Developing the OpenFlexure Microscope towards medical use: technical and social challenges of developing globally accessible hardware for healthcare.

The OpenFlexure Microscope is an accessible, three-dimensional-printed robotic microscope, with sufficient image quality to resolve diagnostic features including parasites and cancerous cells. As access to lab-grade microscopes is a major challenge in global healthcare, the OpenFlexure Microscope has been developed to be manufactured, maintained and used in remote environments, supporting point-of-care diagnosis. The steps taken in transforming the hardware and software from an academic prototype towards an accepted medical device include addressing technical and social challenges, and are key for any innovation targeting improved effectiveness in low-resource healthcare. This article is part of the Theo Murphy meeting issue 'Open, reproducible hardware for microscopy'.

Firing feature-driven neural circuits with scalable memristive neurons for robotic obstacle avoidance.

Neural circuits with specific structures and diverse neuronal firing features are the foundation for supporting intelligent tasks in biology and are regarded as the driver for catalyzing next-generation artificial intelligence. Emulating neural circuits in hardware underpins engineering highly efficient neuromorphic chips, however, implementing a firing features-driven functional neural circuit is still an open question. In this work, inspired by avoidance neural circuits of crickets, we construct a spiking feature-driven sensorimotor control neural circuit consisting of three memristive Hodgkin-Huxley neurons. The ascending neurons exhibit mixed tonic spiking and bursting features, which are used for encoding sensing input. Additionally, we innovatively introduce a selective communication scheme in biology to decode mixed firing features using two descending neurons. We proceed to integrate such a neural circuit with a robot for avoidance control and achieve lower latency than conventional platforms. These results provide a foundation for implementing real brain-like systems driven by firing features with memristive neurons and put constructing high-order intelligent machines on the agenda.

Magnetic steering continuum robot for transluminal procedures with programmable shape and functionalities.

Millimeter-scale soft continuum robots offer safety and adaptability in transluminal procedures due to their passive compliance, but this feature necessitates interactions with surrounding lumina, leading to potential medical risks and restricted mobility. Here, we introduce a millimeter-scale continuum robot, enabling apical extension while maintaining structural stability. Utilizing phase transition components, the robot executes cycles of tip-based elongation, steered accurately through programmable magnetic fields. Each motion cycle features a solid-like backbone for stability, and a liquid-like component for advancement, thereby enabling autonomous shaping without reliance on environmental interactions. Together with clinical imaging technologies, we demonstrate the capability of navigating through tortuous and fragile lumina to transport microsurgical tools. Once it reaches larger anatomical spaces such as stomach, it can morph into functional 3D structures that serve as surgical tools or sensing units, overcoming the constraints of initially narrow pathways. By leveraging this design paradigm, we anticipate enhanced safety, multi-functionality, and cooperative capabilities among millimeter-scale continuum robots, opening new avenues for transluminal robotic surgery.

A Tension Sensor Array for Cable-Driven Surgical Robots.

Tendon-sheath structures are commonly utilized to drive surgical robots due to their compact size, flexibility, and straightforward controllability. However, long-distance cable tension estimation poses a significant challenge due to its frictional characteristics affected by complicated factors. This paper proposes a miniature tension sensor array for an endoscopic cable-driven parallel robot, aiming to integrate sensors into the distal end of long and flexible surgical instruments to sense cable tension and alleviate friction between the tendon and sheath. The sensor array, mounted at the distal end of the robot, boasts the advantages of a small size (16 mm outer diameter) and reduced frictional impact. A force compensation strategy was presented and verified on a platform with a single cable and subsequently implemented on the robot. The robot demonstrated good performance in a series of palpation tests, exhibiting a 0.173 N average error in force estimation and a 0.213 N root-mean-square error. In blind tests, all ten participants were able to differentiate between silicone pads with varying hardness through force feedback provided by a haptic device.

Implementing a Barcode-Based Whole-Life Cycle Management Process to Improve Robotic Instrument Tracking.

Minimally invasive surgery can involve the use of robotics to improve patient outcomes. Some robotic systems require special instruments with a designated number of uses. In China, during the reprocessing of the robotic instruments, health care personnel determined that the existing tracking processes were inadequate. They conducted a quality improvement project with the goal of establishing a barcode-based standardized process for tracking robotic instruments. They implemented technology that generated a unique identifier each time a robotic instrument was reprocessed after use. Nurses scanned the identifier when surgeons used the instrument. The findings included the increased accuracy of use documentation and decreases in untraceable sterilization and use records, charging concerns, and average daily and monthly inventory times. An increase in adverse event reports associated with robotic instruments also was noted. The use of barcode technology for robotic instrument tracking continues at the facility and may be expanded for additional specialty instruments.

