Towards a Tendon-Driven Robotically Steerable Guidewire with a Retractable Distal Balloon.

Minimally invasive endovascular and transcather procedures frequently involve delivering tools to the surgical site via a guidewire. Even when made steerable, the guidewire tip has the potential to cause tissue damage while traversing the vasculature and the connected organs. In this work, a methodology is introduced to integrate a balloon onto a tendon-driven robotically steerable guidewire to cushion the contact with tissue during traversal, stabilize within the vasculature once the guidewire has passed the surgical site, and arrest bloodflow to prevent distal embolization.

Robotically steerable guidewires-Current trends and future directions.

Research on robotically steerable guidewires has surged in the past decade because of their potential in addressing difficulties related to endovascular interventions. These microscale devices exhibit unique challenges in design, fabrication, and control, not necessarily present in mesoscale continuum robots such as robotic catheters and endoscopes. Existing literature on surgical robots mainly addresses advancements in robotic surgery with a focus on current trends in specific clinical procedures.

Design and Modeling of a Compact Spooling Mechanism for the COAST Guidewire Robot.

The treatment of many intravascular procedures begins with a clinician manually placing a guidewire to the target lesion to aid in placing other devices. Manually steering the guidewire is challenging due to the lack of direct tip control and the high tortuosity of vessel structures, potentially resulting in vessel perforation or guidewire fracture. These challenges can be alleviated through the use of robotically steerable guidewires that can improve guidewire tip control, provide force feedback, and, similar to commercial guidewires, are inherently safe due to their compliant structure.

Modeling Non-linear Effects in a 4-DoF Robotic Transcatheter Delivery System.

Transcatheter mitral valve repair (TMVr), a minimally invasive approach, is becoming increasingly popular for treating mitral regurgitation (MR) since nearly half of the MR patients are non-surgical candidates. However, current TMVr devices are operated manually, increasing radiation exposure to the clinical staff and making telesurgery infeasible. A robotically steerable transcatheter delivery system can alleviate these issues while also enhancing consistency, improving precision, and mitigating human fatigue during the procedure.

Ultrasound-Guided Real-Time Joint Space Control of a Robotic Transcatheter Delivery System.

Transcatheter mitral valve repair (TMVr) is growing in popularity for non-surgical mitral regurgitation (MR) patients, but the manual operation of current TMVr devices increases radiation exposure and limits telesurgery feasibility. A robotically steerable delivery system can alleviate these problems, improving safety and precision while reducing staff fatigue. However, precise manipulation of a surgical robotic system requires system modeling and reliable external feedback.

A variable stiffness robotically steerable guidewire for endovascular interventions.

Endovascular interventions typically begin with the placement of a guidewire. Guidewire placement is challenging due to tortuous anatomy and the lack of steerability at the guidewire tip. Navigation often requires several guidewires with different stiffnesses to ensure the target is safely reached.

Teleoperated Navigation of a Robotically Steerable Guidewire under Fluoroscopy in a Flow Environment.

A chronic total occlusion (CTO) is a complete blockage that impedes blood flow in the coronary artery. Minimally invasive procedures for treating CTOs typically involve manually steering a guidewire to the occlusion. However, navigating the guidewire throughout arteries can be challenging due to bifurcations and narrow vessels.

Development of a single port dual arm robotically steerable endoscope for neurosurgical applications.

Single-port surgical robots have gained popularity due to less patient trauma and quicker post-surgery recovery. However, due to limited access provided by a single incision, the miniaturization and maneuverability of these robots still needs to be improved. In this paper, we propose the design of a single-port, dual-arm robotically steerable endoscope containing one steerable major cannula and two steerable minor cannulas.

Design, analysis, and demonstration of the COAST guidewire robot with middle tube rotation for endovascular interventions.

Minimally invasive procedures for endovascular interventions involve manual navigation of a guidewire. Endovascular interventions encompassing highly tortuous vessels would benefit from guidewires which exhibit higher dexterity. This paper introduces a version of the COAST (COaxially Aligned STeerable) guidewire system capable of exhibiting higher dexterity.

Image-based Force Localization and Estimation of a Micro-scale Continuum Guidewire Robot.

Many intravascular procedures are prefaced by the placement of a slender wire called a guidewire. Steering these guidewires is met with challenges in controlling the distal end along with the possibility of damaging vessel walls, or even perforation, which can be fatal. To this end, utilizing robotic guidewires can improve steerability and enable force feedback through intrinsic force sensing.

Design and Modeling of a Sub-2 mm Steerable Neuroendoscopic Grasping Tool.

Minimally invasive procedures, such as endoscopic third ventriculostomy (ETV), benefit from the increased dexterity and safety that surgical continuum robots can bring. However, due to their natural compliance, new compatible end-effectors, such as graspers or scissors, must be developed and their actuation must be considered when developing the robotic structures in which they are housed due to the inherent coupling that will be introduced. In this paper, we integrate a tendon-driven meso-scale grasper, with a closed configuration diameter of 1.

Corrections to "Micropositioning and Control of an Underactuated Platform for Microscopic Applications".

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Simultaneous Shape and Tip Force Sensing for the COAST Guidewire Robot.

Placement of catheters in minimally invasive cardiovascular procedures is preceded by navigating to the target lesion with a guidewire. Traversing through tortuous vascular pathways can be challenging without precise tip control, potentially resulting in the damage or perforation of blood vessels. To improve guidewire navigation, this paper presents 3D shape reconstruction and tip force sensing for the COaxially Aligned STeerable (COAST) guidewire robot using a triplet of adhered single core fiber Bragg grating sensors routed centrally through the robot's slender structure.

