Robotic Assistance for Intraocular Microsurgery: Challenges and Perspectives.

Intraocular surgery, one of the most challenging discipline of microsurgery, requires sensory and motor skills at the limits of human physiological capabilities combined with tremendously difficult requirements for accuracy and steadiness. Nowadays, robotics combined with advanced imaging has opened conspicuous and significant directions in advancing the field of intraocular microsurgery. Having patient treatment with greater safety and efficiency as the final goal, similar to other medical applications, robotics has a real potential to fundamentally change microsurgery by combining human strengths with computer and sensor-based technology in an information-driven environment. Still in its early stages, robotic assistance for intraocular microsurgery has been accepted with precaution in the operating room and successfully tested in a limited number of clinical trials. However, owing to its demonstrated capabilities including hand tremor reduction, haptic feedback, steadiness, enhanced dexterity, micrometer-scale accuracy, and others, microsurgery robotics has evolved as a very promising trend in advancing retinal surgery. This paper will analyze the advances in retinal robotic microsurgery, its current drawbacks and limitations, as well as the possible new directions to expand retinal microsurgery to techniques currently beyond human boundaries or infeasible without robotics.

Simultaneous measurement of the surface shape and thickness for an optical flat with a wavelength-tuning Fizeau interferometer with suppression of drift error.

Two types of phase-shifting algorithms were developed for simultaneous measurement of the surface and thickness variation of an optical flat. During wavelength tuning, phase-shift nonlinearity can cause a spatially nonuniform error and spatially uniform DC drift error. A 19-sample algorithm was developed that eliminates the effect of the spatially uniform error by expanding the 17-sample algorithm with characteristic polynomial theory. The 19-sample algorithm was then altered to measure the surface shape of the optical flat by rotation of the characteristic diagram. The surface shape and thickness variation were measured with these two algorithms and a wavelength-tuning Fizeau interferometer.

Interferometric profile measurement of optical-thickness by wavelength tuning with suppression of spatially uniform error.

Wavelength-tuning interferometry has been widely used for measuring the thickness variation of optical devices used in the semiconductor industry. However, in wavelength-tuning interferometry, the nonlinearity of phase shift causes a spatially uniform error in the calculated phase distribution. In this study, the spatially uniform error is formulated using Taylor series. A new 9-sample phase-shifting algorithm is proposed, with which the uniform spatial phase error can be eliminated. The characteristics of 9-sample algorithm is discussed using Fourier representation and RMS error analysis. Finally, optical-thickness variation of transparent plate is measured using the proposed algorithm and wavelength-tuning Fizeau interferometer and the error is compared with 7-sample algorithm.

Evaluation of the three-dimensional bony coverage before and after rotational acetabular osteotomy.

PURPOSE: Rotational acetabular osteotomy is a type of pelvic osteotomy that involves rotation of the acetabular bone to improve the bony coverage of the femoral head for patients with acetabular dysplasia. Favourable post-operative long-term outcomes have been reported in previous studies. However, there is a paucity of published data regarding three-dimensional bony coverage. The present study investigated the three-dimensional bony coverage of the acetabulum covering the femoral head in hips before and after rotational acetabular osteotomy and in normal hips. METHODS: The computed tomography data of 40 hip joints (12 joints before and after rotational acetabular osteotomy; 16 normal joints) were analyzed. The three-dimensional bony coverage of each joint was evaluated using original software. RESULTS: The post-operative bony coverage improved significantly compared with pre-operative values. In particular, the anterolateral aspect of the acetabulum tended to be dysplastic in patients with acetabular dysplasia compared to those with normal hip joints. However, greater bony coverage at the anterolateral aspect was obtained after rotational acetabular osteotomy. Meanwhile, the results of the present study may indicate that the bony coverage in the anterior aspect may be excessive. CONCLUSION: Three-dimensional analysis indicated that rotational acetabular osteotomy achieved favorable bony coverage. Further investigations are necessary to determine the ideal bony coverage after rotational acetabular osteotomy.

