<p>Robotic platforms have several characteristics such as speed and precision that make them enticing for use in medical procedures. Companies such as Intuitive Medical and Titan Medical have taken advantage of these features to introduce surgical robots for minimally invasive procedures. Such robots aim to reduce procedure and patient recovery times. Current technology requires platforms to be master-slave manipulators controlled by a surgeon, effectively converting the robot into an expensive surgical tool. Research into the interaction between robotic platforms and deformable objects such as human tissue is necessary in the development of autonomous and semi-autonomous surgical systems. This thesis investigates a class of robust linear controllers based on a worst case performance measure known as the $H_{\infty}$ norm, for the purpose of performing so called Indirect Deformable Object Manipulation (IDOM). This task allows positional regulation of regions of interest in a deformable object without directly interacting with them, enabling tasks such as stabilization of tumors during biopsies or automatic suturing. A complete approach to generating linear $H_{\infty}$ based controllers is presented, from derivation of a plant model to the actual synthesis of the controller. The introduction of model uncertainty requires $\mu$ synthesis techniques, which extend $H_{\infty}$ designs to produce highly robust controller solutions. In addition to $H_{\infty}$ and $\mu$ synthesis designs, the thesis presents an approach to design an optimal PID controller with gains that minimize the $H_{\infty}$ norm of a weighted plant. The three control approaches are simulated performing set point regulation in $\text{MATLAB}^{TM}$'s $simulink$. Simulations included disturbance inputs and noises to test stability and robustness of the approaches. $H_{\infty}$ controllers had the best robust performance of the controllers simulated, although all controllers simulated were stable. The $H_{\infty}$ and PID controllers were validated in an experimental setting, with experiments performed on two different deformable synthetic materials. It was found that $H_{\infty}$ techniques were highly robust and provided good tracking performance for a material that behaved in a relatively elastic manner, but failed to track well when applied to a highly nonlinear rubber compound. PID based control was outperformed by $H_{\infty}$ control in experiments performed on the elastic material, but proved to be superior when faced with the nonlinear material. These experimental findings are discussed and a linear $H_{\infty}$ control design approach is proposed.</p> / Master of Applied Science (MASc)

Les robots légers utilisés pour la télé-échographie robotisée permettent, à l'expert médical, d'orienter à distance une sonde ultrasonore 2D. L'analyse en temps réel de l'image ultrasonore du patient, reçue via un lien de communication, permet à l'expert de définir un diagnostic. Les validations cliniques du concept de télé-échographie robotisée montrent qu'il est ainsi possible de pallier le manque d'experts en ultrasonographie sur des sites médicalement isolés. Le robot porte-sonde est positionné et maintenu sur le corps du patient par un assistant à partir des informations communiquées par le spécialiste via visioconférence. Cependant, la faible masse du robot, le fait qu'il soit maintenu par un assistant sur le corps du patient et les mouvements physiologiques du patient provoquent des perturbations dans la position de la sonde et engendrent ainsi des pertes des sections d'intérêt des organes étudiés. Les travaux de cette thèse ont consisté à développer une approche par asservissement visuel basé sur les moments d'image ultrasonore 2D. Le calcul des moments 2D étant basé sur les points du contour de la section d'intérêt, un algorithme de traitement d'images efficace est nécessaire pour détecter et suivre le contour d'intérêt en mouvement. Pour cela, une méthode de contour actif paramétrique basée sur les descripteurs de Fourier est présentée. Les lois de commandes correspondant à trois tâches autonomes autorisant la recherche et le maintien de visibilité d'un organe lors de l'acte médical télé-opéré sont implémentées et validées sur la plateforme robotique du projet ANR Prosit. / The light weight robots used for robotized tele-echography allow the medical expert to remotely operate a 2D-ultrasound probe. The real-time analysis of the patient's ultrasound images, received via a standard communication link, provides the expert with relevant information to define a diagnosis. The clinical validations of the robotized tele-echography concept show that it is possible to overcome the lack of sonographers in medically isolated sites. The robot probe-holder is usually positioned and held on the patient's body by a paramedical staff based on information provided by the specialist via videoconferencing. However, the small mass of the robot, the fact that it is held by an assistant on the patient's body and the patient's physiological movements cause disturbances in the position of the probe ; this thus can generate a loss of the region of interest of the organ being under investigation during the teleoperated medical act. This thesis work focuses on the development of a visual servoing approach based on 2D ultrasound image moments. 2D moments calculation is based on the contour points of the image section of interest, therefore an image-processing algorithm is needed to effectively detect and follow the contour of interest in motion. For this reason, a parametric active contour method based on Fourier descriptors is presented. The control laws, corresponding to three independent autonomous tasks to search and maintain the visibility of an organ within a given ultrasound plane during the tele-operated medical act are implemented and validated on robotic platform project ANR Prosit.

