Hybrid Robotic Research Articles

Self‐Sensing Artificial‐Muscle‐Empowered Humanlike Perception, Interaction, and Positioning

Bioinspired soft and hybrid robots provide a promising solution to developing robots that can interact and collaborate with humans safely and effectively. Bellow‐like pneumatic artificial muscles can produce biological muscle‐like contraction with comparable response time and force output, but closed‐loop control has been a challenge without an effective length sensing solution. Herein, a self‐sensing artificial muscle (SSAM), which can sense its own length regardless of the external loadings and driving pressures, is proposed. Empowered by a seamlessly integrated mutual‐inductance‐based length sensor (MILS), the SSAM can sense its length change as small as 0.01 mm (0.012% of the initial liength 80 mm) in a wide range. The working principle of the MILS is analyzed theoretically to provide a design guideline. An SSAM‐based earthworm‐like locomotion robot is developed with the capability of knowing its real‐time body length change at different gaits. An artificial arm driven by one SSAM is also developed and demonstrated with humanlike capabilities of loading perception, interactive and responsive movements, and accurate positioning. This work provides a promising solution to develop muscle‐driven hybrid robotic systems with embodied intelligence for skilled manipulation and sophisticated human–machine interactions.

A fabrication strategy for millimeter-scale, self-sensing soft-rigid hybrid robots.

Soft robots typically involve manual assembly of core hardware components like actuators, sensors, and controllers. This increases fabrication time and reduces consistency, especially in small-scale soft robots. We present a scalable monolithic fabrication method for millimeter-scale soft-rigid hybrid robots, simplifying the integration of core hardware components. Actuation is provided by soft-foldable polytetrafluoroethylene film-based actuators powered by ionic fluid injection. The desired motion is encoded by integrating a mechanical controller, comprised of rigid-flexible materials. The robot's motion can be self-sensed using an ionic resistive sensor by detecting electrical resistance changes across its body. Our approach is demonstrated by fabricating three distinct soft-rigid hybrid robotic modules, each with unique degrees of freedom: translational, bending, and roto-translational motions. These modules connect to form a soft-rigid hybrid continuum robot with real-time shape-sensing capabilities. We showcase the robot's capabilities by performing object pick-and-place, needle steering and tissue puncturing, and optical fiber steering tasks.

A hybrid robotic system for zygomatic implant placement based on mixed reality navigation

BackgroundsZygomatic implant (ZI) placement surgery is a viable surgical option for patients with severe maxillary atrophy and insufficient residual maxillary bone. Still, it is difficult and risky due to the long path of ZI placement and the narrow field of vision. Dynamic navigation is a superior solution, but it presents challenges such as requiring operators to have advanced skills and experience. Moreover, the precision and stability of manual implantation remain inadequate. These issues are anticipated to be addressed by implementing robot-assisted surgery and achieved by introducing a mixed reality (MR) navigation-guided hybrid robotic system for ZI placement surgery. MethodsThis study utilized a hybrid robotic system to perform the ZI placement surgery. Our first step was to reconstruct a virtual 3D model from preoperative cone-beam CT (CBCT) images. We proposed a series of algorithms based on coordinate transformation, which includes image-phantom registration, HoloLens-tracker registration, drill-phantom calibration, and robot-implant calibration, to unify all objects within the same coordinate system. These algorithms enable real-time tracking of the surgical drill's position and orientation relative to the patient phantom. Subsequently, the surgical drill is directed to the entry position, and the planned implantation paths are superimposed on the patient phantom using HoloLens 2 for visualization. Finally, the hybrid robot system performs the processed of drilling, expansion, and placement of ZIs under the guidance of the MR navigation system. ResultsPhantom experiments of ZI placement were conducted using 10 patient phantoms, with a total of 40 ZIs inserted. Out of these, 20 were manually implanted, and the remaining 20 were robotically implanted. Comparisons between the actual implanted ZI paths and the preoperatively planned ZI paths showed that our MR navigation-guided hybrid robotic system achieved a coronal deviation of 0.887 ± 0.213 mm, an apical deviation of 1.201 ± 0.318 mm, and an angular deviation of 3.468 ± 0.339° This demonstrates significantly better accuracy and stability than manual implantation. ConclusionOur proposed hybrid robotic system enables automated ZI placement surgery guided by MR navigation, achieving greater accuracy and stability compared to manual operations in phantom experiments. Furthermore, this system is expected to apply to animal and cadaveric experiments, to get a good ready for clinical studies.

