At the moment, surgeons struggle curing a widespread eye disease known as retinal vein occlusion where clots obstruct the retinal vessels. Latter vascular disorder involves black spots in people's eyesight and lead eventually to blindness. A recent promising treatment consists in flushing a thrombolytic agent inside the clotted retinal vessels. The surgery implies puncturing vessels ranging from 50 to 400 microns diameter on the backside of the eye, namely the retina. Latest research succeeded in tackling several challenges around this operation: the surgeon's hand tremor and the high precision required amongst other requirements. Despite several breakthroughs, the surgeon only relies on a microscope to perform the surgery through the patient eye's lens, giving poor depth perception to properly puncture the retinal vessels. This way, the surgeon is most likely to pierce through the vessel and inject the thrombolytic drug under the retina, which would endanger the person's eyesight. In this paper, we investigate the use of a novel bio-impedance sensor developed for eye surgery. Together with this new sensor, a detection algorithm has been developed to detect the puncture and double puncture events to give a feedback to the operator of the system. As far as we are aware of, such technology doesn't exist yet in eye surgery to tackle the depth perception question. This paper aims at demonstrating the benefits of this technology.

Retinal Vein Occlusion is a common retinal vascular disorder which can cause severe loss of vision. Retinal vein cannulation followed by injection of an anti-coagulant into the affected vein is a promising treatment. However, given the scale and fragility of the surgical workfield, this procedure is considered too high-risk to perform manually. A first successful robot-assisted procedure has been demonstrated. Even though successful, the procedure remains extremely challenging. This paper aims at providing a solution for the limited perception of instrument-tissue interaction forces as well as depth estimation during retinal vein cannulation. The development of a novel combined force and distance sensing cannulation needle relying on Fiber Bragg grating (FBG) and Optical Coherence Tomography (OCT) A-scan technology is reported. The design, the manufacturing process, the calibration method, and the experimental characterization of the produced sensor are discussed. The functionality of the combined sensing modalities and the real-time distance estimation algorithm are validated respectively on in-vitro and ex-vivo models.

Surgical interventions are increasingly executed minimal invasively. Surgeons insert instruments through tiny incisions in the body and pivot slender instruments to treat organs or tissue below the surface. While a blessing for patients, surgeons need to pay extra attention to overcome the fulcrum effect, reduced haptic feedback and deal with lost hand-eye coordination. The mental load makes it difficult to pay sufficient attention to the forces that are exerted on the body wall. In delicate procedures such as fetal surgery, this might be problematic as irreparable damage could cause premature delivery. As a first attempt to quantify the interaction forces applied on the patient's body wall, a novel 6 degrees of freedom force sensor was developed for an ex-vivo set up. The performance of the sensor was characterised. User experiments were conducted by 3 clinicians on a set up simulating a fetal surgical intervention. During these simulated interventions, the interaction forces were recorded and analysed when a normal instrument was employed. These results were compared with a session where a flexible instrument under haptic guidance was used. The conducted experiments resulted in interesting insights in the interaction forces and stresses that develop during such difficult surgical intervention. The results also implicated that haptic guidance schemes and the use of flexible instruments rather than rigid ones could have a significant impact on the stresses that occur at the body wall.

The design of intrinsically safe systems is an important issue in the development of physical human-robot interactions, in particular in the medical field. In this paper, we explore a new approach, motivated by a medical robotic application framework. The system is statically balanced, in any configuration. Its actuation results from a controllable modification of the balancing. This notably limits the interaction forces between the robot and its environment, but yet authorizes important features like accurate positioning or tracking while in contact, which are key characteristics for the application. In this paper, the robotic device principle is introduced, together with its original actuation, which is developed and experimentally assessed for a one DOF system. Capabilities such as trajectory tracking in the free space, reaction to unexpected collision and tracking of a moving environment are reported. The generalization to more DOF, as required to complete medical tasks, is also discussed.

In this paper, we focus on the technology issues to be solved to develop a cable-driven robot compatible with Magnetic Resonance Imaging constraints. This study is based on the design of a new compact cable-driven manipulator with remote actuators, initially developed for prostate interventions. One of the originalities of the system is to use an instrumented structure to evaluate the cable tensions and lengths in order to perform an adequate control. The sensors assessment has been experimentally achieved and the necessity to introduce a new control strategy using the developed sensors has been demonstrated.