This dissertation presents a new 2D ultrasound-based visual servoing method. The main goal is to automatically guide a robotized 2D ultrasound probe held by a medical robot in order to reach a desired cross-section ultrasound image of an object of interest. This method allows to control both the in-plane and out-of-plane motions of a 2D ultrasound probe. It makes direct use of the 2D ultrasound image in the visual servo scheme, where the feed-back visual features are combinations of image moments. To build the servo scheme, we develop the analytical form of the interaction matrix that relates the image moments time variation to the probe velocity. That modeling is theoretically verified on simple shapes like spherical and cylindrical objects. In order to be able to automatically position the 2D ultrasound probe with respect to an observed object, we propose six relevant independent visual features to control the 6 degrees of freedom of the robotic system. Then, the system is endowed with the capability of automatically interacting with objects without any prior information about their shape, 3D parameters, nor 3D location. To do so, we develop on-line estimation methods that identify the parameters involved in the built visual servo scheme. We conducted both simulation and experimental trials respectively on simulated volumetric objects, and on both objects and soft tissues immersed in a water-filled tank. Successful results have been obtained, which show the validity of the developed methods and their robustness to different errors and perturbations especially those inherent to the ultrasound modality. Keywords: Medical robotics, visual servoing, 2D ultrasound imaging, kinematics modeling, model-free servoing.

Thèse doctorat : Automatique Industrielle : Villeurbanne, INSA : 2005. / Thèse rédigée en anglais. Résumé étendu en français. Titre provenant de l'écran-titre. Bibliogr. p. 155-167.

Compliant and flexible cardiac catheters provide direct access to the inside of the heart via the vascular system without requiring clinicians to stop the heart or open the chest. However, the fast motion of the intracardiac structures makes it difficult to modify and repair the cardiac tissue in a controlled and safe manner. In addition, rigid robotic tools for beating heart surgery require the chest to be opened and the heart exposed, making the procedures highly invasive. The novel robotic catheter system presented here enables minimally invasive repair on the fast-moving structures inside the heart, like the mitral valve annulus, without the invasiveness or risks of stopped heart procedures. In this thesis, I investigate the development of 3D ultrasound-guided robotic catheters for beating heart surgery. First, the force and stiffness values of tissue structures in the left atrium are measured to develop design requirements for the system. This research shows that a catheter will experience contractile forces of 0.5 – 1.0 N and a mean tissue structure stiffness of approximately 0.1 N/mm while interacting with the mitral valve annulus. Next, this thesis presents the catheter system design, including force sensing, tissue resection, and ablation end effectors. In order to operate inside the beating heart, position and force control systems were developed to compensate for the catheter performance limitations of friction and deadzone backlash and evaluated with ex vivo and in vivo experiments. Through the addition of friction and deadzone compensation terms, the system is able to achieve position tracking with less than 1 mm RMS error and force tracking with 0.08 N RMS error under ultrasound image guidance. Finally, this thesis examines how the robotic catheter system enhances beating heart clinical procedures. Specifically, this system improves resection quality while reducing the forces experienced by the tissue by almost 80% and improves ablation performance by reducing contact resistance variations by 97% while applying a constant force on the moving tissue. / Engineering and Applied Sciences

Le contexte de cette thèse est la conception d'assistants robotiques aux gestes chirurgicaux guidés par IRM. Cette conception est rendue délicate par l’environnement qui impose des contraintes de compacité, de légèreté et de compatibilité. La présence du patient dans cet environnement impose également des impératifs de sécurité qui limitent les architectures robotiques viables. Cette thèse vise à évaluer le potentiel applicatif des mécanismes de tenségrité, et plus généralement des systèmes précontraints, qui présentent de nombreuses propriétés intéressantes qui justifient d’envisager leur emploi dans ce contexte, notamment pour leur capacité de raideur variable bénéfique à la sécurité du patient. Afin de juger de la pertinence de leur utilisation, nous nous concentrons sur l’analyse, la conception et la commande de ces systèmes peu connus des roboticiens, étapes nécessaires à leur évaluation. Nos contributions incluent le développement d’outils numériques pour permettre leur analyse, de méthodes de synthèse pour générer des architectures à raideur variable adéquates, et de stratégies de commande pour piloter leur configuration et leur raideur. / This thesis is focused on the design of robotic assistants for MRI-guided surgeries. This design is submitted to several constraints due to the MR-environment, such as compactness, lightness, or compatibility. Safety issues related to the patient within the scanner also restrict the choice of suitable robotic solutions. This thesis thus aims at evaluating the applicative potential of tensegrity mechanisms, and more generally prestressed systems, that exhibit numerous interesting properties for this context. In particular, their stiffness can be adjusted, which is opportune for the patient safety. The relevance of our approach is assessed through the analysis, the design and the control of these systems that are required to fulfil their evaluation. Our contributions include the development of numerical tools for their analysis, synthesis methods for the generation of suitable variable stiffness designs, and control strategies for the simultaneous control of their configuration and their stiffness.

