A Human-Scale Clinically-Ready Electromagnetic Navigation System for Magnetically-Responsive Biomaterials and Medical Devices.

Magnetic navigation systems are used to precisely manipulate magnetically responsive materials enabling the realization of new minimally invasive procedures using magnetic medical devices. Their widespread applicability has been constrained by high infrastructure demands and costs. we report on a portable electromagnetic navigation system, the Navion, which is capable of generating a large magnetic field over a large workspace. The system is easy to install in hospital operating rooms and transportable through healthcare facilities, aiding in the widespread adoption of magnetically responsive medical devices. First, we introduce our design and implementation approach for the system and characterize its performance. Next, we demonstrate in vitro navigation of different microrobot structures using magnetic field gradients and rotating magnetic fields. Spherical permanent magnets, electroplated cylindrical microrobots, microparticle swarms, and magnetic composite bacteria-inspired helical structures are investigated. we also demonstrate the navigation of magnetic catheters in two challenging endovascular tasks: (1) an angiography procedure and (2) deep navigation within the circle of Willis. Catheter navigation is demonstrated in a porcine model in vivo to perform an angiography under magnetic guidance. This article is protected by copyright. All rights reserved.

Autonomous Magnetic Navigation in Endoscopic Image Mosaics.

Endoscopes navigate within the human body to observe anatomical structures with minimal invasiveness. A major shortcoming of their use is their narrow field-of-view during navigation in large, hollow anatomical regions. Mosaics of endoscopic images can provide surgeons with a map of the tool's environment. This would facilitate procedures, improve their efficiency, and potentially generate better patient outcomes. The emergence of magnetically steered endoscopes opens the way to safer procedures and creates an opportunity to provide robotic assistance both in the generation of the mosaic map and in navigation within this map. This paper proposes methods to autonomously navigate magnetic endoscopes to 1) generate endoscopic image mosaics and 2) use these mosaics as user interfaces to navigate throughout the explored area. These are the first strategies, which allow autonomous magnetic navigation in large, hollow organs during minimally invasive surgeries. The feasibility of these methods is demonstrated experimentally both in vitro and ex vivo in the context of the treatment of twin-to-twin transfusion syndrome. This minimally invasive procedure is performed in utero and necessitates coagulating shared vessels of twin fetuses on the placenta. A mosaic of the vasculature in combination with autonomous navigation has the potential to significantly facilitate this challenging surgery.

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.

Self-folding soft-robotic chains with reconfigurable shapes and functionalities.

Magnetic continuum soft robots can actively steer their tip under an external magnetic field, enabling them to effectively navigate in complex in vivo environments and perform minimally invasive interventions. However, the geometries and functionalities of these robotic tools are limited by the inner diameter of the supporting catheter as well as the natural orifices and access ports of the human body. Here, we present a class of magnetic soft-robotic chains (MaSoChains) that can self-fold into large assemblies with stable configurations using a combination of elastic and magnetic energies. By pushing and pulling the MaSoChain relative to its catheter sheath, repeated assembly and disassembly with programmable shapes and functions are achieved. MaSoChains are compatible with state-of-the-art magnetic navigation technologies and provide many desirable features and functions that are difficult to realize through existing surgical tools. This strategy can be further customized and implemented for a wide spectrum of tools for minimally invasive interventions.

A Submillimeter Continuous Variable Stiffness Catheter for Compliance Control.

Minimally invasive robotic surgery often requires functional tools that can change their compliance to adapt to the environment and surgical needs. This paper proposes a submillimeter continuous variable stiffness catheter equipped with a phase-change alloy that has a high stiffness variation in its different states, allowing for rapid compliance control. Variable stiffness is achieved through a variable phase boundary in the alloy due to a controlled radial temperature gradient. This catheter can be safely navigated in its soft state and rigidified to the required stiffness during operation to apply a desired force at the tip. The maximal contact force that the catheter applies to tissue can be continuously modified by a factor of 400 (≈20 mN-8 N). The catheter is equipped with a magnet and a micro-gripper to perform a fully robotic ophthalmic minimally invasive surgery on an eye phantom by means of an electromagnetic navigation system.

A Magnetically Navigated Microcannula for Subretinal Injections.

Retinal disorders, including age-related macular degeneration, are leading causes of vision loss worldwide. New treatments, such as gene therapies and stem cell regeneration, require therapeutics to be introduced to the subretinal space due to poor diffusion to the active component of the retina. Subretinal injections are a difficult and risky surgical procedure and have been suggested as a candidate for robot-assisted surgery. We propose a different actuation paradigm to existing robotic approaches using remote magnetic navigation to control a flexible microcannula. A flexible cannula allows for high dexterity and considerable safety advantages over rigid tools, while maintaining the benefits of micrometer precision, hand tremor removal, and telemanipulation. The position of the cannula is tracked in real-time using near-infrared tip illumination, allowing for semi-automatic placement of the cannula and an intuitive user interface. Using this tool, we successfully performed several subretinal injections in ex-vivo porcine eyes under both microscope and optical coherence tomography visualization.

Magnetic cilia carpets with programmable metachronal waves.