Design and Development of a New Bioinspired Hybrid Robotic Gripper for Multi-Mode Robust Grasping

Design and Development of a New Bioinspired Hybrid Robotic Gripper for Multi-Mode Robust Grasping

Cerebellum-Inspired Model-Free Tracking Control and Visual Servoing of a Rigid-Flexible Hybrid Robotic Endoscope With RCM Constraints

This article designs a model-free control scheme based on a cerebellum-inspired network model for tracking control and visual servoing of a surgical rigid-flexible hybrid robotic endoscope. The hybrid robot is composed of a rigid robot manipulator and a flexible endoscope as the end-effector. Inspired by the cerebellum associated with human motion control, we proposed a cerebellum-inspired model-free control scheme for the visual servoing and tracking control of the robotic endoscope with RCM (remote center of motion) constraints, which does not need to know the kinematic model of the robot. This scheme combines liquid state machines (LSM) and zeroing neural network (ZNN), where the LSM is able to generate control signals and the ZNN is used as the training signal for the LSM. Simulations and physical experiments demonstrate that the proposed cerebellum-inspired control scheme is effective to handle the tracking task under RCM constraints as well as the visual servoing task.

Application of hybrid robotic systems in crop harvesting: Kinematic and dynamic analysis

Harvesting of agricultural crops, especially when the ripe products have to be picked one by one, has always been a major concern of farmers and growers. Consequently, the use of robots and the mechanization of harvesting operations have been considered as the effective means of tackling such challenges. In the present research, the use of hybrid robots (which combine open-loop and closed-loop manipulators) has been proposed for this purpose; because these robots help reduce the size of the workforce and thus slash the harvesting costs, and they also boost the speed and accuracy of harvesting operations. However, using this type of robots without paying attention to some important factors (e.g., using motors of optimal power at the actuated joints of a robot and choosing appropriate lengths for robot links) can have a substantial adverse effect on the manufacturing cost, working space and the effective functioning of such robots. So the main focus of this paper is on the kinematic and dynamic analysis of hybrid robotic systems. The main advantage of this research over similar works is the generality by which it describes the mechanical behavior of these robots; so that by using the recursive algorithms presented in this paper, all kinds of robots in the hybrid class can be analyzed. However, due to the complexity in the analysis of such systems, a hybrid robot consisting of three closed loops and one open loop was considered in this paper as a sample case study, so that we could explain, visually and graphically, all the steps involved in deriving its motion equations. The simulation results for this robotic system demonstrate the efficacy of the proposed method in the kinematic and dynamic analysis of hybrid robots, as efficient and functional crop harvesting equipment.

Model-free dynamic control of robotic joints with integrated elastic ligaments

The combination of elasticity and rigidity found within mammalian limbs enables dexterous manipulation, agile, and versatile behavior, yet most modern robots are either primarily soft or rigid. Hybrid robots, composed of both soft and rigid parts, promote compliance to external forces while maintaining strength and stability provided by rigid robots. Most mammals have ligaments which connect bone to bone, enabling joints to passively redirect forces and softly constrain the range of motion. We present an approach to constructing a new class of hybrid joints through parametric design choices that adjust dynamic properties of the system. The inherent modularity and variability necessitate a model-free controller which can adjust to new contexts in relatively short time. Three joint examples are created along with three tasks to assess quality of the controllers, creating 9 total cases. We show the Soft Actor Critic (SAC) reinforcement learning algorithm outperforms a proportion–integral–derivative (PID) controller in 6/9 cases, yet this changes to 9/9 with a brief re-training period. This work presents a new class of hybrid robotic joints with modifiable dynamics and employs a model-free control training technique which can be fine-tuned for specific scenarios.

Hybrid Robotic and Laparoscopic Gastrectomy for Gastric Cancer: Comparison with Conventional Laparoscopic Gastrectomy.

