Vascular Interventional Robot Research Articles

A Novel Caterpillar-Inspired Vascular Interventional Robot Navigated by Magnetic Sinusoidal Mechanism

Magnetic soft continuum robots (MSCRs) hold significant potential in fulfilling the requirements of vascular interventional robots, enabling safe access to difficult-to-reach areas with enhanced active maneuverability, shape morphing capabilities, and stiffness variability. Their primary advantage lies in their tether-less actuation mechanism that can safely adapt to complex vessel structures. Existing commercial MSCRs primarily employ a magnetic-pull strategy, which suffers from insufficient driving force and a single actuation strategy, limiting their clinical applicability. Inspired by the inchworm crawling locomotion gait, we herein present a novel MSCR that integrates a magnetic sinusoidal actuation mechanism with adjustable frequency and kirigami structures. The developed MSCRs consist of two permanent magnets connected by a micro-spring, which is coated with a silicone membrane featuring a specific notch array. This design enables bio-inspired crawling with controllable velocity and active maneuverability. An analytical model of the magnetic torque and finite element analysis (FEA) simulations of the MSCRs has been constructed. Additionally, the prototype has been validated through two-dimensional in-vitro tracking experiments with actuation frequencies ranging from 1 to 10 Hz. Its stride efficiency has also been verified in a three-dimensional (3D) coronary artery phantom. Diametrically magnetized spherical chain tip enhances active steerability. Kirigami skin is coated over the novel guidewire and catheter, not only providing proximal anchorage for improved stride efficiency but also serving similar function as a cutting balloon. Under the actuation of an external magnetic field, the proposed MSCRs demonstrate the ability to traverse bifurcations and tortuous paths, indicating their potential for dexterous flexibility in pathological vessels.

Design and evaluation of vascular interventional robot system for complex coronary artery lesions.

At present, most vascular intervention robots cannot cope with the more common coronary complex lesions in the clinic. Moreover, the lack of effective force feedback increases the risk of surgery. In this paper, a vascular interventional robot that can collaboratively deliver multiple interventional instruments has been developed to assist doctors in the operation of complex lesions. Based on the doctor's skills and the delivery principle of interventional instruments, the main and slave manipulators of the robot system are designed. Haptic force feedback is generated through resistance measuring mechanism and active drag system. In addition, a force feedback control strategy based on force-velocity mapping is proposed to realize the continuous change of force and avoid vibration. The proposed robot system was evaluated through a series of experiments. The experimental results show that the system can accurately measure the delivery resistance of interventional instruments, and provide haptic force feedback to doctors. The capability of the system to collaboratively deliver multiple interventional instruments is effective. Therefore, it can be considered that the robot system is feasible and effective.

Technical and Clinical Progress on Robot-Assisted Endovascular Interventions: A Review.

Prior methods of patient care have changed in recent years due to the availability of minimally invasive surgical platforms for endovascular interventions. These platforms have demonstrated the ability to improve patients' vascular intervention outcomes, and global morbidities and mortalities from vascular disease are decreasing. Nonetheless, there are still concerns about the long-term effects of exposing interventionalists and patients to the operational hazards in the cath lab, and the perioperative risks that patients undergo. For these reasons, robot-assisted vascular interventions were developed to provide interventionalists with the ability to perform minimally invasive procedures with improved surgical workflow. We conducted a thorough literature search and presented a review of 130 studies published within the last 20 years that focused on robot-assisted endovascular interventions and are closely related to the current gains and obstacles of vascular interventional robots published up to 2022. We assessed both the research-based prototypes and commercial products, with an emphasis on their technical characteristics and application domains. Furthermore, we outlined how the robotic platforms enhanced both surgeons' and patients' perioperative experiences of robot-assisted vascular interventions. Finally, we summarized our findings and proposed three key milestones that could improve the development of the next-generation vascular interventional robots.

