Telestroke network to robotic telestroke network: How to upgrade regional stroke care to include remote robotics?

Objective: Selected patients with large vessel occlusion (LVO) strokes can benefit from endovascular therapy (EVT). However, the effectiveness of EVT is largely dependent on how quickly the patient receives treatment. Recent technological developments have led to the first neurointerventional treatments using robotic assistance, opening up the possibility of performing remote stroke interventions. Existing telestroke networks provide acute stroke care, including remote administration of intravenous thrombolysis (IVT). Therefore, the introduction of remote EVT in distant stroke centers requires an adaptation of the existing telestroke networks. The aim of this work was to propose a framework for centers that are potential candidates for telerobotics according to the resources currently available in these centers. Methods: In this paper, we highlight the future challenges for including remote robotics in telestroke networks. A literature review provides potential solutions. Results: Existing telestroke networks need to determine which centers to prioritize for remote robotic technologies based on objective criteria and cost-effectiveness analysis. Organizational challenges include regional coordination and specific protocols. Technological challenges mainly concern telecommunication networks. Conclusions: Specific adaptations will be necessary if regional telestroke networks are to include remote robotics. Some of these can already be put in place, which could greatly help the future implementation of the technology.

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.

NanoRobotic Structures with Embedded Actuation via Ion Induced Folding.

4D structures are tridimensional structures with time-varying abilities that provide high versatility, sophisticated designs, and a broad spectrum of actuation and sensing possibilities. The downsizing of these structures below 100 µm opens up exceptional opportunities for many disciplines, including photonics, acoustics, medicine, and nanorobotics. However, it requires a paradigm shift in manufacturing methods, especially for dynamic structures. A novel fabrication method based on ion-induced folding of planar multilayer structures embedding their actuation is proposed-the planar structures are fabricated in bulk through batch microfabrication techniques. Programmable and accurate bidirectional foldings (-70° - +90°) of Silica/Chromium/Aluminium (SiO2 /Cr/Al) multilayer structures are modeled, experimentally demonstrated then applied to embedded electrothermal actuation of controllable and dynamic 4D nanorobotic structures. The method is used to produce high-performances case-study grippers for nanorobotic applications in confined environments. Once folded, a gripping task at the nano-scale is demonstrated. The proposed fabrication method is suitable for creating small-scale 4D systems for nanorobotics, medical devices, and tunable metamaterials, where rapid folding and enhanced dynamic control are required.

A Review of SMA-Based Actuators for Bidirectional Rotational Motion: Application to Origami Robots.

Shape memory alloys (SMAs) are a group of metallic alloys capable of sustaining large inelastic strains that can be recovered when subjected to a specific process between two distinct phases. Regarding their unique and outstanding properties, SMAs have drawn considerable attention in various domains and recently became appropriate candidates for origami robots, that require bi-directional rotational motion actuation with limited operational space. However, longitudinal motion-driven actuators are frequently investigated and commonly mentioned, whereas studies in SMA-based rotational motion actuation is still very limited in the literature. This work provides a review of different research efforts related to SMA-based actuators for bi-directional rotational motion (BRM), thus provides a survey and classification of current approaches and design tools that can be applied to origami robots in order to achieve shape-changing. For this purpose, analytical tools for description of actuator behaviour are presented, followed by characterisation and performance prediction. Afterward, the actuators' design methods, sensing, and controlling strategies are discussed. Finally, open challenges are discussed.

Toward Conductive Polymer-Based Soft Milli-Robots for Vacuum Applications.

