La robotique a fait progresser les interventions chirurgicales, avec des interventions moins invasives, une manipulation d’instruments plus précise et une meilleure dextérité. Néanmoins, le manque de retour haptique sur les plates-formes chirurgicales existantes aujourd’hui rend délicat l’accomplissement des gestes chirurgicaux et par conséquent augmente le risque de ces procédures. Avec l’introduction d’un retour haptique, les robots chirurgicaux sont conçus avec une approche de télé-opération bilatérale. Le retard, inhérent à cette approche, est crucial car même un petit retard pourrait déstabiliser le système. En pratique, le retard est inévitable, notamment pour les robots miniaturisés avec communication sans fils. Pour résoudre les problèmes liés à l’instabilité induite par le retard et rendre passif le canal de communication, l’approche de wave variable transformation (WVT) a été proposée. Néanmoins, les performances de suivi sont compromises à cause de la conservation de la condition de passivité. Dans cette thèse, une nouvelle approche de compensation basée sur la structure de wave variable, et considérant moins de condition de conservation est proposée afin d’améliorer les performances de suivi en position, en vitesse et en force. Pour garantir la passivité du système global, une approche énergétique (energy reservoir based regulators) est développée pour ajuster les termes de WVT avec une analyse rigoureuse. La méthode proposée permet d’améliorer les performances de suivi avec uniquement un retard de transmission dans un seul sens. Pour faciliter davantage les procédures chirurgicales, notamment les microchirurgies, deux facteurs d’échelle ont été rajoutés à l’approche de compensation. Une analyse de passivité a été par ailleurs menée en considérant la transparence du système. Les performances de suivi peuvent être obtenues si et seulement si les conditions de passivité et de transparence sont satisfaites. Les approches de compensation, avec et sans mise à l’échelle, ont été vérifiées à travers des simulations et des évaluations expérimentales. / Robotic technology has advanced the surgical procedures in terms of reduced trauma, more accurate manipulation and enhanced dexterity. However, the lack of haptic feedback on existing surgical robotic platforms makes it impossible for the surgeon to feel the operative site,and thus increases the risks of surgical procedures. With the introduction of haptic feedback, the surgical robots are design in bilateral teleoperation way. Time delay in bilateral teleoperation is crucial because even small time delay may destabilize the system. In practice, time delay is unavoidable, e.g. wireless communication miniaturized surgical robots, internet based robotic-assisted telesurgery and transmission of big amount of information, etc. In order to solve the instability caused by time delay in bilateral teleoperation, wave variable transformation (WVT) method has been proposed to passivate the delayed communication channel. However, the tracking performances are compromised due to the conservative passivity condition. In this thesis, a new wave variable compensation (WVC) structure with less conservative condition is proposed to enhance the velocity/position and force tracking performances. In order to guarantee the passivity of the whole system, energy reservoir based regulators are designed to adjust the WVC terms in the proposed structure with rigorous analysis. The WVC is able to achieve tracking performance with only single trip time delay. To better facilitate the surgical procedures, e.g. the microsurgeries, a scaled WVC structure is also developed by adding two scaling factors to the WVC structure. Passivity analysis on the scaled WVC is conducted with consideration of system transparency. Scaled tracking performance can be obtained as long as the two obtained passivity and transparency conditions are satisfied. The proposed WVC and scaled WVC have been verified through simulation and experimental studies.

Image guided therapy procedures under MRI guidance has been a focused research area over past decade. Also, over the last decade, various MRI guided robotic devices have been developed and used clinically for percutaneous interventions, such as prostate biopsy, brachytherapy, and tissue ablation. Though MRI provides better soft tissue contrast compared to Computed Tomography and Ultrasound, it poses various challenges like constrained space, less ergonomic patient access and limited material choices due to its high magnetic field. Even after, advancements in MRI compatible actuation methods and robotic devices using them, most MRI guided interventions are still open-loop in nature and relies on preoperative or intraoperative images. In this thesis, an intraoperative MRI guided robotic system for prostate biopsy comprising of an MRI compatible 4-DOF robotic manipulator, robot controller and control application with Clinical User Interface (CUI) and surgical planning applications (3DSlicer and RadVision) is presented. This system utilizes intraoperative images acquired after each full or partial needle insertion for needle tip localization. Presented system was approved by Institutional Review Board at Brigham and Women's Hospital(BWH) and has been used in 30 patient trials. Successful translation of such a system utilizing intraoperative MR images motivated towards the development of a system architecture for close-loop, real-time MRI guided percutaneous interventions. Robot assisted, close-loop intervention could help in accurate positioning and localization of the therapy delivery instrument, improve physician and patient comfort and allow real-time therapy monitoring. Also, utilizing real-time MR images could allow correction of surgical instrument trajectory and controlled therapy delivery. Two of the applications validating the presented architecture; closed-loop needle steering and MRI guided brain tumor ablation are demonstrated under real-time MRI guidance.