Initial experience in the treatment of lower extremity arterial occlusive disease using a universal vascular interventional surgery robotic system

BackgroundThis study aims to report the treatment process and results of the first officially published robotic peripheral vascular interventional surgery for lower extremity arterial occlusion in China. After a literature search, no domestic or foreign research reports have been found that share the same research content and innovation points. MethodsA 77-year-old female patient with intermittent claudication received drug balloon dilatation using a universal vascular interventional surgery robotic system on June 17, 2023, at Peking Union Medical College Hospital (PUMCH). ResultsWith the help of the vascular interventional robot, the operation successfully re-opened the patient's nearly occluded blood vessel, and the patient's discomfort symptoms were relieved. The total operation lasted 60 ​min, which time was similar to surgeries without robots. The postoperative hospital stay was 2 days. ConclusionThis case has preliminarily verified the effectiveness and safety of vascular interventional robotic surgery. The initial study fills in the gaps in related fields and lays a solid foundation for the future development of universal vascular interventional robots. Larger scale trials and more clinical trials are needed to test and support the clinical application of universal vascular interventional robots.

Design and Performance Evaluation of a Novel Slave System for Endovascular Tele-Surgery

Vascular interventional robots have attracted growing attention in recent years. However, current vascular interventional robot systems generally lack force feedback and cannot quickly clamp the catheter/guidewire. The structure of slave systems is unstable and the power transmission is imprecise, increasing the system’s safety hazards. Vascular intervention robots generally do not follow traditional surgeons’ operation habits and, thus, it is not easy for them to understand and learn how to operate. Therefore, a novel vascular intervention system is proposed. The slave system can quickly clamp the catheter/guidewire, is compatible with various standard catheter/guidewire sizes, has precise power transmission, and has a stable structure. The surface of the catheter/guidewire is clamped without damage. Whether it is on the master side or the slave side, it follows the habits of traditional operators to a great extent. The results show that the measurement accuracy of the axial force meets the requirements of robot-assisted surgery and the system can track the designed position of the catheter/guidewire in real time. This study makes a certain contribution to the development of master–slave systems for endovascular tele-surgery.

Multilevel Operation Strategy of a Vascular Interventional Robot System for Surgical Safety in Teleoperation

Remote-controlled vascular interventional robots have great potential for use in minimally invasive vascular surgeries in recent years due to their ability to reduce the occupational risk of surgeons and improve the stability and accuracy of surgical procedures. However, blood vessels will suffer from the damage caused by collision with medical instruments to some extent even though the surgeries are very successful. Moreover, when surgeons perform unsafe operations, the unsafe operations will not only seriously affect surgical safety (or even cause serious complications) but also restrict the continuity of operation. In this article, a multilevel concept for operating force is first introduced into surgical procedures as a reference for the choice and design of operation strategies. Based on this concept, a novel multilevel operation strategy is first proposed to reduce blood vessel damage, ensure surgical safety, and allow for continuous operation. This strategy can remind surgeons about the operative conditions in real-time, reduce collision to blood vessels, and eliminate unsafe operations online. A prototype was fabricated and calibrated through calibration experiments and the performance of the multilevel operation strategy was validated through <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">in vitro</i> and <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ex vivo</i> experiments. Experimental results demonstrate the engineering effectiveness of the proposed method and motivate the need for further <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">in vivo</i> studies to evaluate improvement on surgical safety.

A Survey on the Progress of Computer-Assisted Vascular Intervention

Vascular diseases seriously threaten human health. As a commonly used minimally invasive surgery, vascular interventional diagnosis and treatment faces a variety of clinical burdens, so the support of computer-aided technology is urgently needed. In recent years, the rapid development of extravascular and intravascular medical imaging technology and artificial intelligence methods has promoted the related research of computer-assisted vascular intervention technology. The organic relationship between the basic content and key technologies of computer-assisted vascular intervention and its applications are reviewed and systematically analyzed, including multi-modal medical angiography image analysis, catheter guide wire position tracking, vascular associated lesion characteristics, morphological recognition, and other hot issues, and the relationships between the above contents and surgical planning and surgical navigation are analyzed. It is concluded that the clinical application trend in this field is to combine the integration of diagnosis and treatment with vascular interventional robot technology. Through the analysis of research status and development trends, it is concluded that the challenges faced by various research content are: the accuracy of the segmentation model to quantify the vascular structure and the completeness of topology extraction, intervention path vectorization and accuracy of multimodal information fusion, correlation between vascular anatomical labeling and surgical path navigation, and the level and evaluation method of human-computer interaction in vascular intervention. Analysis shows that in the process of solving these problems, the artificial intelligence diagnosis and treatment technology will continue to be promoted, especially the rapid development and clinical application of robot-assisted vascular intervention.

