There is an emerging role of artificial intelligence (AI) in endoscopy with studies on early systems showing promising results. However, various limitations inhibit widespread use. The aim of this study was to ascertain the sentiments of endoscopists and understand the benefits and barriers towards adoption of AI systems into healthcare. An anonymous online 18-question survey was disseminated to gastroenterology and surgical departments across UK. A total of 75 endoscopists completed the questionnaire. The majority felt that AI would increase adenoma detection rate (ADR) (72.8%) and aid lesion characterisation (78.6%). However, only a quarter of respondents were either moderately or very familiar with AI, and there was no consensus on necessity of AI in endoscopy. The key barriers identified were cost, accessibility and lack of guidelines. Endoscopists believe AI systems will have a positive impact on endoscopy; however, these systems must provide quality assurance through large clinical trials before adoption.

The ability to track surgical instruments in realtime is crucial for autonomous Robotic Assisted Surgery (RAS). Recently, the fusion of visual and kinematic data has been proposed to track surgical instruments. However, these methods assume that both sensors are equally reliable, and cannot successfully handle cases where there are significant perturbations in one of the sensors' data. In this paper, we address this problem by proposing an enhanced fusion-based method. The main advantage of our method is that it can adjust fusion weights to adapt to sensor perturbations and failures. Another problem is that before performing an autonomous task, these robots have to be repetitively recalibrated by a human for each new patient to estimate the transformations between the different robotic arms. To address this problem, we propose a self-calibration algorithm that empowers the robot to autonomously calibrate the transformations by itself in the beginning of the surgery. We applied our fusion and selfcalibration algorithms for autonomous ultrasound tissue scanning and we showed that the robot achieved stable ultrasound imaging when using our method. Our performance evaluation shows that our proposed method outperforms the state-of-art both in normal and challenging situations.

BACKGROUND: Following rapidly rising COVID-19 case numbers, England entered a national lockdown on 6 January 2021, with staged relaxations of restrictions from 8 March 2021 onwards. AIM: We characterise how the lockdown and subsequent easing of restrictions affected trends in SARS-CoV-2 infection prevalence. METHODS: On average, risk of infection is proportional to infection prevalence. The REal-time Assessment of Community Transmission-1 (REACT-1) study is a repeat cross-sectional study of over 98,000 people every round (rounds approximately monthly) that estimates infection prevalence in England. We used Bayesian P-splines to estimate prevalence and the time-varying reproduction number (Rt) nationally, regionally and by age group from round 8 (beginning 6 January 2021) to round 13 (ending 12 July 2021) of REACT-1. As a comparator, a separate segmented-exponential model was used to quantify the impact on Rt of each relaxation of restrictions. RESULTS: Following an initial plateau of 1.54% until mid-January, infection prevalence decreased until 13 May when it reached a minimum of 0.09%, before increasing until the end of the study to 0.76%. Following the first easing of restrictions, which included schools reopening, the reproduction number Rt increased by 82% (55%, 108%), but then decreased by 61% (82%, 53%) at the second easing of restrictions, which was timed to match the Easter school holidays. Following further relaxations of restrictions, the observed Rt increased steadily, though the increase due to these restrictions being relaxed was offset by the effects of vaccination and also affected by the rapid rise of Delta. There was a high degree of synchrony in the temporal patterns of prevalence between regions and age groups. CONCLUSION: High-resolution prevalence data fitted to P-splines allowed us to show that the lockdown was effective at reducing risk of infection with school holidays/closures playing a significant part.

Soft robotic systems offer benefits over traditional rigid systems through reduced contact trauma with soft tissues and by enabling access through tortuous paths in minimally invasive surgery. However, the inherent deformability of soft robots places both a greater onus on accurate modelling of their shape, and greater challenges in realising intraoperative shape sensing. Herein we present a proprioceptive (self-sensing) soft actuator, with an electrically conductive working fluid. Electrical impedance measurements from up to six electrodes enabled tomographic reconstructions using Electrical Impedance Tomography (EIT). A new Frequency Division Multiplexed (FDM) EIT system was developed capable of measurements of 66 dB SNR with 20 ms temporal resolution. The concept was examined in two two-degree-of-freedom designs: a hydraulic hinged actuator and a pneumatic finger actuator with hydraulic beams. Both cases demonstrated that impedance measurements could be used to infer shape changes, and EIT images reconstructed during actuation showed distinct patterns with respect to each degree of freedom (DOF). Whilst there was some mechanical hysteresis observed, the repeatability of the measurements and resultant images was high. The results show the potential of FDM-EIT as a low-cost, low profile shape sensor in soft robots.