En radiologie interventionnelle, l’assistance robotisée permet de limiter l’exposition du praticien aux rayons X et d’apporter plus de précision pour effectuer des opérations complexes. La présence de robots dans un environnement humain pose alors la question de la sécurité du patient et de l’équipe médicale, que ce soit lors d’interactions ou de manipulations. Dans cette thèse, nous nous intéressons dans un premier temps aux problématiques de sûreté. Une structure d’actionnement intrinsèquement sûre est proposée. Le prototype réalisé permet d’effectuer des tâches de positionnement en mode automatique. Parallèlement, une stratégie de guidage basée sur une approche passive est proposée. Un système à raideur variable permet d’imposer un effort résistif variable à l’utilisateur en vue de contraindre son geste. Dans une deuxième partie, nous étudions la possibilité d’intégrer de tels systèmes sur un dispositif à plusieurs degrés de liberté, répondant au problème de placement d’aiguille. / In the context of interventional radiology, robotic-assisted surgery limits practitioners’ exposure to radiations and brings more accuracy to perform complex interventions. However, the presence of robot in the environment is a potential danger for the patient and the medical staff in case of unexpected interactions and manipulations.In this PhD thesis, we first focus on safety problems. An intrinsically safe mechanism is proposed. The achieved prototype allows to follow both planned trajectories and moving environments.Secondly, a guidance mechanism based on a passive approach is suggested. With a variable stiffness system, using a compliant mechanism, a resistive force is applied to the user which allows him to be guided in his gesture.Based on medical needs, we then study the possibility to integrate and generalize such systems to multiple degrees of freedom.

Ces travaux de thèse apportent plusieurs contributions à la conception de dispositifs d'assistance robotisés pour la réalisation de procédures d'insertion d'aiguille sous imageur à rayons X. Partant de la tâche de positionnement et d'orientation d'une aiguille, plusieurs architectures mécaniques inédites à quatre degrés de liberté ont été proposées. Un algorithme de synthèse dimensionnelle a été conçu pour calculer les paramètres structuraux de ces mécanismes en étudiant leurs singularités, tout en tenant compte des contraintes antagonistes de compacité du système, de capacité d'actionnement et de taille d'espace de travail. Une décomposition modulaire du dispositif d'assistance a permis de proposer des solutions pour un outil dédié à l'insertion d'aiguille avec retour d'effort. Cet outil comporte un dispositif d'insertion, un système de préhension d'aiguille et un capteur d'effort spécifique pour le retour d'effort. / This thesis focuses on finding solutions for the design and the technological bottlenecks involving development of a slave robotic assistant for needle insertion procedures. The needed functionalities for the slave device were sought to be achieved by adopting a modular approach. This required the design and the development of different devices which satisfy targeted functionalities. A study of needle positioning devices was carried out which led to the synthesis of novel mechanisms for the task of needle axis translation and the needle axis orientation. A novel dimensional synthesis algorithm was developed to calculate the structural parameters of these mechanism while studying their singularities and considering the antagonistic constraints of system compactness, actuation torques and workspace size. The modular decomposition also allowed to offer solutions for an insertion tool dedicated to needle insertion with force feedback. This insertion tool consists of a device for inserting the needle, a device for grasping the needle and a force sensor for force feedback.

