An Origami-Based Medical Support System to Mitigate Flexible Shaft Buckling
01 Aug 2020-Journal of Mechanisms and Robotics (American Society of Mechanical Engineers Digital Collection)-Vol. 12, Iss: 4, pp 041005
TL;DR: Varying parameters of a triangulated cylindrical origami pattern were combined to create an effective highly compressible anti-buckling system that maintains a constant inner diameter for supporting an instrument and a constant outer diameter throughout actuation.
Abstract:
This paper presents the development of an origami-inspired support system (the OriGuide) that enables the insertion of flexible instruments using medical robots. Varying parameters of a triangulated cylindrical origami pattern were combined to create an effective highly compressible anti-buckling system that maintains a constant inner diameter for supporting an instrument and a constant outer diameter throughout actuation. The proposed origami pattern is composed of two repeated patterns: a bistable pattern to create support points to mitigate flexible shaft buckling and a monostable pattern to enable axial extension and compression of the support system. The origami-based portion of the device is combined with two rigid mounts for interfacing with the medical robot. The origami-based portion of the device is fabricated from a single sheet of polyethylene terephthalate. The length, outer diameter, and inner diameter that emerge from the fold pattern can be customized to accommodate various robot designs and flexible instrument geometries without increasing the part count. The support system also adds protection to the instrument from external contamination.
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References
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TL;DR: Robotic surgery is still in its infancy and its niche has not yet been well defined, so its current practical uses are mostly confined to smaller surgical procedures.
Abstract: Robotic surgery is a new and exciting emerging technology that is taking the surgical profession by storm. Up to this point, however, the race to acquire and incorporate this emerging technology has primarily been driven by the market. In addition, surgical robots have become the entry fee for centers wanting to be known for excellence in minimally invasive surgery despite the current lack of practical applications. Therefore, robotic devices seem to have more of a marketing role than a practical role. Whether or not robotic devices will grow into a more practical role remains to be seen.
Our goal in writing this review is to provide an objective evaluation of this technology and to touch on some of the subjects that manufacturers of robots do not readily disclose. In this article we discuss the development and evolution of robotic surgery, review current robotic systems, review the current data, discuss the current role of robotics in surgery, and finally we discuss the possible roles of robotic surgery in the future. It is our hope that by the end of this article the reader will be able to make a more informed decision about robotic surgery before “chasing the market.”
1,014 citations
Patent•
16 Mar 2011TL;DR: In this paper, a detection system coupled with the optical fiber bend sensor was proposed to determine a position of at least one joint region of an articulatable arm based on the detected light reflected by or transmitted through the sensor, and a control system comprising a servo controller for effectuating movement of the arm.
Abstract: A surgical instrument is provided, including: at least one articulatable arm having a distal end, a proximal end, and at least one joint region disposed between the distal and proximal ends; an optical fiber bend sensor provided in the at least one joint region of the at least one articulatable arm; a detection system coupled to the optical fiber bend sensor, said detection system comprising a light source and a light detector for detecting light reflected by or transmitted through the optical fiber bend sensor to determine a position of at least one joint region of the at least one articulatable arm based on the detected light reflected by or transmitted through the optical fiber bend sensor; and a control system comprising a servo controller for effectuating movement of the arm.
986 citations
TL;DR: Maximal sterile barrier precautions during the insertion of nontunneled catheters reduce the risk of catheter infection and is cost-effective and consistent with the practice of universal precautions during an invasive procedure.
Abstract: Objective:In many hospitals, the only sterile precautions used during the insertion of a nontunneled central venous catheter are sterile gloves and small sterile drapes. We investigated whether the use of maximal sterile barrier (consisting of mask, cap, sterile gloves, gown, and large drape) would lower the risk of acquiring catheter-related infections.Design:Prospective randomized trial.Setting:A 500-bed cancer referral center.Methods:We randomized patients to have their nontunneled central catheter inserted under maximal sterile barrier precautions or control precautions (sterile gloves and small drape only). All patients were followed for 3 months postinsertion or until the catheter was removed, whichever came first. Catheter-related infections were diagnosed by quantitative catheter cultures and/or simultaneous quantitative blood cultures.Results:The 176 patients whose catheters were inserted by using maximal sterile barrier precautions were comparable to the 167 control patients in underlying disease, degree of immuno-suppression, therapeutic interventions, and catheter risk factors for infections (duration and site of catheterization, number of catheter lumen, catheter insertion difficulty, reason for catheter removal). There were a total of four catheter infections in the test group and 12 in the control group (P=0.03, chi-square test). The catheter-related septicemia rate was 6.3 times higher in the control group (P=0.06, Fisher's exact test). Most (67%) of the catheter infections in the control group occurred during the first 2 months after insertion, whereas 25% of the catheter infections in the maximal sterile precautions group occurred during the same period (P<0.01, Fisher's exact test). Cost-benefit analysis showed the use of such precautions to be highly cost-effective.Conclusion:Maximal sterile barrier precautions during the insertion of nontunneled catheters reduce the risk of catheter infection. This practice is cost-effective and is consistent with the practice of universal precautions during an invasive procedure.
707 citations
TL;DR: Future research will focus on delivery of diagnostic and therapeutic modalities through natural orifices in which investigation is under remote control and navigation, so that truly "noninvasive" surgery will be a reality.
Abstract: Advances in surgery have focused on minimizing the invasiveness of surgical procedures, such that a significant paradigm shift has occurred for some procedures in which surgeons no longer directly touch or see the structures on which they operate. Advancements in video imaging, endoscope technology, and instrumentation have made it possible to convert many procedures in many surgical specialties from open surgeries to endoscopic ones. The use of computers and robotics promises to facilitate complex endoscopic procedures by virtue of voice control over the networked operating room, enhancement of dexterity to facilitate microscale operations, and development of virtual simulator trainers to enhance the ability to learn new complex operations. Future research will focus on delivery of diagnostic and therapeutic modalities through natural orifices in which investigation is under remote control and navigation, so that truly "noninvasive" surgery will be a reality.
580 citations
TL;DR: An introduction to medical robotic technologies is provided, a possible taxonomy is developed, the evolution of a surgical robot is reviewed, and future prospects for innovation are discussed.
Abstract: It has been nearly 20 years since the first appearance of robotics in the operating room. In that time, much progress has been made in integrating robotic technologies with surgical instrumentation, as evidenced by the many thousands of successful robot-assisted cases. However, to build on past success and to fully leverage the potential of surgical robotics in the future, it is essential to maximize a shared understanding and communication among surgeons, engineers, entrepreneurs, and healthcare administrators. This article provides an introduction to medical robotic technologies, develops a possible taxonomy, reviews the evolution of a surgical robot, and discusses future prospects for innovation. Robotic surgery has demonstrated some clear benefits. It remains to be seen where these benefits will outweigh the associated costs over the long term. In the future, surgical robots should be smaller, less expensive, easier to operate, and should seamlessly integrate emerging technologies from a number of different fields. Such advances will enable continued progress in surgical instrumentation and, ultimately, surgical care.
481 citations