Colonoscopy demands multi-finger coordinated motion to achieve safe navigation. As a result, training for colonoscopists is challenging and skill assessment currently relies on subjective scoring by expert proctors. There is a need to provide tools for skill assessment and aid with training new interventionalists. This paper presents a new concept of an in-hand robotic mediation device that can be used for both skill assessment and training. The robotic device can be used to infer the kinematic motion as well as the power input of a user - both of which are proposed to be used for skill assessment and subtask skill classification. Preliminary results collected expert and novice users performing colonoscopy navigation are used to demonstrate this device as a skill assessment tool. A machine-learning model (classification and regression trees) is used for subtask classification of skill and evaluating the most important classification features. A user study demonstrates the effectiveness of this in hand haptic training and assessment tool. We believe that, in the future, this device will enable accelerated skill assessment and training and possible semi-automation of difficult maneuvers.

Injections into specific retinal layers of the eye present a serious challenge to surgeons in terms of accuracy and perception. The emergence of new gene therapies further emphasizes the need for effective tools for localized drug delivery. Unlike the dominant approach of delivering drugs via a transvitreal intraocular pathway, this paper demonstrates the feasibility of delivering injections into the space between the choroid and the retina using an external approach. The design of a cooperative robotic system for enabling robot-assisted extraocular subretinal injections is presented. The system uses a distal micromanipulator that can serve as a hand-held tool for OCT-aided injection or attach to a six degree of freedom (DOF) serial robot arm for cooperative manipulation. The kinematics and control of the robot for constrained cooperative control motions to enable safe needle injection is presented and experimentally evaluated. These results suggest that the proposed external drug delivery approach is feasible, thereby enabling the advantages of preserving the integrity of the retina and omitting the necessity for vitrectomy.

While in the design phase of a robotic system for the procedures performed in surgical confined spaces or hard-to-reach-deep surgical fields, designers can leverage a systematic method to compare the design alternatives for tele-surgical manipulators quantitatively. Unlike most of the work in the literature, we propose an approach for comparing design alternatives by considering the spurious motions along the length of the manipulator in lieu of existing approaches looking at only the end-effector dexterity measures. We propose a performance measure quantifying these spurious motions while the end-effector executes the application-critical tasks such as suturing and tying a knot. A good manipulator design should yield minimal swept volume along its length portions within the confined space. If informed about these spurious motions, that design would lead to reduced force on the internal organs, reducing the pain and discomfort as well as occurrences of extracorporeal inter-manipulator collisions. To validate the proposed approach, we present two illustrative simulation case studies: (1) two planar rigid link serial robots performing the task of following a desired trajectory and (2) two different architectures of tele-surgical manipulators performing the task of passing a circular suture needle under the fulcrum constraints. The results show the applicability of the proposed performance measure in determining the suitability of a particular design alternative for a given task. Although results are promising, using this measure alone for design optimization may compromise overall device dexterity. Therefore, this measure needs to be incorporated into a weighted optimization framework for robot design.

Cricothyrotomy is a life-saving emergency intervention that secures an alternate airway route after a neck injury or obstruction. The procedure starts with identifying the correct location (the cricothyroid membrane) for creating an incision to insert an endotracheal tube. This location is determined using a combination of visual and palpation cues. Enabling robot-assisted remote cricothyrotomy may extend this life-saving procedure to injured soldiers or patients who may not be readily accessible for on-site intervention during search-and-rescue scenarios. As a first step towards achieving this goal, this paper explores the feasibility of palpation-assisted landmark identification for cricothyrotomy. Using a cricothyrotomy training simulator, we explore several alternatives for in-situ remote localization of the cricothyroid membrane. These alternatives include a) unaided telemanipulation, b) telemanipulation with direct force feedback, c) telemanipulation with superimposed motion excitation for on-line stiffness estimation and display, and d) fully autonomous palpation scan initialized based on the user’s understanding of key anatomical landmarks. Using the manually digitized cricothyroid membrane location as ground truth, we compare these four methods for accuracy and repeatability of identifying the landmark for cricothyrotomy, time of completion, and ease of use. These preliminary results suggest that the accuracy of remote cricothyrotomy landmark identification is improved when the user is aided with visual and force cues. They also show that, with proper user initialization, landmark identification using remote palpation is feasible - therefore satisfying a key prerequisite for future robotic solutions for remote cricothyrotomy.