Statistical shape models for 3D medical image segmentation: a review.

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 endoscope apparatus and method of operating the same. The endoscope apparatus comprises an endoscope portion and a control and display unit. The endoscope portion preferably comprises: (i) a sensor disposed at a distal end of the endoscope portion and providing endoscope data; (ii) one or more electronically controlled actuators (e.g., electroactive polymer actuators) controlling the operation of the endoscope portion based on received control signals; (iii) a first wireless transceiver coupled to the sensor and the one or more electronically controlled actuators, transmitting received endoscope data from the sensor and forwarding received control signals to the one or more electronically controlled actuators; and (iv) a portable power source (e.g., a battery) coupled to the sensor, the first wireless transceiver, and the one or more electronically controller actuators. The control and display unit preferably comprises: (i) a second wireless transceiver coupled via a wireless link to the first transceiver in the endoscope portion and receiving endoscope data from the first transceiver and transmitting control signals to the first transceiver; (ii) a control portion coupled to the second wireless transceiver and sending control signals to the one or more actuators in the endoscope portion via the first and second wireless transceivers; and (iii) a display portion that displays information received from the sensor via the first and second wireless transceivers. Another aspect of the present invention is directed to a method for providing single-use endoscopes to one or more hospitals.

Robotic endoscope with wireless interface

An instrument for treating tissue during a medical procedure includes a hand-held portion and a working portion. The hand-held portion is manually supported and moved by a user and the working portion is movably coupled to the hand-held portion. A tracking device is attached to the hand-held portion for tracking the instrument. The tracking device is in communication with a control system, which is used to keep the working portion within or outside of a boundary. A plurality of actuators are operatively coupled to the working portion. The control system instructs the actuators to move the working portion relative to the hand-held portion during the medical procedure in order to maintain a desired relationship between the working portion and the boundary.

Surgical instrument including housing, a cutting accessory that extends from the housing and actuators that establish the position of the cutting accessory relative to the housing

A connector assembly for controllable articles is described herein. The connector assembly engages force transmission elements used to transmit force from one or more force generators with the force transmission elements used to manipulate a controllable article. Additionally, the connector assembly provides organization thereby simplifying the process of connecting a plurality of elements, usually with a quick, single movement.

Connector device for a controllable instrument

The ultimate ambition of a robotic system in surgical theater has to be the safety of the involved humans: patient, physicians, nurses. In order to provide that claim the criteria of ergonomics, redundancy, short reaction time, and accuracy must be met. In contrast to many other surgical robotic applications we are studying complex bone cut trajectories which require several distinct orientations of the robot tool and milling cutter, respectively. Exact bone cuts are especially needed for bone repositionings placed at the human skull in craniofacial surgery. Therefore, the system has to be flexible enough to keep the capability of changing the patient's position during the intra-operative phase. This paper introduces the overall concept and realization of the system.

A safe robot system for craniofacial surgery

Objective: Today's surgical robots normally perform “simple” trajectories, e.g., assisting as tool-holding devices in neurosurgery, or milling linear paths for cavities in total hip replacement. From a clinical point of view, it is still a complex undertaking to implement robots in the operating room. Until now, robot systems have not been used in patient trials to mill “complex” trajectories, which involve many positional and orientation changes and are often necessary in cranio-maxillofacial (CMF) surgery. This paper presents the RobaCKa surgical robot system, which allows more precise execution of surgical interventions and milling of “complex” trajectories.Materials and Methods: The main components of the RobaCKa system are a (former) CASPAR robot system, a POLARIS system, and a force-torque sensor.Results: In the first patient trial (April 2003) the planned trajectory was executed with an error of 0.66 ± 0.2 mm.Conclusions: The use of former industrial robots for surgical applications is possible but...

Development and first patient trial of a surgical robot for complex trajectory milling.

Synthesis of CAD/CAM, robotics and biomaterial implant fabrication: single-step reconstruction in computer-aided frontotemporal bone resection.

Intraoperative Navigation Techniques: Accuracy Tests and Clinical Report

Lasers have been proven to be precise tools for bone ablation. Applying no mechanical stress to the patient, they are potentially very suitable for microsurgery on fragile structures such as the inner ear. However, it remains challenging to control the laser-bone ablation without injuring embedded soft tissue. In this work, we demonstrate a closed-loop control of a short-pulsed CO2 laser to perform laser cochleostomy under the monitoring of an optical coherence tomography (OCT) system. A foresighted detection of the bone-endosteum-perilymph boundary several hundred micrometers before its exposure has been realized. Position and duration of the laser pulses are planned based on the residual bone thickness distribution. OCT itself is also used as a highly accurate tracking system for motion compensation between the target area and the optics. During ex vivo experimental evaluation on fresh porcine cochleae, the ablation process terminated automatically when the thickness of the residual tissue layer uniformly reached a predefined value. The shape of the resulting channel bottom converged to the natural curvature of the endosteal layer without injuring the critical structure. Preliminary measurements in OCT scans indicated that the mean absolute accuracy of the shape approximation was only around 20 μm.

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Jörg Raczkowsky

Papers

A safe robot system for craniofacial surgery

Development and first patient trial of a surgical robot for complex trajectory milling.

Synthesis of CAD/CAM, robotics and biomaterial implant fabrication: single-step reconstruction in computer-aided frontotemporal bone resection.

Intraoperative Navigation Techniques: Accuracy Tests and Clinical Report

Optical Coherence Tomography Guided Laser Cochleostomy: Towards the Accuracy on Tens of Micrometer Scale