OBJECTIVES: Effective communication is critical to the safe delivery of care but is characterized by outdated technologies. Mobile technology has the potential to transform communication and teamwork but the evidence is currently uncertain. The objective of this systematic review was to summarize the quality and breadth of evidence for the impact of mobile technologies on communication and teamwork in hospitals. MATERIALS AND METHODS: Electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL Plus, HMIC, Cochrane Library, and National Institute of Health Research Health Technology Assessment) were searched for English language publications reporting communication- or teamwork-related outcomes from mobile technologies in the hospital setting between 2007 and 2017. RESULTS: We identified 38 publications originating from 30 studies. Only 11% were of high quality and none met best practice guidelines for mobile-technology-based trials. The studies reported a heterogenous range of quantitative, qualitative, and mixed-methods outcomes. There is a lack of high-quality evidence, but nonetheless mobile technology can lead to improvements in workflow, strengthen the quality and efficiency of communication, and enhance accessibility and interteam relationships. DISCUSSION: This review describes the potential benefits that mobile technology can deliver and that mobile technology is ubiquitous among healthcare professionals. Crucially, it highlights the paucity of high-quality evidence for its effectiveness and identifies common barriers to widespread uptake. Limitations include the limited number of participants and a wide variability in methods and reported outcomes. CONCLUSION: Evidence suggests that mobile technology has the potential to significantly improve communication and teamwork in hospital provided key organizational, technological, and security challenges are tackled and better evidence delivered.

Gastrointestinal (GI) cancers account for 1.5 million deaths worldwide. Endoscopic Submucosal Dissection (ESD) is an advanced therapeutic endoscopy technique with superior clinical outcome due to the minimally invasive anden blocremoval of tumours. In the western world, ESD is seldom carried out, due to its complex and challenging nature. Various surgical systems are being developed to make this therapy accessible, however, these solutions have shown limited operational workspace, dexterity, or low force exertion capabilities. The current paper shows the ESD CYCLOPS system, a bimanual surgical robotic attachment that can be mounted at the end of any flexible endoscope. The system is able to achieve forces of up to 46N, and showed a mean error of 0.217mm during an elliptical tracing task. The workspace and instrument dexterity is shown by pre-clinical ex vivo trials, in which ESD is successfully performed by a GI surgeon. The system is currently undergoing pre-clinicalin vivovalidation.

Flexible endoscopy is a routinely performed procedure that has predominantly remained unchanged for decades despite its many challenges. This paper introduces a novel, more intuitive and ergonomic platform that can be used with any flexible endoscope, allowing easier navigation and manipulation. A standard endoscope is robotized and a gaze control system based on eye-tracking is developed and implemented, allowing hands-free manipulation. The system characteristics and step response has been evaluated using visual servoing. Further, the robotized system has been compared with a manually controlled endoscope during a user study. The users (n=11) showed a preference for the gaze controlled endoscope and a lower task load when the task was performed with the gaze control. In addition, gaze control was related to a higher success rate and a lower time to perform the task. The results presented validate the system's technical performance and demonstrate the intuitiveness of hands-free gaze control in flexible endoscopy.

Patients suffering from quadriplegia have limited body motion which prevents them from performing daily activities. We have developed an assistive robotic system with an intuitive free-view gaze interface. The user's point of regard is estimated in 3D space while allowing free head movement and is combined with object recognition and trajectory planning. This framework allows the user to interact with objects using fixations. Two operational modes have been implemented to cater for different eventualities. The automatic mode performs a pre-defined task associated with a gaze-selected object, while the manual mode allows gaze control of the robot's end-effector position on the user's frame of reference. User studies reported effortless operation in automatic mode. A manual pick and place task achieved a success rate of 100% on the users' first attempt.

This paper introduces the design and characterization of a robotic surgical instrument produced mainly with rapid prototyping techniques. Surgical robots have generally complex structures and have therefore an elevated cost. The proposed instrument was designed to incorporate minimal number of components to simplify the assembly process by leveraging the unique strength of rapid prototyping for producing complex, assemble-free components. The modularity, cost-effectiveness and fast manufacturing and assembly features offer the possibility of producing patient or task specific instruments. The proposed robot incorporates an integrated force measurement system, thus allowing the determination of the force exchanged between the instrument and the environment. Detailed experiments were performed to validate the functionality and force sensing capability of the instrument.

