Tissue palpation in endoscopy using EIT and soft actuators.

The integration of soft robots in medical procedures has significantly improved diagnostic and therapeutic interventions, addressing safety concerns and enhancing surgeon dexterity. In conjunction with artificial intelligence, these soft robots hold the potential to expedite autonomous interventions, such as tissue palpation for cancer detection. While cameras are prevalent in surgical instruments, situations with obscured views necessitate palpation. This proof-of-concept study investigates the effectiveness of using a soft robot integrated with Electrical Impedance Tomography (EIT) capabilities for tissue palpation in simulated in vivo inspection of the large intestine. The approach involves classifying tissue samples of varying thickness into healthy and cancerous tissues using the shape changes induced on a hydraulically-driven soft continuum robot during palpation. Shape changes of the robot are mapped using EIT, providing arrays of impedance measurements. Following the fabrication of an in-plane bending soft manipulator, the preliminary tissue phantom design is detailed. The phantom, representing the descending colon wall, considers induced stiffness by surrounding tissues based on a mass-spring model. The shape changes of the manipulator, resulting from interactions with tissues of different stiffness, are measured, and EIT measurements are fed into a Long Short-Term Memory (LSTM) classifier. Train and test datasets are collected as temporal sequences of data from a single training phantom and two test phantoms, namely, A and B, possessing distinctive thickness patterns. The collected dataset from phantom B, which differs in stiffness distribution, remains unseen to the network, thus posing challenges to the classifier. The classifier and proposed method achieve an accuracy of 93 % and 88.1 % on phantom A and B, respectively. Classification results are presented through confusion matrices and heat maps, visualising the accuracy of the algorithm and corresponding classified tissues.

Programmable Chemical Reactions Enable Ultrastrong Soft Pneumatic Actuation.

Soft pneumatic actuation is widely used in wearable devices, soft robots, artificial muscles, and surgery machines. However, generating high-pressure gases in a soft, controllable, and portable way remains a substantial challenge. Here, a class of programmable chemical reactions that can be used to controllably generate gases with a maximum pressure output of nearly 6 MPa is reported. It is proposed to realize the programmability of the chemical reaction process using thermoelectric material with programmable electric current and employing preprogrammed reversible chemical reactants. The programmable chemical reactions as soft pneumatic actuation can be operated independently as miniature gas sources (∼20-100 g) or combined with arbitrary physical structures to make self-contained machines, capable of generating unprecedented pressures of nearly 6 MPa or forces of about 18 kN in a controllable, portable, and silent manner. Striking demonstrations of breaking a brick, a marble, and concrete blocks, raising a sightseeing car, and successful applications in artificial muscles and soft assistive wearables illustrate tremendous application prospects of soft pneumatic actuation via programmable chemical reactions. The study establishes a new paradigm toward ultrastrong soft pneumatic actuation.

Seahorse-Tail-Inspired Soft Pneumatic Actuator: Development and Experimental Characterization.

The study of bio-inspired structures and their reproduction has always fascinated humans. The advent of soft robotics, thanks to soft materials, has enabled considerable progress in this field. Over the years, polyps, worms, cockroaches, jellyfish, and multiple anthropomorphic structures such as hands or limbs have been reproduced. These structures have often been used for gripping and handling delicate objects or those with complex unknown a priori shapes. Several studies have also been conducted on grippers inspired by the seahorse tail. In this paper, a novel biomimetic soft pneumatic actuator inspired by the tail of the seahorse Hippocampus reidi is presented. The actuator has been developed to make a leg to sustain a multi-legged robot. The prototyping of the actuator was possible by combining a 3D-printed reinforcement in thermoplastic polyurethane, mimicking the skeletal apparatus, within a silicone rubber structure, replicating the functions of the external epithelial tissue. The latter has an internal channel for pneumatic actuation that acts as the inner muscle. The study on the anatomy and kinematic behaviour of the seahorse tail suggested the mechanical design of the actuator. Through a test campaign, the actuator prototype was characterized by isotonic tests with an external null load, isometric tests, and activation/deactivation times. Specifically, the full actuator distension of 154.5 mm occurs at 1.8 bar, exerting a maximum force of 11.9 N, with an activation and deactivation time of 74.9 and 94.5 ms, respectively.

