Diffuse Reflectance Spectroscopy (DRS) is a wellestablished optical technique for tissue composition assessment which has been clinically evaluated for tumour detection to ensure the complete removal of cancerous tissue. While pointwise assessment has many potential applications, incorporating automated large-area scanning would enable holistic tissue sampling with higher consistency. We propose a robotic system to facilitate autonomous DRS scanning with hybrid visual servoing control. A specially designed height compensation module enables precise contact condition control. The evaluation results show that the system can accurately execute the scanning command and acquire consistent DRS spectra with comparable results to the manual collection, which is the current gold standard protocol. Integrating the proposed system into surgery lays the groundwork for autonomous intra-operative DRS tissue assessment with high reliability and repeatability. This could reduce the need for manual scanning by the surgeon while ensuring complete tumor removal in clinical practice.

Minimally Invasive Surgery has advanced surgical practice, yet early-stage gastrointestinal cancer treatment remains challenging. Endoscopic Submucosal Dissection offers a solution but faces maneuverability constraints in complex anatomical environments. This paper presents a novel inflatable soft robotic manipulator with a biocompatible thin-film shell and tendon-driven antagonistic actuation. The robot remains compact at 6.5 mm of diameter, expanding to 11.7 mm to enhance stiffness for force exertion and precise manipulation. Featuring two decoupled wrists with four degrees of freedom, it enables dexterous motion for advanced endoscopic procedures. The study details design, fabrication, actuation modeling, workspace evaluation, and simulated retraction experiments in a constrained environment. Results demonstrate high repeatability, high master-slave control accuracy, effective workspace utilization, and feasibility for endoluminal applications, enhancing robotic-assisted endoscopic procedures with improved dexterity and adaptability under soft actuation constraints.

This paper presents a soft Cable-Driven Parallel Robot for gastrointestinal surgery. The robot consists of an inflatable scaffold and a hydraulic variable stiffness end-effector and features six degrees of freedom. Experiments involving passage through a colon model, knot tying, and retraction have demonstrated its flexibility and the concept of navigating through the colon in a soft configuration, then increasing rigidity at the lesion site to collaborate with the endoscope in performing surgery. Meanwhile, the robot can sense the contact force through hydraulic pressure variations within the end-effector shaft, providing haptic feedback, which reduces the effects of Coulomb friction. When using the robot to calculate pressing forces, it achieved accuracy with a mean error of 0.051 N and a standard deviation (STD) of 0.066 N. For lifting forces, it achieved a mean error of 0.066 N and a STD of 0.083 N. These results demonstrate the potential of the robot for tissue palpation applications.

In recent years, the area of Robot-Assisted Minimally Invasive Surgery (RAMIS) is standing on the the verge of a new wave of innovations. However, autonomy in RAMIS is still in a primitive stage. Therefore, most surgeries still require manual control of the endoscope and the robotic instruments, resulting in surgeons needing to switch attention between performing surgical procedures and moving endoscope camera. Automation may reduce the complexity of surgical operations and consequently reduce the cognitive load on the surgeon while speeding up the surgical process. In this paper, a hybrid robotic endoscope control system based on fusion model of natural language processing (NLP) and modified YOLO-V8 vision model is proposed. This proposed system can analyze the current surgical workflow and generate logs to summarize the procedure for teaching and providing feedback to junior surgeons. The user study of this system indicated a significant reduction of the number of clutching actions and mean task time, which effectively enhanced the surgical training.

In this article, we investigate the model based position control of soft hydraulic actuators arranged in an an-tagonistic pair. A dynamical model of the system is constructed by employing the port-Hamiltonian formulation. A control algorithm is designed with an energy shaping approach, which accounts for the pressure dynamics of the fluid. A nonlinear observer is included to compensate the effect of unknown external forces. Simulations demonstrate the effectiveness of the proposed approach, and experiments achieve positioning accuracy of 0.043 mm with a standard deviation of 0.033 mm in the presence of constant external forces up to 1 N.

Incorrectly sized balloon catheters can lead to increased post-surgical complications, yet even with preoperative imaging, correct selection remains a challenge. With limited feedback during surgery, it is difficult to verify correct deployment. We propose the use of integrated impedance measurements and Electrical Impedance Tomography (EIT) imaging to assess the deformation of the balloon and determine the size and shape of the surrounding lumen. Previous work using single impedance measurements, or pressure data and analytical models, whilst demonstrating high sizing accuracy, have assumed a circular cross section. Here we extend these methods by adding a multitude of electrodes to detect elliptical and occluded lumen and obtain EIT images to localise deformations. Using a 14 Fr (5.3 mm) catheter as an example, numerical simulations were performed to find the optimal electrode configuration of two rings of 8 electrodes spaced 10 mm apart. The simulations predicted that the maximum detectable aspect ratio decreased from 0.9 for a 14mm balloon to 0.5 at 30mm. The sizing and ellipticity detection results were verified experimentally. A prototype robotic balloon catheter was constructed to automatically inflate a compliant balloon while simultaneously recording EIT and pressure data. Data were collected in experiments replicating stenotic vessels with an elliptical and asymmetrical profile, and the widening of a lumen during angioplasty. After calibration, the system was able to correctly localise the occlusion and detect aspect ratios of 0.75. EIT images further localised the occlusion and visualised the dilation of the lumen during balloon inflation.

