96 results found
Runciman M, Avery J, Darzi A, et al., 2021, Open Loop Position Control of Soft Hydraulic Actuators for Minimally Invasive Surgery, APPLIED SCIENCES-BASEL, Vol: 11
Ezzat A, Kogkas A, Holt J, et al., 2021, An eye-tracking based robotic scrub nurse: proof of concept, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 35, Pages: 5381-5391, ISSN: 0930-2794
Kinross JM, Mason SE, Mylonas G, et al., 2021, Next-generation robotics in gastrointestinal surgery (vol 17, pg 430, 2020), NATURE REVIEWS GASTROENTEROLOGY & HEPATOLOGY, Vol: 18, Pages: 589-589, ISSN: 1759-5045
Sivananthan A, Kogkas A, Glover B, et al., 2021, A novel gaze-controlled flexible robotized endoscope; preliminary trial and report, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 35, Pages: 4890-4899, ISSN: 0930-2794
BackgroundInterventional endoluminal therapy is rapidly advancing as a minimally invasive surgical technique. The expanding remit of endoscopic therapy necessitates precision control. Eye tracking is an emerging technology which allows intuitive control of devices. This was a feasibility study to establish if a novel eye gaze-controlled endoscopic system could be used to intuitively control an endoscope.MethodsAn eye gaze-control system consisting of eye tracking glasses, specialist cameras and a joystick was used to control a robotically driven endoscope allowing steering, advancement, withdrawal and retroflexion. Eight experienced and eight non-endoscopists used both the eye gaze system and a conventional endoscope to identify ten targets in two simulated environments: a sphere and an upper gastrointestinal (UGI) model.Completion of tasks was timed. Subjective feedback was collected from each participant on task load (NASA Task Load Index) and acceptance of technology (Van der Laan scale).ResultsWhen using gaze-control endoscopy, non-endoscopists were significantly quicker when using gaze-control rather than conventional endoscopy (sphere task 3:54 ± 1:17 vs. 9:05 ± 5:40 min, p = 0.012, and UGI model task 1:59 ± 0:24 vs 3:45 ± 0:53 min, p < .001).Non-endoscopists reported significantly higher NASA-TLX workload total scores using conventional endoscopy versus gaze-control (80.6 ± 11.3 vs 22.5 ± 13.8, p < .001). Endoscopists reported significantly higher total NASA-TLX workload scores using gaze control versus conventional endoscopy (54.2 ± 16 vs 26.9 ± 15.3, p = 0.012). All subjects reported that the gaze-control had positive ‘usefulness’ and ‘satisfaction’ score of 0.56 ± 0.83 and 1.43 &
Khan DZ, Golahmadi AK, Mylonas G, et al., 2021, Tool-tissue Forces in Surgery: A Systematic Review, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Ashraf H, Sodergren M, Mylonas G, et al., 2021, The Identification of Gaze Behaviour and Physiological Markers Associated With Making An Error During Laparoscopic Cholecystectomy, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Golahmadi AK, Khan DZ, Mylonas GP, et al., 2021, Tool-tissue forces in surgery: A systematic review, Annals of Medicine and Surgery, Vol: 65, Pages: 1-7, ISSN: 2049-0801
BackgroundExcessive tool-tissue interaction forces often result in tissue damage and intraoperative complications, while insufficient forces prevent the completion of the task. This review sought to explore the tool-tissue interaction forces exerted by instruments during surgery across different specialities, tissues, manoeuvres and experience levels.Materials & methodsA PRISMA-guided systematic review was carried out using Embase, Medline and Web of Science databases.ResultsOf 462 articles screened, 45 studies discussing surgical tool-tissue forces were included. The studies were categorized into 9 different specialities with the mean of average forces lowest for ophthalmology (0.04N) and highest for orthopaedic surgery (210N). Nervous tissue required the least amount of force to manipulate (mean of average: 0.4N), whilst connective tissue (including bone) required the most (mean of average: 45.8). For manoeuvres, drilling recorded the highest forces (mean of average: 14N), whilst sharp dissection recorded the lowest (mean of average: 0.03N). When comparing differences in the mean of average forces between groups, novices exerted 22.7% more force than experts, and presence of a feedback mechanism (e.g. audio) reduced exerted forces by 47.9%.ConclusionsThe measurement of tool-tissue forces is a novel but rapidly expanding field. The range of forces applied varies according to surgical speciality, tissue, manoeuvre, operator experience and feedback provided. Knowledge of the safe range of surgical forces will improve surgical safety whilst maintaining effectiveness. Measuring forces during surgery may provide an objective metric for training and assessment. Development of smart instruments, robotics and integrated feedback systems will facilitate this.