Journey from human hands to robot hands: biological inspiration of anthropomorphic robotic manipulators.

The development of robotic hands that can replicate the complex movements and dexterity of the human hand has been a longstanding challenge for scientists and engineers. A human hand is capable of not only delicate operation but also crushing with power. For performing tasks alongside and in place of humans, an anthropomorphic manipulator design is considered the most advanced implementation, because it is able to follow humans' examples and use tools designed for people. In this article, we explore the journey from human hands to robot hands, tracing the historical advancements and current state-of-the-art in hand manipulator development. We begin by investigating the anatomy and function of the human hand, highlighting the bone-tendon-muscle structure, skin properties, and motion mechanisms. We then delve into the field of robotic hand development, focusing on highly anthropomorphic designs. Finally, we identify the requirements and directions for achieving the next level of robotic hand technology.

Fast-Response Variable-Stiffness Magnetic Catheters for Minimally Invasive Surgery.

In minimally invasive surgery, such as cardiac ablation, magnetically steered catheters made of variable-stiffness materials can enable higher dexterity and higher force application to human tissue. However, the long transition time between soft and rigid states leads to a significant increase in procedure duration. Here, a fast-response, multisegmented catheter is described for minimally invasive surgery made of variable-stiffness thread (FRVST) that encapsulates a helical cooling channel. The rapid stiffness change in the FRVST, composed of a nontoxic shape memory polymer, is achieved by an active cooling system that pumps water through the helical channel. The FRVST displays a 66 times stiffness change and a 26 times transition enhancement compare with the noncooled version. The catheter allows for selective bending of each segment up to 127° in air and up to 76° in water under an 80 mT external magnetic field. The inner working channel can be used for cooling an ablation tip during a procedure and for information exchange via the deployment of wires or surgical tools.

Latent Representation-Based Learning Controller for Pneumatic and Hydraulic Dual Actuation of Pressure-Driven Soft Actuators.

The pneumatic and hydraulic dual actuation of pressure-driven soft actuators (PSAs) is promising because of their potential to develop novel practical soft robots and expand the range of soft robot applications. However, the physical characteristics of air and water are largely different, which makes it challenging to quickly adapt to a selected actuation method and achieve method-independent accurate control performance. Herein, we propose a novel LAtent Representation-based Feedforward Neural Network (LAR-FNN) for dual actuation. The LAR-FNN consists of an autoencoder (AE) and a feedforward neural network (FNN). The AE generates a latent representation of a PSA from a 30-s stairstep response. Subsequently, the FNN provides an individual inverse model of the target PSA and calculates feedforward control input by using the latent representation. The experimental results with PSAs demonstrate that the LAR-FNN can meet the requirements of dual actuation control (i.e., accurate control performance regardless of the actuation method with a short adaptation time) with a single neural network. The results suggest that a LAR-FNN can contribute to soft dual-actuation robot development and the field of soft robotics.

Interactive Multi-Stage Robotic Positioner for Intra-Operative MRI-Guided Stereotactic Neurosurgery.

