Imperial College London

Dr George Mylonas

Faculty of MedicineDepartment of Surgery & Cancer

Lecturer in Robotics and Technology in Cancer
 
 
 
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Contact

 

+44 (0)20 3312 5145george.mylonas Website

 
 
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Location

 

Room 5Paterson WingSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
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80 results found

Kinross JM, Mason SE, Mylonas G, Darzi Aet al., 2020, Next-generation robotics in gastrointestinal surgery., Nat Rev Gastroenterol Hepatol

The global numbers of robotic gastrointestinal surgeries are increasing. However, the evidence base for robotic gastrointestinal surgery does not yet support its widespread adoption or justify its cost. The reasons for its continued popularity are complex, but a notable driver is the push for innovation - robotic surgery is seen as a compelling solution for delivering on the promise of minimally invasive precision surgery - and a changing commercial landscape delivers the promise of increased affordability. Novel systems will leverage the robot as a data-driven platform, integrating advances in imaging, artificial intelligence and machine learning for decision support. However, if this vision is to be realized, lessons must be heeded from current clinical trials and translational strategies, which have failed to demonstrate patient benefit. In this Perspective, we critically appraise current research to define the principles on which the next generation of gastrointestinal robotics trials should be based. We also discuss the emerging commercial landscape and define existing and new technologies.

Journal article

Zhao M, Oude Vrielink TJC, Kogkas A, Runciman M, Elson D, Mylonas Get al., 2020, LaryngoTORS: a novel cable-driven parallel robotic system for transoral laser phonosurgery, IEEE Robotics and Automation Letters, Vol: 5, Pages: 1516-1523, ISSN: 2377-3766

Transoral laser phonosurgery is a commonly used surgical procedure in which a laser beam is used to perform incision, ablation or photocoagulation of laryngeal tissues. Two techniques are commonly practiced: free beam and fiber delivery. For free beam delivery, a laser scanner is integrated into a surgical microscope to provide an accurate laser scanning pattern. This approach can only be used under direct line of sight, which may cause increased postoperative pain to the patient and injury, is uncomfortable for the surgeon during prolonged operations, the manipulability is poor and extensive training is required. In contrast, in the fiber delivery technique, a flexible fiber is used to transmit the laser beam and therefore does not require direct line of sight. However, this can only achieve manual level accuracy, repeatability and velocity, and does not allow for pattern scanning. Robotic systems have been developed to overcome the limitations of both techniques. However, these systems offer limited workspace and degrees-of-freedom (DoF), limiting their clinical applicability. This work presents the LaryngoTORS, a robotic system that aims at overcoming the limitations of the two techniques, by using a cable-driven parallel mechanism (CDPM) attached at the end of a curved laryngeal blade for controlling the end tip of the laser fiber. The system allows autonomous generation of scanning patterns or user driven freepath scanning. Path scan validation demonstrated errors as low as 0.054±0.028 mm and high repeatability of 0.027±0.020 mm (6×2 mm arc line). Ex vivo tests on chicken tissue have been carried out. The results show the ability of the system to overcome limitations of current methods with high accuracy and repeatability using the superior fiber delivery approach.

Journal article

Runciman M, Avery J, Zhao M, Darzi A, Mylonas GPet al., 2020, Deployable, variable stiffness, cable driven robot for minimally invasive surgery, Frontiers in Robotics and AI, Vol: 6, Pages: 1-16, ISSN: 2296-9144

Minimally Invasive Surgery (MIS) imposes a trade-off between non-invasive access and surgical capability. Treatment of early gastric cancers over 20 mm in diameter can be achieved by performing Endoscopic Submucosal Dissection (ESD) with a flexible endoscope; however, this procedure is technically challenging, suffers from extended operation times and requires extensive training. To facilitate the ESD procedure, we have created a deployable cable driven robot that increases the surgical capabilities of the flexible endoscope while attempting to minimize the impact on the access that they offer. Using a low-profile inflatable support structure in the shape of a hollow hexagonal prism, our robot can fold around the flexible endoscope and, when the target site has been reached, achieve a 73.16% increase in volume and increase its radial stiffness. A sheath around the variable stiffness structure delivers a series of force transmission cables that connect to two independent tubular end-effectors through which standard flexible endoscopic instruments can pass and be anchored. Using a simple control scheme based on the length of each cable, the pose of the two instruments can be controlled by haptic controllers in each hand of the user. The forces exerted by a single instrument were measured, and a maximum magnitude of 8.29 N observed along a single axis. The working channels and tip control of the flexible endoscope remain in use in conjunction with our robot and were used during a procedure imitating the demands of ESD was successfully carried out by a novice user. Not only does this robot facilitate difficult surgical techniques, but it can be easily customized and rapidly produced at low cost due to a programmatic design approach.