A fully autonomous robotic ultrasound system for thyroid scanning.

The current thyroid ultrasound relies heavily on the experience and skills of the sonographer and the expertise of the radiologist, and the process is physically and cognitively exhausting. In this paper, we report a fully autonomous robotic ultrasound system, which is able to scan thyroid regions without human assistance and identify malignant nod- ules. In this system, human skeleton point recognition, reinforcement learning, and force feedback are used to deal with the difficulties in locating thyroid targets. The orientation of the ultrasound probe is adjusted dynamically via Bayesian optimization. Experimental results on human participants demonstrated that this system can perform high-quality ultrasound scans, close to manual scans obtained by clinicians. Additionally, it has the potential to detect thyroid nodules and provide data on nodule characteristics for American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) calculation.

A Lightweight and Affordable Wearable Haptic Controller for Robot-Assisted Microsurgery.

In robot-assisted microsurgery (RAMS), surgeons often face the challenge of operating with minimal feedback, particularly lacking in haptic feedback. However, most traditional desktop haptic devices have restricted operational areas and limited dexterity. This report describes a novel, lightweight, and low-budget wearable haptic controller for teleoperated microsurgical robotic systems. We designed a wearable haptic interface entirely made using off-the-shelf material-PolyJet Photopolymer, fabricated using liquid and solid hybrid 3D co-printing technology. This interface was designed to resemble human soft tissues and can be wrapped around the fingertips, offering direct contact feedback to the operator. We also demonstrated that the device can be easily integrated with our motion tracking system for remote microsurgery. Two motion tracking methods, marker-based and marker-less, were compared in trajectory-tracking experiments at different depths to find the most effective motion tracking method for our RAMS system. The results indicate that within the 4 to 8 cm tracking range, the marker-based method achieved exceptional detection rates. Furthermore, the performance of three fusion algorithms was compared to establish the unscented Kalman filter as the most accurate and reliable. The effectiveness of the wearable haptic controller was evaluated through user studies focusing on the usefulness of haptic feedback. The results revealed that haptic feedback significantly enhances depth perception for operators during teleoperated RAMS.

Development of a Two-Finger Haptic Robotic Hand with Novel Stiffness Detection and Impedance Control.

Haptic hands and grippers, designed to enable skillful object manipulation, are pivotal for high-precision interaction with environments. These technologies are particularly vital in fields such as minimally invasive surgery, where they enhance surgical accuracy and tactile feedback: in the development of advanced prosthetic limbs, offering users improved functionality and a more natural sense of touch, and within industrial automation and manufacturing, they contribute to more efficient, safe, and flexible production processes. This paper presents the development of a two-finger robotic hand that employs simple yet precise strategies to manipulate objects without damaging or dropping them. Our innovative approach fused force-sensitive resistor (FSR) sensors with the average current of servomotors to enhance both the speed and accuracy of grasping. Therefore, we aim to create a grasping mechanism that is more dexterous than grippers and less complex than robotic hands. To achieve this goal, we designed a two-finger robotic hand with two degrees of freedom on each finger; an FSR was integrated into each fingertip to enable object categorization and the detection of the initial contact. Subsequently, servomotor currents were monitored continuously to implement impedance control and maintain the grasp of objects in a wide range of stiffness. The proposed hand categorized objects' stiffness upon initial contact and exerted accurate force by fusing FSR and the motor currents. An experimental test was conducted using a Yale-CMU-Berkeley (YCB) object set consisted of a foam ball, an empty soda can, an apple, a glass cup, a plastic cup, and a small milk packet. The robotic hand successfully picked up these objects from a table and sat them down without inflicting any damage or dropping them midway. Our results represent a significant step forward in developing haptic robotic hands with advanced object perception and manipulation capabilities.

Looking to the Future; Veterinary Robotic Surgery.

This article details the rise of surgical robots in the human surgical sphere as well as their use in veterinary medicine. Sections will describe in detail the equipment required for these procedures and the advantages and disadvantages of their use. Specific attention is given to the articulated instrumentation, which affords psychomotor benefits not only for surgical precision but also for surgeon ergonomics. A discussion of the possible indications and current use of robotics in veterinary medicine and the challenges to integrating robotics is also provided.

Novel Operation Mechanism and Multifunctional Applications of Bubble Microrobots.

