Smart Surgical Tools Research Articles

Tactile Sensing for Minimally Invasive Surgery: Conventional Methods and Potential Emerging Tactile Technologies.

As opposed to open surgery procedures, minimally invasive surgery (MIS) utilizes small skin incisions to insert a camera and surgical instruments. MIS has numerous advantages such as reduced postoperative pain, shorter hospital stay, faster recovery time, and reduced learning curve for surgical trainees. MIS comprises surgical approaches, including laparoscopic surgery, endoscopic surgery, and robotic-assisted surgery. Despite the advantages that MIS provides to patients and surgeons, it remains limited by the lost sense of touch due to the indirect contact with tissues under operation, especially in robotic-assisted surgery. Surgeons, without haptic feedback, could unintentionally apply excessive forces that may cause tissue damage. Therefore, incorporating tactile sensation into MIS tools has become an interesting research topic. Designing, fabricating, and integrating force sensors onto different locations on the surgical tools are currently under development by several companies and research groups. In this context, electrical force sensing modality, including piezoelectric, resistive, and capacitive sensors, is the most conventionally considered approach to measure the grasping force, manipulation force, torque, and tissue compliance. For instance, piezoelectric sensors exhibit high sensitivity and accuracy, but the drawbacks of thermal sensitivity and the inability to detect static loads constrain their adoption in MIS tools. Optical-based tactile sensing is another conventional approach that facilitates electrically passive force sensing compatible with magnetic resonance imaging. Estimations of applied loadings are calculated from the induced changes in the intensity, wavelength, or phase of light transmitted through optical fibers. Nonetheless, new emerging technologies are also evoking a high potential of contributions to the field of smart surgical tools. The recent development of flexible, highly sensitive tactile microfluidic-based sensors has become an emerging field in tactile sensing, which contributed to wearable electronics and smart-skin applications. Another emerging technology is imaging-based tactile sensing that achieved superior multi-axial force measurements by implementing image sensors with high pixel densities and frame rates to track visual changes on a sensing surface. This article aims to review the literature on MIS tactile sensing technologies in terms of working principles, design requirements, and specifications. Moreover, this work highlights and discusses the promising potential of a few emerging technologies towards establishing low-cost, high-performance MIS force sensing.

Remote photoacoustic sensing using speckle-analysis

Laser surgery is a rising surgical technique, which offers several advantages compared to the traditional scalpel. However, laser surgery lacks a contact-free feedback system which offers high imaging contrast to identify the tissue type ablated and also a high penetration depth. Photoacoustic imaging has the potential to fill this gap. Since photoacoustic detection is commonly contact based, a new non-interferometric detection technique based on speckle-analysis for remote detection is presented in this work. Phantom and ex-vivo experiments are carried out in transmission and reflection-mode for proof of concept. In summary, the potential of the remote speckle sensing technique for photoacoustic detection is demonstrated. In future, this technique might be applied for usage as a remote feedback system for laser surgery, which could help to broaden the applications of lasers as smart surgical tools.

Smart Surgical Catheter for C-Reactive Protein Sensing Based on an Imperceptible Organic Transistor.

Organic field‐effect transistors (OFETs)‐based sensors have a great potential to be integrated with the next generation smart surgical tools for monitoring different real‐time signals during surgery. However, allowing ultraflexible OFETs to have compatibility with standard medical sterilization procedures remains challenging. A novel capsule‐like OFET structure is demonstrated by utilizing the fluoropolymer CYTOP to serve both encapsulation and peeling‐off enhancement purposes. By adapting a thermally stable organic semiconductor, 2,10‐diphenylbis[1]benzothieno[2,3‐d;2′,3′‐d′]naphtho[2,3‐b;6,7‐b′]dithiophene (DPh‐BBTNDT), these devices show excellent stability in their electrical performance after sterilizing under boiling water and 100 °C‐saturated steam for 30 min. The ultrathin thickness (630 nm) enables the device to have superb mechanical flexibility with smallest bending radius down to 1.5 µm, which is essential for application on the highly tortuous medical catheter inside the human body. By immobilizing anti‐human C‐reactive protein (CRP) (an inflammation biomarker) monoclonal antibody on an extended gate of the OFET, a sensitivity for detecting CRP antigen down to 1 µg mL−1 can be achieved. An ecofriendly water floatation method realized by employing the wettability difference between CYTOP and polyacrylonitrile (PAN) can be used to transfer the device on a ventricular catheter, which successfully distinguishes an inflammatory patient from a healthy one.

Robotic-assisted surgery in ophthalmology.

Provide an overview of the current landscape of robotics in ophthalmology, including the pros and cons of system designs, the clinical development path, and the likely future direction of the field. Robots designed for eye surgery should meet certain basic requirements. Three designs are currently being developed: smart surgical tools such as the steady hand, comanipulation devices and telemanipulators using either a fixed or virtual remote center of motion. Successful human intraocular surgery is being performed using the Preceyes surgical system. Another telemanipulation robot, the da Vinci Surgical System, has been used to perform a pterygium repair in humans and was successful in ex-vivo corneal surgery despite its nonophthalmic design. Apart from Preceyes' BV research platform, none of the currently eye-specific systems has reached a commercial stage. Systems are likely to evolve from robotic assistance during specific procedural steps to semiautonomous surgery, as smart sensors are introduced to enhance the basic functionalities of robotic systems. Robotics is still in its infancy in ophthalmology but is rapidly reaching a stage wherein it will be introduced into everyday ophthalmic practice. It will most likely be introduced first for demanding vitreo-retinal procedures, followed by anterior segment applications.

