Cannula-mounted Robots for Semi-autonomous Vertebroplasty: A Comparison of Piezo-based and Screw-based Inchworm Drive Designs.

Vertebral compression fractures are estimated to affect over 200 million people globally. Percutaneous vertebroplasty is a widely accepted minimally invasive treatment, but it has limitations including prolonged radiation exposure for providers and a steep learning curve. To address these challenges, we present two cannula-mounted robot designs for semi-autonomous, high-precision cannula insertion.

Will your next surgeon be a robot? Autonomy and AI in robotic surgery.

State-of-the-art surgery is performed robotically under direct surgeon control. However, surgical outcome is limited by the availability, skill, and day-to-day performance of the operating surgeon. What will it take to improve surgical outcomes independent of human limitations? In this Review, we explore the technological evolution of robotic surgery and current trends in robotics and artificial intelligence that could lead to a future generation of autonomous surgical robots that will outperform today's teleoperated robots.

Near-infrared beacons: tracking anatomy with biocompatible fluorescent dots for mixed reality surgical navigation.

Purpose: Mixed reality for surgical navigation is an emerging tool for precision surgery. Achieving reliable surgical guidance hinges on robust tracking of the mixed reality device relative to patient anatomy. Contemporary approaches either introduce bulky fiducials that need to be invasively attached to the anatomy or make strong assumptions about the patient remaining stationary.

Enhancing Surgical Precision in Autonomous Robotic Incisions via Physics-Based Tissue Cutting Simulation.

In soft tissue surgeries, such as tumor resections, achieving precision is of utmost importance. Surgeons conventionally achieve this precision through intraoperative adjustments to the cutting plan, responding to deformations from tool-tissue interactions. This study examines the integration of physics-based tissue cutting simulations into autonomous robotic surgery to preoperatively predict and compensate for such deformations, aiming to improve surgical precision and reduce the necessity for dynamic adjustments during autonomous surgeries.

A Robotic Injection System for Consistent Pneumo-dissection of the Deep Stroma in Big Bubble DALK Surgery.

In this paper we present a novel robotic injection system capable of performing clinically relevant pneumo-dissection of the deep stroma for the big bubble DALK procedure. Because the recommended clinical technique to insert a needle into the deep stroma using a horizontal approach results in inconsistent dissection, we designed an automatic injection robot to employ a vertical approach to consistently pneumo-dissect the tissue. In bench testing with synthetic tissues, the system was able to generate a max pressure of 90 kPa and held the pressure with a deviation of 0.

Design and Evaluation of an Eye Mountable AutoDALK Robot for Deep Anterior Lamellar Keratoplasty.

Partial-thickness corneal transplants using a deep anterior lamellar keratoplasty (DALK) approach has demonstrated better patient outcomes than a full-thickness cornea transplant. However, despite better clinical outcomes from the DALK procedure, adoption of the technique has been limited because the accurate insertion of the needle into the deep stroma remains technically challenging. In this work, we present a novel hands-free eye mountable robot for automatic needle placement in the cornea, AutoDALK, that has the potential to simplify this critical step in the DALK procedure.

Automatic and real-time tissue sensing for autonomous intestinal anastomosis using hybrid MLP-DC-CNN classifier-based optical coherence tomography.

Anastomosis is a common and critical part of reconstructive procedures within gastrointestinal, urologic, and gynecologic surgery. The use of autonomous surgical robots such as the smart tissue autonomous robot (STAR) system demonstrates an improved efficiency and consistency of the laparoscopic small bowel anastomosis over the current da Vinci surgical system. However, the STAR workflow requires auxiliary manual monitoring during the suturing procedure to avoid missed or wrong stitches.

Autonomous System for Tumor Resection (ASTR) - Dual-Arm Robotic Midline Partial Glossectomy.

Head and neck cancers are the seventh most common cancers worldwide, with squamous cell carcinoma being the most prevalent histologic subtype. Surgical resection is a primary treatment modality for many patients with head and neck squamous cell carcinoma, and accurately identifying tumor boundaries and ensuring sufficient resection margins are critical for optimizing oncologic outcomes. This study presents an innovative autonomous system for tumor resection (ASTR) and conducts a feasibility study by performing supervised autonomous midline partial glossectomy for pseudotumor with millimeter accuracy.

Common-path optical coherence tomography guided vertical pneumodissection for DALK.

We reported a design and evaluation of an optical coherence tomography (OCT) sensor-integrated 27 gauge vertically inserted razor edge cannula (VIREC) for pneumatic dissection of Descemet's membrane (DM) from the stromal layer. The VIREC was inserted vertically at the apex of the cornea to the desired depth near DM. The study was performed using ex vivo bovine corneas (N = 5) and rabbit corneas (N = 5).

Percutaneous epicardial pacing in infants using direct visualization: A feasibility animal study.

Background: Pacemaker implantation in infants and small children is limited to epicardial lead placement via open chest surgery. We propose a minimally invasive solution using a novel percutaneous access kit.

Objective: To evaluate the acute safety and feasibility of a novel percutaneous pericardial access tool kit to implant pacemaker leads on the epicardium under direct visualization.

A novel videoscope and tool kit for percutaneous pericardial access under direct visualization.

Background: Pericardial access is necessary for the application of epicardial cardiac therapies including ablation catheters, pacing and defibrillation leads, and left atrial appendage closure systems. Pericardial access under fluoroscopic guidance is difficult in patients without pericardial effusions and may result in coronary artery damage, ventricular injury, or perforation with potentially life-threatening pericardial bleeding in up to 10% of cases. There is a clinical need for a pericardial access technique to safely deliver epicardial cardiac therapies.