Intelligent control of neurosurgical robot MM-3 using dynamic motion scaling.

OBJECTIVE Advanced and intelligent robotic control is necessary for neurosurgical robots, which require great accuracy and precision. In this article, the authors propose methods for dynamically and automatically controlling the motion-scaling ratio of a master-slave neurosurgical robotic system to reduce the task completion time. METHODS Three dynamic motion-scaling modes were proposed and compared with the conventional fixed motion-scaling mode. These 3 modes were defined as follows: 1) the distance between a target point and the tip of the slave manipulator, 2) the distance between the tips of the slave manipulators, and 3) the velocity of the master manipulator. Five test subjects, 2 of whom were neurosurgeons, sutured 0.3-mm artificial blood vessels using the MM-3 neurosurgical robot in each mode. RESULTS The task time, total path length, and helpfulness score were evaluated. Although no statistically significant differences were observed, the mode using the distance between the tips of the slave manipulators improves the suturing performance. CONCLUSIONS Dynamic motion scaling has great potential for the intelligent and accurate control of neurosurgical robots.

An Analysis of the Characteristics and Improved Use of Newly Developed CT-based Navigation System in Total Hip Arthroplasty.

We developed a surface matching-type computed tomography (CT)-based navigation system for total hip arthroplasty (the N-navi; TEIJIN NAKASHIMA MEDICAL, Okayama, Japan). In the registration step, surface matching was performed with digitizing points on the pelvic bone surface after coarse paired matching. In the present study, we made model bones from the CT data of patients whose acetabular shapes had various deformities. We measured the distances and angles after surface matching from the fiducial points and evaluated the ability to correct surface-matching registration on each pelvic form, using several areas and numbers of points. When the surface-matching points were taken on the superior area of the acetabulum, the correction was easy for the external direction, but it was difficult to correct for the anterior and proximal directions. The correction was difficult for external and proximal directions on the posterior area. Each area of surface-matching points has particular directions that are easily corrected and other directions that are difficult to correct. The shape of the pelvis also affected the correction ability. Our present findings suggest that checking the position after coarse paired matching and choosing the surface-matching area and points that are optimal to correct will improve the accuracy of total hip arthroplasty and reduce surgical times.

A multi-degree-of-freedom needle driver with a short tip and small shaft for pediatric laparoscopic surgery: in vivo assessment of multi-directional suturing on the vertical plane of the liver in rabbits.

BACKGROUND: Laparoscopic Kasai portoenterostomy has been performed in infants with biliary atresia at several institutions, but laparoscopic anastomosis requiring multi-directional suturing on a vertical plane of the liver remains a challenge. To assist multi-directional suturing, we developed a multi-degree-of-freedom (DOF) needle driver whose tip length was 15 mm and shaft diameter was 3.5 mm. The tip of the multi-DOF needle driver has three DOFs for grasp, flection and rotation. The aim of this study was to evaluate the performance of the multi-DOF needle driver in two kinds of in vivo experiments. METHODS: Surgeons were asked to perform four-directional laparoscopic suturing on a vertical plane of the liver in six rabbits using the multi-DOF needle driver or a conventional needle driver. The needle grasping time, the needle handling time, the number of needle insertions, the number of liver lacerations, the suturing width and depth, and the area of necrotic tissues were analyzed and compared. Additionally, one surgeon was asked to perform laparoscopic hepato-jejunostomy in four rabbits to assess the feasibility of Kasai portoenterostomy using the multi-DOF needle driver. RESULTS: The suturing depth using the multi-DOF needle driver was significantly larger than that using the conventional needle driver in both the right and downward suturing directions. No statistically significant differences were found in other metrics. Liver lacerations were observed only when suturing was performed using the conventional needle driver. The experimental laparoscopic hepato-jejunostomy using the multi-DOF needle driver was successful. CONCLUSIONS: Using the multi-DOF needle driver, uniform multi-directional suturing on a vertical plane of the liver could be performed. The short distal tip of the multi-DOF needle driver demonstrated its advantages in multi-directional suturing in a small body cavity. The multi-DOF needle driver may be able to be used to perform complex tasks in laparoscopic Kasai portoenterostomy.