Sensor failures or oversupply in wireless sensor networks (WSNs), especially initial random deployment, create both spare sensors (whose area is fully covered by other sensors) and sensing holes. We envision a team of robots to relocate sensors and improve their area coverage. Existing algorithms, including centralized ones and the only localized G-R3S2, move only spare sensors and have limited improvement because non-spare sensors, with area coverage mostly overlapped by neighbour sensors, are not moved, and additional sensors are deployed to fill existing holes. We propose a localized algorithm, called Localized Ant-based Sensor Relocation Algorithm with Greedy Walk (LASR-G), where each robot may carry at most one sensor and makes decision that depends only on locally detected information. In LASR-G, each robot calculates corresponding pickup or dropping probability, and relocates sensor with currently low coverage contribution to another location where sensing hole would be significantly reduced. The basic algorithm optimizes only area coverage, while modified algorithm includes also the cost of robot movement. We compare LASR-G with G-R3S2, and examine both single robot and multi robots scenarios. The simulation results show the advantages of LASR-G over G-R3S2.

Our goal is to introduce a novel method for representing, generalising, and comparing gaits; particularly, walking gait. Human walking gaits are a result of complex, interdependent factors that include variations resulting from embodiments, environment and tasks, making techniques that use average template frameworks suboptimal for systematic analysis or corrective interventions. The proposed work aims to devise methodologies for being able to represent gaits and gait transitions such that optimal policies that eliminate the inter-personal variations from tasks and embodiment may be recovered. Our approach is built upon (i) work in the domain of null-space policy recovery and (ii) previous work in generalisation for point-to-point movements. The problem is formalised using a walking phase model, and the null-space learning method is used to generalise a consistent policy from multiple observations with rich variations. Once recovered, the underlying policies (mapped to different gait phases) can serve as reference guideline to quantify and identify pathological gaits while being robust against interpersonal and task variations. To validate our methods, we have demonstrated robustness of our method with simulated sagittal 2-link gait data with multiple ground truth constraints and policies. Pathological gait identification was then tested on real-world human gait data with induced gait abnormality, with the proposed method showing significant robustness to variations in speed and embodiment compared to template based methods. Future work will extend this to kinetic features and higher degree-of-freedom.

Sensor failures or oversupply in wireless sensor networks (WSNs), especially initial random deployment, create both spare sensors (whose area is fully covered by other sensors) and sensing holes. We envision a team of robots to relocate sensors and improve their area coverage. Existing algorithms, including centralized ones and the only localized G-R3S2, move only spare sensors and have limited improvement because non-spare sensors, with area coverage mostly overlapped by neighbour sensors, are not moved, and additional sensors are deployed to fill existing holes. We propose a localized algorithm, called Localized Ant-based Sensor Relocation Algorithm with Greedy Walk (LASR-G), where each robot may carry at most one sensor and makes decision that depends only on locally detected information. In LASR-G, each robot calculates corresponding pickup or dropping probability, and relocates sensor with currently low coverage contribution to another location where sensing hole would be significantly reduced. The basic algorithm optimizes only area coverage, while modified algorithm includes also the cost of robot movement. We compare LASR-G with G-R3S2, and examine both single robot and multi robots scenarios. The simulation results show the advantages of LASR-G over G-R3S2.

