Collaborative Control Method and Experimental Research on Robot-Assisted Craniomaxillofacial Osteotomy Based on the Force Feedback and Optical Navigation.

OBJECTIVE: Surgical robot has advantages in high accuracy and stability. But during the robot-assisted bone surgery, the lack of force information from surgical area and incapability of intervention from surgeons become the obstacle. The aim of the study is to introduce a collaborative control method based on the force feedback and optical navigation, which may optimally combine the excellent performance of surgical robot with clinical experiences of surgeons. MATERIALS AND METHODS: The CMF ROBOT system was integrated with the force feedback system to ensure the collaborative control. Force-velocity control algorithm based on force feedback was designed for this control method. In the preliminary experimental test, under the collaborative control mode based on force feedback and optical navigation, the craniomaxillofacial surgical robot entered the osteotomy line area according to the preoperative surgical plan, namely, right maxillary Le Fort I osteotomy, left maxillary Le Fort I osteotomy, and genioplasty. RESULTS: The force sensor was able to collect and record the resistance data of the cutting process of the robot-assisted craniomaxillofacial osteotomy assisted in real time. The statistical results showed that the repeatability of collaborative control mode was acceptable in bilateral maxillary Le Fort I osteotomies (right, P =0.124>0.05 and left, P =0.183>0.05) and unfavorable in genioplasty ( P =0.048<0.05). CONCLUSION: The feasibility of robot-assisted craniomaxillofacial osteotomy under the collaborative control method based on the force feedback and optical navigation was proved in some extent. The outcome of this research may improve the flexibility and safety of surgical robot to meet the demand of craniomaxillofacial osteotomy.

Error Analysis of Robot-Assisted Orthognathic Surgery.

OBJECTIVE: Orthognathic surgery is an effective method to correct the dentomaxillofacial deformities. The aim of the study is to introduce the robot-assisted orthognathic surgery and demonstrate the accuracy and feasibility of robot-assisted osteotomy in transferring the preoperative virtual surgical planning (VSP) into the intraoperative phase. METHODS: The CMF robot system, a craniomaxillofacial surgical robot system was developed, consisted of a robotic arm with 6 degrees of freedom, a self-developed end-effector, and an optical localizer. The individualized end-effector was installed with reciprocating saw so that it could perform osteotomy. The study included control and experimental groups. In control group, under the guidance of navigation system, surgeon performed the osteotomies on 3 skull models. In experimental group, according to the preoperative VSP, the robot completed the osteotomies on 3 skull models automatically with assistance of navigation. Statistical analysis was carried out to evaluate the accuracy and feasibility of robot-assisted orthognathic surgery and compare the errors between robot-assisted automatic osteotomy and navigation-assisted manual osteotomy. RESULTS: All the osteotomies were successfully completed. The overall osteotomy error was 1.07 ±â€Š0.19 mm in the control group, and 1.12 ±â€Š0.20 mm in the experimental group. No significant difference in osteotomy errors was found in the robot-assisted osteotomy groups (P = 0.353). There was consistence of errors between robot-assisted automatic osteotomy and navigation-assisted manual osteotomy. CONCLUSION: In robot-assisted orthognathic surgery, the robot can complete an osteotomy according to the preoperative VSP and transfer a preoperative VSP into the actual surgical operation with good accuracy and feasibility.

Robotic system for accurate percutaneous puncture guided by 3D-2D ultrasound.

PURPOSE: Ultrasound (US)-guided robotic systems can reduce the reliance on the experience and skills of surgeons and enable automatic and accurate percutaneous puncture. Two-dimensional (2D) and three-dimensional (3D) US guidance have various advantages and disadvantages. The planned puncture path in the US data directly affects the puncture quality and tissue injury risk. It is difficult to define the optimal path in 2D US images and achieve accurate and safe puncture under the guidance of 3D US volume. This study aims to propose a robotic system guided by 3D-2D US to realize accurate and safe percutaneous puncture. METHODS: We proposed a 3D-2D US-guided percutaneous puncture robotic system by integrating a 3D US scanning robotic system and a 2D US-guided puncture robotic system. The optimal spatial puncture path that targets the lesion and avoids other important tissues was determined in the 3D US volume reconstructed through robotic US scanning. Thereafter, the puncture robot was placed at the puncture site determined according to the planned path. The optimal path was mapped to the 2D US image taken at the puncture site. Finally, the 2D US image and puncture path were used to guide the robot in performing an accurate and safe percutaneous puncture. RESULTS: The proposed robotic system based on the guidance of 3D-2D US exhibits the advantages of both 3D US and 2D US to improve the accuracy of percutaneous puncture and reduce the risk of tissue injury. The experimental results of phantom puncture demonstrate that the mean puncture accuracy of the system is 1.09 ± 0.35 mm, and the puncture success rate with single needle insertion is 100%. CONCLUSION: A percutaneous puncture robotic system based on 3D-2D US guidance was proposed and tested successfully. The experimental results demonstrate the feasibility of the proposed system for achieving accurate and safe robotic percutaneous puncture.

Automatic and accurate needle detection in 2D ultrasound during robot-assisted needle insertion process.

