Since the first robotic surgical intervention was performed in 1985 using a PUMA industrial manipulator, development in the field of surgical robotics has been relatively fast paced, despite the tremendous costs involved in developing new robotic interventional devices. This is due to the clear advantages to augmented a clinicians skill and dexterity with the precision and reliability of computer controlled motion. A natural extension of robotic surgical intervention is the integration of image guided interventions, which give the promise of reduced trauma, procedure time and inaccuracies. Despite magnetic resonance imaging (MRI) being one of the most effective imaging modalities for visualizing soft tissue structures within the body, MRI guided surgical robotics has been frustrated by the high magnetic field in the MRI image space and the extreme sensitivity to electromagnetic interference. The primary contributions of this dissertation relate to enabling the use of direct, live MR imaging to guide and assist interventional procedures. These are the two focus areas: creation both of an integrated MRI-guided development platform and of a stereotactic neural intervention system. The integrated series of modules of the development platform represent a significant advancement in the practice of creating MRI guided mechatronic devices, as well as an understanding of design requirements for creating actuated devices to operate within a diagnostic MRI. This knowledge was gained through a systematic approach to understanding, isolating, characterizing, and circumventing difficulties associated with developing MRI-guided interventional systems. These contributions have been validated on the levels of the individual modules, the total development system, and several deployed interventional devices. An overview of this work is presented with a summary of contributions and lessons learned along the way.

During a laparoscopic surgery, an endoscopic camera is used to provide visual feedback of the surgery to the surgeon and is controlled by a skilled assisting surgeon or a nurse. However, in robot-assisted teleoperated systems such as the daVinci surgical system, the same control lies with the operating surgeons. This results in an added task of constantly changing view point of the endoscope which can be disruptive and also increase the cognitive load on the surgeons. The work presented in this thesis aims to provide an approach that results in an intelligent camera control for such systems using machine learning algorithms. A particular task of pick and place was selected to demonstrate this approach. To add a layer of intelligence to the endoscope, the task was classified into subtasks representing the intent of the user. Neural networks with long short term memory cells (LSTMs) were trained to classify the motion of the instruments in the subtasks and a policy was calculated for each subtask using inverse reinforcement learning (IRL). Since current surgical robots do not enable the movement of the camera and instruments simultaneously, an expert data set was unavailable that could be used to train the models. Hence, a user study was conducted in which the participants were asked to complete the task of picking and placing a ring on a peg in a 3-D immersive simulation environment created using CHAI libraries. A virtual reality headset, Oculus Rift, was used during the study to track the head movements of the users to obtain their view points while they performed the task. This was considered to be expert data and was used to train the algorithm to automate the endoscope motion. A 71.3% accuracy was obtained for the classification of the task into 4 subtasks and the inverse reinforcement learning resulted in an automated trajectory of the endoscope which was 94.7% similar to the human trajectories collected demonstrating that the approach provided in thesis can be used to automate endoscopic motion similar to a skilled assisting surgeon.

Les travaux de cette thèse proposent une nouvelle approche pour le guidage assisté par robots d'aiguilles flexibles pour des procédures percutanées. La méthode est basée sur l'utilisation d'une rotation de l'aiguille avec un rapport cyclique variable pour réaliser une insertion avec des arcs de rayons de courbure différents. Elle combine un retour visuel avec une stratégie de planification adaptative pour compenser les incertitudes du système et les perturbations. Par rapport aux approches présentées précédemment dans la littérature, la stratégie de planification en boucle fermée est adaptée à des scènes dynamiques qui présentent des changements de position des obstacles et de la cible. Cette approche a été implémentée sur un système robotique et les résultats obtenus in vitro confirment tout l'intérêt de cette technique. / This thesis proposes a robot-assisted approach for automatic steering of flexible beveled needles in percutaneous procedures. The method uses duty-cycled rotation of the needle to perform insertion with arcs of adjustable curvature, and combines closed-loop imaging feedback with an intraoperative motion replanning strategy to compensate for system uncertainties and disturbances. Differently from previous approaches, the closed-loop replanning strategy is suitable for dynamic scenes that present changes of obstacles and target positions. Indeed, we implemented the proposed system using a robotic manipulator, and the results obtained from in vitro tests confirmed the viability of our method.

