Microrobots have the potential to revolutionize many aspects of medicine. These untethered, wirelessly controlled and powered devices will make existing therapeutic and diagnostic procedures less invasive and will enable new procedures never before possible. The aim of this review is threefold: first, to provide a comprehensive survey of the technological state of the art in medical microrobots; second, to explore the potential impact of medical microrobots and inspire future research in this field; and third, to provide a collection of valuable information and engineering tools for the design of medical microrobots.

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Microrobots for Minimally Invasive Medicine

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

The present invention was developed by a neurosurgeon and seeks to mimic the results of primate neurological research which is indicative of a human's actual neurological control structures and logic. Specifically, the motor proprioceptive and tactile neurophysiology functioning of the surgeon's hands and internal hand control system from the muscular level through the intrafusal fiber system of the neural network is considered in creating the robot and method of operation of the present invention. Therefore, the surgery is not slowed down as in the art, because the surgeon is in conscious and subconscious natural agreement and harmonization with the robotically actuated surgical instruments based on neurological mimicking of the surgeon's behavior with the functioning of the robot. Therefore, the robot can enhance the surgeon's humanly limited senses while not introducing disruptive variables to the surgeon's naturally occurring operation of his neurophysiology. This is therefore also a new field, neurophysiological symbiotic robotics.

Surgical robot and robotic controller

A surgical tool system includes a surgical tool for cutting and stapling tissue and a tactile feedback system integrated onto a handle of the tool that generates relevant feedback in at least the form of haptic effects to the user. The tactile feedback alerts the user of tissue properties, i.e., the type of tissue or other structures located within the jaws of the stapler, whether the quantity or thickness of tissue located within the jaws of the stapler is appropriate for the selected stapler cartridge, whether the proper length of staples has been fired based on the length of tissue located in the jaws, whether a blood vessel is located within the jaws of the stapler, whether the stapling process has successfully sealed the tissue located within the jaws of the stapler, the position of the cutting element, and/or when the stapling procedure or firing cycle is completed.

Surgical stapler having haptic feedback

Dynamic analysis of flexible manipulators, a literature review

This paper reports the development of a robotic system designed to extend a human’s ability to perform small-scale (sub-millimeter) manipulation tasks requiring human judgement, sensory integration and hand-eye coordination. Our novel approach, which we call “steady hand” micromanipulation, is for tools to be held simultaneously both by the operator’s hand and a specially designed actively controlled robot arm. The robot’s controller senses forces exerted by the operator on the tool and by the tool on the environment, and uses this information in various control modes to provide smooth, tremor-free precise positional control and force scaling. Our goal is to develop a manipulation system with the precision and sensitivity of a machine, but with the manipulative transparency and immediacy of handheld tools for tasks characterized by compliant or semi-rigid contacts with the environment.

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A Steady-Hand Robotic System for Microsurgical Augmentation

This paper reports the development of a new miniature force sensor designed to measure contact forces at the tip of a microsurgical instrument in three dimensions, and its application to scaled force feedback using a cooperatively manipulated microsurgical assistant robot. The principal features of the sensor are its small size of 12.5 mm in diameter and 15 mm in height, a novel configuration of flexure beams and strain gauges in order to measure forces isotropically at the instrument tip 40 mm from the sensor body, and sub-mN three-axis force-sensing resolution.

A miniature microsurgical instrument tip force sensor for enhanced force feedback during robot-assisted manipulation

Purpose: Vitreoretinal surgery involves the manipulation of delicate retinal membranes with a required surgical accuracy often on the order of tens of microns, a scale at or near the limit of human positional ability. In addition, forces imposed by the tissue on the surgical cool are exceedingly small. Here we investigate the magnitude of forces generated during retinal surgery in cadaveric porcine eyes and compare the results with the magnitude of forces discernable by retinal surgeons. This data will be used as a design guideline for robotic surgical augmentation systems currently under development Methods: The study was performed in two phases. First, retinal surgeons manipulated the retina of porcine cadaver eyes with a calibrated 1-axis force sensing retinal pick while data was simultaneously recorded. In the second phase, blindfolded subjects held the pick and were instructed to press a button whenever an “event” was felt. Events were generated by slowly tapping the end of the pick with varying force while both the magnitudes of forces applied and the responses of the subjects we recorded. The magnitudes of forces generated during retinal surgery were then compared with those that could be discerned by the subjects. Results: Roughly 75% of all forces measured during retinal microsurgery were found to be less than 7.5 mN in magnitude, however only 19.3 ± 8.1% (N=492) of events generated at this level could be felt by the subjects. Conclusions: The results of this study indicate that a majority of retinal surgery is probably performed without the surgeon being able to “feel” interactions between retinal tissue and the surgical tool. Prior studies have indicated that relying on visual feedback alone increases the length of manual manipulation tasks and reduces task accuracy. The lack of tactile sensation during retinal surgery similarly could adversely affect surgical outcome.

/pdf/surgical-forces-and-tactile-perception-during-retinal-1ygov1p2yw.pdf

Surgical Forces and Tactile Perception During Retinal Microsurgery

Reports preliminary experiments with a robot system designed to cooperatively extend a human's ability to perform fine manipulation tasks requiring human judgement, sensory integration and hand-eye coordination. A completed steady-hand robot is reported. A stable force control law is reviewed. Preliminary experiments validate theoretical predictions of stable one-dimensional control of tool-tip forces in contact with both linearly and nonlinearly compliant objects. Preliminary feasibility experiments demonstrate stable one-dimensional robotic augmentation and "force scaling" of a human operator's tactile input.

Preliminary experiments in cooperative human/robot force control for robot assisted microsurgical manipulation

Featured are new methods for performing intra-ocular surgery that allow surgical personnel to access the intra-ocular volume to perform a surgical procedure or technique but which does not require the use of sutures to seal the sclera and/or conjunctiva following the procedure. The methods of the present invention generally include providing an entry alignment device and inserting the entry alignment device into an eye through both the conjunctiva and sclera so as to form an entry aperture that extends between the exterior of the eye and the intra-ocular volume within the eye. The provided alignment device is configured so as to form or provide an aperture or opening in each of the conjunctiva and sclera of the eye and to maintain these apertures or openings in each of the conjunctiva and sclera aligned during the surgical procedure so these apertures or openings form the entry aperture. In more particular aspects, the provided entry alignment device is sized such that when the entry alignment device is removed from the eye following the completion of the surgical procedure, the aperture or opening formed in the sclera seals without the use of sutures. In a more specific aspect of the present invention, the provided entry alignment device is sized such that the apertures or openings and thus the entry aperture are self sealing. In other embodiments, a plurality of entry alignment devices are provided so a plurality of entry apertures can be formed in the eye. The invention also features a high speed vitreous cutting and aspirating device particularly configured for use in such methods and surgical procedures and techniques as well as the related entry alignment devices and other surgical instruments.

Patrick S. Jensen

Papers

A Steady-Hand Robotic System for Microsurgical Augmentation

A miniature microsurgical instrument tip force sensor for enhanced force feedback during robot-assisted manipulation

Surgical Forces and Tactile Perception During Retinal Microsurgery

Preliminary experiments in cooperative human/robot force control for robot assisted microsurgical manipulation

Sutureless occular surgical methods and instruments for use in such methods