Liu T, Yang T, Xu W, et al., 2021, Efficient Inverse Kinematics and Planning of a Hybrid Active and Passive Cable-Driven Segmented Manipulator, IEEE Transactions on Systems, Man, and Cybernetics: Systems, ISSN: 2168-2216
A cable-driven segmented manipulator (CDSM) has superior dexterity for operations in confined space due to its light-slender body and redundant degree of freedoms (DOFs). However, its inverse kinematics resolving and configuration planning are very challenging due to the complex structure and strict constraints. In this article, we propose a two-layer geometric iteration (TLGI) method for inverse kinematics resolving and configuration-constrained Cartesian path planning. The computation efficiency is largely improved and singularities are avoided. First, the end-effector attitude is decomposed into a direction vector and a rotation angle. The former and the end-effector position are combined into state variables of the inner layer, and the latter is treated separately as the state variable of the outer layer. Then, the TLGI method enables to rapidly reach the desired 6-DOF pose by two-layer iterations, i.e., the inner and outer loop iteration. Second, during the inner loop iteration, the CDSM is modeled as an equivalent articulated arm whose end-effector position and direction is the same as that of CDSM, but its links length and joint angles depend on the current configuration of CDSM. Then, the efficient forward and backward reaching inverse kinematics (FABRIKs) method is extended to apply on CDSM so that it can fast reach the inner state variables. During the outer loop iteration, three different rotation cases, i.e., the rotating around the end, root, and both end and root, are designed to switch automatically to reach the outer state variable iteratively. Moreover, by parameterizing geometric constraints of the environment, a TLGI-based configuration-pose simultaneous planning method is also put forward to efficiently achieve additional configuration constraints for operations of CDSM in confined space. Finally, the proposed method is verified by both the simulations and experiments.
Saracino A, Oude-Vrielink TJC, Menciassi A, et al., 2020, Haptic Intracorporeal Palpation Using a Cable-Driven Parallel Robot: A User Study, IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, Vol: 67, Pages: 3452-3463, ISSN: 0018-9294
Arezzo A, Francis N, Mintz Y, et al., 2020, EAES recommendations for recovery plan in minimally invasive surgery amid COVID-19 pandemic, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 35, Pages: 1-17, ISSN: 0930-2794
BackgroundCOVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts’ opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic.MethodsRecommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement.ResultsA total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus.ConclusionThe recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems.
Avery J, Shulakova D, Runciman M, et al., 2020, Tactile sensor for minimally invasive surgery using Electrical Impedance Tomography, IEEE Transactions on Medical Robotics and Bionics, Vol: 2, Pages: 561-564, ISSN: 2576-3202
Whilst offering numerous benefits to patients, minimally invasive surgery (MIS) has a disadvantage in the loss of tactile feedback to the surgeon, traditionally offering valuable qualitative tissue assessment, such as tumour identification and localisation. Tactile sensors aim to overcome this loss of sensation by detecting tissue characteristics such as stiffness, composition and temperature. Tactile sensors have previously been incorporated into MIS robotic end effectors, which require lengthy scanning procedures due to localised sensitivity. Distributed tactile sensors, or “artificial skin” offer a map of tissue properties in a single instance but are often not suitable for MIS applications due to limited biocompatibility or large collapsed volumes. We propose a deployable, soft, tactile sensor with a deformable saline chamber and integrated Electrical Impedance Tomography (EIT) electrodes. During contact with tissue, the saline is displaced from the chamber and the lesion size and stiffness can be inferred from the resultant impedance changes. Through optimisation of the EIT measurement protocol and hardware the sensor was capable of localising the centre of mass of palpation targets within 1.5 mm in simulation and 2.3–4.6mm in phantom experiments. Reconstructed image metrics differentiated target objects from 8–30 mm.
