Robotic Catheter Research Articles

Force control for the robot-assisted laparoscopic ultrasound scanning system

Laparoscopic ultrasound scanning, an acritical diagnostic imaging method for liver diseases, necessitates precise contact force control that is typically dependent on skilled physicians. Given its high mobility and controllability, the robot is anticipated to supplant physicians in performing laparoscopic ultrasound scans. Consequently, this study introduces a laparoscopic ultrasound scanning system paired with a learning-based force controller. Compared with traditional methods, our approach offers precise control over the contact force between the ultrasound probe and human organ surfaces during scanning, reducing the learning curve for surgeons in laparoscopic liver ultrasound scanning. Acknowledging the complex nonlinear mechanical model involved when the laparoscopic ultrasound probe contacts human organs and tissues, we propose a learning-based method utilizing a long short-term memory network to estimate the contact force. This method allows for the precise estimation of contact force with human organ tissues by analyzing tendon force. The results indicate that the proposed LSTM neural network can accurately fit the mechanical model of the robotic catheter, with a root mean square error of 3.44 mN. Finally, we conducted a force control experiment for ultrasound scanning on a silicone liver model. The results indicate that the proposed method can achieve relatively stable force control for laparoscopic ultrasound scanning, with a maximum error of 2.41 mN during the transient phase of system control and a maximum absolute error of 1.8 mN in the steady state.

Robust Path Planning via Learning from Demonstrations for Robotic Catheters in Deformable Environments.

Navigation through tortuous and deformable vessels using catheters with limited steering capability underscores the need for reliable path planning. State-of-the-art path planners do not fully account for the deformable nature of the environment. This work proposes a robust path planner via a learning from demonstrations method, named Curriculum Generative Adversarial Imitation Learning (C-GAIL). This path planning framework takes into account the interaction between steerable catheters and vessel walls and the deformable property of vessels. In-silico comparative experiments show that the proposed network achieves a 38% higher success rate in static environments and 17% higher in dynamic environments compared to a state-of-the-art approach based on GAIL. In-vitro validation experiments indicate that the path generated by the proposed C-GAIL path planner achieves a targeting error of 1.26 ±0.55mm and a tracking error of 5.18 ±3.48mm. These results represent improvements of 41% and 40% over the conventional centerline-following technique for targeting error and tracking error, respectively. The proposed C-GAIL path planner outperforms the state-of-the-art GAIL approach. The in-vitro validation experiments demonstrate that the path generated by the proposed C-GAIL path planner aligns better with the actual steering capability of the pneumatic artificial muscle-driven catheter utilized in this study. Therefore, the proposed approach can provide enhanced support to the user in navigating the catheter towards the target with greater accuracy, effectively meeting clinical accuracy requirements. The proposed path planning framework exhibits superior performance in managing uncertainty associated with vessel deformation, thereby resulting in lower tracking errors.

Magnetic Soft Catheter Robot System for Minimally Invasive Treatments of Articular Cartilage Defects.

Articular cartilage defects are among the most common orthopedic diseases, which seriously affect patients' health and daily activities, without prompt treatment. The repair biocarrier-based treatment has shown great promise. Total joint injection and open surgery are two main methods to deliver functional repair biocarriers into the knee joint. However, the exhibited drawbacks of these methods hinder their utility. The repair effect of total joint injection is unstable due to the low targeting rate of the repair biocarriers, whereas open surgery causes serious trauma to patients, thereby prolonging the postoperative healing time. In this study, we develop a magnetic soft catheter robot (MSCR) system to perform precise in situ repair of articular cartilage defects with minimal incision. The MSCR processes a size of millimeters, allowing it to enter the joint cavity through a tiny skin incision to reduce postoperative trauma. Meanwhile, a hybrid control strategy combining neural network and visual servo is applied to sequentially complete the coarse and fine positioning of the MSCR on the cartilage defect sites. After reaching the target, the photosensitive hydrogel is injected and anchored into the defect sites through the MSCR, ultimately completing the in situ cartilage repair. The in vitro and ex vivo experiments were conducted on a 3D printed human femur model and an isolated porcine femur, respectively, to demonstrate the potential of our system for the articular cartilage repair.