Magnetic resonance imaging (MRI) demonstrates clear advantages over other imaging modalities in neurosurgery with its ability to delineate critical neurovascular structures and cancerous tissue in high-resolution 3D anatomical roadmaps. However, its application has been limited to interventions performed based on static pre/post-operative imaging, where errors accrue from stereotactic frame setup, image registration, and brain shift. To leverage the powerful intra-operative functions of MRI, e.g., instrument tracking, monitoring of physiological changes and tissue temperature in MRI-guided bilateral stereotactic neurosurgery, a multi-stage robotic positioner is proposed. The system positions cannula/needle instruments using a lightweight (203 g) and compact (Ø97 × 81 mm) skull-mounted structure that fits within most standard imaging head coils. With optimized design in soft robotics, the system operates in two stages: i) manual coarse adjustment performed interactively by the surgeon (workspace of ±30°), ii) automatic fine adjustment with precise (<0.2° orientation error), responsive (1.4 Hz bandwidth), and high-resolution (0.058°) soft robotic positioning. Orientation locking provides sufficient transmission stiffness (4.07 N/mm) for instrument advancement. The system's clinical workflow and accuracy is validated with lab-based (<0.8 mm) and MRI-based testing on skull phantoms (<1.7 mm) and a cadaver subject (<2.2 mm). Custom-made wireless omni-directional tracking markers facilitated robot registration under MRI.

A Millimeter-Scale Soft Robot for Tissue Biopsy Procedures.

While interest in soft robotics as surgical tools has grown due to their inherently safe interactions with the body, their feasibility is limited in the amount of force that can be transmitted during procedures. This is especially apparent in minimally invasive procedures where millimeter-scale devices are necessary for reaching the desired surgical site, such as in interventional bronchoscopy. To leverage the benefits of soft robotics in minimally invasive surgery, a soft robot with integrated tip steering, stabilization, and needle deployment capabilities is proposed for lung tissue biopsy procedures. Design, fabrication, and modeling of the force transmission of this soft robotic platform allows for integration into a system with a diameter of 3.5 mm. Characterizations of the soft robot are performed to analyze bending angle, force transmission, and expansion during needle deployment. In-vitro experiments of both the needle deployment mechanism and fully integrated soft robot validate the proposed workflow and capabilities in a simulated surgical setting.

Transparent Pneumatic Tactile Sensors for Soft Biomedical Robotics.

Palpation is a simple but effective method to distinguish tumors from healthy tissues. The development of miniaturized tactile sensors embedded on endoscopic or robotic devices is key to achieving precise palpation diagnosis and subsequent timely treatment. This paper reports on the fabrication and characterization of a novel tactile sensor with mechanical flexibility and optical transparency that can be easily mounted on soft surgical endoscopes and robotics. By utilizing the pneumatic sensing mechanism, the sensor offers a high sensitivity of 1.25 mbar and negligible hysteresis, enabling the detection of phantom tissues with different stiffnesses ranging from 0 to 2.5 MPa. Our configuration, combining pneumatic sensing and hydraulic actuating, also eliminates electrical wiring from the functional elements located at the robot end-effector, thereby enhancing the system safety. The optical transparency path in the sensors together with its mechanical sensing capability open interesting possibilities in the early detection of solid tumor as well as in the development of all-in-one soft surgical robots that can perform visual/mechanical feedback and optical therapy.

A bio-inspired expandable soft suction gripper for minimal invasive surgery-an explorative design study.

Gripping slippery and flexible tissues during minimal invasive surgery (MIS) is often challenging using a conventional tissue gripper. A force grip has to compensate for the low friction coefficient between the gripper's jaws and the tissue surface. This study focuses on the development of a suction gripper. This device applies a pressure difference to grip the target tissue without the need to enclose it. Inspiration is taken from biological suction discs, as these are able to attach to a wide variety of substrates, varying from soft and slimy surfaces to rigid and rough rocks. Our bio-inspired suction gripper is divided into two main parts: (1) the suction chamber inside the handle where vacuum pressure is generated, and (2) the suction tip that attaches to the target tissue. The suction gripper fits through a∅10 mm trocar and unfolds in a larger suction surface when being extracted. The suction tip is structured in a layered manner. The tip integrates five functions in separate layers to allow for safe and effective tissue handling: (1) foldability, (2) air-tightness, (3) slideability, (4) friction magnification and (5) seal generation. The contact surface of the tip creates an air-tight seal with the tissue and enhances frictional support. The suction tip's shape grip allows for the gripping of small tissue pieces and enhances its resistance against shear forces. The experiments illustrated that our suction gripper outperforms man-made suction discs, as well as currently described suction grippers in literature in terms of attachment force (5.95±0.52 N on muscle tissue) and substrate versatility. Our bio-inspired suction gripper offers the opportunity for a safer alternative to the conventional tissue gripper in MIS.

