Endovascular techniques have been embraced as a minimally-invasive treatment approach within different disciplines of interventional radiology and cardiology. The current practice of endovascular procedures, however, is limited by a number of factors including exposure to high doses of X-ray radiation, limited 3D imaging, and lack of contact force sensing from the endovascular tools and the vascular anatomy. More recently, advances in steerable catheters and development of master/slave robots have aimed to improve these practices by removing the operator from the radiation source and increasing the precision and stability of catheter motion with added degrees-of-freedom. Despite their increased application and a growing research interest in this area, many such systems have been designed without considering the natural manipulation skills and ergonomic preferences of the operators. Existing studies on tool interactions and natural manipulation skills of the operators are limited. In this manuscript, new technical developments in different aspects of robotic endovascular intervention including catheter instrumentation, intra-operative imaging and navigation techniques, as well as master/slave based robotic catheterization platforms are reviewed. We further address emerging trends and new research opportunities towards more widespread clinical acceptance of robotically assisted endovascular technologies.

Current and emerging robot-assisted endovascular catheterization technologies: a review.

Remote-controlled vascular interventional robots (RVIRs) are being developed to increase the overall accuracy of surgical operations and reduce the occupational risks of intervening physicians, such as radiation exposure and chronic neck/back pain. Several RVIRs have been used to operate catheters or guidewires accurately. However, a lack of cooperation between the catheters and guidewires results in the surgeon being unable to complete complex surgery by propelling the catheter/guidewire to the target position. Furthermore, it is a significant challenge to operate the catheter/guidewire accurately and detect their proximal force without damaging their surfaces. In this study, we introduce a novel method that allows catheters and guidewires to be operated simultaneously in complex surgery. Our method accurately captures force measurements and enables precisely controlled catheter and guidewire operation. A prototype is validated through various experiments. The results demonstrate the feasibility of the proposed RVIR to operate a catheter and guidewire accurately, detect the resistance forces, and complete complex surgical operations in a cooperative manner.

A cooperation of catheters and guidewires-based novel remote-controlled vascular interventional robot

Remote-controlled vascular interventional robots (RVIRs) are being developed to increase the accuracy of surgical operations and reduce the number of occupational risks sustained by intervening physicians, such as radiation exposure and chronic neck/back pain. However, complex control of the RVIRs improves the doctor's operation difficulty and reduces the operation efficiency. Furthermore, incomplete sterilization of the RVIRs will increase the risk of infection, or even cause medical accidents. In this study, we introduced a novel method that provides higher operation efficiency than a previous prototype and allows for complete robot sterilization. A prototype was fabricated and validated through laboratory setting experiments and an in-human experiment. The results illustrated that the proposed RVIR has better performance compared with the previous prototype, and preliminarily demonstrated that the proposed RVIR has good safety and reliability and can be used in clinical surgeries.

Operation evaluation in-human of a novel remote-controlled vascular interventional robot.

Minimally invasive vascular interventional surgery is widely used and remote-controlled vascular interventional surgery robots (RVIRs) are being developed to reduce the occupational risk of the intervening physician in minimally invasive vascular interventional surgeries. Skilled surgeon performs surgeries mainly depending on the detection of collisions. Inaccurate force feedback will be difficult for surgeons to perform surgeries or even results in medical accidents. In addition, the surgeon cannot quickly and easily distinguish whether the proximal force exceeds the safety threshold of blood vessels or not, and thus it results in damage to the blood vessels. In this paper, we present a novel method comprising compensatory force measurement and multimodal force feedback (MFF). Calibration experiments and performance evaluation experiments were carried out. Experimental results demonstrated that the proposed method can measure the proximal force of catheter/guidewire accurately and assist surgeons to distinguish the change of proximal force more easily. This novel method is suitable for use in actual surgical operations.

Compensatory force measurement and multimodal force feedback for remote-controlled vascular interventional robot

A robotically assisted catheterization system can obviously reduce the radiation exposure to the surgeon and lesson the fatigue caused by standing for long time in protective clothing. However, effective detection and feedback of proximal force signals is essential to the success of a surgery. This paper presents a compact, cost-effective force-sensing device based on strain gauges, for our team developed slave side, to measure the proximal force signals of the input catheter. A significant advantage is that the proposed sensing device can detect the force signals directly without any mechanical transmission, and this can increase the measurement accuracy of force information. In addition, a haptic interface based on MR fluid is designed to provide a realistic sense of operation according to the force signals from the slave side, so as to improve the safety and success of a surgery. Comparing experimental results from an insertion test and a load cell, show that the average error for force measurement is less than 0.01 N. This research provides important insights into the design of compact, ergonomic, robotic catheter manipulators for intraoperative navigation using effective tactile sensing devices.

Performance evaluation of a strain-gauge force sensor for a haptic robot-assisted catheter operating system

Utilizing catheters with unchangeable distal tip, traditional endovascular minimally invasive surgery is manually performed by surgeons present in an operating room filled with X-ray radiation. It has many disadvantages, such as poor maneuverability, radiation injury and undesirable interactivity, Thus it is difficult to guarantee the safety and efficiency. In order to improve these limitations, this paper develops a novel robotic catheter system with master-slave control, including the steerable catheter integrated with two magnetic tracking sensors, interventional mechanisms with force feedback and 3D guiding image with the collision test. The results demonstrate that the constructed system can reduce the usage of X-rays; surgeons can be located in the control room away from the operating room in the master-slave way; catheterization can be performed successfully and safely to the target point with high maneuverability.