Jin Kang: Image-guided smart surgical tools for surgery

Jin Kang: Image-guided smart surgical tools for surgery

Bio-inspired highly flexible dual-mode electronic cilia.

Inspired by biological cilia, a highly flexible dual-mode electronic cilia (EC) sensor is fabricated from graphene-coated magnetic cilia arrays. Polydimethylsiloxane is used as a matrix to make the artificial cilia flexible while Co particles are used to endow the cilia with magnetic properties and graphene coating is employed to make the cilia conductive. The EC-based sensor shows a high sensitivity of 0.4% Pa-1 for a pressure of 0-100 Pa and a low detection limit of 0.9 Pa. The responsive behavior of the EC-based sensor is highly stable in a wide frequency range of 0.1-10 Hz up to 10 000 cycles. Meanwhile, the magnetic field sensitivity of the EC sensor is around 12.08 T-1 for a magnetic field intensity of 150-160 mT. Consequently, the EC sensor is successfully applied in blood pulse monitoring, pressure and magnetic field switching, and visualized pressure and magnetic field detection. Due to its high sensitivity, high durability and dual-mode responsiveness, the flexible EC sensor goes far beyond the capability of human skin, and is believed to have great potential in healthcare, robotics, e-skin and smart surgical tools, etc.

Smart surgical tool.

A laser-induced breakdown spectroscopy (LIBS) guided smart surgical tool using a femtosecond fiber laser is developed. This system provides real-time material identification by processing and analyzing the peak intensity and ratio of atomic emissions of LIBS signals. Algorithms to identify emissions of different tissues and metals are developed and implemented into the real-time control system. This system provides a powerful smart surgical tool for precise robotic microsurgery applications with real-time feedback and control.

유연성/신축성 전극의 제조 및 특성

Flexible/stretchable electronics have recently focused, since their applications extend to emerging flexible displays, sensors, dielectric elastomer actuator and generators, and smart surgical tools. Flexible/stretchable electrodes should be synchronized with employing mechanical deformations of either flexing or stretching modes. Thus, the research area is one of the tough subjects, since the electrodes should keep their basic functions of electrodes under various mode of mechanical deformations. In this review, we discuss the recent development in the preparation and properties of such flexi- ble/stretchable electrodes.

Fluorescent PLLA-nanodiamond composites for bone tissue engineering

Superior mechanical properties, rich surface chemistry, and good biocompatibility of diamond nanoparticles make them attractive in biomaterial applications. A multifunctional fluorescent composite bone scaffold material has been produced utilizing a biodegradable polymer, poly( l-lactic acid) (PLLA), and octadecylamine-functionalized nanodiamond (ND-ODA). The uniform dispersion of nanoparticles in the polymer led to significant increase in hardness and Young’s modulus of the composites. Addition of 10%wt of ND-ODA resulted in more than 200% increase in Young’s modulus and 800% increase in hardness, bringing the nanocomposite properties close to that of the human cortical bone. Testing of ND-ODA/PLLA as a matrix supporting murine osteoblast (7F2) cell growth for up to 1 week showed that the addition of ND-ODA had no negative effects on cell proliferation. ND-ODA serves as a multifunctional additive providing improved mechanical properties, bright fluorescence, and options for drug loading and delivery via surface modification. Thus ND-ODA/PLLA composites open up numerous avenues for their use as components of bone scaffolds and smart surgical tools such as fixation devices in musculoskeletal tissue engineering and regenerative medicine. Intense fluorescence of ND-ODA/PLLA scaffolds can be used to monitor bone re-growth replacing the implant in vivo.

Integration of UWB and Wireless Pressure Mapping in Surgical Navigation

Wireless technologies are becoming more prevalent in hospital environments. An ultra-wideband (UWB) indoor tracking system is outlined, which has dynamic 3-D real-time root-mean-square error in the range of 5.24-6.37 mm using line-of-sight signals in different experiments. This high 3-D accuracy opens up many new applications to UWB indoor wireless positioning, which includes its use for tracking smart surgical tools and its ability to register relevant objects in the scene such as a spacer block for real-time pressure mapping of the femoral condyles. Experimental results quantifying the operating room (OR) environment for UWB transmission fit to the IEEE 802.15.4a channel model are included. A simulation of our UWB positioning system with interference from an IEEE 802.11a source shows the need for a front-end bandpass filter at our UWB receiver. Both microcantilever and microelectromechanical systems-based wireless pressure sensors are presented including quantitative performance metrics (e.g., hysteresis, sensitivity). The data for these sensors is transmitted over the 315- and 433.92-MHz telemetry bands. These bands are examined for their performance in the OR.

Smart surgical tools and augmenting devices

In this survey paper, the authors analyze the general structure of robotic systems for computer-assisted surgery, present a classification of such systems based on the degree of intelligence of the tools, and discuss some examples of different classes of devices. Computer-assisted surgery accelerated progress is related, on the one hand, to the improvement of medical imaging techniques and, on the other hand, to the evolution of surgical instrumentation. The integration of these two factors has determined an extraordinary progress that is not just a linear temporal development, but it is a discontinuity as regards traditional surgical procedures. Specifically, the authors consider the following classes of robotic-derived surgical devices/systems: a) handheld tools augmenting the capabilities of the surgeon; b) teleoperated surgical tools; and c) autonomous surgical robots. The paper will focus essentially on the analysis of systems and components of robots and tools designed for minimally invasive surgery. Although different classification methods exist on the basis of the clinical needs and/or on the design approach, the devices which will be illustrated in this paper are classified on the basis of their scale, degrees of freedom, autonomy, embedded intelligence, and features of the interface between the surgeon and the patient.