For the last two decades, the development of conducting polymers (CP) as artificial muscles, by materials researchers and chemists, has made establishing a reliable and repeatable synthesis of such materials possible. CP-based milli-robots were mostly unknown in soft robotics, however, today, they play a vital role in robotics and smart materials forums. Indeed, this subclass of soft robots has reached a crucial moment in their history, a moment where they can display rather interesting features, based on established foundations in terms of modeling, control, sensing, and planning in various applications. The purpose of this paper is to present the potential of conductive polymer-based soft milli-robots as high-performance devices for vacuum applications. To that end, a trilayer polypyrrole-based actuator was first used inside a scanning electron microscope (SEM), characterized for different applied voltages, over a relatively long period. Additionally, the tip positioning of the cantilever was also controlled using a closed-loop control. Furthermore, as a proof of concept for more complex soft milli-robots, an S-shaped soft milli-robot was modeled, using a hybrid model comprised of two models; a multi-physics model and a kinematic model. It was then fabricated using laser machining and finally characterized using its tip displacement. polypyrrole-based soft milli-robots proved to have tremendous potential as high-performance soft robots at the microscale for a wide range of applications, including SEM micro-manipulation as well as biomedical applications.

In Vivo Inspection of the Olfactory Epithelium: Feasibility of Robotized Optical Biopsy.

Inspecting the olfactory cleft can be of high interest, as it is an open access to neurons, and thus an opportunity to collect in situ related data in a non-invasive way. Also, recent studies show a strong link between olfactory deficiency and neurodegenerative diseases such as Alzheimer and Parkinson diseases. However, no inspection of this area is possible today, as it is very difficult to access. Only robot-assisted interventions seem viable to provide the required dexterity. The feasibility of this approach is demonstrated in this article, which shows that the path complexity to the olfactory cleft can be managed with a concentric tube robot (CTR), a particular type of continuum robot. First, new anatomical data are elaborated, in particular for the olfactory cleft, that remains hardly characterized. 3D reconstructions are conducted on the database of 20 subjects, using CT scan images. Measurements are performed to describe the anatomy, including metrics with inter-subject variability. Then, the existence of collision-free passageways for CTR is shown using the 3D reconstructions. Among the 20 subjects, 19 can be inspected using only 3 different robot geometries. This constitutes an essential step towards a robotic device to inspect subjects for clinical purposes.

Developments and Control of Biocompatible Conducting Polymer for Intracorporeal Continuum Robots.

Dexterity of robots is highly required when it comes to integration for medical applications. Major efforts have been conducted to increase the dexterity at the distal parts of medical robots. This paper reports on developments toward integrating biocompatible conducting polymers (CP) into inherently dexterous concentric tube robot paradigm. In the form of tri-layer thin structures, CP micro-actuators produce high strains while requiring less than 1 V for actuation. Fabrication, characterization, and first integrations of such micro-actuators are presented. The integration is validated in a preliminary telescopic soft robot prototype with qualitative and quantitative performance assessment of accurate position control for trajectory tracking scenarios. Further, CP micro-actuators are integrated to a laser steering system in a closed-loop control scheme with displacements up to 5 mm. Our first developments aim toward intracorporeal medical robotics, with miniaturized actuators to be embedded into continuum robots.

Scanning Micromirror Platform Based on MEMS Technology for Medical Application.

This topical review discusses recent development and trends on scanning micromirrors for biomedical applications. This also includes a biomedical micro robot for precise manipulations in a limited volume. The characteristics of medical scanning micromirror are explained in general with the fundamental of microelectromechanical systems (MEMS) for fabrication processes. Along with the explanations of mechanism and design, the principle of actuation are provided for general readers. In this review, several testing methodology and examples are described based on many types of actuators, such as, electrothermal actuators, electrostatic actuators, electromagnetic actuators, pneumatic actuators, and shape memory alloy. Moreover, this review provides description of the key fabrication processes and common materials in order to be a basic guideline for selecting micro-actuators. With recent developments on scanning micromirrors, performances of biomedical application are enhanced for higher resolution, high accuracy, and high dexterity. With further developments on integrations and control schemes, MEMS-based scanning micromirrors would be able to achieve a better performance for medical applications due to small size, ease in microfabrication, mass production, high scanning speed, low power consumption, mechanical stable, and integration compatibility.