A cable-driven segmented manipulator (CDSM) has superior dexterity for operations in confined space due to its light-slender body and redundant degree of freedoms (DOFs). However, its inverse kinematics resolving and configuration planning are very challenging due to the complex structure and strict constraints. In this article, we propose a two-layer geometric iteration (TLGI) method for inverse kinematics resolving and configuration-constrained Cartesian path planning. The computation efficiency is largely improved and singularities are avoided. First, the end-effector attitude is decomposed into a direction vector and a rotation angle. The former and the end-effector position are combined into state variables of the inner layer, and the latter is treated separately as the state variable of the outer layer. Then, the TLGI method enables to rapidly reach the desired 6-DOF pose by two-layer iterations, i.e., the inner and outer loop iteration. Second, during the inner loop iteration, the CDSM is modeled as an equivalent articulated arm whose end-effector position and direction is the same as that of CDSM, but its links length and joint angles depend on the current configuration of CDSM. Then, the efficient forward and backward reaching inverse kinematics (FABRIKs) method is extended to apply on CDSM so that it can fast reach the inner state variables. During the outer loop iteration, three different rotation cases, i.e., the rotating around the end, root, and both end and root, are designed to switch automatically to reach the outer state variable iteratively. Moreover, by parameterizing geometric constraints of the environment, a TLGI-based configuration-pose simultaneous planning method is also put forward to efficiently achieve additional configuration constraints for operations of CDSM in confined space. Finally, the proposed method is verified by both the simulations and experiments.

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.

This paper presents a three-tendon actuated continuum robot with an origami backbone to assist the elderly and physically impaired individuals in performing activities of daily living. The proposed design solution is an inherently safe and cost-effective alternative to current assistive robots. The origami backbone based on a variation of the Yoshimura pattern provides controlled deployment of the robot and enables length variation (15 cm - 56 cm) in order to increase the reachable workspace. A pneumatic stiffness mechanism was implemented, increasing the weight bearing capabilities of the continuum robot to 500 g. This new stiffness modulation approach was assessed with the use of several testing rigs. Additionally, the robot is joypad controlled and is easily transportable due to its high packing efficiency of 73% and light weight of 1.3 kg for the main body (including the actuation system). For demonstration of usability studies, the robot was successfully tested at a simulated kitchen terminal and also performed pick and place tasks.

Advanced Brain-Computer Interface (BCI) paradigms aim to solve some problems as BCI illiteracy and unfamiliarity of the subjects to be able to control their elicited motor imagery (MI) successfully, hence improving training time and performance of BCI systems. This work evaluates the effect and performance of an Implicit BCI supported by the Gaze Monitoring (IBCI-GM) paradigm for virtual rehabilitation therapy of patients suffering from partial or total paralysis of their upper limbs; this paradigm also was compared with alternative forms of advanced BCI methods such as Virtual Reality-based BCI (VR-BCI) with a head-mounted display (HMD) and a computer screen (CS). Eight subjects participated in the experiments; four subjects tested the VR-BCI with a CS, and the rest of them tested both BCI advanced methods (IBCI-GM and VR-BCI with an HMD). The subjects were asked to control a virtual arm through MI of flexion and extension movements. The VR-BCI HMD was the approached best method; however, IBCI-GM had significant results and was more practical for users, but it depends on the ability to perform eye movements to be applied by patients. Therefore, these methods should be tested with more subjects to have definitive results.

In the present paper we discuss a novel dynamic controller for Cable Driven Parallel Robots, based on the Backstepping technique. The main challenge in controlling these robots, is expressing the dynamic equilibrium with respect to the joint variables. This drawback makes the definition of closed-loop controllers more challenging, in comparison with their serial counterparts. The problem is tackled by considering redundant dynamics, expressed in both task and joints space and solved through the method of quasi-velocity. We propose the usage of the observer linearization to estimate the end effector pose and stiffness, by just measuring the motor position, velocity and torque. These variables are used in the feedback loop to control the pose of the end effector. A 3-tendon planar platform is used for the experimental analysis.

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.

Colonoscopy is the gold standard screening test for colorectal cancer. However, it can miss up to 22% of lesions. One way to reduce this misrate is by guiding the endoscopist's attention towards suspicious areas (red-flagging). In this paper, we present the proof-of-concept of a novel endoscopic imaging device for the scanning of tubular organs such as the colon and the esophagus. The envisaged concept works as an accessory for any conventional flexible endoscope using it as a rail. It can generate a red-flagged map of the whole organ by orbiting and sliding a radial array of optical sensors around and along the endoscope. This concept paves the way for a semi-automated concurrent red-flagging technique for colonoscopy that enhances the endoscopist's situational awareness and reduces misrate.

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.

This paper proposes a semi-autonomous navigated master-slave system, for robot assisted remote echography for early trauma assessment. Two RGB-D sensors are used to capture real-time 3D information of the scene at the slave side where the patient is located. A 3D statistical shape model is built and used to generate a customized patient model based on the point cloud generated by the RGB-D sensors. The customized patient model can be updated and adaptively fitted to the patient. The model is also used to generate a trajectory to navigate a KUKA robotic arm and safely conduct the ultrasound examination. Extensive validation of the proposed system shows promising results in terms of accuracy and robustness.

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.

The increasing number of degrees-of-freedom involved in new generations of surgical robotics and the need for incorporating active constraints and haptic feedback, require more intuitive and effective ways of robot control. This paper presents a novel manipulator that allows for ergonomic bimanual joint-level control of an anthropomorphic surgical robot. Through the combined use of bidirectional compressed airflow, the manipulator can operate on nearly zero friction and simulate a range of frictional forces. As a generic platform, the system can withstand large payloads and is able to accommodate a wide range of existing haptic manipulators. The performance of the proposed platform is evaluated with detailed experimental tests and proven to provide negligible friction even at high loads. Its dynamic friction is controllable and positional locking can be flexibly applied. Detailed experimental results demonstrate the practical value of the system.

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.

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.