Shared Control Schemes for Middle Ear Surgery.

This paper deals with the control of a redundant cobot arm to accomplish peg-in-hole insertion tasks in the context of middle ear surgery. It mainly focuses on the development of two shared control laws that combine local measurements provided by position or force sensors with the globally observed visual information. We first investigate the two classical and well-established control modes, i.e., a position-based end-frame tele-operation controller and a comanipulation controller. Based on these two control architectures, we then propose a combination of visual feedback and position/force-based inputs in the same control scheme. In contrast to the conventional control designs where all degrees of freedom (DoF) are equally controlled, the proposed shared controllers allow teleoperation of linear/translational DoFs while the rotational ones are simultaneously handled by a vision-based controller. Such controllers reduce the task complexity, e.g., a complex peg-in-hole task is simplified for the operator to basic translations in the space where tool orientations are automatically controlled. Various experiments are conducted, using a 7-DoF robot arm equipped with a force/torque sensor and a camera, validating the proposed controllers in the context of simulating a minimally invasive surgical procedure. The obtained results in terms of accuracy, ergonomics and rapidity are discussed in this paper.

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.

Comparison of Noninvasive Imagery Methods to Observe Healthy and Degenerated Olfactory Epithelium in Mice for the Early Diagnosis of Neurodegenerative Diseases.

Olfactory dysfunction could be an early and reliable indicator for the diagnosis of neurodegenerative disorders such as Alzheimer and Parkinson's diseases. In this paper, we compare the potential of different noninvasive medical imaging modalities (optical coherence tomography, confocal microscopy, and fluorescence endomicroscopy) to distinguish how the olfactory epithelium, both at the cellular and the structural levels, is altered. Investigations were carried out on three experimental groups: two pathological groups (mice models with deliberately altered olfactory epithelium and Alzheimer's disease transgenic mice models) were compared with healthy mice models. As histological staining, the three tested noninvasive imaging tools demonstrated the general tubular organization of the olfactory epithelium on healthy mice. Contrary to OCT, confocal microscopy, and endomicroscopy allowed visualizing the inner structure of olfactory epithelium as well as its morphological or functional changes on pathological models, alterations classically observed with histological assessment. The results could lead to relevant development of imaging tools for noninvasive and early diagnosis of neurodegenerative diseases through the in situ characterization of the olfactory epithelium.

Review on Otological Robotic Systems: Toward Microrobot-Assisted Cholesteatoma Surgery.

Otologic surgical procedures over time have become minimally invasive due to the development of medicine, microtechniques, and robotics. This trend then provides an expected reduction in the patient's recovery time and improvement in the accuracy of diagnosis and treatment. One of the most challenging difficulties that such techniques face are precise control of the instrument and supply of an ergonomic system to the surgeon. The objective of this literature review is to present requirements and guidelines for a surgical robotic system dedicated to middle ear surgery. This review is particularly focused on cholesteatoma surgery (diagnosis and surgical tools), which is one of the most frequent pathologies that urge for an enhanced treatment. This review also presents the current robotic systems that are implemented for otologic 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.

Shearlet transform: a good candidate for compressed sensing in optical coherence tomography.

This paper deals with the development of a fast and smart acquisition technique of Optical Coherence Tomography (OCT) data that has the capability to reconstruct missing data of OCT image. The main objective is to reduce the acquisition time (i.e., increase the frame rate) of an OCT-scan system by choosing a trajectory that covers entirely the image but that does not take all the measurements. The reconstruction of the missing data is achieved by applying an updated Fast Iterative Soft-Thresholding Algorithm (FISTA) on a sparse representation of the image. Several sparse representations have been tested and the shearlets-based approach seems to outperform the other ones (e.g. wavelets, curvelets and by applying bilinear interpolation). The targeted application is a fast OCT imaging solution allowing an efficient compensation of the artefacts induced by the patient physiological motions for diagnostic purpose through optical biopsies (3D micrometric resolution optical images). The obtained results seem promising in terms of low time processing and improvement of the quality of the reconstructed image compared to the traditional sparse acquisition.

Multi-view vision system for laparoscopy surgery.

PURPOSE: A global endoscopic view of the surgical field could help avoid complications such as perforation of occluded organs and may reduce the endoscope displacements and also the usual time of laparoscopic procedure using a conventional endoscopy system. An augmented laparoscopy system was developed by increasing the field of view of a traditional endoscope. This system was implemented and tested in vitro using a testbench. METHOD: High-definition miniature cameras were integrated into a traditional endoscope to obtain a panoramic vision device with a large field of view of the abdominal cavity. The additional cameras are mounted around the endoscopy body as a pair of glasses providing a global view of the abdominal cavity completing the traditional endoscopic view. Each camera can reach a frame rate of 30 images/second with a resolution of 1,600 x 1,200 pixels. To be able to fix the cameras to the endoscope, a deployment, fixation and rapid extraction system of the proposed device through the trocar was designed and validated in preclinical experiments (testbench and human cadaver). The preclinical experiments compared the time required to perform a pick-and-place task with the traditional endoscope alone and with the proposed system alone. RESULTS: A statistically significant reduction in procedure time was found using an augmented video endoscopy system for a pick-and-place task. CONCLUSION: An augmented laparoscopy system with increased field of view is feasible and may be advantageous compared with a traditional endoscope. In vivo testing of the system should be done to establish the clinical utility of this innovation.

Enhanced vision system for laparoscopic surgery.

Laparoscopic surgery offers benefits to the patients but poses new challenges to the surgeons, including a limited field of view. In this paper, we present an innovative vision system that can be combined with a traditional laparoscope, and provides the surgeon with a global view of the abdominal cavity, bringing him or her closer to open surgery conditions. We present our first experiments performed on a testbench mimicking a laparoscopic setup: they demonstrate an important time gain in performing a complex task consisting bringing a thread into the field of view of the laparoscope.