CardioXplorer: An Open-Source Modular Teleoperative Robotic Catheter Ablation System

Atrial fibrillation, the most prevalent cardiac arrhythmia, is treated by catheter ablation to isolate electrical triggers. Clinical trials on robotic catheter systems hold promise for improving the safety and efficacy of the procedure. However, expense and proprietary designs hinder accessibility to such systems. This paper details an open-source, modular, three-degree-of-freedom robotic platform for teleoperating commercial ablation catheters through joystick navigation. We also demonstrate a catheter-agnostic handle interface permitting customization with commercial catheters. Collaborating clinicians performed benchtop targeting trials, comparing manual and robotic catheter navigation performance. The robot reduced task duration by 1.59 s across participants and five trials. Validation through mean motion jerk analysis revealed 35.2% smoother robotic navigation for experts (≥10 years experience) compared to the intermediate group. Yet, both groups achieved smoother robot motion relative to the manual approach, with the experts and intermediates exhibiting 42.2% and 13.6% improvements, respectively. These results highlight the potential of this system for enhancing catheter-based procedures. The source code and designs of CardioXplorer have been made publicly available to lower boundaries and drive innovations that enhance procedure efficacy beyond human capabilities.

29. SOFT ROBOTICS APPLIED TO MEDICINE: STEERABLE TIP CATHETER GUIDED BY COMPUTER VISION

Abstract Introduction A soft, biocompatible, and deformation-controlled robotic catheter, guided by computer vision and propelled by the pressurized injection of a saline solution, has been developed. The catheter incorporates a camera at its end to navigate through the human circulatory system to the point where the problem is located and it can release the appropriate surgical instruments for the situation, for example, microscalpel, laser or even a microrobot. This work contributes to the reduction of the risks associated with conventional catheterization, such as unwanted punctures, and eliminates the need to use radiation on the patient for guidance. Methods Finite element simulation models are created in COMSOL to evaluate the performance of hydraulically actuated deformable catheter designs. The catheter is manufactured using flexible materials through additive manufacturing and curing of a biocompatible silicone, PDMS, on molds. Experimental measurements include the pressure reached by the saline solution, the curvature achieved by the catheter, the distance traveled within the conduit system, and the acquisition and processing of images of the traversed conduits. Results Simulation results identify the optimal design among the considered alternatives. A prototype of the catheter is fabricated, and its movement is precisely controlled to navigate safely within a conduit. Conclusion The feasibility of a soft and autonomous catheter with the desired characteristics and behavior to contribute to the reduction of risks associated with catheterization practices is demonstrated.

Comparative Analysis of Interactive Modalities for Intuitive Endovascular Interventions.

Endovascular intervention is a minimally invasive method for treating cardiovascular diseases. Although fluoroscopy, known for real-time catheter visualization, is commonly used, it exposes patients and physicians to ionizing radiation and lacks depth perception due to its 2D nature. To address these limitations, a study was conducted using teleoperation and 3D visualization techniques. This in-vitro study involved the use of a robotic catheter system and aimed to evaluate user performance through both subjective and objective measures. The focus was on determining the most effective modes of interaction. Three interactive modes for guiding robotic catheters were compared in the study: 1) Mode GM, using a gamepad for control and a standard 2D monitor for visual feedback; 2) Mode GH, with a gamepad for control and HoloLens providing 3D visualization; and 3) Mode HH, where HoloLens serves as both control input and visualization device. Mode GH outperformed other modalities in subjective metrics, except for mental demand. It exhibited a median tracking error of 4.72 mm, a median targeting error of 1.01 mm, a median duration of 82.34 s, and a median natural logarithm of dimensionless squared jerk of 40.38 in the in-vitro study. Mode GH showed 8.5%, 4.7%, 6.5%, and 3.9% improvements over Mode GM and 1.5%, 33.6%, 34.9%, and 8.1% over Mode HH for tracking error, targeting error, duration, and dimensionless squared jerk, respectively. To sum up, the user study emphasizes the potential benefits of employing HoloLens for enhanced 3D visualization in catheterization. The user study also illustrates the advantages of using a gamepad for catheter teleoperation, including user-friendliness and passive haptic feedback, compared to HoloLens. To further gauge the potential of using a more traditional joystick as a control input device, an additional study utilizing the Haption VirtuoseTM robot was conducted. It reveals the potential for achieving smoother trajectories, with a 38.9% reduction in total path length compared to a gamepad, potentially due to its larger range of motion and single-handed control.