Additive manufacturing is a technology in constant evolution. It is able to produce objects otherwise either impractical or unfavorable for traditional manufacturing technologies, especially in relatively limited quantities. The advancement of Selective Laser Melting (SLM) has made it possible to manufacture functional, production-quality components directly from rapid prototyping for long-term use. This work studies the SLM process and identifies the optimal process parameters for the rapid manufacturing of a miniaturized robotic surgical instrument. The proposed robotic instrument has been designed to exploit the advantages of rapid manufacturing and rapid assembly, following a shift from large scale manufacturing of generalized surgical instruments to the production of small batches of patient or procedure-specific.

Humans frequently need to allocate resources across multiple time-steps. Economic theory proposes that subjects do so according to a stable set of intertemporal preferences, but the computational demands of such decisions encourage the use of formally less competent heuristics. Few empirical studies have examined dynamic resource allocation decisions systematically. Here we conducted an experiment involving the dynamic consumption over approximately 15 minutes of a limited budget of relief from moderately painful stimuli. We had previously elicited the participants' time preferences for the same painful stimuli in one-off choices, allowing us to assess self-consistency. Participants exhibited three characteristic behaviors: saving relief until the end, spreading relief across time, and early spending, of which the last was markedly less prominent. The likelihood that behavior was heuristic rather than normative is suggested by the weak correspondence between one-off and dynamic choices. We show that the consumption choices are consistent with a combination of simple heuristics involving early-spending, spreading or saving of relief until the end, with subjects predominantly exhibiting the last two.

This paper introduces the CYCLOPS, a novel robotic tool for single-access and natural-orifice endoscopic surgery. Based on the concept of tendon-driven parallel robots, this highly original design gives the system some of its unique capabilities. Just to name a few, unparalleled force exertion capabilities of up to 65N, large and adjustable workspace, bimanual instrument triangulation. Due to the simplicity and nature of the design, the system could be adapted to an existing laparoscope or flexible endoscope. This promises a more immediate and accelerated route to clinical translation not only through endearing low-cost and adaptive features, but also by directly addressing several major barriers of existing designs.

Precise and repetitive positional control of surgical robots is important to reduce time and risks of surgical procedures. These factors become particularly important when deploying the surgical system through a flexible path to areas with a tight workspace such as the stomach or oesophagus where high dexterity, flexibility, accuracy and stability are required. This paper presents a flexible access robot combining articulated joints and continuum flexible section for both transluminal and endoluminal surgeries. Kinematic model and control strategy for the flexible robot are described in the paper. The experiment simulating a transoral gastric procedure demonstrates great flexibility and dexterity of the device. The results show that good accuracy and repetitive control of the device are achieved, which demonstrate the potential application of the device for transluminal or endoluminal surgery.

We propose a learning-based controller to enable autonomous execution of the eFAST scanning by a lightweight robotic manipulator according to expert demonstrations. The benefits of this approach are two-fold. Firstly, the automatically acquired USS images can be sent to the expert radiologist from a remote location without the need for complex robotic tele-operation. Secondly, the application of learning by demonstration alleviates the complexity of robotic programming and allows extracting operator-specific knowledge in situ in a natural and intuitive way. The provision of incorporating force information can further improve the versatility of the system, allowing easy adaptation to different dynamic environments.

Standard theories of decision-making involving delayed outcomes predict that people should defer a punishment, whilst advancing a reward. In some cases, such as pain, people seem to prefer to expedite punishment, implying that its anticipation carries a cost, often conceptualized as 'dread'. Despite empirical support for the existence of dread, whether and how it depends on prospective delay is unknown. Furthermore, it is unclear whether dread represents a stable component of value, or is modulated by biases such as framing effects. Here, we examine choices made between different numbers of painful shocks to be delivered faithfully at different time points up to 15 minutes in the future, as well as choices between hypothetical painful dental appointments at time points of up to approximately eight months in the future, to test alternative models for how future pain is disvalued. We show that future pain initially becomes increasingly aversive with increasing delay, but does so at a decreasing rate. This is consistent with a value model in which moment-by-moment dread increases up to the time of expected pain, such that dread becomes equivalent to the discounted expectation of pain. For a minority of individuals pain has maximum negative value at intermediate delay, suggesting that the dread function may itself be prospectively discounted in time. Framing an outcome as relief reduces the overall preference to expedite pain, which can be parameterized by reducing the rate of the dread-discounting function. Our data support an account of disvaluation for primary punishments such as pain, which differs fundamentally from existing models applied to financial punishments, in which dread exerts a powerful but time-dependent influence over choice.