PurposeThe benefits of robotic gastrectomy remain controversial. We designed this study to elucidate the advantages of a hybrid robot and laparoscopic gastrectomy over conventional laparoscopic surgery.Materials and MethodsA total of 176 patients who underwent gastrectomy for gastric cancer were included in this study. We compared 88 patients treated with hybrid robotic and laparoscopic gastrectomy (HRLG) and 88 patients who underwent conventional laparoscopic gastrectomy (CLG). In HRLG, suprapancreatic lymph node (LN) dissection was performed in a robotic setting. Clinicopathological characteristics, operative details, and short-term outcomes were analyzed for the patients.ResultsThe number of LNs retrieved from the suprapancreatic area was significantly greater in the HRLG group (11.27±5.46 vs. 9.17±5.19, P=0.010). C-reactive protein levels were greater in the CLG group on both postoperative day (POD) 1 (5.11±2.64 vs. 4.29±2.38, P=0.030) and POD 5 (9.86±6.51 vs. 7.75±5.17, P=0.019). In addition, the neutrophil-to-lymphocyte ratio was significantly greater in the CLG group on both POD 1 (7.44±4.72 vs. 6.16±2.91, P=0.031) and POD 5 (4.87±3.75 vs. 3.81±1.87, P=0.020). Pulmonary complications occurred only in the CLG group (4/88 [4.5%] vs. 0/88 [0%], P=0.043).ConclusionsHRLG is superior to CLG in terms of suprapancreatic LN dissection and postoperative inflammatory response.

605 STEPWISE APPROACH TO ROBOTIC SURGERY IN A HIGH-VOLUME CENTER WITHOUT PREVIOUS EXPERIENCE IN ROBOTIC ESOPHAGEAL SURGERY

Abstract Minimally Invasive esophagectomy has been introduced to reduce the trauma associated with open surgery while keeping the same oncological outcome. Robotic platforms could facilitate this. Even with the increasing availability of surgical robots and the standardization of the technique, it can be difficult to convince high volume centers to change their surgical approach. Our aim is to assess the impact of the learning curve for robotic surgery in a high-volume laparoscopic center. Methods We retrospectively analyzed a prospectively collected database in a tertiary referral center for esophagogastric surgery. We identified two groups composed by the patients who underwent Ivor-Lewis (IL) esophagectomy by a hybrid laparoscopic (HL) approach (standard laparoscopy + open thoracotomy) and those who underwent a hybrid robotic (HR) approach (robotic abdominal part + open thoracotomy) with the Davinci Xi surgical platform for lower esophageal or EGJ cancer from November 2018 to September 2019. Data regarding post-operative stay, complications, leaks, total number of lymph nodes and length of surgery were analyzed. Complications were reported according to the ECCG classification. Results We selected 50 consecutive IL cases among which there were our first 17 HR cases. There were no differences in terms of demographics, comorbidities and neoadjuvant treatments between the two groups. No statistical difference was observed in post-operative stay(median 12 vs 10 days in HL and HR respectively, p = 0.09), overall complication rate was 33% in HL and 35% in HR(p = 0.9), patients with leaks 1(3.03%) in HL and 1(5.88%) in HR(p = 0.6), total lymph nodes median of 38 in HL vs 30 in HR(p = 0.4). Only the total length of surgery was statistically longer in the HR group (median 446 vs 478 min, p = 0.01). Conclusion We showed that in the setting of a high-volume center with no previous robotic surgery expertise, robotically performing only the abdominal phase could represent an effective alternative to familiarize with the robotic system without compromising the clinical outcome and workflow. We understand that the main advantages would be seen when using the robot during the thoracic part. After these first cases we will proceed to adopt it during the most demanding part of the operation.

A Self-Aware and Scalable Solution for Efficient Mobile-Cloud Hybrid Robotics.

Backed by the virtually unbounded resources of the cloud, battery-powered mobile robotics can also benefit from cloud computing, meeting the demands of even the most computationally and resource-intensive tasks. However, many existing mobile-cloud hybrid (MCH) robotic tasks are inefficient in terms of optimizing trade-offs between simultaneously conflicting objectives, such as minimizing both battery power consumption and network usage. To tackle this problem we propose a novel approach that can be used not only to instrument an MCH robotic task but also to search for its efficient configurations representing compromise solution between the objectives. We introduce a general-purpose MCH framework to measure, at runtime, how well the tasks meet these two objectives. The framework employs these efficient configurations to make decisions at runtime, which are based on: (1) changing of the environment (i.e., WiFi signal level variation), and (2) itself in a changing environment (i.e., actual observed packet loss in the network). Also, we introduce a novel search-based multi-objective optimization (MOO) algorithm, which works in two steps to search for efficient configurations of MCH applications. Analysis of our results shows that: (i) using self-adaptive and self-aware decisions, an MCH foraging task performed by a battery-powered robot can achieve better optimization in a changing environment than using static offloading or running the task only on the robot. However, a self-adaptive decision would fall behind when the change in the environment happens within the system. In such a case, a self-aware system can perform well, in terms of minimizing the two objectives. (ii) The Two-Step algorithm can search for better quality configurations for MCH robotic tasks of having a size from small to medium scale, in terms of the total number of their offloadable modules.