Microrobots have emerged as powerful tools for manipulating particles, cells, and assembling biological tissue structures at the microscale. However, achieving precise and flexible operation of arbitrary-shaped microstructures in 3D space remains a challenge. In this study, three novel operation methods based on bubble microrobots are proposed to enable delicate and multifunctional manipulation of various microstructures. These methods include 3D turnover, fixed-point rotation, and 3D ejection. By harnessing the combined principles of the effect of the heat flow field and surface tension of an optothermally generated bubble, the bubble microrobot can perform tasks such as flipping an SIA humanoid structure, rotating a bird-like structure, and launching a hollow rocket-like structure. The proposed multi-mode operation of bubble microrobots enables diverse attitude adjustments of microstructures with different sizes and shapes in both 2D and 3D spaces. As a demonstration, a biological microenvironment of brain glioblastoma is constructed by the bubble microrobot. The simplicity, versatility, and flexibility of this proposed method hold great promise for applications in micromanipulation, assembly, and tissue engineering.

[Overview of the Development of Spatial Positioning Accuracy Testing Technology for Surgical Robots].

Characteristics of two major categories of RA equipment which defined in the standard are interpreted firstly. Few representative RA equipment in current market and their key product features are introduced. Then, classifications of different indexes of spatial positioning accuracy are declared, the difficulties of performing testing process on each indexes are further explained. Meanwhile, different kinds of three dimensional coordinate measuring equipment that are cutting edge at present stage are introduced with their main methods of use explained. According to characteristics of three dimensional coordinate measuring equipment on the market, proper measuring equipment for testing certain index of spatial positioning accuracy and corresponding experiment method are introduced.

Adaptive wireless millirobotic locomotion into distal vasculature.

Microcatheters have enabled diverse minimally invasive endovascular operations and notable health benefits compared with open surgeries. However, with tortuous routes far from the arterial puncture site, the distal vascular regions remain challenging for safe catheter access. Therefore, we propose a wireless stent-shaped magnetic soft robot to be deployed, actively navigated, used for medical functions, and retrieved in the example M4 segment of the middle cerebral artery. We investigate shape-adaptively controlled locomotion in phantoms emulating the physiological conditions here, where the lumen diameter shrinks from 1.5 mm to 1 mm, the radius of curvature of the tortuous lumen gets as small as 3 mm, the lumen bifurcation angle goes up to 120°, and the pulsatile flow speed reaches up to 26 cm/s. The robot can also withstand the flow when the magnetic actuation is turned off. These locomotion capabilities are confirmed in porcine arteries ex vivo. Furthermore, variants of the robot could release the tissue plasminogen activator on-demand locally for thrombolysis and function as flow diverters, initiating promising therapies towards acute ischemic stroke, aneurysm, arteriovenous malformation, dural arteriovenous fistulas, and brain tumors. These functions should facilitate the robot's usage in new distal endovascular operations.

IoT Security and Computation Management on a Multi-Robot System for Rescue Operations Based on a Cloud Framework.

There is a growing body of literature that recognizes the importance of Multi-Robot coordination and Modular Robotics. This work evaluates the secure coordination of an Unmanned Aerial Vehicle (UAV) via a drone simulation in Unity and an Unmanned Ground Vehicle (UGV) as a rover. Each robot is equipped with sensors to gather information to send to a cloud server where all computations are performed. Each vehicle is registered by blockchain ledger-based network security. In addition to these, relevant information and alerts are displayed on a website for the users. The usage of UAV-UGV cooperation allows for autonomous surveillance due to the high vantage field of view. Furthermore, the usage of cloud computation lowers the cost of microcontrollers by reducing their complexity. Lastly, blockchain technology mitigates the security issues related to adversarial or malicious robotic nodes connecting to the cluster and not agreeing to privacy rules and norms.

A miniature robotic steerable endoscope for maxillary sinus surgery called PliENT.

In endoscopic maxillary sinus surgery, the maxillary sinus is accessed through the nasal cavity which constitutes a narrow and tortuous pathway. However, surgeons still use rigid endoscopes and rigid, straight or pre-bent instruments for this procedure. Resection of the uncinate process and creation of a medial antrostomy is warranted to access the pathology inside the maxillary sinus and depending on the location of the pathology (lateral, inferior or anterior wall), additional resection of healthy tissue and/or functional structures like the lacrimal duct and/or inferior turbinate is necessary to gain optimal access. In order to avoid this additional resection, a functional single-handed, steerable endoscope for endoscopic maxillary sinus surgery has been designed and built. This endoscope is, to our knowledge, the most slender active steerable endoscope ever reported for maxillary sinus surgery. The performance of the endoscope was validated by two surgeons on a cadaver. An increased field of view was found in comparison to currently used endoscopes. As a direct consequence, a reduced need for resection of healthy tissue was confirmed.

Autonomous robotic surgery makes light work of anastomosis.