Compensation for correlated error in multilayer interferometer.

Wavelength tuning interferometry is used to measure and estimate the surface shape of a sample. However, in multilayer interferometry (e.g., a lithium niobate [LNB] crystal wafer attached to a supporting plate), the correlated error between the higher harmonics and the phase-shift error causes considerable error in the calculated phase. In this study, the correlated errors calculated by various types of windowed phase-shifting algorithms are analyzed in connection with the characteristic polynomial theory and Fourier representation of the algorithms. The surface shape and optical thickness variation of the LNB wafer are measured simultaneously using the windowed phase-shifting algorithms. The results are compared in terms of the observed ripples and measurement repeatability. The experimental results show that the 4N-3 algorithm is optimal and possesses the smallest repeatability error.

Interferometric measurement of surface shape by wavelength tuning suppressing random intensity error.

In this research, the susceptibility of the phase-shifting algorithms to the random intensity error is formulated and estimated. The susceptibility of the random intensity error of conventional windowed phase-shifting algorithms is discussed, and the 7N-6 phase-shifting algorithm is developed to minimize the random intensity error using the characteristic polynomial theory. Finally, the surface shape of the transparent wedge plate is measured using a wavelength-tuning Fizeau interferometer and the 7N-6 algorithm. The experimental results indicate that the surface shape measurement accuracy for the transparent plate is 2.5 nm.

Focused Ultrasound and Lithotripsy.

Shock wave lithotripsy has generally been a first choice for kidney stone removal. The shock wave lithotripter uses an order of microsecond pulse durations and up to a 100 MPa pressure spike triggered at approximately 0.5-2 Hz to fragment kidney stones through mechanical mechanisms. One important mechanism is cavitation. We proposed an alternative type of lithotripsy method that maximizes cavitation activity to disintegrate kidney stones using high-intensity focused ultrasound (HIFU). Here we outline the method according to the previously published literature (Matsumoto et al., Dynamics of bubble cloud in focused ultrasound. Proceedings of the second international symposium on therapeutic ultrasound, pp 290-299, 2002; Ikeda et al., Ultrasound Med Biol 32:1383-1397, 2006; Yoshizawa et al., Med Biol Eng Comput 47:851-860, 2009; Koizumi et al., A control framework for the non-invasive ultrasound the ragnostic system. Proceedings of 2009 IEEE/RSJ International Conference on Intelligent Robotics and Systems (IROS), pp 4511-4516, 2009; Koizumi et al., IEEE Trans Robot 25:522-538, 2009). Cavitation activity is highly unpredictable; thus, a precise control system is needed. The proposed method comprises three steps of control in kidney stone treatment. The first step is control of localized high pressure fluctuation on the stone. The second step is monitoring of cavitation activity and giving feedback on the optimized ultrasound conditions. The third step is stone tracking and precise ultrasound focusing on the stone. For the high pressure control we designed a two-frequency wave (cavitation control (C-C) waveform); a high frequency ultrasound pulse (1-4 MHz) to create a cavitation cloud, and a low frequency trailing pulse (0.5 MHz) following the high frequency pulse to force the cloud into collapse. High speed photography showed cavitation collapse on a kidney stone and shock wave emission from the cloud. We also conducted in-vitro erosion tests of model and natural kidney stones. For the model stones, the erosion rate of the C-C waveform showed a distinct advantage with the combined high and low frequency waves over either wave alone. For optimization of the high frequency ultrasound intensity, we investigated the relationship between subharmonic emission from cavitation bubbles and stone erosion volume. For stone tracking we have also developed a non-invasive ultrasound theragnostic system (NIUTS) that compensates for kidney motion. Natural stones were eroded and most of the resulting fragments were less than 1 mm in diameter. The small fragments were small enough to pass through the urethra. The results demonstrate that, with the precise control of cavitation activity, focused ultrasound has the potential to be used to develop a less invasive and more controllable lithotripsy system.