An Analytical and Modular Software Workbench for Solving Kinematics and Dynamics of Series-Parallel Hybrid Robots

Abstract Parallel mechanisms are increasingly being used as modular subsystem units in various robots and man-machine interfaces for their superior stiffness, payload-to-weight ratio, and dynamic properties. This leads to series-parallel hybrid robotic systems that are challenging to model and control due to the presence of various closed loops. Most model-based kinematic and dynamic modeling tools resolve loop closure constraints numerically and hence suffer from inefficiency and accuracy issues. Additionally, they do not exploit the modularity in robot design. In this paper, we present a modular and analytical approach toward kinematic and dynamic modeling of series-parallel hybrid robots. This approach has been implemented in a software framework called hybrid robot dynamics (hyrodyn) and its application is demonstrated with the help of a series-parallel hybrid humanoid robot recently developed at DFKI-RIC.

Invited Commentary

Advanced hybrid coronary revascularization (AHCR) marries the long-term patency and survival benefits of multiple internal mammary arterial grafts to the effectiveness of drug-eluting stents for residual stenoses among patients with complex left main and 3-vessel coronary artery disease. This technique affords patients a sternal-sparing approach, potentially allowing patients an earlier return to full activity while avoiding the risk of sternal wound complications associated with standard coronary artery bypass grafting (CABG). In this issue of The Annals of Thoracic Surgery, Balkhy and colleagues1Balkhy H.H. Kitahara H. Hirai T. Matsukage H. Nathan S. Residual SYNTAX score after advanced hybrid robotic totally endoscopic coronary revascularization.Ann Thorac Surg. 2020; 109: 1826-1833Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar report outcomes from their series of AHCR using multiple internal mammary arterial grafts and second-generation drug-eluting stents. Patients were evaluated by an experienced heart team that calculated baseline and residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) scores. Compared with open surgical revascularization, operative times were prolonged, but the authors should be congratulated for excellent early outcomes with no 30-day mortality, surgical site infection, perioperative stroke, or reexploration for bleeding. Another strength of the current study was the routine use of follow-up angiography, leading to a more comprehensive assessment of the completeness of revascularization. Incomplete revascularization has been more rigorously defined by the residual SYNTAX score (rSS). A key finding by Balkhy and associates1Balkhy H.H. Kitahara H. Hirai T. Matsukage H. Nathan S. Residual SYNTAX score after advanced hybrid robotic totally endoscopic coronary revascularization.Ann Thorac Surg. 2020; 109: 1826-1833Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar is that patients with increased rSSs (suggesting incomplete revascularization) were associated with higher mortality and major adverse cardiac events, which indicates the importance of complete revascularization to optimize clinical results in complex coronary artery disease. As the authors noted, however, it is difficult to elucidate whether these outcomes arise directly from incomplete revascularization, as this group did have greater comorbidities and the sample size was too small to allow for adjustments. Inferior outcomes have been associated with incomplete revascularization in previous studies of percutaneous coronary intervention, and standard CABG and hybrid coronary revascularization, particularly in patients on renal dialysis. When heart teams consider AHCR options, the concept of a “predictive rSS” for all possible revascularization options may guide the optimal treatment strategy. Each lesion should be assessed regarding the feasibility of both percutaneous coronary intervention and CABG and hypothetical rSSs, presuming the failure of various revascularization strategies could be calculated. In this fashion, heart teams could assess revascularization options based on predictive “worst case” scenarios and their presumed likelihood, providing insight into the potential best strategy. To date, only one randomized controlled trial has been conducted.2Gąsior M. Zembala M.O. Tajstra M. et al.Hybrid revascularization for multivessel coronary artery disease.JACC Cardiovasc Interv. 2014; 7: 1277-1283Crossref PubMed Scopus (89) Google Scholar Although underpowered for long-term outcomes and lacking protocol-driven angiographic follow-up, reduced perioperative complications were demonstrated with an increased risk of long-term revascularization. Inclusion of large observational studies in meta-analyses has also demonstrated similar results.3Nolan S. Filion K.B. Atallah R. Moss E. Reynier P. Eisenberg M.J. Hybrid coronary revascularization vs. complete coronary artery bypass grafting for multivessel coronary artery disease: a systematic review and meta-analysis.J Invasive Cardiol. 2018; 30: E131-E149PubMed Google Scholar The effectiveness of AHCR can only be ascertained through a multicenter prospective randomized controlled trial of complex revascularization comparing standard CABG with AHCR. Ideally, this study would assess the differences in initial surgical complications along with long-term major adverse cardiac events and revascularization rates and include a cohort of protocol-driven angiographic follow-up to ascertain the mode of revascularization failure. The future for AHCR remains bright, but will rely heavily on experienced heart teams. With persistence in continued training, the development of simplified robotic techniques, and appropriate funding for dedicated prospective clinical trials to determine which patient subsets benefit most, AHCR may ultimately be proven to be the best approach for many patients to improve outcomes and minimize complications. Residual SYNTAX Score After Advanced Hybrid Robotic Totally Endoscopic Coronary RevascularizationThe Annals of Thoracic SurgeryVol. 109Issue 6PreviewAdvanced hybrid coronary revascularization (AHCR) combines multivessel robotic beating-heart totally endoscopic coronary artery bypass with percutaneous coronary intervention. The aim of this study was to quantify the remaining coronary artery disease after AHCR using the residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) study score. Full-Text PDF