An autonomous robotic laparoscopic surgical technique is capable of tracking tissue motion and offers consistency in suturing for the anastomosis of the small bowel.

Soft robotic constrictor for in vitro modeling of dynamic tissue compression.

Here we present a microengineered soft-robotic in vitro platform developed by integrating a pneumatically regulated novel elastomeric actuator with primary culture of human cells. This system is capable of generating dynamic bending motion akin to the constriction of tubular organs that can exert controlled compressive forces on cultured living cells. Using this platform, we demonstrate cyclic compression of primary human endothelial cells, fibroblasts, and smooth muscle cells to show physiological changes in their morphology due to applied forces. Moreover, we present mechanically actuatable organotypic models to examine the effects of compressive forces on three-dimensional multicellular constructs designed to emulate complex tissues such as solid tumors and vascular networks. Our work provides a preliminary demonstration of how soft-robotics technology can be leveraged for in vitro modeling of complex physiological tissue microenvironment, and may enable the development of new research tools for mechanobiology and related areas.

Swarming Aqua Sperm Micromotors for Active Bacterial Biofilms Removal in Confined Spaces.

Microscale self-propelled robots show great promise in the biomedical field and are the focus of many researchers. These tiny devices, which move and navigate by themselves, are typically based on inorganic microstructures that are not biodegradable and potentially toxic, often using toxic fuels or elaborate external energy sources, which limits their real-world applications. One potential solution to these issues is to go back to nature. Here, the authors use high-speed Aqua Sperm micromotors obtained from North African catfish (Clarias gariepinus, B. 1822) to destroy bacterial biofilm. These Aqua Sperm micromotors use water-induced dynein ATPase catalyzed adenosine triphosphate (ATP) degradation as biocompatible fuel to trigger their fast speed and snake-like undulatory locomotion that facilitate biofilm destruction in less than one minute. This efficient biofilm destruction is due to the ultra-fast velocity as well as the head size of Aqua Sperm micromotors being similar to bacteria, which facilitates their entry to and navigation within the biofilm matrix. In addition, the authors demonstrate the real-world application of Aqua Sperm micromotors by destroying biofilms that had colonized medical and laboratory tubing. The implemented system extends the biomedical application of Aqua Sperm micromotors to include hybrid robots for fertilization or cargo tasks.

Propelling and perturbing appendages together facilitate strenuous ground self-righting.

Terrestrial animals must self-right when overturned on the ground, but this locomotor task is strenuous. To do so, the discoid cockroach often pushes its wings against the ground to begin a somersault which rarely succeeds. As it repeatedly attempts this, the animal probabilistically rolls to the side to self-right. During winged self-righting, the animal flails its legs vigorously. Here, we studied whether wing opening and leg flailing together facilitate strenuous ground self-righting. Adding mass to increase hind leg flailing kinetic energy increased the animal's self-righting probability. We then developed a robot with similar strenuous self-righting behavior and used it as a physical model for systematic experiments. The robot's self-righting probability increased with wing opening and leg flailing amplitudes. A potential energy landscape model revealed that, although wing opening did not generate sufficient kinetic energy to overcome the high pitch potential energy barrier to somersault, it reduced the barrier for rolling, facilitating the small kinetic energy from leg flailing to probabilistically overcome it to self-right. The model also revealed that the stereotyped body motion during self-righting emerged from physical interaction of the body and appendages with the ground. Our work demonstrated the usefulness of potential energy landscape for modeling self-righting transitions.

Semi-Automated Determination of Heavy Metals in Autopsy Tissue Using Robot-Assisted Sample Preparation and ICP-MS.

The endoprosthetic care of hip and knee joints introduces multiple materials into the human body. Metal containing implant surfaces release degradation products such as particulate wear and corrosion debris, metal-protein complexes, free metallic ions, inorganic metal salts or oxides. Depending on the material composition of the prostheses, a systemic exposure occurs and may result in increasing metal concentrations in body fluids and tissues especially in the case of malfunctions of the arthroplasty components. High concentrations of Cr, Co, Ni, Ti and Al affect multiple organs such as thyroid, heart, lung and cranial nerves and may lead to metallosis, intoxications, poly-neuropathy, retinopathy, cardiomyopathy and the formation of localized pseudo tumors. The determination of the concentration of metals in body fluids and tissues can be used for predicting failure of hip or knee replacements to prevent subsequent severe intoxications. A semi-automated robot-assisted measurement system is presented for the determination of heavy metals in human tissue samples using inductively coupled plasma mass spectrometry (ICP-MS). The manual and automated measurement processes were similarly validated using certified reference material and the results are compared and discussed. The automation system was successfully applied in the determination of heavy metals in human tissue; the first results are presented.