This paper describes a multitasking robotic platform for Minimally Invasive Surgery (MIS). The device is designed to be introduced through a standard trocar port. Once the device is inserted to the desired surgical site, it can be reconfigured by lifting an articulated section, and protruding two tendon driven flexible arms. Each of the arms holds an interchangeable surgical instrument. The articulated section features a 2 Degrees-of-Freedom (DoF) universal joint followed by a single DoF yaw joint. It incorporates an on-board camera and LED light source at the distal end, leaving a Ø3mm channel for an additional instrument. The main shaft of the robot is largely hollow, leaving ample space for the insertion of two tendon driven flexible arms integrated with surgical instruments. The ex-vivo and in-vivo experiments demonstrate the potential clinical value of the device for performing surgical tasks through single incision or natural orifice transluminal procedures.

This paper introduces an articulated robotic device based on universal joints with embedded micro motors for minimally invasive surgery. The device features an articulated distal tip with seven independently controllable degrees-of-freedom (DoF), arranged as two universal joints (intersecting pitch and yaw) and three single DoF joints (yaw only); two Ø3mm internal channels, one for an on-board camera for visualization and the other for passing interventional instruments. The design allows the robot to explore the entire peritoneal cavity from a chosen single incision point. A trans-vaginal procedure using the device to locate the uterine horn, as a model of a human fallopian tube, and apply an endoscopic clip was carried out during a live porcine trial to demonstrate the potential for performing a Natural Orifice Translumenal Endoscopic Surgery (NOTES) tubal ligation procedure.

Patients' functional recovery at home following surgery may be evaluated by monitoring their activities of daily living. Existing tools for assessing these activities are labor-intensive to administer and rely heavily on recall. This study describes the use of a wireless ear-worn activity recognition sensor to monitor postoperative activity levels continuously using a Bayesian activity classification framework. The device was used to monitor the postoperative recovery of five patients following abdominal surgery. Activity was classified into four groups ranging from very low (level 0) to high (level 3). Overall, patients were found to be undertaking a higher proportion of level 0 activities on postoperative day 1 which was gradually replaced by higher-level activities over the next 3 days. This study demonstrates how a pervasive healthcare technology can objectively monitor functional recovery in the unsupervised home setting. This may be a useful adjunct to existing postoperative monitoring systems.

This paper introduces a stereoscopic fibroscope imaging system for minimally invasive surgery (MIS) and examines the feasibility of utilizing images transmitted from the distal fibroscope tip to a proximally mounted CCD camera to recover both camera motion and 3D scene information. Fibre image guides facilitate instrument miniaturization and have the advantage of being more easily integrated with articulated robotic instruments. In this paper, twin 10,000 pixel coherent fibre bundles (590mum diameter) have been integrated into a bespoke laparoscopic imaging instrument. Images captured by the system have been used to build a 3D map of the environment and reconstruct the laparoscope's 3D pose and motion using a SLAM algorithm. Detailed phantom validation of the system demonstrates its practical value and potential for flexible MIS instrument integration due to the small footprint and flexible nature of the fibre image guides.

As medical robotics gathers increasing attention, the ergonomics of the surgical-console design becomes an important issue. Motivated by the need of augmenting the surgeon mastery, we explore the capabilities of a near infrared brain-computer interface as a complementary input modality to enhance the human-robot interaction at the robotic console. A multistage analysis framework is proposed and evaluated by an exploratory off-line synchronous study. The three stages of the data processing flow, namely dimensionality reduction, solution to binary problems and aggregation into multi-class decision are examined to address key challenges during the pattern recognition step. Early experimental results endorse near infrared based brain-computer interface as a suitable additional communication modality between the surgeon and the robotic console.

This paper presents a human-robot interface with perceptual docking to allow for the control of multiple microbots. The aim is to demonstrate that real-time eye tracking can be used for empowering robots with human vision by using knowledge acquired in situ. Several micro-robots can be directly controlled through a combination of manual and eye control. The novel control environment is demonstrated on a virtual biopsy of gastric lesion through an endoluminal approach. Twenty-one subjects were recruited to test the control environment. Statistical analysis was conducted on the completion time of the task using the keyboard control and the proposed eye tracking framework. System integration with the concept of perceptual docking framework demonstrated statistically significant improvement of task execution.