Advanced Soft Robotic System for In Situ 3D Bioprinting and Endoscopic Surgery.

Three-dimensional (3D) bioprinting technology offers great potential in the treatment of tissue and organ damage. Conventional approaches generally rely on a large form factor desktop bioprinter to create in vitro 3D living constructs before introducing them into the patient's body, which poses several drawbacks such as surface mismatches, structure damage, and high contamination along with tissue injury due to transport and large open-field surgery. In situ bioprinting inside a living body is a potentially transformational solution as the body serves as an excellent bioreactor. This work introduces a multifunctional and flexible in situ 3D bioprinter (F3DB), which features a high degree of freedom soft printing head integrated into a flexible robotic arm to deliver multilayered biomaterials to internal organs/tissues. The device has a master-slave architecture and is operated by a kinematic inversion model and learning-based controllers. The 3D printing capabilities with different patterns, surfaces, and on a colon phantom are also tested with different composite hydrogels and biomaterials. The F3DB capability to perform endoscopic surgery is further demonstrated with fresh porcine tissue. The new system is expected to bridge a gap in the field of in situ bioprinting and support the future development of advanced endoscopic surgical robots.

A Review of Robotic Thoracic Surgery Adoption and Future Innovations.

The embracing of new technology and surgical innovation has been one of the hallmarks of cardiothoracic surgery. The adoption of video-assisted thoracoscopic surgery was the paradigm-changing perspective shift that has enabled an entire culture of minimally invasive cardiothoracic surgery. From this foundation robotically assisted thoracic surgery has developed into mainstream practice. The aim of this review is to recount the technological and academic milestones of the past as well as describe future technological innovations that will shape the future of thoracic robotic surgery.

Thermomagnetic-Responsive Self-Folding Microgrippers for Improving Minimally Invasive Surgical Techniques and Biopsies.

Traditional open surgery complications are typically due to trauma caused by accessing the procedural site rather than the procedure itself. Minimally invasive surgery allows for fewer complications as microdevices operate through small incisions or natural orifices. However, current minimally invasive tools typically have restricted maneuverability, accessibility, and positional control of microdevices. Thermomagnetic-responsive microgrippers are microscopic multi-fingered devices that respond to temperature changes due to the presence of thermal-responsive polymers. Polymeric devices, made of poly(N-isopropylacrylamide-co-acrylic acid) (pNIPAM-AAc) and polypropylene fumarate (PPF), self-fold due to swelling and contracting of the hydrogel layer. In comparison, soft metallic devices feature a pre-stressed metal bilayer and polymer hinges that soften with increased temperature. Both types of microdevices can self-actuate when exposed to the elevated temperature of a cancerous tumor region, allowing for direct targeting for biopsies. Microgrippers can also be doped to become magnetically responsive, allowing for direction without tethers and the retrieval of microdevices containing excised tissue. The smaller size of stimuli-responsive microgrippers allows for their movement through hard-to-reach areas within the body and the successful extraction of intact cells, RNA and DNA. This review discusses the mechanisms of thermal- and magnetic-responsive microdevices and recent advances in microgripper technology to improve minimally invasive surgical techniques.

Potential of the Coordinated Actions of Multiple Protein-Based Micromachines for Medical Applications.