Free-Space Dynamic Modeling of an MRI-Actuated Robotic Catheter

Free-Space Dynamic Modeling of an MRI-Actuated Robotic Catheter

The Critical Technologies of Vascular Interventional Robotic Catheterization: A Review

The Critical Technologies of Vascular Interventional Robotic Catheterization: A Review

Robotic Catheter Ablation: An Evaluation and Prototyping Platform

Cardiac arrhythmia affects a large portion of the population, particularly the elderly. As the population ages, the number of patients suffering from this condition is expected to rise, underlining the importance of more efficient treatment methods. Radio-frequency (RF) catheter ablation is the treatment of choice for many cardiac arrhythmias. To recover a normal heartbeat, the abnormal pacemakers inside the heart are first identified and then isolated or destroyed by applying RF energy through the use of an ablation catheter. While the catheter’s design and precise navigation are topics of significant interest, there is currently no standardized evaluation setup to compare different catheter ablation systems. This paper addresses this problem by introducing an evaluation platform including an in vitro anatomical model, a catheter tracking system, and a dedicated graphical user interface. This platform enables performance assessment of catheter ablation systems using various metrics, such as procedure duration, contact stability, ablation angle and user satisfaction. A simulation environment is also presented, allowing for rapid assessment of usability-related parameters. We demonstrate the efficacy of the evaluation platform through a proof-of-concept study, and the efficacy of the simulation environment through evaluating different control gains.

Analytical Computation of the Contact Force Jacobian for MRI-Actuated Robotic Catheter.

Contact force Jacobian relates the changes in the contact force to the changes in the actuation of a robotic catheter in contact with a surface. In this paper, we present an analytical method for calculating the contact force Jacobian for the Cosserat rod model of an MRI-actuated robotic catheter. First, the Cosserat rod model of the MRI-actuated robotic catheter under tip contact position constraint is introduced. For the analytical derivation of contact force Jacobian, the initial value problem parameter derivatives are defined and calculated analytically. Finally, simulation results show that the presented analytical method calculates the contact force Jacobian in significantly shorter computation time with comparable accuracy, compared to direct numerical computation.

Integrated Magnetic Location Sensing and Actuation of Steerable Robotic Catheters for Peripheral Arterial Disease Treatment

Integrated Magnetic Location Sensing and Actuation of Steerable Robotic Catheters for Peripheral Arterial Disease Treatment

Interventionalist Hand Motion Recognition With Convolutional Neural Network in Robot-Assisted Coronary Interventions

The development of procedural competencies by interventional cardiology fellows for minimally invasive treatment of cardiac diseases depend on their effective training and evaluation. Learning tool manipulation for safe robotic percutaneous coronary interventions requires expert supervision and use of high-fidelity systems. However, with limited proficiency for real-time hand motion recognition. Therefore, this study proposes a deep learning-based model for identifying operators’ actions. The proposed model is based on the convolutional neural network that consist of one dimensional convolutional layers for automatic feature map extraction, down sampling, and fully connected layers for inference. The developed models were evaluated using a multi-modal dataset collected from sensory glove, EM, and sEMG sensors and real-time angiograms in the course of in-vivo catheterization trials performed by nine subjects (two experts and seven novices) using a custom-built robotic catheter system. The results indicate that the model achieves a 92–96% accuracy in identifying five actions across four clusters compared with a recognition performance of 83% when recognizing all six actions. Furthermore, we compared the proposed model performance with existing studies, the analyses show that our model has a 2-3% higher accuracy for five-action recognition. Therefore, the proposed model could be employed for real-time hand motion recognition in R-PCI trials.

Development of a soft robotic catheter for vascular intervention surgery

Development of a soft robotic catheter for vascular intervention surgery

Force Control With a Novel Robotic Catheterization System Based on Braided Sleeve Grippers

Force Control With a Novel Robotic Catheterization System Based on Braided Sleeve Grippers

Minimally invasive bioprinting for in situ liver regeneration.

In situ bioprinting is promising for developing scaffolds directly on defect models in operating rooms, which provides a new strategy for in situ tissue regeneration. However, due to the limitation of existing in situ biofabrication technologies including printing depth and suitable bioinks, bioprinting scaffolds in deep dermal or extremity injuries remains a grand challenge. Here, we present an in vivo scaffold fabrication approach by minimally invasive bioprinting electroactive hydrogel scaffolds to promote in situ tissue regeneration. The minimally invasive bioprinting system consists of a ferromagnetic soft catheter robot for extrusion, a digital laparoscope for in situ monitoring, and a Veress needle for establishing a pneumoperitoneum. After 3D reconstruction of the defects with computed tomography, electroactive hydrogel scaffolds are printed within partial liver resection of live rats, and in situ tissue regeneration is achieved by promoting the proliferation, migration, and differentiation of cells and maintaining liver function in vivo.

Telerobotic Transcatheter Delivery System for Mitral Valve Implant.