Determining human intention is a challenging task for establishing affective human robot interaction. The aim of this paper is to provide a vision based framework to achieve a level of understanding about people in an environment before engaging in active communication or interaction. The proposed method combines multiple cues in a Bayesian framework to identify people in the scene and determine potential intentions. To improve the system performance, contextual feedback is used, which allows the Bayesian network to evolve and adjust itself according to the surrounding environment. Our results demonstrate the effectiveness of the technique in dealing with human-robot interaction in a relatively crowded environment.

The levator ani is the main muscular support of the pelvic floor organs and damage caused by childbirth can affect its function. The full functionality of this muscle group is still unknown but it is essential for effective surgical planning. To elucidate its functional significance, a physical-based statistical shape model was built from the levator ani surfaces of 15 subjects scanned in an open access scanner. Simulation of dynamic exercises was performed on the resulting surfaces with finite element analysis. Statistical shape modeling was performed on the training set consisting of the original and simulated shapes along with thickness and strain distributions. Simulation results are presented on 15 subjects. The statistical shape model shows good correspondence to inter- and intra-subject shape variability, with the modes of variation highlighting movement in the posterior of the levator ani as well as in the levator arms. Strain distribution plots and the modes of variation show results that correspond to clinical findings. Further validation of the technique and a repeatability test were performed on four subjects with internal global pressure readings taken from a perineometer and five patients suffering from minor pelvic floor disorders due to obstructed defaecation. A Mann-Whitney nonparametric test was used to compare the normal model fitting to the two subject groups.

This paper introduces a novel technique for controlling an articulated robotic device through the eyes of the surgeon during minimally invasive surgery. The system consists of a binocular eye-tracking unit and a robotic instrument featuring a long, rigid shaft with an articulated distal tip for minimally invasive interventions. They have been integrated into a daVinci surgical robot to provide a seamless and non-invasive localization of eye fixations of the surgeon. By using a gaze contingent framework, the surgeonpsilas fixations in 3D are converted into commands that direct the robotic probe to the desired location. Experimental results illustrate the ability of the system to perform real-time gaze contingent robot control and opens up a new avenue for improving current human-robot interfaces.

This paper discusses the developing market for medical robotics. It first describes some of the dynamics and market drivers in health care, and then provides an outline of the areas of consideration when developing a commercial medical robot. The paper also offers three case studies of robotic systems that have been commercialized. Finally, it summarizes some of the key ingredients to be considered for the commercialization process.

Understanding of the dynamic behaviour of the levator ani is important to the assessment of pelvic floor dysfunction. Whilst shape modelling allows the depiction of 3D morphological variation of the levator ani between different patient groups, it is insufficient to determine the underlying behaviour of how the muscle deforms during contraction and strain. The purpose of this study is to perform a subject specific finite element analysis of the levator ani with open access magnetic resonance imaging. The method is based on a Mooney-Rivlin hyperelastic model and permits dynamic study of subjects under natural physiological loadings. The value of the proposed modelling framework is demonstrated with dynamic 3D data from nulliparous, female subjects. These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

The levator ani is vulnerable to injury during childbirth and effective surgical intervention requires full knowledge of the morphology and mechanical properties of the muscle structure. The shape of the levator ani and regional thickening during different levels of physiological loading can provide an indication of pelvic floor dysfunction. This paper describes a coupled approach for shape and thickness statistical modelling based on harmonic embedding for volumetric analysis of the levator ani. With harmonic embedding, the dynamic information extracted by the statistical modelling captures shape and thickness variation of the levator ani across different subjects and during varying levels of stress. With this study, we demonstrate that the derived model is compact and physiologically meaningful, demonstrating the practical value of the technique. These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

The use of virtual and augmented reality techniques in medicine is rapidly increasing particularly in the area of minimal access surgery. Such surgery is a form of teleoperation in which accurate perception of depth and orientation, navigation, and interaction with the operative space are vital. Virtual and augmented reality techniques will allow us to produce new views of the operative site and introduce extra information into the scene such as safe paths for instruments to follow etc. A path following task is developed and human factors issues are addressed by varying viewing conditions (standard mono, stereo, multiple views and tool-linked view), presence or absence of haptic feedback, and orientation of the task. The results show that performance is improved with haptic feedback, but not by the various viewing conditions and is significantly worse for side aligned orientations.