Design and Functionality of a Multilumen Thoracic Access Port for Pericardial Access Under Direct Visualization.

Small vasculature, venous obstruction, or congenital anomalies can preclude transvenous access to the heart, often resulting in open chest surgery to implant cardiac therapy leads for pacing, defibrillation, or cardiac resynchronization. A minimally invasive approach under direct visualization could reduce tissue damage, minimize pain, shorten recovery time, and obviate the need for fluoroscopy. Therefore, PeriPath was designed as a single-use, low-cost pericardial access tool based on clinical requirements.

Muscle usage and workload assessment of cardiac ablation procedure with the use of a novel catheter torque tool in a pediatric simulator.

Background: Cardiac ablation catheters are small in diameter and pose ergonomic challenges that can affect catheter stability. Significant finger dexterity and strength are necessary to maneuver them safely. We evaluated a novel torque tool to reduce muscle activation when manipulating catheters and improve perceived workload of ablation tasks.

An infant phantom for pediatric pericardial access and electrophysiology training.

Background: Cardiac procedures in infants and children require a high level of skill and dexterity owing to small stature and anatomy. Lower incidence of procedure volume in this population results in fewer clinical opportunities for learning. Simulators have grown in popularity for education and training, though most existing simulators are often cost-prohibitive or model adult anatomy.

Deep point cloud landmark localization for fringe projection profilometry.

Point clouds have been widely used due to their information being richer than images. Fringe projection profilometry (FPP) is one of the camera-based point cloud acquisition techniques that is being developed as a vision system for robotic surgery. For semi-autonomous robotic suturing, fluorescent fiducials were previously used on a target tissue as suture landmarks.

Surgical pericardial adhesions do not preclude minimally invasive epicardial pacemaker lead placement in an infant porcine model.

Background: Pericardial adhesions in infants and small children following cardiac surgery can impede access to the epicardium. We previously described minimally invasive epicardial lead placement under direct visualization in an infant porcine model using a single subxiphoid incision. The objective of this study was to assess the acute feasibility of this approach in the presence of postoperative pericardial adhesions.

Role of surgeon intuition and computer-aided design in Fontan optimization: A computational fluid dynamics simulation study.

Objective: Customized Fontan designs, generated by computer-aided design (CAD) and optimized by computational fluid dynamics simulations, can lead to novel, patient-specific Fontan conduits unconstrained by off-the-shelf grafts. The relative contributions of both surgical expertise and CAD to Fontan optimization have not been addressed. In this study, we assessed hemodynamic performance of Fontans designed by both surgeon's unconstrained modeling (SUM) and by CAD.

Percutaneous epicardial placement of a prototype miniature pacemaker under direct visualization: An infant porcine chronic survival study.

Introduction: Pacemaker implantation in infants typically consists of surgical epicardial lead placement with an abdominal generator. Here, we describe the chronic performance of our minimally invasive prototype miniature pacemaker implanted under direct visualization in an immature porcine model.

Methods: Twelve piglets underwent miniature pacemaker implantation.

Chronic performance of subxiphoid minimally invasive pericardial Model 20066 pacemaker lead insertion in an infant animal model.

Purpose: To describe chronic performance of subxiphoid minimally invasive pacemaker lead insertion in a piglet model.

Methods: Minimally invasive pacemaker lead implantation was performed through a 10-mm incision under direct visualization using the PeriPath port. Epicardial access was obtained and the commercially available Medtronic Model 20066 pacemaker lead was inserted into the pericardial space and epicardial fixation was performed using the side-action helix.

Landmark-Guided Deformable Image Registration for Supervised Autonomous Robotic Tumor Resection.

Oral squamous cell carcinoma (OSCC) is the most common cancer in the head and neck region, and is associated with high morbidity and mortality rates. Surgical resection is usually the primary treatment strategy for OSCC, and maintaining effective tumor resection margins is paramount to surgical outcomes. In practice, wide tumor excisions impair post-surgical organ function, while narrow resection margins are associated with tumor recurrence.

A Confidence-Based Shared Control Strategy for the Smart Tissue Autonomous Robot (STAR).

Autonomous robotic assisted surgery (RAS) systems aim to reduce human errors and improve patient outcomes leveraging robotic accuracy and repeatability during surgical procedures. However, full automation of RAS in complex surgical environments is still not feasible and collaboration with the surgeon is required for safe and effective use. In this work, we utilize our Smart Tissue Autonomous Robot (STAR) to develop and evaluate a shared control strategy for the collaboration of the robot with a human operator in surgical scenarios.

Minimally invasive percutaneous epicardial placement of a prototype miniature pacemaker with a leadlet under direct visualization: A feasibility study in an infant porcine model.

Background: Pacemaker implantation in infants is limited to epicardial lead placement and an abdominal generator pocket. We propose a minimally invasive solution using a prototype miniature pacemaker with a steroid-eluting leadlet that can affix against the epicardium under thoracoscopy.

Objective: The purpose of this study was to evaluate the safety and feasibility of acute implantation of a prototype miniature pacemaker in an infant porcine model.

Semi-Autonomous Laparoscopic Robotic Electro-surgery with a Novel 3D Endoscope.

This paper reports a robotic laparoscopic surgery system performing electro-surgery on porcine cadaver kidney, and evaluates its accuracy in an open loop control scheme to conduct targeting and cutting tasks guided by a novel 3D endoscope. We describe the design and integration of the novel laparoscopic imaging system that is capable of reconstructing the surgical field using structured light. A targeting task is first performed to determine the average positioning error of the system as guided by the laparoscopic camera.