Mitral regurgitation (MR) is the most common type of valvular heart disease, affecting over 2% of the world population, and the gold-standard treatment is surgical mitral valve repair/replacement. Compared to open-heart surgeries, minimally invasive surgeries (MIS) using transcatheter approaches have become popular because of their notable benefits such as less postoperative pain, shorter hospital stay, and faster recovery time. However, commercially available catheters are manually actuated, causing over-exposure of clinical staff to radiation and increased risk of human error during medical interventions. To tackle this problem, in this letter, we propose a telerobotic transcatheter delivery system, which consists of a robotic catheter (5.7 mm OD), a reinforced guide tube (1.11m length), and an actuation system. We present the robotic system design, fabrication of key components, and static model of reinforced quadlumen tube. The robot interface design enables the user to intuitively control the robot. We demonstrate the effectiveness of the telerobotic transcatheter delivery system and reinforced quadlumen tube in a realistic human cardiovascular phantom for preclinical evaluation.

A Fast Soft Continuum Catheter Robot Manufacturing Strategy Based on Heterogeneous Modular Magnetic Units.

Developing small-scale continuum catheter robots with inherent soft bodies and high adaptability to different environments holds great promise for biomedical engineering applications. However, current reports indicate that these robots meet challenges when it comes to quick and flexible fabrication with simpler processing components. Herein, we report a millimeter-scale magnetic-polymer-based modular continuum catheter robot (MMCCR) that is capable of performing multifarious bending through a fast and general modular fabrication strategy. By preprogramming the magnetization directions of two types of simple magnetic units, the assembled MMCCR with three discrete magnetic sections could be transformed from a single curvature pose with a large tender angle to a multicurvature S shape in the applied magnetic field. Through static and dynamic deformation analyses for MMCCRs, high adaptability to varied confined spaces can be predicted. By employing a bronchial tree phantom, the proposed MMCCRs demonstrated their capability to adaptively access different channels, even those with challenging geometries that require large bending angles and unique S-shaped contours. The proposed MMCCRs and the fabrication strategy shine new light on the design and development of magnetic continuum robots with versatile deformation styles, which would further enrich broad potential applications in biomedical engineering.

Enhancing Nodule Biopsy Through Technology Integration.

Technology in navigating to peripheral pulmonary nodules has improved in recent years. The recent integration of a robotic platform using shape-sensing technology and mobile cone-beam computed tomography imaging technology has enhanced confidence in sampling lesions with intraprocedural imaging by complimenting the pre-planned navigation to peripheral pulmonary nodules. We present 2 cases using the software integration that improved the robotic catheter positioning to allow for diagnostic specimens to be obtained in the initial biopsies.

Position-based dynamics simulator of vessel deformations for path planning in robotic endovascular catheterization.

A major challenge during autonomous navigation in endovascular interventions is the complexity of operating in a deformable but constrained workspace with an instrument. Simulation of deformations for it can provide a cost-effective training platform for path planning. Aim of this study is to develop a realistic, auto-adaptive, and visually plausible simulator to predict vessels' global deformation induced by the robotic catheter's contact and cyclic heartbeat motion. Based on a Position-based Dynamics (PBD) approach for vessel modeling, Particle Swarm Optimization (PSO) algorithm is employed for an auto-adaptive calibration of PBD deformation parameters and of the vessels movement due to a heartbeat. In-vitro experiments were conducted and compared with in-silico results. The end-user evaluation results were reported through quantitative performance metrics and a 5-Point Likert Scale questionnaire. Compared with literature, this simulator has an error of 0.23±0.13% for deformation and 0.30±0.85mm for the aortic root displacement. In-vitro experiments show an error of 1.35±1.38mm for deformation prediction. The end-user evaluation results show that novices are more accustomed to using joystick controllers, and cardiologists are more satisfied with the visual authenticity. The real-time and accurate performance of the simulator make this framework suitable for creating a dynamic environment for autonomous navigation of robotic catheters.

Towards the Design and Development of a Robotic Transcatheter Delivery System for Mitral Valve Implant.

Minimally-invasive surgeries using transcatheter approaches and sophisticated imaging modalities are gaining popularity to treat mitral regurgitation (MR). This paper proposes the next generation of a robotic catheter to deliver an implant onto the mitral valve (MV) through a transseptal approach. The proposed robot has an outer diameter (OD) of 5.7 mm, a rigid distal end length of 20 mm, a prismatic tube that can be advanced by 50-60 mm, and a bending joint that can easily bend 120° to reach the valve opening. The implant can be rotated 75° bidirectionally by the distal torsion joint to orient it with the MV leaflet for precise implantation. The robotic joints are modeled individually, the forward and inverse kinematics are derived, and the robot motion validation is carried out through experimentation. A modified kinematics (MK) model, Prandtl-Ishlinskii (PI) hysteresis model, and hybrid of MK and PI model are used to compensate for the catheter nonlinearities. A preliminary study is conducted to evaluate if force sensing can be used to compensate for the effects of fluid flow. Also, the implantation procedure is demonstrated in a phantom heart.