Metachronal waves commonly exist in natural cilia carpets. These emergent phenomena, which originate from phase differences between neighbouring self-beating cilia, are essential for biological transport processes including locomotion, liquid pumping, feeding, and cell delivery. However, studies of such complex active systems are limited, particularly from the experimental side. Here we report magnetically actuated, soft, artificial cilia carpets. By stretching and folding onto curved templates, programmable magnetization patterns can be encoded into artificial cilia carpets, which exhibit metachronal waves in dynamic magnetic fields. We have tested both the transport capabilities in a fluid environment and the locomotion capabilities on a solid surface. This robotic system provides a highly customizable experimental platform that not only assists in understanding fundamental rules of natural cilia carpets, but also paves a path to cilia-inspired soft robots for future biomedical applications.

Magnetically Active Cardiac Patches as an Untethered, Non-Blood Contacting Ventricular Assist Device.

Patients suffering from heart failure often require circulatory support using ventricular assist devices (VADs). However, most existing VADs provide nonpulsatile flow, involve direct contact between the blood flow and the device's lumen and moving components, and require a driveline to connect to an external power source. These design features often lead to complications such as gastrointestinal bleeding, device thrombosis, and driveline infections. Here, a concept of magnetically active cardiac patches (MACPs) that can potentially function as non-blood contacting, untethered pulsatile VADs inside a magnetic actuationsystem is reported. The MACPs, which are composed of permanent magnets and 3D-printed patches, are attached to the epicardial surfaces, thus avoiding direct contact with the blood flow. They provide powerful actuation assisting native heart pumping inside a magnetic actuation system. In ex vivo experiments on a healthy pig's heart, it is shown that the ventricular ejection fractions are as high as 37% in the left ventricle and 63% in the right ventricle. Non-blood contacting, untethered VADs can eliminate the risk of serious complications associated with existing devices, and provide an alternative solution for myocardial training and therapy for patients with heart failure.

3D path planning for flexible needle steering in neurosurgery.

BACKGROUND: We propose a 3D path planning method to steer flexible needles along curved paths in the context of deep brain stimulation (DBS) procedures. METHODS: Our approach is based on a rapidly exploring random tree strategy, and it takes into account constraints coming from anatomical obstacles and physical constraints dictated by flexible needle kinematics. The strategy is evaluated in simulation on a realistic 3D CAD model of the brain. RESULTS: The subthalamic nucleus (STN) and the fornix can be reached along several curved paths from various entry points. As compared with the usual straight line path, these curved paths avoid tissue damage to important neural structures while allowing for a much greater selection of entry points. CONCLUSIONS: This path planning method offers alternative curved paths to reach DBS targets with flexible needles. The method potentially leads to safer paths and additional entry points capable of reaching the desired stimulation targets.

Magnetic quadrupole assemblies with arbitrary shapes and magnetizations.

Magnetic dipole-dipole interactions govern the behavior of magnetic matter across scales from micrometer colloidal particles to centimeter magnetic soft robots. This pairwise long-range interaction creates rich emergent phenomena under both static and dynamic magnetic fields. However, magnetic dipole particles, from either ferromagnetic or paramagnetic materials, tend to form chain-like structures as low-energy configurations due to dipole symmetry. The repulsion force between two magnetic dipoles raises challenges for creating stable magnetic assemblies with complex two-dimensional (2D) shapes. In this work, we propose a magnetic quadrupole module that is able to form stable and frustration-free magnetic assemblies with arbitrary 2D shapes. The quadrupole structure changes the magnetic particle-particle interaction in terms of both symmetry and strength. Each module has a tunable dipole moment that allows the magnetization of overall assemblies to be programmed at the single module level. We provide a simple combinatorial design method to reach both arbitrary shapes and arbitrary magnetizations concurrently. Last, by combining modules with soft segments, we demonstrate programmable actuation of magnetic metamaterials that could be used in applications for soft robots and electromagnetic metasurfaces.

Interventional MR elastography for MRI-guided percutaneous procedures.

PURPOSE: MRI-guided thermal ablations require reliable monitoring methods to ensure complete destruction of the diseased tissue while avoiding damage to the surrounding healthy tissue. Based on the fact that thermal ablations result in substantial changes in biomechanical properties, interventional MR elastography (MRE) dedicated to the monitoring of MR-guided thermal therapies is proposed here. METHODS: Interventional MRE consists of a needle MRE driver, a fast and interactive gradient echo pulse sequence with motion encoding, and an inverse problem solver in real-time. This complete protocol was tested in vivo on swine and the ability to monitor elasticity changes in real-time was assessed in phantom. RESULTS: Thanks to a short repetition time, a reduction of the number of phase-offsets and the use of a sliding window, one refreshed elastogram was provided every 2.56 s for an excitation frequency of 100 Hz. In vivo elastograms of swine liver were successfully provided in real-time during one breath-hold. Changes of elasticity were successfully monitored in a phantom during its gelation with the same elastogram frame rate. CONCLUSION: This study demonstrates the ability of detecting elasticity changes in real-time and providing elastograms in vivo with interventional MRE that could be used for the monitoring of thermal ablations.