Intra-operative imaging is sometimes available to assist in needle biopsy, but typical open- loop insertion does not account for unmodeled needle deflection or target shift. Robotic closed-loop compensation for deviation from an initial straight-line trajectory can reduce the targeting error, using image-guidance for rotational control of an asymmetric bevel tip. By pairing closed-loop trajectory compensation with a hands-on cooperatively controlled needle insertion, a physician's control of the procedure can be maintained while incorporating benefits of robotic accuracy. Additionally, if puncture of a membrane can be detected, an enhanced haptic response can assist the physician in perceived anatomical localization of the needle tip. Functionality was implemented on a needle placement robot suitable for use in the MR environment and capable of holding a typical clinically used biopsy gun. The robot is configured for cooperatively controlled needle insertion with continuous closed-loop image- guided needle rotation. The robot and custom controller were tested for their effect on the Signal-to-Noise ratio (SNR) of MR images, and the results showed an approximate drop of only 12% in signal when the robot was present, and no additional signal drop when the robot was powered on or moving. The hardware and software subsystems were developed for clinical translation, and after each was validated in the lab they were integrated into the clinical environment to mimic the workflow of MRI-guided targeted biopsy. The full system was evaluated in-bore at Brigham and Women’s Hospital in Boston, MA where experiments for real-time puncture detection and MR image-guided targeted needle insertions under cooperative control were performed. Results showed overall targeting accuracy was 3.42mm RMS, improving accuracy by approximately 50% as compared to clinical trials of prostate biopsy using manual needle insertion. A cooperatively controlled robotic biopsy is more likely to gain acceptance by physicians over teleoperation due to maintaining proximity to the surgical site, but regulatory hurdles regarding robotic needle insertion still exist. The current robotic system framework is suitable for clinical use as it was fully validated in-bore, but some modifications could be made to increase the likelihood of regulatory approval. With these modifications the system could be ready for cadaver and pre- clinical animal trials within one year, and ready for in-human clinical trials in the next two to three years.

La chirurgie sans cicatrices, visant à réaliser des opérations chirurgicales sans cicatrices visibles, est l'avant-garde dans le domaine de la chirurgie mini-invasive. L'absence d'instruments adéquats est l'un des freins à son utilisation en routine clinique. Dans ce contexte, nous introduisons un nouveau robot chirurgical téléopéré, composé d'un endoscope et de deux instruments flexibles, avec 10 DDL motorisés. Cette thèse explore les différentes façons de contrôler le système. La cinématique du robot est analysée et différentes stratégies de contrôle maître/esclave, allant du contrôle articulaire au Cartésien, sont proposées. Ces stratégies ont été testés sur un simulateur virtuel ainsi que sur le système réel en laboratoire et en ex-vivo. Les résultats montrent qu’un seul utilisateur est capable de contrôler le robot et d’effectuer des tâches complexes en utilisant deux interfaces haptiques. / No-scar surgery, which aims at performing surgical operations without visible scars, is the vanguard in the field of Minimally Invasive Surgery (MIS). The lack of adequate instrumentation is one of the issues to its clinical routine use. In this context, we introduce a novel teleoperated surgical robot, consisting of an endoscope and two flexible instruments, with 10 motorized DOFs. This thesis investigates the possibilities to control the system. The robot kinematics is analyzed, and differentmaster/slave control strategies, ranging from joint to Cartesian control, are proposed. These strategies have been tested on a specifically developed virtual simulator and on the real system in laboratory and ex-vivo experiments. The results show that a single user is capable to control the robotic system and to perform complex tasks by means of two haptic interfaces.

Robotic-assisted surgery is a rapid growing field, facing challenging tasks and demands from surgeons, in particular in minimally invasive and microsurgery. However many of the present robotic systems are not well integrated in the surgical workflow, too big or too expensive. Micron is an innovative fully handheld active micromanipulator that helps surgeons to improve position accuracy and precision in microsurgery by cancelling the normal hand tremor. This thesis proposes an improvement and development of Micron, considering as target the stapedotomy procedure, microsurgery performed at the middle ear that aims to restore the hearing impairments. Two tools, a handle and a brace were designed and prototyped and the control was adapted; at the end the entire system was assessed through some experiments. Promising results were obtained in terms of tremor cancellation but further research is needed in order to reach clear advantages.

No description available.

<p>Minimally Invasive Robotic Surgery (MIRS) has revolutionized the way modern surgery is conducted by allowing for smaller incisions, finer control, reduced pain, and faster recovery. The state-of-the-art end-effector technology used for MIRS are tools based off of the rigid-body instruments used in traditional ‘open’ surgery. The rigid nature of the end-effectors, specifically the grasping jaws, leads to a lack of force feedback when implemented in a robotic system. </p> <p>Without additional feedback from active sensing, the blanching that occurs from restricted blood flow around a grasping site is the only indication a surgeon can use to assess the force applied to a tissue. Ongoing efforts to develop active force sensing solutions are currently faced with two major obstacles: miniaturization and sterilization. The lack of force feedback causes a gap between intention and result during robotic surgery. </p> <p>This work proposes the introduction of Visual Force Feedback (VFF) through the integration of a compliant end-effector design. Visual Force Feedback is an intuition, developed through practice, that allows a surgeon to estimate the reaction force of a compliant mechanism by the deflection of the outer flexures. An understanding of the relationship between opening size, flexure deformation, and pinch force allows for rapid estimation of the force applied to a manipulated object. </p> <p>Force and dimensional data were gathered through finite element simulation and the finite element model was validated with physical experimentation on a custom test bench. Multiple functions relating the flexure deformation to the reactionary force, referred to as pinch force, for specific opening sizes were resolved. Notable observations made through the analysis of these results were: (1) a closely linear relationship between outer flexure deformation and pinch force in both experimental and computational results and (2) a higher rate of pinch force increase due to draw displacement as an effect of wider jaw opening. These findings are intended to help shrink the gap between intention and result in the field of MIRS.</p>