Cloud Communication-Based Sensing Performance Evaluation of a Vascular Interventional Robot System

As an essential method for diagnosing and treating cardiovascular and cerebrovascular diseases, interventional surgery has always been a research hotspot in biomedical engineering research. The vascular interventional robot can improve the surgical environment of the surgeon and improve the safety and stability of the operation when assisting the surgeon to complete the surgical operation. In today&#x2019;s global pandemic phenomena, the study of operating vascular interventional robots in remote situations is of more significant value. Based on the previous animal experiments and clinical trials, this paper presents a preliminary study of the interventional robot to complete surgery operations under the condition of long-distance cloud communication. After analyzing the influence of time delay in remote operation, a control strategy for predicting time delay was proposed, and an evaluation experiment was conducted. Through the human model evaluation, the sensing performance of robotic surgery under the condition of long-distance cloud communication is analyzed and compared with the experiments in previous studies. The experimental results show that the operator can remotely control the robot to complete the intubation operation, which is valuable for further study and animal experiments.

Research on real-time detection system of catheter delivering force in vascular interventional robots

In existing vascular interventional surgical robots, it is difficult to accurately detect the delivery force of the catheter/guidewire at the slave side. Aiming to solve this problem, a real-time force detection system was designed for vascular interventional surgical (VIS) robots based on catheter push force. Firstly, the transfer process of catheter operating forces in the slave end of the interventional robot was analyzed and modeled, and the design principle of the catheter operating force detection system was obtained. Secondly, based on the principle of stress and strain, a torque sensor was designed and integrated into the internal transmission shaft of the slave end of the interventional robot, and a data acquisition and processing system was established. Thirdly, an ATI high-precision torque sensor was used to build the experimental platform, and the designed sensor was tested and calibrated. Finally, sensor test experiments under ideal static/dynamic conditions and simulated catheter delivery tests based on actual human computed tomography (CT) data and vascular model were carried out. The results showed that the average relative detection error of the designed sensor system was 1.26% under ideal static conditions and 1.38% under ideal dynamic stability conditions. The system can detect on-line catheter operation force at high precision, which is of great significance towards improving patient safety in interventional robotic surgery.

Machine Learning-Based Surgical State Perception and Collaborative Control for a Vascular Interventional Robot

In robot-assisted vascular interventional surg- ery (VIS), surgeons often need to operate outside the operating room to avoid exposure to X-ray. However, it greatly changes the operating ways of surgeons, which affects judgment and operation safety. In this paper, a novel VIS robot system was developed to predict guidewire insertion states and operate collaboratively. To assist the surgeons in perceiving the insertion state, an insertion multi-states prediction model based on softmax logistic regression was proposed. Combined with the prediction model, a human-machine collaborative control strategy was designed, which allows surgeons to perceive the insertion states based on not only the force feedback constructed by the master side but also the prediction results from the slave side. Moreover, a human-machine trust evaluation model and a master-slave collaborative mapping model were proposed for improving safety and efficiency of surgery. To verify the effectiveness of these models, the evaluation experiments in the blood vessel model were carried out. It was indicated by the experiment results that the guidewire insertion states can be predicted by the prediction model in different environments, and the overall accuracy is 93%. The master-slave mapping ratio can be adjusted by the collaborative control strategy automatically to adapt to different surgical conditions. The experimental results showed the usability of the robot-assisted VIS system with the novel force-based perception method.

Remote vascular interventional surgery robotics: a literature review.