Cursi F, Mylonas GP, Kormushev P, 2020, Adaptive kinematic modelling for multiobjective control of a redundant surgical robotic tool, Robotics, Vol: 9, Pages: 68-68, ISSN: 2218-6581
Accurate kinematic models are essential for effective control of surgical robots. For tendon driven robots, which are common for minimally invasive surgery, the high nonlinearities in the transmission make modelling complex. Machine learning techniques are a preferred approach to tackle this problem. However, surgical environments are rarely structured, due to organs being very soft and deformable, and unpredictable, for instance, because of fluids in the system, wear and break of the tendons that lead to changes of the system’s behaviour. Therefore, the model needs to quickly adapt. In this work, we propose a method to learn the kinematic model of a redundant surgical robot and control it to perform surgical tasks both autonomously and in teleoperation. The approach employs Feedforward Artificial Neural Networks (ANN) for building the kinematic model of the robot offline, and an online adaptive strategy in order to allow the system to conform to the changing environment. To prove the capabilities of the method, a comparison with a simple feedback controller for autonomous tracking is carried out. Simulation results show that the proposed method is capable of achieving very small tracking errors, even when unpredicted changes in the system occur, such as broken joints. The method proved effective also in guaranteeing accurate tracking in teleoperation.
Runciman M, Darzi A, Mylonas GP, 2020, Soft robotics in minimally invasive surgery (Part 2), Galvanotechnik, Vol: 111, Pages: 1236-1237, ISSN: 0016-4232
Kinross JM, Mason SE, Mylonas G, et al., 2020, Next-generation robotics in gastrointestinal surgery, Nature Reviews Gastroenterology and Hepatology, Vol: 17, Pages: 430-440, ISSN: 1759-5045
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.
Zhao M, Oude Vrielink TJC, Kogkas A, et 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.
Runciman M, Avery J, Zhao M, et 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.
Zhao M, Oude Vrielink J, Kogkas A, et al., 2020, LaryngoTORS: A Novel Cable-Driven Parallel Robot for Transoral Laser Surgery, International Conference on Robotics and Automation (ICRA)
Zhao M, Zhang H, Mylonas GP, et al., 2020, Cable-driven parallel robot assisted confocal imaging of the larynx
LaryngoTORS, a transoral laryngeal surgery robot, can manipulate instruments accurately. Confocal imaging has potentials in laryngeal cancer diagnosis but suffer from high scanning requirement. This work studies using LaryngoTORS to assist confocal imaging of larynx.
Ezzat A, Thakkar R, Kogkas A, et 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
Avery J, Runciman M, Darzi A, et 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
Soft robotic systems offer benefits over traditional rigid systems through reduced contact trauma with soft tissues and by enabling access through tortuous paths in minimally invasive surgery. However, the inherent deformability of soft robots places both a greater onus on accurate modelling of their shape, and greater challenges in realising intraoperative shape sensing. Herein we present a proprioceptive (self-sensing) soft actuator, with an electrically conductive working fluid. Electrical impedance measurements from up to six electrodes enabled tomographic reconstructions using Electrical Impedance Tomography (EIT). A new Frequency Division Multiplexed (FDM) EIT system was developed capable of measurements of 66 dB SNR with 20 ms temporal resolution. The concept was examined in two two-degree-of-freedom designs: a hydraulic hinged actuator and a pneumatic finger actuator with hydraulic beams. Both cases demonstrated that impedance measurements could be used to infer shape changes, and EIT images reconstructed during actuation showed distinct patterns with respect to each degree of freedom (DOF). Whilst there was some mechanical hysteresis observed, the repeatability of the measurements and resultant images was high. The results show the potential of FDM-EIT as a low-cost, low profile shape sensor in soft robots.
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.