Thesis (MScEng)--Stellenbosch University, 2009. / ENGLISH ABSTRACT: Minimal invasive surgery (MIS) enables surgeons to operate through a few small incisions made in the patient’s body. Through these incisions, long rigid instruments are inserted into the body and manipulated to perform the necessary surgical tasks. Conventional instruments, however, are constrained by having only five degrees of freedom (DOF), as well as having scaled and mirrored movements, thereby limiting the surgeon’s dexterity. Surgeons are also deprived of depth perception and hand-eye coordination due to only having two-dimensional visual feedback. Surgical robotics attempt to alleviate these drawbacks by increasing dexterity, eliminating the fulcrum effect and providing the surgeon with three-dimensional visualisation. This reduces the risks to the patient as well as to the surgeon. However, existing MIS systems are extremely expensive and bulky in operating rooms, preventing their more widespread adoption. In this thesis, a new, inexpensive seven-DOF primary slave manipulator (PSM) is presented. The four-DOF wrist is actuated through a tendon mechanism driven by five 12 VDC motors. A repeatability study on the wrist’s joint position was done and showed a standard deviation of 0.38 degrees. A strength test was also done and demonstrated that the manipulator is able to resist a 10 N opposing tip force and is capable of a theoretical gripping force of 15 N. / AFRIKAANSE OPSOMMING: Minimale indringende chirurgie (MIC) maak dit vir chirurge moontlik om operasies uit te voer deur ’n paar klein insnydings wat op die pasiënt se liggaam gemaak word. Deur hierdie insnydings word lang onbuigsame instrumente in die liggaam ingesit en gemanipuleer om die nodige chirurgiese take uit te voer. Konvensionele instrumente is egter beperk vanweë die feit dat hulle net vyf vryheidsgrade het, asook afgeskaalde bewegings en spieëlbewegings, en gevolglik die chirurg se handvaardigheid beperk. Chirurge word ook ontneem van dieptewaarneming en hand-oog-koördinasie, want hulle is beperk tot tweedimensionele visuele terugvoer. Chirurgiese robotika poog om hierdie nadele aan te spreek deur handvaardigheid te vermeerder, die hefboomeffek uit te skakel en die chirurg driedimensionele visualisering te bied. Dit verminder die risiko’s vir die pasiënt én vir die chirurg. Bestaande MIC-stelsels is egter uiters duur en neem baie plek op in teaters, wat verhoed dat hulle op ’n groter skaal gebruik word. In hierdie tesis word ’n nuwe, goedkoop sewevryheidsgrade- primêre slaafmanipuleerder (PSM) voorgelê. Die viervryheidsgrade-pols word beweeg deur ’n tendonmeganisme wat aangedryf word deur vyf 12 VDC-motors. ’n Herhaalbaarheidstudie is op die pols se gewrigsposisie gedoen, wat ’n standaardafwyking van 0.38 grade aangetoon het. ’n Sterktetoets is ook gedoen en het gewys dat die manipuleerder in staat is om ’n 10 N-teenkantelkrag te weerstaan en dat dit oor ’n teoretiese greepsterkte van 15 N beskik.

An MRI’s superior soft tissue contrast and ability to perform parametric scanning make it a powerful tool for use during medical procedures; from surgery to rehabilitation. However, the MRI’s strong static magnetic field, fast switching gradients and constrained space make accomplishing procedures within it difficult. Recent advances in the field of robotics have enabled the creation of devices capable of assisting medical practitioners in this environment. In this work, technologies to enable the use and control of robotic assistive devices for MRI interventions are presented. This includes a modular controller that is designed, built and used to control two surgical systems with minimal effect on image quality. Progressive improvements to an MRI conditional actuator including the construction of a first of a kind plastic piezoelectric resonant motor stator that improves the motor’s compatibility with the MRI is presented. Finally, control algorithms are evaluated for real-time functional MRI based control of a rehabilitation robot which includes the use of a robot for controlling brain activity of a subject in an online experiment.