La radiologie interventionnelle percutanée permet le diagnostic ou le traitement de tissus cancéreux grâce à l'utilisation d'aiguilles et d'un guidage par imageur. Bénéfique pour le patient, ce type de procédure clinique est en revanche complexe pour le radiologue. Afin de lui apporter une assistance et de contrôler l'aiguille de manière déportée, nous proposons dans ces travaux de réaliser des dispositifs robotisés compliants, donc monoblocs, et multi-matériaux en exploitant la fabrication additive multi-matériaux. Pour y parvenir, nous proposons plusieurs solutions pour réaliser les fonctions cinématique, d'actionnement et de perception. En particulier, nous proposons une nouvelle liaison compliante, la liaison HSC, ainsi qu'un nouvel actionneur pneumatique pour l'insertion d'aiguille. Nous démontrons finalement les apports de la fabrication additive pour la robotique médicale en combinant l'ensemble de ces solutions dans un dispositif assurant un contrôle à distance de l'aiguille. / Percutaneous interventional radiology permits the diagnosis or the treatment of cancer tissues thanks to the use of needles and imaging devices. Being minimally invasive, such procedures are beneficial for the patient, but for the radiologist, they are highly complex. In order to assist the physician and remotely control the needle, we propose in this work the design and the manufacturing of multi-material compliant devices by taking advantage of multi-material additive manufacturing. To perform the design of such device, we propose several solutions in terms of kinematics, actuation and sensing. In particular, we developed a new compliant joint, the HSC joint, as well as a new pneumatic actuator for needle insertion. In the end, we demonstrate in the thesis the contributions of multi-material additive manufacturing for medical robotics, by combining all those solutions into a single device that remotely controls both the orientation and the insertion of the needle

Les avancées technologiques ont ouvert la voie à des approches de biopsie optique innovantes. Elles permettent à l'inverse des méthodes physiques de profiter des avantages d'une procédure mini-invasive, temps réels et répétitive. Le système de tomographie par cohérence optique (OCT) (la technique de biopsie optique utilisée dans cette thèse) propose des approches qui naviguent dans le corps humain grâce à des sondes endoscopiques robotisées. Toutefois, leur contrôle une fois à l’intérieur du corps devient difficile, surtout si l’objectif est de suivre l’évolution d'une zone cible, en faisant un travail de repositionnement dans le temps. L'asservissement visuel est un outil de choix pour le contrôle et le positionnement directement par l'image. Néanmoins, la richesse des informations présentes dans les images autorisent l'utilisation de plusieurs types d'information visuelle. Dans ce contexte, nous proposons l'utilisation de primitives visuelles innovantes fondées sur les ondelettes. Ainsi, deux approches d'asservissements visuels fondées sur les ondelettes ont été développées. La première approche est un asservissement visuel 2D pose fondé sur les ondelettes spectrales continues qui assure une convergence sur un espace plus important avec une bonne robustesse au bruit et une commande découplée. La deuxième est un asservissement visuel 2D direct fondé sur les ondelettes multirésolution, principalement pour faire du positionnement aux petits déplacements. Par ailleurs, la deuxième méthode couvre les 6 DDL quand la première se limite aux 3 DDL dans les images CCD. De plus, ces deux approches ont prouvé leurs aptitudes à faire du positionnement des coupes OCT. Mais encore, nous avons proposé une méthode de positionnement partitionnée que nous pouvons qualifier d'hybride, car elle exploite deux modalités d'images (OCT - CCD) pour assurer un positionnement sur SE(3) d'un échantillon. De même, nous avons proposé une méthode d'étalonnage des images de coupe et de volume OCT, liée aux distorsions générées par le chemin optique parcouru par le faisceau laser OCT. Finalement, ces travaux ouvrent la voie vers des applications dans le positionnement des volumes OCT, la compensation de mouvement physiologique et le suivi d'outils par des images OCT. / The technological advances have facilitated the optical biopsy approaches, unlike physical methods to take advantage of a minimally invasive, real time and repetitive procedure. The optical coherence tomography system is one of the optical biopsy techniques used in this thesis to prospect in the human body with robotized OCT endoscopic probes. Nevertheless, their control once inside the body becomes difficult, especially if the goal is following changes in the target area. The visual servoing is an ideal tool for the control and positioning of the robot. However, the amount of information present in the images allows the use of several types of visual features. In this thesis, we propose to use an innovative visual servoing feature based on wavelets. This representation developed as the evolution of the Fourier transform for non-stationary signals provides a time-frequency representation of the signal with a better extraction of the relevant information. Indeed, two visual servoing approaches based on wavelets were developed. The first approach is a 2D pose visual servoing based on spectral continuous wavelets, which ensures convergence over a larger area and decoupled control. The second is a direct 2D visual servoing based on multiresolution wavelets, mainly for small displacements positioning. However, the latter covers the 6 DOF when the previous one is limited to 3 DDL with a CCD camera. Both approaches have proven their ability to make the positioning of B-Scan OCT images. After that, we have proposed a method of partitioned positioning, that we can qualify by hybrid because it uses two image modalities to ensure SE(3) positioning of a sample. On the other side, we proposed a calibration method of B-Scan and 3D-Scan OCT images, due to the distortions generated by the optical path of the laser beam in OCT. Finally, these thesis is a beginning work for applications in positioning of 3D-Scan OCT, physiological motion compensation and monitoring tools by OCT images.