Journal article

Ezzat A, Thakkar R, Kogkas A, Mylonas Get al., 2019, Perceptions of surgeons and scrub nurses towards a novel eye-tracking based robotic scrub nurse platform, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY, Pages: 81-82, ISSN: 0007-1323

Conference paper

Runciman M, Darzi A, Mylonas G, 2019, Soft robotics in minimally invasive surgery, Soft Robotics, Vol: 6, Pages: 423-443, ISSN: 2169-5172

Soft robotic devices have desirable traits for applications in minimally invasive surgery (MIS) but many interdisciplinary challenges remain unsolved. To understand current technologies, we carried out a keyword search using the Web of Science and Scopus databases, applied inclusion and exclusion criteria, and compared several characteristics of the soft robotic devices for MIS in the resulting articles. There was low diversity in the device designs and a wide-ranging level of detail regarding their capabilities. We propose a standardised comparison methodology to characterise soft robotics for various MIS applications, which will aid designers producing the next generation of devices.

Journal article

Fathi J, Vrielink TJCO, Runciman MS, Mylonas GPet al., 2019, A Deployable Soft Robotic Arm with Stiffness Modulation for Assistive Living Applications, International Conference on Robotics and Automation (ICRA), Publisher: IEEE, Pages: 1479-1485, ISSN: 1050-4729

Conference paper

Patel N, Kogkas A, Ben Glover AD, Mylonas Get al., 2019, EYE GAZE-CONTROLLED ROBOTIC FLEXIBLE ENDOSCOPY: A FEASIBILITY STUDY, Annual Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, Pages: A38-A39, ISSN: 0017-5749

Conference paper

Wang M-Y, Kogkas AA, Darzi A, Mylonas GPet al., 2019, Free-View, 3D Gaze-Guided, Assistive Robotic System for Activities of Daily Living, 25th IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Publisher: IEEE, Pages: 2355-2361, ISSN: 2153-0858

Conference paper

Vrielink TJCO, Puyal JG-B, Kogkas A, Darzi A, Mylonas Get al., 2019, Intuitive Gaze-Control of a Robotized Flexible Endoscope, 25th IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Publisher: IEEE, Pages: 1776-1782, ISSN: 2153-0858

Conference paper

Avery J, Runciman M, Darzi A, Mylonas GPet al., 2019, Shape Sensing of Variable Stiffness Soft Robots using Electrical Impedance Tomography, International Conference on Robotics and Automation (ICRA), Publisher: IEEE, Pages: 9066-9072, ISSN: 1050-4729

Conference paper

Kogkas A, Ezzat A, Thakkar R, Darzi A, Mylonas Get al., 2019, Free-View, 3D Gaze-Guided Robotic Scrub Nurse, Pages: 164-172, ISBN: 9783030322533

© 2019, Springer Nature Switzerland AG. We introduce a novel 3D gaze-guided robotic scrub nurse (RN) and test the platform in simulated surgery to determine usability and acceptability with clinical teams. Surgeons and trained scrub nurses performed an ex vivo task on pig colon. Surgeons used gaze via wearable eye-tracking glasses to select surgical instruments on a screen, in turn initiating RN to deliver the instrument. Comparison was done between human- and robot-assisted tasks (HT vs RT). Real-time gaze-screen interaction was based on a framework developed with synergy of conventional wearable eye-tracking, motion capture system and RGB-D cameras. NASA-TLX and Van der Laan’s technology acceptance questionnaires were collected and analyzed. 10 teams of surgical trainees (ST) and scrub nurses (HN) participated. Overall, NASA-TLX feedback was positive. ST and HN revealed no statistically significant difference in overall task load. Task performance feedback was unaffected. Frustration was reported by ST. Overall, Van der Laan’s scores showed positive usefulness and satisfaction scores following RN use. There was no significant difference in task interruptions across HT vs RT. Similarly, no statistical difference was found in duration to task completion in both groups. Quantitative and qualitative feedback was positive. The source of frustration has been understood. Importantly, there was no significant difference in task workflow or operative time, with overall perceptions towards task performance remaining unchanged in HT vs RT.

