µRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery.

Laser microsurgery is the current gold standard surgical technique for the treatment of selected diseases in delicate organs such as the larynx. However, the operations require large surgical expertise and dexterity, and face significant limitations imposed by available technology, such as the requirement for direct line of sight to the surgical field, restricted access, and direct manual control of the surgical instruments. To change this status quo, the European project µRALP pioneered research towards a complete redesign of current laser microsurgery systems, focusing on the development of robotic micro-technologies to enable endoscopic operations. This has fostered awareness and interest in this field, which presents a unique set of needs, requirements and constraints, leading to research and technological developments beyond µRALP and its research consortium. This paper reviews the achievements and key contributions of such research, providing an overview of the current state of the art in robot-assisted endoscopic laser microsurgery. The primary target application considered is phonomicrosurgery, which is a representative use case involving highly challenging microsurgical techniques for the treatment of glottic diseases. The paper starts by presenting the motivations and rationale for endoscopic laser microsurgery, which leads to the introduction of robotics as an enabling technology for improved surgical field accessibility, visualization and management. Then, research goals, achievements, and current state of different technologies that can build-up to an effective robotic system for endoscopic laser microsurgery are presented. This includes research in micro-robotic laser steering, flexible robotic endoscopes, augmented imaging, assistive surgeon-robot interfaces, and cognitive surgical systems. Innovations in each of these areas are shown to provide sizable progress towards more precise, safer and higher quality endoscopic laser microsurgeries. Yet, major impact is really expected from the full integration of such individual contributions into a complete clinical surgical robotic system, as illustrated in the end of this paper with a description of preliminary cadaver trials conducted with the integrated µRALP system. Overall, the contribution of this paper lays in outlining the current state of the art and open challenges in the area of robot-assisted endoscopic laser microsurgery, which has important clinical applications even beyond laryngology.

Measuring the mechanical behaviour of human oocytes with a very simple SU-8 micro-tool.

The elasticity of human oocytes has been estimated by means of a very simple SU-8 microsystem. The device consists of a double SU-8 layer spin coated on a silicon wafer. A micro-beam is patterned by standard photolithography. The silicon wafer is back etched using deep reactive ion etching (DRIE) in order to release the micro-beam. Because the SU-8 resin exhibits a very low Young modulus, beams with stiffnesses of 12 N/m have been easily fabricated. Although the stiffness is not as low as that of Atomic Force Microscopes cantilevers, it was possible to estimate the "deformation-load" characteristics of a few oocytes. A "flattening parameter" of the oocytes is proposed as a function of the applied load and experimental values range from 0.86 microm(2)/Pa to 3.4 microm(2)/Pa for the oocytes under test. Note that this paper belongs to the very few communications concerning the mechanical behaviour of human oocytes.

Geometrical capillary network analysis.

BACKGROUND: Skin microcirculation, especially the superficial network, can be assessed by a computer capillary video microscope system. The study of morphology and dynamics of microcirculation must include all dynamic and cooperative processes between the capillaries. For characterizing capillary ensembles, the statistical and geometrical properties of the network need to be explored. METHODS: The microvaculature of the skin and the microcirculation were investigated by combining videocapillaroscopy (VCP) and image processing techniques based on computational geometry and graph theory. Our goal was to characterize the capillary network in noisy pictures of the scalp. Different geometric methods were developed, based on proximity parameters (distance and surface) in order to circumscribe and construct this network. RESULTS: By studying the distribution of these parameters, extreme values or outliers, which usually correspond to artifact subregions in the pictures could be eliminated. Different algorithms were developed and has been implemented in an image processing software (Capilab Toolbox). CONCLUSION: This computerized system is capable of real-time processings, increasing the quality of videocapillaroscope images and minimizing the disturbance of artifacts. The algorithms presented here are easy to implement and can process any kind of images of the skin, even in the scalp. In association with an example-based detection system, this method can be generalized to other stimuli in the same conditions.