Robotic bronchoscopy has the potential to improve the early detection of lung cancer. For the technology to be broadly adopted, the physician needs to be able to control the robotic bronchoscope in an instinctive and effective manner. In this paper, we describe the algorithms used to manipulate/drive the Auris Monarch Platform, a 10 degree-of-freedom bronchoscope and sheath, using a 3 degree-of-freedom user input. We introduce the concept of paired driving where the devices co-insert and co-articulate depending on their relative insertion. The paper presents safety algorithms such as auto-relax on retract and tension monitoring. The drive modes were developed, optimized, and clinically tested in lung models, human cadavers and live porcine models prior to their commercial release. Clinical studies show that the physician is able to reach significantly deeper in the lung than with classic bronchoscopes.

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.

This paper introduces a modular, mechatronic joint design for a flexible access minimally invasive surgical platform. The design features a hybrid tendon-micromotor actuation scheme coupled via an internal “ring gear”. This configuration transmits the rotary motion of the embedded micromotor to joint rotation in an efficient manner while also providing a hollow lumen through the centre of the joint unit. Detailed analyses of the joint design including tendon path length, positional accuracy and force/torque transmission characteristics are presented. The design has been incorporated into a dexterous, seven degree-of-freedom flexible access platform and its clinical efficacy for performing a Natural Orifice Translumenal Endoscopic Surgery (NOTES) diagnostic peritoneoscopy in an in-vivo environment is presented.

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.

This paper proposes a novel approach for the identification of the internal structure and mechanical properties of biological soft tissue using a force sensitive wheeled probe to generate a 'mechanical image' by rolling across the surface of a solid organ. Initially, a testing facility for validating the concept ex-vivo was developed. Preliminary validation tests were carried out on a silicone phantom with embedded abnormalities with the aim to link the derived 'mechanical image' with the known internal structure. Ex-vivo validation tests were also conducted on excised porcine livers. The data were analyzed in four parts: 1) the dynamic analysis of wheel-tissue interaction to validate that the measured parameters are representative of underlying tissue stiffness; 2) the development of a 'mechanical image' from the rolling data; 3) a comparison of standard 1-DOF indentation testing with 2-DOF rolling and 4) the characterization of the relationship between force and tissue deflection from the data contained within the mechanical image. The results show that the 'rolling mechanical image' is capable of capturing information relating to the underlying tissue stiffness distribution and characterizing the force-tissue deflection profile for a tissue sample. Examples of scenarios, where this information could potentially be used, include providing a surgeon with the ability to probe solid organs in-vivo during robot-assisted MIS or providing prior information for the modeling of tool-tissue interactions, such as steerable needles.

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 proposes a novel approach for the identification of tissue properties in-vivo using a force sensitive wheeled probe. The purpose of such a device is to compensate a surgeon for a portion of the loss of haptic and tactile feedback experienced during robotic-assisted minimally invasive surgery. Initially, a testing facility for validating the concept ex-vivo was developed and used to characterize two different testing modalities - static (1-DOF) tissue indentation and rolling (2-DOF) tissue indentation. As part of the static indentation experiments a mathematical model was developed to classify tissue condition based on changes in mechanical response. The purpose of the rolling indentation tests was to detect tissue abnormalities, such as tumors, which are difficult to isolate under static testing conditions. During such tests, the test-rig was capable of detecting simulated miniature buried masses at depths of 12mm. Based on these experiments a portable device capable of carrying out similar tests in-vivo was developed. The device was designed to be operated through a trocar port and its key feature is the ability to transition between static indentation and rolling indentation modalities without retracting and changing the tool.

This paper proposes a novel nonlinear viscoelastic soft tissue model generated from ex vivo experimental results on ovine liver using a force sensitive probe. In order to study the biomechanics of soft tissue, static indentation tests were applied on ovine liver. An empirical constitutive equation was extracted from the examined data. A mechanical model combining linear viscoelasticity with a nonlinear function of strain-stress is proposed. The developed model has been evaluated both statically and dynamically with different strain rates - i.e. where the velocity of indentation is varied. By comparing simulation results and measured experimental data, it has been concluded that the proposed model is robust for modelling both static and dynamic indentation conditions. The effect of changing boundary conditions on the parameters in the proposed model has been studied by choosing test sites with different underlying tissue thicknesses. The results indicate that for small strain, the effect of the thickness condition is reasonable to be neglected.