Hybrid Robotics for Endoscopic Skull Base Surgery: Preclinical Evaluation and Surgeon First Impression

A robotic endoscope holder should theoretically provide various advantages in transnasal endoscopic skull base surgery, but only recently has a robotic system become commercially available. The objective of this study was to provide a preclinical evaluation of potential advantages and surgeon first impression of this robotic hybrid solution. Thirty skull base surgeons, attending the Joint European Diploma of Endoscopic Skull Base Surgery 2018-2019 in Paris, France, were enrolled. A questionnaire, mainly concerning personal surgical experience and habits, was administered. The test phase consisted of 2 different dry-lab tasks, performed with and without EndoscopeRobot, according to randomization and on 2 different days. A modified NASA Task Load Index test was subsequently administered via e-mail to all participants. Completion times and modified Global Evaluative Assessment of Robotic Skills in Endoscopy scores of the videotaped tasks were recorded. Nineteen otorhinolaryngologic surgeons and 11 neurosurgeons, with different surgical habits and endoscopic experience, were enrolled. No one appeared unfavorable a priori to robotic endoscopic surgery. Although the robot did not provide an advantage in the simple grasping task 1, a trend toward better completion times and efficacy was evident in the bimanual task 2, when performed with the robot and bimanually. According to the modified NASA Task Load Index test, surgeons felt more successful with the robot in task 2, finding it less stressful and mentally demanding. Endoscopic skull base surgeons seem to view a hybrid robotic solution positively. EndoscopeRobot seems to provide a benefit to the single surgeon with experience in bimanual endoscopic surgery. Further preclinical and clinical evaluation of this technology is necessary.

Residual SYNTAX Score After Advanced Hybrid Robotic Totally Endoscopic Coronary Revascularization

Advanced hybrid coronary revascularization (AHCR) combines multivessel robotic beating-heart totally endoscopic coronary artery bypass with percutaneous coronary intervention. The aim of this study was to quantify the remaining coronary artery disease after AHCR using the residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) study score. From July 2013 to September 2017, patients who had postoperative angiography after AHCR were reviewed. The cohort was divided into two groups: group 1, complete or near-complete revascularization (residual SYNTAX score of 8 or less); and group 2, incomplete revascularization (residual SYNTAX score more than 8). Among 308 patients who underwent totally endoscopic coronary artery bypass, 57 patients received AHCR and 51 patients had postoperative angiograms that allowed calculations of residual SYNTAX score. Mean baseline and residual SYNTAX scores were 33.1 ± 11.0 and 4.6 ± 6.5 respectively. There were 44 patients (86%) in the complete or near-complete revascularization group, and of these, 16 patients (31%) achieved true complete revascularization (residual SYNTAX score= 0). Overall graft patency was 96.2%. There were no differences in preoperative characteristics or postoperative outcomes between the two groups. Two-year survival rate and freedom from major adverse cardiac events (death, myocardial infarction, and repeat revascularization) were significantly higher in the complete or near-complete revascularization group compared with the incomplete revascularization group. Advanced hybrid coronary revascularization at our institution was safely performed with excellent early outcomes, graft patency, and high achievement of complete or near-complete revascularization. Residual SYNTAX score might predict long-term ischemic events after hybrid coronary revascularization.