Untethered mobile micromachines hold great promise in the development of effective and minimally invasive therapies. Although diverse medical micromachines for specific applications have been developed over the past few decades, the coordinated action of multiple machines with different functions remains largely unexplored. In this study, we created three types of biocompatible micromachines using proteins and demonstrated the potential of their coordinated action for medical applications. As a proof of concept, we demonstrated neural replacement therapy, in which neuroblastomas were killed by using an anticancer prodrug and the first machine that contains enzymes, enabling the conversion of the prodrug into a cytotoxic drug. Subsequently, a second machine composed of extracellular matrix was placed on the dead cancer cells to provide a suitable environment for cell adhesion, on which embryonic stem (ES) cells and stromal cells that promote neural differentiation of stem cells were attached by using third machines capable of delivering cells to target positions with desired patterns. As a result, neuroblastomas were replaced with novel healthy neurons derived from ES cells by teaming multiple protein-based machines. We believe that this work highlights the potential of heterogeneous machine groups for medical treatment and the utility of highly biocompatible and functional micromachines made from proteins, representing an important step forward in building more sophisticated micromachine-based therapies.

A Soft Sensor for Bleeding Detection in Colonoscopies.

Colonoscopies allow surgeons to detect common diseases i.e. colorectal cancer, ulcers and other ailments. However, there is a risk of bleeding in the lower gastrointestinal (GI) tract while maneuvering endoscopes. This may be due to perforations, hemorrhaging, polyps, diverticuli or post-biopsy complications. Thus, it is essential for the surgeon to be able to detect bleeding at the site and evaluate the severity of blood leakage. This paper presents a soft sensor that can detect the presence of blood at the bleeding site during colonoscopies. The sensor consists of optical waveguides that interface with a microfluidic channel. Blood flow causes absorption and scattering of incident light that can be picked up by the optical sensing apparatus via light transmission through the waveguide. The surgeon can be alerted when bleeding occurs through a graphical user interface. The device is compact and measures only 1 mm thick. This allows the sensor to be circumferentially mounted onto a colonoscope at different locations. The sensor is able to record the presence of blood as an optical loss, rapidly detect the presence of blood in under 100 milliseconds as it enters the microchannel, and differentiate between gastric fluid and blood through changes in measured optical loss.

Soft Multi-Directional Force Sensor for Underwater Robotic Application.

Tactile information is crucial for recognizing physical interactions, manipulation of an object, and motion planning for a robotic gripper; however, concurrent tactile technologies have certain limitations over directional force sensing. In particular, they are expensive, difficult to fabricate, and mostly unsuitable for underwater use. Here, we present a facile and cost-effective synthesis technique of a flexible multi-directional force sensing system, which is also favorable to be utilized in underwater environments. We made use of four flex sensors within a silicone-made hemispherical shell structure. Each sensor was placed 90° apart and aligned with the curve of the hemispherical shape. If the force is applied on the top of the hemisphere, all the flex sensors would bend uniformly and yield nearly identical readings. When force is applied from a different direction, a set of flex sensors would characterize distinctive output patterns to localize the point of contact as well as the direction and magnitude of the force. The deformation of the fabricated soft sensor due to applied force was simulated numerically and compared with the experimental results. The fabricated sensor was experimentally calibrated and tested for characterization including an underwater demonstration. This study would widen the scope of identification of multi-directional force sensing, especially for underwater soft robotic applications.

Multiresponsive Ti3C2Tx MXene-Based Actuators Enabled by Dual-Mechanism Synergism for Soft Robotics.

Multiresponsive and high-performance flexible actuators with a simple configuration, high mechanical strength, and low-power consumption are highly desirable for soft robotics. Here, a novel mechanically robust and multiresponsive Ti3C2Tx MXene-based actuator with high actuation performance via dual-mechanism synergistic effect driven by the hygroexpansion of bacterial cellulose (BC) layer and the thermal expansion of biaxially oriented polypropylene (BOPP) layer is developed. The actuator is flexible and shows an ultrahigh tensile strength of 195 MPa. Unlike the conventional bimorph-structured actuators based on a single-mechanism, the actuator developed provides a favorable architecture for dual-mechanism synergism, resulting in exceptionally reversible actuation performance under electricity and near-infrared (NIR) light stimuli. Typically, the developed actuator can produce the largest bending angle (∼400°) at the lowest voltage (≤4 V) compared with that reported previously for single mechanism soft actuators. Furthermore, the actuator also can be driven by a NIR light at a 2 m distance, displaying an excellent long-distance photoresponsive property. Finally, various intriguing applications are demonstrated to show the great potential of the actuator for soft robotics.