Le syndrome de parésie spastique consécutif à un accident vasculaire cérébral (AVC) comprend plusieurs composantes dont la rétraction musculaire, la parésie sensible à l’étirement et l’hyperactivité musculaire, trois symptômes concourant à une altération de la fonction motrice du membre supérieur dans l’hémiparésie. Les progrès d’un patient atteint par ce syndrome peuvent reposer sur deux types de plasticité cérébrale : post-lésionnelle et liée à l’activité. Les maîtres-mots pour optimiser une récupération motrice par la plasticité liée à l’activité sont : intensité, répétition, effort, attention portée au mouvement, tâche dirigée vers un but et mouvement actif. Au regard des différentes techniques de rééducation, la thérapie utilisant un dispositif robotisé répond à ces principes stimulateurs de la plasticité cérébrale liée à l’activité. Cependant les modalités exactes de l’intervention robotisée et sa durée souhaitable n’ont pas été clarifiées.Une première étude rétrospective a montré que les bénéfices cliniques et cinématiques associés à l’utilisation combinée de l’ergothérapie conventionnelle et de la robot-thérapie sur au moins trois mois suggèrent l’intérêt d’une durée de traitement longue chez des patients aux limitations modérées en phase tardive de la période subaiguë. Une deuxième étude rétrospective suggère qu’à quatre ans, l’évolution lente de la fonction motrice pour ces mêmes patients semble fonction de la sévérité initiale, où finalement les moins bons régressent et les meilleurs s’améliorent un peu. Enfin, une étude prospective randomisée contrôlée en phase subaiguë a démontré que l’entraînement de mouvements sur robot sans assistance améliore l’amplitude active d’extension du coude plus que le même entraînement avec assistance au besoin, qui pourtant a permis au patient d’effectuer environ un tiers de mouvements en plus par séance. Aussi, le facteur difficulté de l’effort prévaudrait sur celui du nombre de répétitions pour stimuler la plasticité cérébrale. Ce dernier principe ne s’exprime cependant que sur le mouvement élémentaire qui est directement entraîné par le robot, en l’occurrence l’extension du coude, tandis que d’autres mouvements fondamentaux dans l’utilisation du bras humain, par exemple la flexion de l’épaule en charge, l’extension du poignet et la préhension digitale, ne sont pas exercés avec la plupart des versions actuelles des robots d’assistance à la rééducation. L’autre limite majeure de la thérapie assistée par un dispositif robotisé est qu’elle ignore la maladie musculaire présentée par les patients (rétractions), ne s’adressant qu’à la composante neurologique de la parésie spastique (parésie de l’agoniste et cocontraction de l’antagoniste). C’est ainsi que malgré le grand nombre de répétitions de mouvements qu’elle permet, nous n’avons pas constaté que la thérapie assistée par un robot se montrait plus efficace que la thérapie conventionnelle seule sur la progression de la fonction globale du membre supérieur en phase subaiguë après un AVC.Les données issues de ce travail devraient permettre aux thérapeutes ayant accès à des dispositifs robotisés d’aide à la rééducation du membre supérieur d’affiner les modalités et la durée de leur prise en charge. L’association de la thérapie assistée par robots à d’autres thérapies pourrait permettre d’optimiser la réduction des troubles moteurs dans l’hémiparésie après un AVC. / Following stroke, the syndrome of deforming spastic paresis includes several components in which three main symptoms, soft tissue contracture, stretch-sensitive paresis and spastic muscle overactivity, impede motor function. Patient progress may utilize two types of brain plasticity: lesion-induced and behavior-induced. The key notions to optimize motor recovery through behavior-induced plasticity are: repetition, effort, attention to movement, goal-directed task and active movement. Robot-assisted therapy fulfills all these conditions. However, the exact modalities of use and optimal duration are yet to be defined.From a first retrospective study, the magnitude of the clinical and kinematic benefits associated with the combined use of robot-assisted and conventional occupational therapies during three months suggest the value of a long duration treatment in the late subacute phase for moderately impaired hemiparetic patients. A second retrospective study observed the four-year long-term evolution of motor function for these patients, which appears to be related to the baseline severity, in which the more severely affected deteriorate and the less severe patients improve a little. Finally, a prospective randomized controlled study demonstrated that non-assisted movement training was associated with greater active elbow extension improvement than training with the assist-as-needed modality even though the latter offered the patient 33% movements more in each session. Therefore, the difficulty of effort appears to be a more effective factor of brain plasticity than the number of movement repetitions. This principle has however been demonstrated only for the primary movement directly trained by the robot, that is, elbow extension. The other movements that are essential in human upper limb use, such as shoulder flexion, wrist extension, gross and fine digit prehension, are not trained with the most current versions of robots used in upper limb rehabilitation. In addition, another important limitation of robot-assisted therapy is that it ignores the muscle disorder (antagonist shortening) of spastic paresis by focusing only on the neural disorder component (paresis in agonists and cocontraction in antagonists). Despite the high number of movement repetitions in robot-assisted therapy, our prospective study has not been able to show superiority of robot-assisted therapy over conventional occupational therapy in improving overall upper limb motor function in the subacute phase after stroke.The findings of this work should help therapists with access to robotic devices to refine the modalities and duration of their use in patient care. Combining robot-assisted therapy with other therapies might optimize the reduction of motor disorder in hemiparesis following stroke.