Design and Kinematic Analysis of a Novel Hybrid Kinematic Mechanism With Seven-Degrees-of-Freedom and Variable Topology for Operation in Space

We propose a novel hybrid robot with seven degrees-of-freedom (DOF) and variable topology for operation in space. Design specifications of the space robot are presented for the type synthesis of hybrid mechanisms. Based on GF set theory, three design rules are given, thus providing the design method of the 7DOF hybrid space robot mechanism. Twenty-four combinations of the hybrid robotic mechanisms are obtained. The final synthesized configuration for the design of the space robot has a 3DOF parallel module and a 4DOF serial module with four revolute (RRRR) joints. The parallel module consists of a limb with universal-prismatic (UP) joints and two limbs with universal-prismatic-spherical (UPS) joints. The topology of the hybrid robot can be changed, and it will become an RPRR four-bar mechanism when it is folded for launch. The closed-form solution for the inverse displacement model is developed, and then the forward displacement equations are also obtained. After that, the Jacobian matrix is derived from the displacement model; the Jacobian matrix will analyze the singularity and workspace. We find that there are four singularities of mechanisms. The dexterous workspace of the hybrid robot is a good match for the grapple operation in space. An experiment with the prototype shows the present hybrid robot can grapple to a satellite-rocket docking ring and therefore validates the kinematic equations.

Hybrid FES–robotic gait rehabilitation technologies: a review on mechanical design, actuation, and control strategies

Gait disorders in neurologically disabled people can be treated by various techniques available today which include passive orthoses, functional electrical stimulation (FES) and robot assisted gait training devices (RAGT). However, each system has its own drawback. For example, gait rehabilitation with orthosis is physically taxing for the patient with no significant functional improvement. FES uses muscle powers as physiological actuators to promote balance and improve gait but leads to fatigue, along with poor control of joint trajectories. RAGT devices including powered exoskeletons, gait rehabilitation systems employing programmable footplates and mobile training platforms, have shown significant advantages but the devices are not yet mature due to numerous drawbacks associated with physical and cognitive interaction, energy-management and portability issues. The combination of FES technology and RAGT devices, often named hybrid FES–robot technologies, has arisen as a promising approach to aid in gait restoration. This work reports a comprehensive review on the hybrid FES–robot technologies over the last decades, focusing on different mechanical structures, actuator designs, sensing technologies, and control approaches. The hybrid robotic structures are classified into two categories: (i) orthotic-based hybrid systems, where (a) FES is used to stimulate the muscles and produce joint torque while the robotic system acts as energy dissipating device, and (b) FES and robotic systems are both torque-generating devices; and (ii) non-orthotic based hybrid systems. The review compiles a variety of sources and illustrates the technology’s most important challenges in the fields of hybrid rehabilitation robotics which may contribute towards further development of hybrid robot systems.

Robotic Transnasal Endoscopic Skull Base Surgery: Systematic Review of the Literature and Report of a Novel Prototype for a Hybrid System (Brescia Endoscope Assistant Robotic Holder).

Although robotics has already been applied to several surgical fields, available systems are not designed for endoscopic skull base surgery (ESBS). New conception prototypes have been recently described for ESBS. The aim of this study was to provide a systematic literature review of robotics for ESBS and describe a novel prototype developed at the University of Brescia. PubMed and Scopus databases were searched using a combination of terms, including Robotics OR Robot and Surgery OR Otolaryngology OR Skull Base OR Holder. The retrieved papers were analyzed, recording the following features: interface, tools under robotic control, force feedback, safety systems, setup time, and operative time. A novel hybrid robotic system has been developed and tested in a preclinical setting at the University of Brescia, using an industrial manipulator and readily available off-the-shelf components. A total of 11 robotic prototypes for ESBS were identified. Almost all prototypes present a difficult emergency management as one of the main limits. The Brescia Endoscope Assistant Robotic holder has proven the feasibility of an intuitive robotic movement, using the surgeon's head position: a 6 degree of freedom sensor was used and 2 light sources were added to glasses that were therefore recognized by a commercially available sensor. Robotic system prototypes designed for ESBS and reported in the literature still present significant technical limitations. Hybrid robot assistance has a huge potential and might soon be feasible in ESBS.