Simultaneous measurement of surface shape and optical thickness using wavelength tuning and a polynomial window function.

In this study, a 6N - 5 phase shifting algorithm comprising a polynomial window function and discrete Fourier transform is developed for the simultaneous measurement of the surface shape and optical thickness of a transparent plate with suppression of the coupling errors between the higher harmonics and phase shift error. The characteristics of the 6N - 5 algorithm were estimated by connection with the Fourier representation in the frequency domain. The phase error of the measurements performed using the 6N - 5 algorithm is discussed and compared with those of measurements obtained using other algorithms. Finally, the surface shape and optical thickness of a transparent plate were measured simultaneously using the 6N - 5 algorithm and a wavelength tuning interferometer.

Measurement of optical thickness variation of BK7 plate by wavelength tuning interferometry.

This paper presents the derivation of a 17-sample phase-shifting algorithm that can compensate the miscalibration and first-order nonlinearity of phase shift error, coupling error, and bias modulation of the intensity and satisfy the fringe contrast maximum condition. The phase error of measurements performed using the 17-sample algorithm is discussed and compared with those of measurements obtained using other algorithms. Finally, the optical thickness variation of a BK7 optically transparent plate obtained using a wavelength tuning Fizeau interferometer and the 17-sample algorithm are presented. The experimental results indicate that the optical thickness variation measurement accuracy for the BK7 plate was 3 nm.

Absolute optical thickness measurement of transparent plate using excess fraction method and wavelength-tuning Fizeau interferometer.

The absolute optical thickness of a transparent plate 6-mm thick and 10 mm in diameter was measured by the excess fraction method and a wavelength-tuning Fizeau interferometer. The optical thickness, defined by the group refractive index at the central wavelength, was measured by wavelength scanning. The optical thickness deviation, defined by the ordinary refractive index, was measured using the phase-shifting technique. Two kinds of optical thicknesses, measured by discrete Fourier analysis and the phase-shifting technique, were synthesized to obtain the optical thickness with respect to the ordinary refractive index using Sellmeier equation and least-square fitting.

Measurement of absolute optical thickness of mask glass by wavelength-tuning Fourier analysis.

Optical thickness is a fundamental characteristic of an optical component. A measurement method combining discrete Fourier-transform (DFT) analysis and a phase-shifting technique gives an appropriate value for the absolute optical thickness of a transparent plate. However, there is a systematic error caused by the nonlinearity of the phase-shifting technique. In this research the absolute optical-thickness distribution of mask blank glass was measured using DFT and wavelength-tuning Fizeau interferometry without using sensitive phase-shifting techniques. The error occurring during the DFT analysis was compensated for by using the unwrapping correlation. The experimental results indicated that the absolute optical thickness of mask glass was measured with an accuracy of 5 nm.

Surface measurement of indium tin oxide thin film by wavelength-tuning Fizeau interferometry.

Indium-tin oxide (ITO) thin films have been widely used in displays such as liquid crystal displays and touch panels because of their favorable electrical conductivity and optical transparency. The surface shape and thickness of ITO thin films must be precisely measured to improve their reliability and performance. Conventional measurement techniques take single point measurements and require expensive systems. In this paper, we measure the surface shape of an ITO thin film on top of a transparent plate using wavelength-tuning Fizeau interferometry. The surface shape was determined by compensating for the phase error introduced by optical interference from the thin film, which was calculated using the phase and amplitude distributions measured by wavelength-tuning. The proposed measurement method achieved noncontact, large-aperture, and precise measurements of transparent thin films. The surface shape of the sample was experimentally measured to an accuracy of 5.13 nm.

Quantitative pediatric surgical skill assessment using a rapid-prototyped chest model.

