This paper reports the design, construction, and experimental validation of a novel hand-held robot for inoffice laser surgery of the vocal folds. In-office endoscopic laser surgery is an emerging trend in Laryngology: It promises to deliver the same patient outcomes of traditional surgical treatment (i.e., in the operating room), at a fraction of the cost. Unfortunately, office procedures can be challenging to perform; the optical fibers used for laser delivery can only emit light forward in a line-of-sight fashion, which severely limits anatomical access. The robot we present in this paper aims to overcome these challenges. The end effector of the robot is a steerable laser fiber, created through the combination of a thin optical fiber (Ø 0.225 mm) with a tendon-actuated Nickel- Titanium notched sheath that provides bending. This device can be seamlessly used with most commercially available endoscopes, as it is sufficiently small (0Ø 1.1 mm) to pass through a working channel. To control the fiber, we propose a compact actuation unit that can be mounted on top of the endoscope handle, so that, during a procedure, the operating physician can operate both the endoscope and the steerable fiber with a single hand. We report simulation and phantom experiments demonstrating that the proposed device substantially enhances surgical access compared to current clinical fibers.

Interactive simulators are used in several important applications which include the training simulators for teleoperated robotic laparoscopic surgery. While stateof-art simulators are capable of rendering realistic visuals and accurate dynamics, grasping is often implemented using kinematic simplification techniques that prevent truly multimanual manipulation, which is often an important requirement of the actual task. Realistic grasping and manipulation in simulation is a challenging problem due to the constraints imposed by the implementation of rigid-body dynamics and collision computation techniques in state-of-the-art physics libraries. We present a penalty based parametric approach to achieve multi-manual grasping and manipulation of complex objects at arbitrary postures in a real-time dynamic simulation. This approach is demonstrated by accomplishing multi-manual tasks modeled after realistic scenarios, which include the grasping and manipulation of a two-handed screwdriver task and the manipulation of a deformable thread.

Surgeons and robots typically use different approaches for bone milling. Surgeons adjust their speed and tool incidence angle constantly, which enables them to efficiently mill porous bone. Surgeons also adjust milling parameters such as speed and depth of cut throughout the procedure based on proximity to sensitive structures like nerves and blood vessels. In this paper we use image-based bone density estimates and segmentations of vital anatomy to make a robot mill more like a surgeon and less like an industrial computer numeric controlled (CNC) milling machine. We produce patient-specific plans optimizing velocity and incidence angles for spherical cutting burrs. These plans are particularly useful in bones of variable density and porosity like the human temporal bone. They result in fast milling in non-critical areas, reducing overall procedure time, and lower forces near vital anatomy. We experimentally demonstrate the algorithm on temporal bone phantoms and show that it reduces mean forces near vital anatomy by 63% and peak forces by 50% in comparison to a CNC-type path, without adding time to the procedure.

In this paper we present a feed forward controller to regulate the depth of laser incisions in soft tissue. Such a controller is compatible with the requirements of laser microsurgery, where space constraints limit the use of sensing devices. The controller is based on an inverse model that maps the desired incision depth to the required laser exposure time. This model is extracted from experimental data through the use of statistical learning methods. To prove the concept, the controller is implemented in a robot-assisted laser microsurgery system that enables precision control of exposure time and laser motion. The validity and the accuracy of the controller is verified experimentally on ex-vivo muscle tissue (chicken breast), revealing an RMSE of 0.12 mm for incisions ranging up to 1 mm. In addition, we demonstrate how the model can be used to implement the automatic ablation of entire volumes of tissue, through the superposition of controlled laser incisions.