京都大学 / 新制・課程博士 / 博士(工学) / 甲第24608号 / 工博第5114号 / 新制||工||1978(附属図書館) / 京都大学大学院工学研究科機械理工学専攻 / (主査)教授 松野 文俊, 教授 小森 雅晴, 教授 森本 淳 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DGAM

Introduction: In recent years, robot-assisted surgery has taken over as a first option in rectal cancer treatment. The overall perception is that robot-assisted surgery is a method with good surgical outcomes. Many current studies have focused on comparing robot-assisted surgery to conventional laparoscopy. To our knowledge, few studies have been conducted to compare surgical outcomes in rectal cancer over time in robot-assisted surgery as training and knowledge increases in the field. Aim: To examine the two most commonly used robot-assisted surgical procedures in rectal cancer, to compare surgical outcomes of each procedure over a ten-year period. Method: A retrospective comparative study design was used. The national Swedish Colorectal Cancer Registry (SCRCR) was used to identify patients who underwent robot-assisted rectal cancer surgery at Örebro University Hospital between 2013 and 2022. Two surgical procedures were assessed: anterior resection and abdomino-perineal resection. Studied outcomes included: console-time, operation time, blood loss, hospital stay and conversion rate. Group comparisons were performed. Results: In total 202 patients were included and grouped into two periods (2013-2017; 2018-2022). A statistically significant reduction was observed in both procedures regarding blood loss in the later period. No other statistically significant differences were identified. Patients operated with APR in the later period were less fit. Conclusion: The surgical procedures showed comparable clinical outcomes in both periods. Our study showed that more complex cases in the group operated with APR were selected in the second period, which could imply that a higher degree of surgical proficiency was obtained over time.

Yes / Safe and successful surgery depends on effective teamwork between professional groups, each playing their part in a complex division of labour. This article reports the first empirical examination of how introduction of robot-assisted surgery changes the division of labour within surgical teams and impacts teamwork and patient safety. Data collection and analysis was informed by realist principles. Interviews were conducted with surgical teams across nine UK hospitals and, in a multi-site case study across four hospitals, data were collected using a range of methods, including ethnographic observation, video recording and semi-structured interviews. Our findings reveal that as the robot enables the surgeon to do more, the surgical assistant's role becomes less clearly defined. Robot-assisted surgery also introduces new tasks for the surgical assistant and scrub practitioner, in terms of communicating information to the surgeon. However, the use of robot-assisted surgery does not redistribute work in a uniform way; contextual factors of individual experience and team relationships shape changes to the division of labour. For instance, in some situations, scrub practitioners take on the role of supporting inexperienced surgical assistants. These changes in the division of labour do not persist when team members return to operations that are not robot-assisted. This study contributes to wider literature on divisions of labour in healthcare and how this is impacted by the introduction of new technologies. In particular, we emphasise the need to pay attention to often neglected micro-level contextual factors. This can highlight behaviours that can be promoted to benefit patient care.

This project was initiated by Dr. Sasan Dadbaksh upon listening to the requirements I presented for my master thesis. My requirements were to do a master thesis project in the field of additive manufacturing specifically fused deposition modeling that should not only involve the research work but should also present an opportunity to develop hardware and should involve experimental testing. Then Sasan came up with the idea of developing a system capable to perform 3D printing with the extruder fixed in one position and the motion required for 3D printing will be provided by the robotic arm. The title of developing green build strategies for robot assisted plastic 3D printing came into being. The main concept behind the title of developing robot assisted plastic 3D printing platform is to develop such a system that can offer additive manufacturing services, specifically of fused deposition modeling 3D printing, as an inbound process during the manufacturing of any part through subtractive processes with the help of a robotic arm along with the repair of any kind of parts with the assistance of fused deposition modeling 3D printing. The main objectives of the master thesis include building a stationary filament extrusion module to interact with a robot hand and establishing a strategy for a robot hand to move the part to appropriate locations to complete building a part on a preform without support structures. The targets that were achieved with the completion of this thesis project includes the development of the complete hardware that consists of a mechanical structure with the option of mounting the components required to run the extrusion setup, learning the basic working of the software that are able to simulate the 3D printing process with the robotic arm (Robot Studio and Robo DK), creation of the simulation of the whole process, achieving communication between the robotic arm and the microcontroller of the extruder and finally the printing of a simple part for the demonstration. The components needed to be installed on the structure includes the motor, extruder, hot end, nozzle, filament. The structure also accumulated the required electronics that includes power supply, microcontroller, and an LCD to monitor the extrusion parameters. The developed machine runs on the state-of-the-art components that belong to the few of the best manufacturers of the technology.