Switchable Adhesion: On-Demand Bonding and Debonding.

Adhesives have a long and illustrious history throughout human history. The development of synthetic polymers has highly improved adhesions in terms of their strength and environmental tolerance. As soft robotics, flexible electronics, and intelligent gadgets become more prevalent, adhesives with changeable adhesion capabilities will become more necessary. These adhesives should be programmable and switchable, with the ability to respond to light, electromagnetic fields, thermal, and other stimuli. These requirements necessitate novel concepts in adhesion engineering and material science. Considerable studies have been carried out to develop a wide range of adhesives. This review focuses on stimuli-responsive material-based adhesives, outlining current research on switchable and controlled adhesives, including design and manufacturing techniques. Finally, the potential for smart adhesives in applications, and the development of future adhesive forms are critically suggested.

Inflatable Particle-Jammed Robotic Gripper Based on Integration of Positive Pressure and Partial Filling.

In this work, we proposed an inflatable particle-jamming gripper based on a novel grasping strategy of integrating the positive pressure and partial filling, in which the positive pressure increases the contact area between the gripper and objects, and the grain package in a partial-filled state provides significant grasping adaptation for the gripper. First, we design and fabricate the inflatable particle-jamming gripper and clarify its working mechanism. Then three kinds of grippers, including the proposed inflatable gripper, full-filled gripper, and partial-filled gripper, are experimentally compared for the capability of grasping objects of various sizes, and their performances from four metrics (compliance, reliability, grasping robustness, and lifting efficiency) are evaluated as well. Furthermore, a theoretical analysis is carried out for different grasping performances among the three kinds of grippers, in which the inflatable gripper performs a more promising grasping performance. In this article, by inflating the gripper to an ordered extent with positive pressure, the originally full-filled gripper turns into a partial-filled state. Based on the unique grasping strategy of the proposed gripper, it is possible to achieve a brilliant compliance and robust grasps. Even though the object is located 20 mm away from the gripper-center-axis, valid grasps are observed as well. It is concluded that the proposed gripper could potentially have a wide range of applications in the industry and daily activities.

Twisting and Braiding Fluid-Driven Soft Artificial Muscle Fibers for Robotic Applications.

Research on soft artificial muscles (SAMs) is rapidly growing, both in developing new actuation ideas and improving existing structures with multifunctionality. The human body has more than 600 muscles that drive organs and joints to achieve desired functions. Inspired by the human muscles, this article presents a new type of SAM fiber formed from twisting and braiding soft hydraulic filament artificial muscles with high aspect ratio, high strain, and high energy efficiency. We systematically investigated the relationship between input pressure and output elongation as well as contraction force of the new muscles using different configurations in terms of an array of single and multiple muscles arranged in nontwisting (or straight), twisting, and braiding variants. Experimental results revealed that the twisting and braiding configurations greatly enhanced the muscle elongation and generated force compared with their nontwisting/braiding counterparts. To demonstrate the new muscles' usability, we implemented several muscle variants to bidirectionally manipulate 3D-printed human fingers and elbow, mimicking the human upper limb with a full range of motion. We also created a bioinspired growing soft tubular muscle that could simultaneously exert longitudinal and radial expansion upon pressurization, similar to that of auxetic metamaterial structures. The new growing soft tubular muscles were experimentally validated and the results showed that they could be potentially implemented in several emerging applications, including smart compression garments, stent-like supporting devices, and tubular grippers for medical use.