Fathi J, Vrielink TJCO, Runciman MS, et 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
Patel N, Kogkas A, Ben Glover AD, et 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
Wang M-Y, Kogkas AA, Darzi A, et 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
Patients suffering from quadriplegia have limited body motion which prevents them from performing daily activities. We have developed an assistive robotic system with an intuitive free-view gaze interface. The user's point of regard is estimated in 3D space while allowing free head movement and is combined with object recognition and trajectory planning. This framework allows the user to interact with objects using fixations. Two operational modes have been implemented to cater for different eventualities. The automatic mode performs a pre-defined task associated with a gaze-selected object, while the manual mode allows gaze control of the robot's end-effector position on the user's frame of reference. User studies reported effortless operation in automatic mode. A manual pick and place task achieved a success rate of 100% on the users' first attempt.
Vrielink TJCO, Puyal JG-B, Kogkas A, et 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
Flexible endoscopy is a routinely performed procedure that has predominantly remained unchanged for decades despite its many challenges. This paper introduces a novel, more intuitive and ergonomic platform that can be used with any flexible endoscope, allowing easier navigation and manipulation. A standard endoscope is robotized and a gaze control system based on eye-tracking is developed and implemented, allowing hands-free manipulation. The system characteristics and step response has been evaluated using visual servoing. Further, the robotized system has been compared with a manually controlled endoscope during a user study. The users (n=11) showed a preference for the gaze controlled endoscope and a lower task load when the task was performed with the gaze control. In addition, gaze control was related to a higher success rate and a lower time to perform the task. The results presented validate the system's technical performance and demonstrate the intuitiveness of hands-free gaze control in flexible endoscopy.
Zhao M, Oude Vrielink J, Kogkas A, et al., 2019, Prototype Designs of a Cable-driven Parallel Robot for Transoral Laser Surgery, Hamlyn Symposium on Medical Robotics
Oude Vrielink TJC, Vitiello V, Mylonas GP, 2019, Robotic surgery in cancer, Bioengineering Innovative Solutions for Cancer, Pages: 245-269, ISBN: 9780128138878
Cancer is responsible for the death of thousands of people around the world. When diagnosed and treated at an early stage, long-term survival rates are very high, and today advanced screening has considerably improved early cancer detection and diagnosis. The contemporary view is that surgical cancer removal should also aim at minimizing the external and internal trauma to the patient, for improved postoperative healing and cosmesis. Toward these two goals, minimally invasive surgery (MIS) approaches strive for organ-sparing-as opposed to radical-surgery, using miniaturized surgical instruments introduced through small incisions on the patient skin, or through natural orifices. The operational challenges of such approaches are obvious. Robotic surgery, still in its infancy, is known to improve surgical practice. However, certain operational challenges remain and clear long-term evidence about the superior curative outcomes of robotic surgery over conventional approaches is a subject of debate. This chapter introduces MIS, discusses its limitations for both conventional and robotic approaches, and highlights future opportunities for improving surgical outcomes. Gastrointestinal cancer surgery is used as a representative case study.
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
Kogkas A, Ezzat A, Thakkar R, et al., 2019, Free-View, 3D Gaze-Guided Robotic Scrub Nurse, Editors: Shen, Liu, Peters, Staib, Essert, Zhou, Yap, Khan, Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 164-172, ISBN: 978-3-030-32253-3
Vrielink TJCO, Chao M, Darzi A, et 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
Gastrointestinal (GI) cancers account for 1.5 million deaths worldwide. Endoscopic Submucosal Dissection (ESD) is an advanced therapeutic endoscopy technique with superior clinical outcome due to the minimally invasive and en bloc removal of tumours. In the western world, ESD is seldom carried out, due to its complex and challenging nature. Various surgical systems are being developed to make this therapy accessible, however, these solutions have shown limited operational workspace, dexterity, or low force exertion capabilities. The current paper shows the ESD CYCLOPS system, a bimanual surgical robotic attachment that can be mounted at the end of any flexible endoscope. The system is able to achieve forces of up to 46N, and showed a mean error of 0.217mm during an elliptical tracing task. The workspace and instrument dexterity is shown by pre-clinical ex vivo trials, in which ESD is successfully performed by a GI surgeon. The system is currently undergoing pre-clinical in vivo validation.
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