This paper provides a broad overview of medical robot systems used in surgery. After introducing basic concepts of computer-integrated surgery, surgical CAD/CAM, and surgical assistants, it discusses some of the major design issues particular to medical robots. It then illustrates these issues and the broader themes introduced earlier with examples of current surgical CAD/CAM and surgical assistant systems. Finally, it provides a brief synopsis of current research challenges and closes with a few thoughts on the research/industry/clinician teamwork that is essential for progress in the field.

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Medical robotics in computer-integrated surgery

An instrument guide device comprises an elongated guide shaft having proximal and distal ends and including an instrument lumen for receiving therethrough a manually operated instrument having an instrument shaft. A distal bendable member is disposed at the distal end of the guide shaft and a proximal bendable member is disposed at the proximal end of the guide shaft. Actuation means extends between the distal and proximal bendable members and provides a bending of the distal bendable member controlled from the proximal bendable member. The proximal bendable member is controlled from the manually operated instrument to cause a corresponding bending of said distal bendable member.

Surgical instrument guide device

Needle insertion into soft tissue: a survey.

Monoclonal antibody (MoAb) for cancer treatment has been greatly progressed during this decade. Six kinds of MoAbs are now in clinical use in Japan. Here we review on the development of MoAbs such as rituximab, bevacizumab and cetuximab. The characterization and the nomenclature of MoAb are also described. Panitumumab, a new MoAb targeting epithelial growth factor receptor(EGFR), and the resistance of colorectal cancer with KRAS mutation for anti-EGFR MoAbs are on recent topics. The concept of bevacizumab beyond progression (BBP) and the unfavorable results of bevacizumab in elder nonsmall cell lung carcinoma patients are so suggestive considering the strategy of the individualized cancer therapy. Finally, "drug lag" for the development of anti-cancer agents between Eastern and Western has to be discussed.

Antibody therapy in cancer

Sinusitis and other disorders of the ear, nose and throat are diagnosed and/or treated using minimally invasive approaches with flexible or rigid instruments. Various methods and devices are used for remodeling or changing the shape, size or configuration of a sinus ostium or duct or other anatomical structure in the ear, nose or throat; implanting a device, cells or tissues; removing matter from the ear, nose or throat; delivering diagnostic or therapeutic substances or performing other diagnostic or therapeutic procedures. Introducing devices (e.g., guide catheters, tubes, guidewires, elongate probes, other elongate members) may be used to facilitate insertion of working devices (e.g. catheters e.g. balloon catheters, guidewires, tissue cutting or remodeling devices, devices for implanting elements like stents, electrosurgical devices, energy emitting devices, devices for delivering diagnostic or therapeutic agents, substance delivery implants, scopes etc.) into the paranasal sinuses or other structures in the ear, nose or throat.

Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures

Computer-assisted oral and maxillofacial surgery (OMS) has been rapidly evolving since the last decade. State-of-the-art surgical navigation in OMS still suffers from bulky tracking sensors, troublesome image registration procedures, patient movement, loss of depth perception in visual guidance, and low navigation accuracy. We present an augmented reality navigation system with automatic marker-free image registration using 3-D image overlay and stereo tracking for dental surgery. A customized stereo camera is designed to track both the patient and instrument. Image registration is performed by patient tracking and real-time 3-D contour matching, without requiring any fiducial and reference markers. Real-time autostereoscopic 3-D imaging is implemented with the help of a consumer-level graphics processing unit. The resulting 3-D image of the patient's anatomy is overlaid on the surgical site by a half-silvered mirror using image registration and IP-camera registration to guide the surgeon by exposing hidden critical structures. The 3-D image of the surgical instrument is also overlaid over the real one for an augmented display. The 3-D images present both stereo and motion parallax from which depth perception can be obtained. Experiments were performed to evaluate various aspects of the system; the overall image overlay error of the proposed system was 0.71 mm.

Augmented Reality Navigation With Automatic Marker-Free Image Registration Using 3-D Image Overlay for Dental Surgery

Uniaxial stress-strain data were obtained from in vitro experiments on 20 porcine livers for compressions, elongations and cycles of compression and then elongation. There were about 70 cylindrical samples, with diameter 7 mm and varying height (4–11 mm). The combined compression and elongation test provide a unified framework for both compression and elongation for applications such as computer-aided surgical simulation. It enable the zero stress state of the experimental liver sample to be precisely determined. A new equation that combined both logarithmic and polynomial strain energy forms was proposed in modelling these experimental data. The assumption of incompressibility was justified from a preliminary Poisson's ratio for elongation and compression at 0.43±0.16 and 0.47±0.15, respectively. This equation provided a good fit for the observed mechanical properties of liver during compression-elongation cycles and for separate compressions or elongations. The root mean square errors were 91.92±17.43 Pa, 57.55±13.23 Pa and 29.78±17.67 Pa, respectively. In comparison with existing strain energy functions, this combined model was the better constitutive equation. Application of this theoretical model to small liver samples and other tissues demonstrated its suitability as the material model of choice for soft tissue.

Combined compression and elongation experiments and non-linear modelling of liver tissue for surgical simulation.

Knowledge of the biomechanical properties of soft tissue, such as liver, is important in modelling computer aided surgical procedures. Liver tissue does not bear mechanical loads, and, in numerical simulation research, is typically assumed to be isotropic. Nevertheless, a typical biological soft tissue is anisotropic. In vitro uniaxial tension and compression experiments were conducted on porcine cylindrical and cubical liver tissue samples respectively assuming a simplistic architecture of liver tissue with its constituent lobule and connective tissues components. With the primary axis perpendicular to the cross sectional surface of samples, the tissue is stiffer with tensile or compressive force in the axial direction compared to that of the transverse direction. At 20% strain, about twice as much force is required to elongate a longitudinal tissue sample than that of a transverse sample. Results of the study suggest that liver tissue is transversely isotropic. A combined strain energy based constitutive equation for transversely isotropic material is proposed. The improved capability of this equation to model the experimental data compared to its previously disclosed isotropic version suggests that the assumption on the fourth invariant in the constitutive equation is probably correct and that anisotropy properties of liver tissue should be considered in surgical simulation.

Transversely isotropic properties of porcine liver tissue: experiments and constitutive modelling.

Background

Oral and maxillofacial surgery has not been benefitting from image guidance techniques owing to the limitations in image registration.



Methods

A real-time markerless image registration method is proposed by integrating a shape matching method into a 2D tracking framework. The image registration is performed by matching the patient's teeth model with intraoperative video to obtain its pose. The resulting pose is used to overlay relevant models from the same CT space on the camera video for augmented reality.



Results

The proposed system was evaluated on mandible/maxilla phantoms, a volunteer and clinical data. Experimental results show that the target overlay error is about 1 mm, and the frame rate of registration update yields 3–5 frames per second with a 4 K camera.



Conclusions

The significance of this work lies in its simplicity in clinical setting and the seamless integration into the current medical procedure with satisfactory response time and overlay accuracy. Copyright © 2016 John Wiley & Sons, Ltd.

Etsuko Kobayashi

Papers

Augmented Reality Navigation With Automatic Marker-Free Image Registration Using 3-D Image Overlay for Dental Surgery

Combined compression and elongation experiments and non-linear modelling of liver tissue for surgical simulation.

Transversely isotropic properties of porcine liver tissue: experiments and constitutive modelling.

Video see‐through augmented reality for oral and maxillofacial surgery

Real-time computer-generated integral imaging and 3D image calibration for augmented reality surgical navigation