INTRODUCTION: Though minimally invasive pediatric surgery has become more widespread, pediatric-specific surgical skills have not been quantitatively assessed. MATERIAL AND METHODS: As a first step toward the quantification of pediatric-specific surgical skills, a pediatric chest model comprising a three-dimensional rapid-prototyped pediatric ribcage with accurate anatomical dimensions, a suturing skin model with force-sensing capability, and forceps with motion-tracking sensors were developed. A skill assessment experiment was conducted by recruiting 16 inexperienced pediatric surgeons and 14 experienced pediatric surgeons to perform an endoscopic intracorporeal suturing and knot-tying task in both the pediatric chest model setup and the conventional box trainer setup. RESULTS: The instrument motion measurement was successful in only 20 surgeons due to sensor failure. The task completion time, total path length of instruments, and applied force were compared between the inexperienced and experienced surgeons as well as between the box trainer and chest model setups. The experienced surgeons demonstrated better performance in all parameters for both setups, and the pediatric chest model was more challenging due to the pediatric features replicated by the model. CONCLUSION: The pediatric chest model was valid for pediatric skill assessment, and further analysis of the collected data will be conducted to further investigate pediatric-specific skills.

Design of phase shifting algorithms: fringe contrast maximum.

In phase shifting interferometry, the fringe contrast is preferred to be at a maximum when there is no phase shift error. In the measurement of highly-reflective surfaces, the signal contrast is relatively low and the measurement would be aborted when the contrast falls below a threshold value. The fringe contrast depends on the design of the phase shifting algorithm. The condition for achieving the fringe contrast maximum is derived as a set of linear equations of the sampling amplitudes. The minimum number of samples necessary for constructing an error-compensating algorithm that is insensitive to the jth harmonic component and to the phase shift error is discussed. As examples, two new algorithms (15-sample and (3N - 2)-sample) were derived that are useful for the measurement for highly-reflective surfaces.

Multiple-surface interferometry of highly reflective wafer by wavelength tuning.

The surface shape and optical thickness variation of a lithium niobate (LNB) wafer were measured simultaneously using a wavelength-tuning interferometer with a new phase-shifting algorithm. It is necessary to suppress the harmonic signals for testing a highly reflective sample such as a crystal wafer. The LNB wafer subjected to polishing, which is in optical contact with a fused-silica (FS) supporting plate, generates six different overlapping interference fringes. The reflectivity of the wafer is typically 15%, yielding significant harmonic signals. The new algorithm can flexibly select the phase-shift interval and effectively suppress the harmonic signals and crosstalk. Experimental results indicated that the optical thickness variation of the LNB wafer was measured with an accuracy of 2 nm.

[Projects to accelerate the practical use of innovative medical devices to collaborate with TWIns, Center for Advanced Biomedical Sciences, Waseda University and School of Engineering, The University of Tokyo].

Division of Medical Devices has been conducting the projects to accelerate the practical use of innovative medical devices to collaborate with TWIns, Center for Advanced Biomedical Sciences, Waseda University and School of Engineering, The University of Tokyo. The TWIns has been studying to aim at establishment of preclinical evaluation methods by "Engineering Based Medicine", and established Regulatory Science Institute for Medical Devices. School of Engineering, The University of Tokyo has been studying to aim at establishment of assessment methodology for innovative minimally invasive therapeutic devices, materials, and nanobio diagnostic devices. This report reviews the exchanges of personnel, the implement systems and the research progress of these projects.

A new navigation system for minimally invasive total knee arthroplasty.

A computer-assisted navigation system to be used for total knee arthroplasties (TKAs) was reported to improve the accuracy of bone resection and result in precise implant placement, but the concomitant surgical invasion and time consumption are clinical problems. We developed a computed tomography (CT)-based navigation system (NNS) to be used for minimally invasive TKA. It requires only the reference points from a small limited area of the medial femoral condyle and proximal tibia through a skin incision to obtain optical images. Here we evaluated the usefulness and accuracy of the NNS in comparison with the commercially available BrainLAB image-free navigation system (BLS). In a clinical experiment, the registration times obtained with the NNS tended to be shorter than those obtained with the BLS, but not significantly so. The NNS group tended to be in the extended position in the sagittal plane of the distal femur within 3 degrees, and the BLS group showed rather flexed deviation in the sagittal plane of the anterior femur.