Aiming at developing a safe, intuitive, and collaborative steerable drilling robotic system for pedicle screw fixation procedures, in this paper, we leverage our recently developed steerable drilling robotic framework, and developed a collaborative drilling mode to control this system. In this control mode, first a user positions a concentric tube steerable drilling robot (CT-SDR) in the workspace and aligns it based on a preplanned trajectory. Next, the CT-SDR is directly controlled by the user through an admittance mode to perform a drilling procedure and creating a J-shape tunnel. To evaluate the user comfort and intuitiveness of the drilling procedure using this system and the proposed control interface, we performed a user study with 11 subjects, who had no prior experience in using this system. The results of this study were analyzed using various qualitative and quantitative metrics.

Surgical automation requires precise guidance and understanding of the scene. Current methods in the literature rely on bulky depth cameras to create maps of the anatomy; however, this does not translate well to space-limited clinical applications. Monocular cameras are small and allow minimally invasive surgeries in tight spaces, but additional processing is required to generate 3D scene understanding. We propose a 3D mapping pipeline that uses only RGB images to create segmented point clouds of the target anatomy. To ensure the most accurate reconstruction, we compare different structure from motion algorithms’ performance on mapping the central airway obstructions, and test the pipeline on a downstream task of tumor resection. In several metrics, including post-procedure percentage tissue charring, our pipeline performs comparably to RGB-D cameras and, in some cases, even surpasses their downstream task performance. These promising results demonstrate that automation guidance can be achieved in minimally invasive procedures with monocular cameras. This study is a step toward the complete autonomy of surgical robots.

Current pelvic fixation techniques rely on rigid drilling tools, which inherently constrain the placement of rigid medical screws in the complex anatomy of pelvis. These constraints prevent medical screws from following anatomically optimal pathways and force clinicians to fixate screws in linear trajectories. This suboptimal approach, combined with the unnatural placement of the excessively long screws, lead to complications such as screw misplacement, extended surgery times, and increased radiation exposure due to repeated X-ray images taken ensure to safety of procedure. To address these challenges, in this paper, we present the design and development of a unique 4-degree-of-freedom (DoF) pelvic concentric tube steerable drilling robot (pelvic CT-SDR). The pelvic CT-SDR is capable of creating long S-shaped drilling trajectories that follow the natural curvatures of the pelvic anatomy. The performance of the pelvic CT-SDR was thoroughly evaluated through several S-shape drilling experiments in simulated bone phantoms.

To address the screw loosening and pullout limitations of rigid pedicle screws in spinal fixation procedures, and to leverage our recently developed Concentric Tube Steerable Drilling Robot (CT-SDR) and Flexible Pedicle Screw (FPS), in this paper, we introduce the concept of Augmented Bridge Spinal Fixation (AB-SF). In this concept, two connecting J-shape tunnels are first drilled through pedicles of vertebra using the CT-SDR. Next, two FPSs are passed through this tunnel and bone cement is then injected through the cannulated region of the FPS to form an augmented bridge between two pedicles and reinforce strength of the fixated spine. To experimentally analyze and study the feasibility of AB-SF technique, we first used our robotic system (i.e., a CT-SDR integrated with a robotic arm) to create two different fixation scenarios in which two J-shape tunnels, forming a bridge, were drilled at different depth of a vertebral phantom. Next, we implanted two FPSs within the drilled tunnels and then successfully simulated the bone cement augmentation process.

In this paper, we introduce S3D: A Spatial Steerable Surgical Drilling Framework for Robotic Spinal Fixation Procedures. S3D is designed to enable realistic steerable drilling while accounting for the anatomical constraints associated with vertebral access in spinal fixation (SF) procedures. To achieve this, we first enhanced our previously designed concentric tube Steerable Drilling Robot (CT-SDR) to facilitate steerable drilling across all vertebral levels of the spinal column. Additionally, we propose a four-Phase calibration, registration, and navigation procedure to perform realistic SF procedures on a spine holder phantom by integrating the CT-SDR with a seven-degree-of-freedom robotic manipulator. The functionality of this framework is validated through planar and out-of-plane steerable drilling experiments in vertebral phantoms.

Spinal fixation procedures are currently limited by the rigidity of the existing instruments and pedicle screws leading to fixation failures and rigid pedicle screw pull out. Leveraging our recently developed Concentric Tube Steerable Drilling Robot (CT-SDR) in integration with a robotic manipulator, to address the aforementioned issue, here we introduce the transformative concept of Spatial Spinal Fixation (SSF) using a unique Flexible Pedicle Screw (FPS). The proposed SSF procedure enables planar and out-of-plane placement of the FPS throughout the full volume of the vertebral body. In other words, not only does our fixation system provide the option of drilling in-plane and out-of-plane trajectories, it also enables implanting the FPS inside linear (represented by an I-shape) and/or non-linear (represented by J-shape) trajectories. To thoroughly evaluate the functionality of our proposed robotic system and the SSF procedure, we have performed various experiments by drilling different I-J and J-J drilling trajectory pairs into our custom-designed L3 vertebral phantoms and analyzed the accuracy of the procedure using various metrics.

Communication latency in any delicate telerobotic operation (such as remote surgery over distance) would impose a significant challenge due to the temporal degradation of visual perception and can substantially affect the outcomes. Less is known, however, about the neurophysiological basis of how operators adapt/react to delayed visual feedback. Identification of such neural markers might provide novel ways for future applications to monitor the mental workload (MW). In this study, we recorded electroencephalography (EEG) data from nine users while performing a peg transfer task using the da Vinci Research Kit with three levels of induced visual delay in the video feedback. Our results suggest that spectral EEG-based features can provide markers of the operator's MW modulated by arbitrary visual delay. We also show that the exposure to different visual delays could be successfully classified/detected solely from EEG data, using a Riemannian geometry-based classifier, which highlights the utility of EEG signals for detecting the effect of visual delay on brain activity.

In this paper, we present the design, fabrication, and evaluation of a novel flexible, yet structurally strong, Concentric Tube Steerable Drilling Robot (CT-SDR) to improve minimally invasive treatment of spinal tumors. Inspired by concentric tube robots, the proposed two degree-of-freedom (DoF) CT-SDR, for the first time, not only allows a surgeon to intuitively and quickly drill smooth planar and out-of-plane J- and U- shape curved trajectories, but it also, enables drilling cavities through a hard tissue in a minimally invasive fashion. We successfully evaluated the performance and efficacy of the proposed CT-SDR in drilling various planar and out-of-plane J-shape branch, U-shape, and cavity drilling scenarios on simulated bone materials.