Despite the recent advances in continuum robots for minimally invasive surgery or interventions, their applications to endovascular neurosurgery have remained technically challenging due to the difficulty of miniaturization. Aimed at enabling robotic applications to neurovascular interventions for endovascular treatments of stroke or brain aneurysms, we present a telerobotically controlled magnetic soft continuum robot capable of active steering and navigation under externally applied magnetic fields. For magnetic steering, a seven-degree-of-freedom (7-DOF) serial manipulator is employed to place an actuating magnet that can be manipulated via real-time teleoperation of the robot arm. A motorized linear drive is used to advance or retract the magnetic soft continuum robot, the distal tip of which is steered by the actuating magnet to enable endovascular navigation in the complex cerebral vasculature. We demonstrate the system's ability to guide selective navigation in different branches of cerebral arteries using anatomical models under visual feedback. We also compare the navigational performance of our system with that of a manually controlled passive guidewire and a conventional magnet-tipped guidewire. We found that the telerobotically controlled magnetic soft continuum robot allows for safer and quicker access to hard-to-reach areas in clinically challenging anatomies by enabling smooth navigation in narrow and winding pathways.

Robotic systems have the potential to assist vitreoretinal surgeons in extremely difficult surgical tasks inside the human eye. In addition to reducing hand tremor and improving tool positioning, a robotic assistant can provide assistive motion guidance using virtual fixtures, and incorporate real-time feedback from intraocular force sensing ophthalmic instruments to present tissue manipulation forces, that are otherwise physically imperceptible to the surgeon. This paper presents the design of an FBG-based, multi-function instrument that is capable of measuring mN-level forces at the instrument tip located inside the eye, and also the sclera contact location on the instrument shaft and the corresponding contact force. The given information is used to augment cooperatively controlled robot behavior with variable admittance control. This effectively creates an adaptive remote center-of-motion (RCM) constraint to minimize eye motion, but also allows the translation of the RCM location if the instrument is not near the retina. In addition, it provides force scaling for sclera force feedback. The calibration and validation of the multi-function force sensing instrument are presented, along with demonstration and performance assessment of the variable admittance robot control on an eye phantom.

Robotic assistants and smart surgical instruments have been developed to overcome many significant physiological limitations faced by vitreoretinal surgeons, one of which is lack of force perception below 7.5 mN. This paper reports the development of a new force sensor based on fiber Bragg grating (FBG) with the ability to sense forces at the tip of the surgical instrument located inside the eye and also provide information about instrument interaction with the sclera. The sclera section provides vital feedback for cooperative robot control to minimize potentially dangerous forces on the eye. Preliminary results with 2×2 degree-of-freedom (DOF) sensor and force scaling robot control demonstrate significant reduction of forces on the sclera. The design and analysis of the sensor is presented along with a simulated robot assisted retinal membrane peeling on a phantom with sclera constraints and audio feedback.

Highly accurate positioning is fundamental to the performance of vitreoretinal microsurgery. Of vitreoretinal procedures, membrane peeling is among the most prone to complications since extremely delicate manipulation of retinal tissue is required. Associated tool-to-tissue interaction forces are usually below the threshold of human perception, and the surgical tools are moved very slowly, within the 0.1-0.5 mm/s range. During the procedure, unintentional tool motion and excessive forces can easily give rise to vision loss or irreversible damage to the retina. A successful surgery includes two key features: controlled tremor-free tool motion and control of applied force. In this study, we present the potential benefits of a micro-force sensing robot in vitreoretinal surgery. Our main contribution is implementing fiber Bragg grating based force sensing in an active tremor canceling handheld micromanipulator, known as Micron, to measure tool-to-tissue interaction forces in real time. Implemented auditory sensory substitution assists in reducing and limiting forces. In order to test the functionality and performance, the force sensing Micron was evaluated in peeling experiments with adhesive bandages and with the inner shell membrane from chicken eggs. Our findings show that the combination of active tremor canceling together with auditory sensory substitution is the most promising aid that keeps peeling forces below 7 mN with a significant reduction in 2-20 Hz oscillations.

This paper reports the development of novel micro-force sensing tools for retinal microsurgery. Retinal microsurgery requires extremely delicate manipulation of retinal tissue, and tool-to-tissue interaction forces are frequently below human perceptual thresholds. Further, the interaction between the tool shaft and sclera makes accurate sensing of forces exerted on the retina very difficult with previously developed force sensing schemes, in which the sensor is located outside the eye. In the work reported here, we incorporate 160 µm Fiber Bragg Grating (FBG) strain sensors into the tool shaft to sense forces distal to the sclera. The sensor is applicable both with robotically manipulated and freehand tools. Preliminary results with a 1 degree-of-freedom (DOF) sensor have demonstrated 0.25 mN resolution, and work is underway to develop 2 and 3 DOF tools. The design and analysis of the force sensing tool is presented with preliminary testing data and some initial experiments using the tool with both freehand and robotic manipulation.