Development of a novel robotic catheter system for endovascular minimally invasive surgery

The invention discloses a catheter robot system for a minimally invasive interventional operation in a blood vessel, relating to a robot system for assisting the minimally invasive interventional operation in the blood vessel, which aims to lower the radiation hazard to patients and doctors on site, realize compartmental interventional operation at different sites and feed back the conveying force of a catheter. A main hand handle and a computer mainframe are arranged in a control room; a control cabinet, a catheter handle, master and slave intervention devices, a magnetic field generator and a controllable catheter are arranged in an operation room; a pose signal of the main hand handle is delivered to the control cabinet after processed by the computer mainframe; the control cabinet is internally provided with a motion control card and a driver; the motion control card receives a command to send an instruction to the driver; the driver delivers a control signal to the motors of the master and slave intervention devices, thereby controlling the intervention devices to realize the pushing/pulling, rotation and bending operations of the controllable catheter; a pose sensor acquires pose information on a controllable bent section, and the pose signal is delivered by the motion control card to the computer mainframe for signal processing. The invention is used for the minimally invasive interventional operation in the blood vessel.

Catheter robot system for minimally invasive interventional operation in blood vessel

The invention relates to a catheter intervention device with the conveying resistance feedback function, belonging to a catheter intervention device, and aiming at solving the problems that the existing catheter intervention device is not compact in structure, does not have the conveying resistance feedback function and is operated at the surgical site by doctors getting involved the surgery. Output shafts of a left and a right motors are fixedly sheathed with a left side driving gear and a first-stage driving gear; the left side driving gear is meshed with a left side driven gear; the first-stage driving gear is meshed with a first-stage driven gear; a second-stage driving bevel gear is fixedly connected with the first-stage driven gear; the second-stage driving bevel gear is meshed witha second-stage driven bevel gear; a third-stage driving gear is fixedly connected with the second-stage driven bevel gear; the third-stage driving gear is meshed with a third-stage driven gear; a driving friction inner wheel is fixedly provided with a touch force sensor; the driving friction inner wheel is connected with a driving friction outer wheel by the touch force sensor; a signal output end of the touch force sensor is connected with a signal input end of an amplification circuit board; and an amplifying signal output end of the amplification circuit board is connected with a signal input end of an inner ring of a second electric conduction sliding ring. The catheter intervention device is used for continuously conveying a catheter and feedback of the force.

Catheter intervention device with conveying resistance feedback function

The invention discloses an intervention operation catheter clamping jaw with dual force feedback function, which relates to an intervention operation catheter clamping jaw and solves the problem that a minimally-invasive intervention operation catheter conveying device cannot feed back a push-pull force and a torsional force at the same time. Compression springs are fixedly connected in symmetrically placed spring fixing pieces, clamping disks are connected on the compression springs, a catheter is clamped through the two clamping disks, the clamping disks are connected with armatures through steel wire ropes, the armatures are arranged opposite to electromagnets, the spring fixing pieces and the electromagnets are fixed on an inner torsional ring and an inner ring end cover, an inner torsional rotating shaft and an inner ring shaft are matched with an inner ring of a deep groove ball bearing, a sliding sleeve is sleeved on an outer ring of the deep groove ball bearing, the sliding sleeve is matched with an inner ring of a sleeve type linear motion bearing, the linear motion bearing is fixed on a connector, a push sensor is arranged on the connector, and a torsional force sensor is arranged on the inner torsional ring. The intervention operation catheter clamping jaw realizes clamping, push-pull and torsional dual force feedback function of the intervention operation catheter.

Intervention operation catheter clamping jaw with dual force feedback function

The invention provides an operation device of a radio frequency electrode ablation catheter handle, which relates to an operation device of a catheter handle. The invention solves the problems that in the catheter intervene type operation, the intervene process of the radio frequency electrode ablation catheter needs the manual operation of a doctor, so the operation difficulty is great, the precision is not easy to control, and the doctor can not avoid the radiation. An outer sun wheel is arranged on an inner sun wheel shaft through an outer sun wheel connecting disc, a planetary wheel is arranged between the outer sun wheel and an inner sun wheel, outer teeth of the planetary wheel are respectively engaged with inner teeth of the outer sun wheel and outer teeth of the inner sun wheel, a ball nut is arranged on a lead screw, the other end of the planetary wheel shaft is connected with one end of the lead screw through a sleeve barrel shaft coupler, and a slide button clamping and grasping element of the catheter handle is fixed on the ball nut. The invention controls the rotation of the radio frequency electrode ablation catheter handle and the slide of the slide button on the handle through a differential planetary wheel system mechanism, the deflection rotation of the far end of the catheter connected with the handle is further realized, the operation and the control are accurate and convenient, and in addition, the operation is easy.

Kai Li

Papers

Development of a novel robotic catheter system for endovascular minimally invasive surgery

Catheter robot system for minimally invasive interventional operation in blood vessel

Catheter intervention device with conveying resistance feedback function

Intervention operation catheter clamping jaw with dual force feedback function

Operation device of radio frequency electrode ablation catheter handle