Kinematics, dynamics, and control system of a new 5-degree-of-freedom hybrid robot manipulator

Hybrid robotic application is a continuously developing field, as hybrid robot manipulators have demonstrated clearly to possess benefits of both serial structures and parallel mechanisms. In this article, the physical prototype and the specially designed control system for a new 5-degree-of-freedom hybrid robot manipulator are developed. The mechanical structure, kinematics, dynamics, and control system of this robot manipulator are presented. A newly appropriate set of closed-form solutions, which can avoid multiple solutions, is proposed to address the inverse kinematics problem of this robot manipulator. Additionally, simulations of the kinematics and dynamics of this robot manipulator and the tests for the repeatability and accuracy of both the position and path are first simulated with two numerical examples and then conducted on the physical prototype.

Laparoscopic, hybrid, and totally robotic Roux-en-Y gastric bypass.

The laparoscopic approach to Roux-en-Y gastric bypass (RYGB) is a highly regarded and frequently used bariatric procedure. We review our experience with robotic approaches to RYGB. We hypothesized that the robotic approach is safe and may produce similar outcomes to previously reported laparoscopic surgery. We conducted our study at the University Hospital, USA. Data regarding RYGB procedures performed in 2006-2013 were retrospectively reviewed from a prospectively maintained, dedicated database. Procedures were categorized into three groups: laparoscopic, hybrid robotic (HR), and total robotic (TR). Patient characteristics, operative variables, and postoperative short- and long-term outcomes were compared between groups and to recently published larger laparoscopic series. Our study included 192 RYGB consecutive patients who underwent laparoscopic, HR, or TR surgery. Mean patient age, preoperative body mass index, and preoperative weight were 40.4±9.3years (range 22-64), 46. 2±5.9kg/m(2) (range 35-64), and 130. 3±22.1kg (range 76.7-193.4) respectively. Ninety-two patients (47.9%) had undergone previous abdominal surgery. Mean operative time, estimated blood loss, and length of stay were 223.4±39.2min (range 130-338), 21.9±18.8mL (range 5-10), and 2.6±1.1days (range 2-15), respectively. There were 248 concomitant procedures such as upper endoscopy, cholecystectomy, etc., 7 revisional surgeries, and 2 conversions to open surgery. Intraoperative complications included one liver laceration and one bowel injury. There were two cases each of bowel obstruction, transfusions, and deep vein thrombosis/pulmonary embolus, but no deaths or anastomotic leaks. Early experience with TR approach for RYGB is safe, with similar outcomes to the laparoscopic approach.

A Simple and Novel Hybrid Robotic System for Robot-Assisted Femur Fracture Reduction

When performing femur fracture reduction surgery, both the patient and surgeon are exposed to a great amount of radiation, which is harmful to their health. In order to reduce such radiation from the usage of an image intensifier, various robots have been proposed for femur fracture reduction surgery. Most of these robots are based on serial architecture. The low transportable load and poor accuracy are both inherent in serial robots, which makes them inappropriate for femur fracture reduction. Some parallel robots based on the 'Stewart platform' have also been developed for femur fracture reduction, but their restricted workspace limits their applicability and accessibility. To balance the accuracy, payload and workspace, a new robot system is reported in this paper. The proposed robot system consists of a 2-d.o.f. device and a 6-d.o.f. hybrid robot. The 2-d.o.f. device is used for distraction, which requires a very large force. The hybrid robot is used to manipulate a bone fragment for alignment and fixation purposes. The hybrid robot possesses the characteristic of a Cartesian coordinate robot; all the movements of the actuators are linear, which makes its motion smooth for low-speed fracture reduction procedures. The forward and inverse kinematics of the proposed robot are analyzed. The analysis is much simpler compared to traditional serial manipulators and parallel Stewart platform robots. A prototype of the proposed system is made using a rapid fabrication system called Objet. The positioning accuracy of the proposed system is measured using a coordinate-measuring machine. The results show that the algorithms presented in this paper for the control of the robot are accurate and robust.