 1[a]); this functionality helps the surgeon isolate the target intestinal segment from surrounding bundles. Once a preliminary suction hold has been established, the grasper envelops the intestine by inflating a pair of pneumatic fiber-reinforced soft actuators (FRSAs) (Fig. 1[b]-[c]), whose separation can be modulated up to 40 mm using a miniaturized scissor lift mechanism (MSLM). This approach distributes the force necessary to grasp and hold the intestine over a large surface area (i.e., the whole surface of the FRSAs) rather than concentrating it in a small region, allowing safe, robust grasps even on dilated intestinal segments. Inflation of the FRSAs and suction are controlled using two buttons (Fig. 1 [d]). The horizontal position of the FRSAs and the separation between them are independently actuated via two linear motors, which the surgeon controls using a rocker switch and trigger, respectively (Fig. 1 [d]). Each actuator is equipped with two soft sensors to interpret 3D interaction forces via a machine learning algorithm.","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":"121129010","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":"Flexible Magnetic Soft Stent for Mobile Flow Diversion","authors":"Tianlu Wang, M. Sitti","doi":"10.31256/hsmr2023.23","DOIUrl":"https://doi.org/10.31256/hsmr2023.23","url":null,"abstract":"With the advantages in dimensions and exceptional locomotion capabilities, small-scale mobile robots have offered new opportunities for medical interventions in hard-to-reach regions, including the distal arteries in the circulatory systems. In this field, the wireless soft robots fabricated with compliant materials further provide unique adaptation capabilities and, thus, many exciting potential applications [1]. Although various locomotion abilities have been demonstrated and studied from the aspects of robot design, control strategies, and soft- bodied interactions [2], rare effective functions other than drug delivery have been properly incorporated into these robots for potential in-vivo utilities. Our group has recently developed a medical robotic system with a stent- shaped magnetic soft device (Stentbot) and the associated spatial magnetic actuation setup, which realized the on- demand local drug delivery and the flow diversion using a millimeter wireless robot design [3]. Its flexible locomotion capabilities have indicated its benefits of working as a mobile flow diverter if clinical migrations or misplacements happen when treating brain aneurysms using stent-like structures. However, this single-material development traded off the performance in locomotion abilities and the efficacy of flow diversion. For example, pure mesh-like structures ensure full body adaptation for the retrievable locomotion among the lumens with varying diameters, but the effectiveness of flow diversion is reduced since flow could go through the meshes freely. On the other hand, a full surface-sealed, hollow tube structure where all the gaps among meshes are filled could have a perfect flow diversion effect. However, the radial stiffness of the structure is notably increased, such that the shape adaptation capability is reduced. Therefore, there is a missing solution for the effective flow diverter with proper adaptation for the future treatments of brain aneurysms and other diseases, such as arteriovenous malformation.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"119 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":"131950904","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":"SLAM-based Trackerless Navigation System for Lateral Skull base Surgery: A Pilot Cadaver Study","authors":"Haoying Zhou, Ryan A Bartholomew, Maud Boreel, Alejandro Garcia, Krish Suresh, Saksham Gupta, J. Guenette, Daniel Lee, C. Corrales, J. Jagadeesan","doi":"10.31256/hsmr2023.2","DOIUrl":"https://doi.org/10.31256/hsmr2023.2","url":null,"abstract":"Lateral skull base surgery requires drilling near del- icate structures with high accuracy. Misidentification of anatomy within the opaque temporal bone can lead to inadvertent surgical complications with high morbidity including facial paralysis, hearing loss, and dysequi- librium. Given that benign pathology is typically the indication for surgery, it is of elevated importance for the lateral skull base surgeon to deftly tread the line between underexposure, which risks persistent disease, and overexposure, which risks iatrogenic injury. The safety and efficacy of lateral skull base surgery may be improved with a viable surgical navigation system. Despite the availability of surgical navigation systems for nearly three decades, they are infrequently used for lateral skull base surgeries. The navigation systems depend on external tracking equipment and can suffer from cumbersome registration and calibration steps, and suffer from metallic interference or line-of-sight issues. Moreover, for lateral skull base surgery, the patient head position may be adjusted intraoperatively and result in a significant registration error.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"4 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":"130667884","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":"Feasibility of Mobile Application for Surgical Robot Teleoperation","authors":"Akhilesh Deo, P. Kazanzides","doi":"10.31256/hsmr2023.63","DOIUrl":"https://doi.org/10.31256/hsmr2023.63","url":null,"abstract":"In recent years, robotic surgery has gained popularity due to its numerous advantages, including greater control and access for surgeons, shorter recovery times, and lower levels of pain for patients [1]. However, surgical robot systems require extensive training for surgeons to master their use. Simulation-based training has become a component of surgical education [2], providing a safe environment for trainees to acquire and refine their skills. However, most existing training platforms require bulky and expensive control consoles, which limits their availability and convenience. The development of a low- cost and easily deployed control console can address these limitations, thereby potentially enhancing the effectiveness of robotic surgery training. A system that satisfies these criteria can also enable medical robotics research in low-resource environments, where cost and accessibility are the most significant impediments to research. This paper describes the creation and evaluation of an iPhone application for these purposes.","PeriodicalId":129686,"journal":{"name":"Proceedings of The 15th Hamlyn Symposium on Medical Robotics 2023","volume":"395 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":"123259928","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}