PURPOSE: Robot-assisted needle insertion guided by 2D ultrasound (US) can effectively improve the accuracy and success rate of clinical puncture. To this end, automatic and accurate needle-tracking methods are important for monitoring puncture processes, avoiding the needle deviating from the intended path, and reducing the risk of injury to surrounding tissues. This work aims to develop a framework for automatic and accurate detection of an inserted needle in 2D US image during the insertion process. METHODS: We propose a novel convolutional neural network architecture comprising of a two-channel encoder and single-channel decoder for needle segmentation using needle motion information extracted from two adjacent US image frames. Based on the novel network, we further propose an automatic needle detection framework. According to the prediction result of the previous frame, a region of interest of the needle in the US image was extracted and fed into the proposed network to achieve finer and faster continuous needle localization. RESULTS: The performance of our method was evaluated based on 1000 pairs of US images extracted from robot-assisted needle insertions on freshly excised bovine and porcine tissues. The needle segmentation network achieved 99.7% accuracy, 86.2% precision, 89.1% recall, and an F1-score of 0.87. The needle detection framework successfully localized the needle with a mean tip error of 0.45 ± 0.33 mm and a mean orientation error of 0.42° ± 0.34° and achieved a total processing time of 50 ms per image. CONCLUSION: The proposed framework demonstrated the capability to realize robust, accurate, and real-time needle localization during robot-assisted needle insertion processes. It has a promising application in tracking the needle and ensuring the safety of robotic-assisted automatic puncture during challenging US-guided minimally invasive procedures.

Automatic ultrasound scanning robotic system with optical waveguide-based force measurement.

PURPOSE: The three-dimensional (3D) ultrasound (US) imaging realized by continuous scanning of a region is of great value for medical diagnosis and robot-assisted needle insertion. During scanning, the contact force and posture between the probe and skin of the patient are crucial factors that determine the quality of US imaging. We propose a robotic system for automatic scanning of curved surfaces with a stable contact force and vertical contact posture (the probe is parallel to the normal of the surface at the contact point). METHODS: A 6-DOF robotic arm is used to hold and drive a two-dimensional (2D) US probe to complete automatic scanning. Further, a path-planning strategy is proposed to generate the scan path covering the selected area automatically. We also developed a novel force-measuring device based on optical waveguides to measure the distributed contact force and contact posture. Based on the measured force and posture, the robotic arm automatically adjusts the position and orientation of the probe and maintains a stable contact force and vertical contact posture at each scan point. RESULTS: The novel force-measuring device is easy to fabricate, integrates with the probe and has the capacity of measuring the force distributed on the contact surface and estimating the contact posture. The experimental results of automatic scanning of a US phantom and parts of the human body demonstrate that the proposed system performs well in automatically scanning curved surfaces, maintaining a stable contact force and vertical contact posture and producing a good quality 3D US volume. CONCLUSION: An automatic US scanning robotic system with an optical waveguide-based force-measuring device was developed and tested successfully. Experimental results demonstrated the feasibility of the proposed system to scan the human body.

Circ_0000003 regulates glutamine metabolism and tumor progression of tongue squamous cell carcinoma via the miR­330­3p/GLS axis.

Various circular RNAs (circRNAs) have been shown to exert vital functions in tongue squamous cell carcinoma (TSCC). However, their roles in TSCC progression remain to be elucidated. This research aimed to investigate the role and mechanism of hsa_circ_0000003 (circ_0000003) in TSCC progression. Here, we found that circ_0000003 expression was upregulated in TSCC tissues and cell lines, and high circ_0000003 expression was correlated with advanced TNM stage, increased tumor size and poor patient survival. Circ_0000003 was revealed to facilitate cell proliferation, migration and invasion of TSCC cells. Mechanistically, we found that circ_0000003 acted as a competing endogenous RNA (ceRNA) that sponged miR­330­3p, thereby elevating glutaminase (GLS) expression. Accordingly, cell invasion, migration, glutamine consumption, α­ketoglutarate (α­KG) production and ATP production were significantly decreased by circ_0000003 knockdown in TSCC cells, and these effects were reversed by miR­330­3p inhibition. In conclusion, circ_0000003 facilitates TSCC cell proliferation, migration, invasion and glutamine catabolism by regulating the miR­330­3p/GLS pathway.

Ultrasound-guided needle insertion robotic system for percutaneous puncture.

PURPOSE: Ultrasound (US)-guided percutaneous puncture technology can realize real-time, minimally invasive interventional therapy without radiation. The location accuracy of the puncture needle directly determines the precision and safety of the operation. It is a challenge for novices and young surgeons to perform a free-hand puncture guided by the ultrasound images to achieve the desired accuracy. This work aims to develop a robotic system to assist surgeons to perform percutaneous punctures with high precision. METHODS: An US-guided puncture robot was designed to allow the mounting and control of the needle to achieve localization and insertion. The US probe fitted within the puncture robot was held by a passive arm. Moreover, the puncture robot was calibrated with a novel calibration method to achieve coordinate transformation between the robot and the US image. The system allowed the operators to plan the puncture target and puncture path on US images, and the robot performed needle insertion automatically. Five groups of puncture experiments were performed to verify the validity and accuracy of the proposed robotic system. RESULTS: Assisted by the robotic system, the positioning and orientation accuracies of the needle insertion were 0.9 ± 0.29 mm and 0.76 ± 0.34°, respectively. These are improved compared with the results obtained with the free-hand puncture (1.82 ± 0.51 mm and 2.79 ± 1.32°, respectively). Moreover, the proposed robotic system can reduce the operation time and number of needle insertions (14.28 ± 3.21 s and one needle insertion, respectively), compared with the free-hand puncture (25.14 ± 6.09 s and 1.96 ± 0.68 needle insertions, respectively). CONCLUSION: A robotic system for percutaneous puncture guided by US images was developed and demonstrated. The experimental results indicate that the proposed system is accurate and feasible. It can assist novices and young surgeons to perform the puncture operation with increased accuracy.