Book chapter

Achanccaray D, Mylonas G, Andreu-Perez J, 2019, An Implicit Brain Computer Interface Supported by Gaze Monitoring for Virtual Therapy, IEEE International Conference on Systems, Man and Cybernetics (SMC), Publisher: IEEE, Pages: 2829-2832, ISSN: 1062-922X

Conference paper

Zhao M, Oude Vrielink J, Kogkas A, Mylonas G, Elson Det al., Prototype Designs of a Cable-driven Parallel Robot for Transoral Laser Surgery, Hamlyn Symposium on Medical Robotics

Conference paper

Vrielink TJCO, Chao M, Darzi A, Mylonas GPet al., 2018, ESD CYCLOPS: A new robotic surgical system for GI surgery, IEEE International Conference on Robotics and Automation (ICRA), Publisher: IEEE COMPUTER SOC, Pages: 150-157, ISSN: 1050-4729

Conference paper

Pittiglio G, Kogkas A, Vrielink JO, Mylonas Get al., 2018, Dynamic Control of Cable Driven Parallel Robots with Unknown Cable Stiffness: a Joint Space Approach, IEEE International Conference on Robotics and Automation (ICRA), Publisher: IEEE COMPUTER SOC, Pages: 948-955, ISSN: 1050-4729

Conference paper

Runciman M, Darzi A, Mylonas G, 2018, Deployable disposable self-propelling and variable stiffness devices for minimally invasive surgery, Conference on New Technologies for Computer/Robot Assisted Surgery

Conference paper

Miyashita K, Oude Vrielink T, Mylonas G, 2018, A cable-driven parallel manipulator with force sensing capabilities for high-accuracy tissue endomicroscopy, International Journal of Computer Assisted Radiology and Surgery, Vol: 13, Pages: 659-669, ISSN: 1861-6429

PURPOSE: Endomicroscopy (EM) provides high resolution, non-invasive histological tissue information and can be used for scanning of large areas of tissue to assess cancerous and pre-cancerous lesions and their margins. However, current robotic solutions do not provide the accuracy and force sensitivity required to perform safe and accurate tissue scanning. METHODS: A new surgical instrument has been developed that uses a cable-driven parallel mechanism (CPDM) to manipulate an EM probe. End-effector forces are determined by measuring the tensions in each cable. As a result, the instrument allows to accurately apply a contact force on a tissue, while at the same time offering high resolution and highly repeatable probe movement. RESULTS: 0.2 and 0.6 N force sensitivities were found for 1 and 2 DoF image acquisition methods, respectively. A back-stepping technique can be used when a higher force sensitivity is required for the acquisition of high quality tissue images. This method was successful in acquiring images on ex vivo liver tissue. CONCLUSION: The proposed approach offers high force sensitivity and precise control, which is essential for robotic EM. The technical benefits of the current system can also be used for other surgical robotic applications, including safe autonomous control, haptic feedback and palpation.

Journal article

Avila Rencoret FB, Mylonas G, Elson D, 2018, Robotic wide-field optical biopsy endoscopy, OSA Biophotonics Congress 2018, Publisher: OSA publishing

This paper describes a novel robotic framework for wide-field optical biopsy endoscopy, characterizes in vitro its spatial and spectral resolution, real time hyperspectral tissue classification, and demonstrates its feasibility on fresh porcine cadaveric colon.

Conference paper

Avila Rencoret FB, Mylonas GP, Elson D, Robotic Wide-Field Optical Biopsy Imaging For Flexible Endoscopy, 26th International Congress of the European Association for Endoscopic Surgery (EAES)

Conference paper

Elson D, Avila Rencoret F, Mylonas G, Robotic Wide-Field Optical Biopsy Imaging for Flexible Endoscopy (Gerhard Buess Technology Award), 26th Annual International EAES Congress

Conference paper

Zhao M, Oude Vrielink T, Elson D, Mylonas Get al., Endoscopic TORS-CYCLOPS: A Novel Cable-driven Parallel Robot for Transoral Laser Surgery, 26th Annual International EAES Congress

Conference paper

Ashraf H, Sodergren M, Merali N, Mylonas G, Singh H, Darzi Aet al., 2017, Eye-tracking technology in medical education: A systematic review, Medical Teacher, Vol: 40, Pages: 62-69, ISSN: 0142-159X

Background: Eye-tracking technology is an established research tool within allied industries such as advertising, psychology and aerospace. This review aims to consolidate literature describing the evidence for use of eye-tracking as an adjunct to traditional teaching methods in medical education.Methods: A systematic literature review was conducted in line with STORIES guidelines. A search of EMBASE, OVID MEDLINE, PsycINFO, TRIP database, and Science Direct was conducted until January 2017. Studies describing the use of eye-tracking in the training, assessment, and feedback of clinicians were included in the review.Results: Thirty-three studies were included in the final qualitative synthesis. Three studies were based on the use of gaze training, three studies on the changes in gaze behavior during the learning curve, 17 studies on clinical assessment and six studies focused on the use of eye-tracking methodology as a feedback tool. The studies demonstrated feasibility and validity in the use of eye-tracking as a training and assessment method.Conclusions: Overall, eye-tracking methodology has contributed significantly to the training, assessment, and feedback practices used in the clinical setting. The technology provides reliable quantitative data, which can be interpreted to give an indication of clinical skill, provide training solutions and aid in feedback and reflection. This review provides a detailed summary of evidence relating to eye-tracking methodology and its uses as a training method, changes in visual gaze behavior during the learning curve, eye-tracking methodology for proficiency assessment and its uses as a feedback tool.