Real-time Pose Tracking for a Continuum Guidewire Robot under Fluoroscopic Imaging.

Atherosclerosis is a medical condition that causes buildup of plaque in the blood vessels and narrowing of the arteries. Surgeons often treat this condition through angioplasty with catheter placements. Continuum guidewire robots offer significant advantages for catheter placements due to their dexterity.

Telerobotic Transcatheter Delivery System for Mitral Valve Implant.

Mitral regurgitation (MR) is the most common type of valvular heart disease, affecting over 2% of the world population, and the gold-standard treatment is surgical mitral valve repair/replacement. Compared to open-heart surgeries, minimally invasive surgeries (MIS) using transcatheter approaches have become popular because of their notable benefits such as less postoperative pain, shorter hospital stay, and faster recovery time. However, commercially available catheters are manually actuated, causing over-exposure of clinical staff to radiation and increased risk of human error during medical interventions.

Compact Design and Task Space Control of a Robotic Transcatheter Delivery System for Mitral Valve Implant.

Mitral regurgitation (MR) is one of the most common valvular abnormalities, and the gold-standard for treatment is surgical mitral valve repair/replacement. Most patients with severe MR are over the age of 75, which makes open-heart surgery challenging. Thus, minimally invasive surgeries using transcatheter approaches are gaining popularity.

Preclinical Evaluation of a Novel Steerable Robotic Neuroendoscope Tool.

Background And Objectives: To improve the outcomes of minimally invasive, endoscopic, intracranial procedures, steerable robotic tools have been developed but still require thorough evaluation before use in a clinical setting. This paper compares a novel steerable robotic neuroendoscope tool against a standard rigid tool.

Methods: Seventeen participants, 8 nonmedical and 9 medical (neurosurgery residents and fellows), were recruited.

Kinematic Modeling and Jacobian-based Control of the COAST Guidewire Robot.

Manual guidewire navigation and placement for minimally invasive surgeries suffer from technical challenges due to imprecise tip motion control to traverse highly tortuous vasculature. Robotically steerable guidewires can address these challenges by actuating a compliant tip through multiple degrees-of-freedom for maneuvering through vascular pathways. In this paper, we detail the kinematic mapping of a COaxially Aligned STeerable (COAST) guidewire robot that is capable of executing follow-the-leader motion in three dimensional vascular pathways.

Model-based Design of the COAST Guidewire Robot for Large Deflection.

Minimally invasive endovascular procedures involve the manual placement of a guidewire, which is made difficult by vascular tortuosity and the lack of precise tip control. Steerable guidewire systems have been developed with tendon-driven, magnetic, and concentric tube actuation strategies to enable precise tip control, however, selecting machining parameters for such robots does not have a strict procedure. In this paper, we develop a systematic design procedure for selecting the tube pairs of the COaxially Aligned STeerable (COAST) guidewire robot.

Towards comprehensive evaluation of the FLEXotendon glove-III: a case series evaluation in pediatric clinical cases and able-bodied adults.

Injuries involving the nervous system, such as a brachial plexus palsy or traumatic brain injury, can lead to impairment in the functionality of the hand. Assistive robotics have been proposed as a possible method to improve patient outcomes in rehabilitation. The work presented here evaluates the FLEXotendon Glove-III, a 5 degree-of-freedom, voice-controlled, tendon-driven soft robotic hand exoskeleton, with two human subjects with hand impairments and four able-bodied subjects.

Towards the Design and Development of a Robotic Transcatheter Delivery System for Mitral Valve Implant.

Minimally-invasive surgeries using transcatheter approaches and sophisticated imaging modalities are gaining popularity to treat mitral regurgitation (MR). This paper proposes the next generation of a robotic catheter to deliver an implant onto the mitral valve (MV) through a transseptal approach. The proposed robot has an outer diameter (OD) of 5.

Evaluation of the FLEXotendon glove-III through a human subject case study.

Cervical spinal cord injury (SCI) can significantly impair an individual's hand functionality due to the disruption of nerve signals from the brain to the upper extremity. Robotic assistive hand exoskeletons have been proposed as a potential technology to facilitate improved patient rehabilitation outcomes, but few exoskeleton studies utilize standardized hand function tests and questionnaires to produce quantitative data regarding exoskeleton performance. This work presents the human subject case study evaluation of the FLEXotendon Glove-III, a 5 degree-of-freedom voice-controlled, tendon-driven soft robotic assistive hand exoskeleton for individuals with SCI.

Supervised segmentation for guiding peripheral revascularization with forward-viewing, robotically steered ultrasound guidewire.

Background: Approximately 500 000 patients present with critical limb ischemia (CLI) each year in the U.S., requiring revascularization to avoid amputation.

Fluoroscopic Image-Based 3-D Environment Reconstruction and Automated Path Planning for a Robotically Steerable Guidewire.

Cardiovascular diseases are the leading cause of death globally and surgical treatments for these often begin with the manual placement of a long compliant wire, called a guidewire, through different vasculature. To improve procedure outcomes and reduce radiation exposure, we propose steps towards a fully automated approach for steerable guidewire navigation within vessels. In this paper, we utilize fluoroscopic images to fully reconstruct 3-D printed phantom vasculature models by using a shape-from-silhouette algorithm.

Towards Real-time pose estimation of the Mitral Valve Robot under C-arm X-ray Fluoroscopy.

Mitral regurgitation (MR) is a condition caused by a deformity in the mitral valve leading to the backflow of blood into the left atrium. MR can be treated through a minimally invasive procedure and our lab is currently developing a robot that could potentially be used to treat MR. The robot would carry a clip that latches onto the valve's leaflets and closes them to minimize leakage.