Journal article

Kogkas AA, Darzi A, Mylonas GP, 2017, Gaze-contingent perceptually enabled interactions in the operating theatre., International Journal of Computer Assisted Radiology and Surgery, Vol: 12, Pages: 1131-1140, ISSN: 1861-6410

PURPOSE: Improved surgical outcome and patient safety in the operating theatre are constant challenges. We hypothesise that a framework that collects and utilises information -especially perceptually enabled ones-from multiple sources, could help to meet the above goals. This paper presents some core functionalities of a wider low-cost framework under development that allows perceptually enabled interaction within the surgical environment. METHODS: The synergy of wearable eye-tracking and advanced computer vision methodologies, such as SLAM, is exploited. As a demonstration of one of the framework's possible functionalities, an articulated collaborative robotic arm and laser pointer is integrated and the set-up is used to project the surgeon's fixation point in 3D space. RESULTS: The implementation is evaluated over 60 fixations on predefined targets, with distances between the subject and the targets of 92-212 cm and between the robot and the targets of 42-193 cm. The median overall system error is currently 3.98 cm. Its real-time potential is also highlighted. CONCLUSIONS: The work presented here represents an introduction and preliminary experimental validation of core functionalities of a larger framework under development. The proposed framework is geared towards a safer and more efficient surgical theatre.

Journal article

Mylonas G, patel N, teare J, darzi Aet al., 2017, CYCLOPS: An endoscope attachment for Endoscopic Submucosal Dissection, SAGES 2017 Annual Meeting

Poster

Oude Vrielink TJC, Darzi, Mylonas G, 2016, microCYCLOPS: A Robotic System for Microsurgical Applications, 6th Joint Workshop on New Technologies for Computer/Robot Assisted Surgery (CRAS 2016)

Conference paper

Avila-Rencoret F, Oude Vrielink T, Elson DS, Mylonas Get al., EndoSDR: Concurrent Endoscopic Screening, Diagnosis, and Removal of GI cancers (prize winner), Business Engineering and Surgical Technologies Innovation Symposium (BEST)

Conference paper

Avila Rencoret FB, Elson D, Mylonas G, A Robotic Hyperspectral Scanning Framework for Endoscopy, CRAS - Workshop on Computer/Robot Assisted Surgery

Gastrointestinal (GI) endoscopy is the gold-standard procedure for detection and treatment of dysplastic lesions and early stage GI cancers. Despite its proven effectiveness, its sensitivity remains suboptimal due to the subjective nature of the examination, which is substantially reliant on human-operator skills. For bowel cancer, colonoscopy can miss up to 22% of dysplastic lesions, with even higher miss rates for small (<5 mm diameter) and flat lesions. We propose a robotic hyperspectral (HS) scanning framework that aims to improve the sensitivity of GI endoscopy by automated scanning and real-time classification of wide tissue areas based on their HS features. A “hot-spot” map is generated to highlight dysplastic or cancerous lesions for further scrutiny or concurrent resection. The device works as an add-on accessory to any conventional endoscope, and to our knowledge, is the first of its kind. This paper focuses on characterising its optical resolution on rigid and deformable colon phantoms. We report for the first time 2D and 3D wide-area reconstruction of endoscopic HS data with sub-millimetre optical resolution. The current setup, compatible with the anatomical dimensions of the colon, could allow the identification of flat and small pre-cancerous lesions that are currently missed. The proposed framework will lay the foundations towards the next generation of augmented reality endoscopy while increasing its sensitivity and specificity.

Conference paper

Kogkas A, Darzi A, Mylonas GP, Gaze-Driven Human-Robot Interaction in the Operating Theatre, 6th Joint Workshop on New Technologies for Computer/Robot Assisted Surgery (CRAS 2016)

Conference paper

Khan DZ, Oude Vrielink TJC, Marcus H, Darzi A, Mylonas Get al., NeuroCYCLOPS: development and preclinical validation of a robotic platform for endoscopic neurosurgery, European Association of Neurosurgical Societies (EANS 2016), Publisher: European Association of Neurosurgical Societies

Conference paper

Oude Vrielink TJC, Khan DZ, Marcus H, Darzi A, Mylonas Get al., 2016, NeuroCYCLOPS: a novel system for endoscopic neurosurgery, London, The Hamlyn Symposium on Medical Robotics, Publisher: Imperial College London, Pages: 36-37

Conference paper

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