Vascular interventional doctors are exposed to radiation hazards during surgery and endure high work intensity. Remote vascular interventional surgery robotics is a hot research field, in which researchers aim to not only protect the health of interventional doctors, but to also improve surgical accuracy and efficiency. However, the current vascular interventional robots have numerous shortcomings, such as poor haptic feedback, few compatible surgeries and instruments, and cumbersome maintenance and operational procedures. Nevertheless, vascular interventional surgery combined with robotics provides more cutting-edge directions, such as Internet remote surgery combined with 5G network technology and the application of artificial intelligence in surgical procedures. To summarize the developmental status and key technical points of intravascular interventional surgical robotics research, we performed a systematic literature search to retrieve original articles related to remote vascular interventional surgery robotics published up to December 2020. This review, which includes 113 articles published in English, introduces the mechanical and structural characteristics of various aspects of vascular interventional surgical robotics, discusses the current key features of vascular interventional surgical robotics in force sensing, haptic feedback, and control methods, and summarizes current frontiers in autonomous surgery, long-distance robotic telesurgery, and magnetic resonance imaging (MRI)-compatible structures. On the basis of summarizing the current research status of remote vascular interventional surgery robotics, we aim to propose a variety of prospects for future robotic systems.

A Novel Remote-Controlled Vascular Interventional Robotic System Based on Hollow Ultrasonic Motor.

Cardiovascular diseases (CVDs) are the deadliest diseases worldwide. Master-slave robotic systems have been widely used in vascular interventional surgery with the benefit of high safety, efficient operation, and procedural facilitation. This paper introduces a remote-controlled vascular interventional robot (RVIR) that aims to enable surgeons to perform complex vascular interventions reliably and accurately under a magnetic resonance imaging (MRI) environment. The slave robot includes a guidewire manipulator (GM) and catheter manipulator (CM) that are mainly composed of a hollow driving mechanism and a linear motion platform. The hollow driving mechanism is based on a traveling wave-type hollow ultrasonic motor (HUM) which has high positional precision, fast response, and magnetic interference resistance and realizes the cooperation of the guidewire and catheter by omitting the redundant transmission mechanism and maintaining good coaxiality. The HUM stator, the core part of the RVIR, is optimized by an adaptive genetic algorithm for better quality and greater amplitude of traveling waves, which are beneficial to the drive efficiency and precision. The robot system features great cooperating performance, small hysteresis, and high kinematic accuracy and has been experimentally verified for its capability to precisely manipulate the guidewire and catheter.

Research on a Novel Vascular Interventional Surgery Robot and Control Method Based on Precise Delivery

In a vascular interventional surgery robot system, accurately pushing the guidewire into the patient-specific branch vessel is the core step of the entire operation, so it has become the focus of the master-slave co-control of the guidewire propulsion and manipulation mechanism. Some vascular interventional surgery robots have been used for delivery of the guidewire; however, problems such as the inability to reliably clamp the guidewire and the lack of accurate force feedback prevent doctors from using robots for accurate delivery. In addition, failure to disinfect surgical robots quickly and completely increases the risk of surgery. This article introduces a new type of master-slave vascular interventional robot with reliable clamping of the catheter/guidewire, accurate perception of the lead-in force of the guidewire for precise delivery and fast disinfection. In response to the problem of the nonlinear and uncertain disturbance of the catheter/guidewire resistance affecting the delivery mechanism, an adaptive sliding controller based on master-slave tracking is designed. Through experiments and analysis of the fuzzy sliding mode controller (FSMC) experimental platform, the results show that a vascular interventional robot control system with good tracking performance and strong robustness has been designed.

Advantage of Steerable Catheter and Haptic Feedback for a 5-DOF Vascular Intervention Robot System

Vascular intervention involves inserting a catheter and guidewire into blood vessels to diagnose and treat a disease in an X-ray environment. In this conventional vascular intervention procedure, the doctor is exposed to considerable radiation. To reduce the exposure, we developed a master–slave robot system. A steerable catheter is employed to shorten the task-time and reduce the contact force applied to the vessel walls during catheter insertion. The steerable catheter helps to select a vascular branch; thus, the radiation exposure time for patients is reduced, and perforation in the patient’s vessel is prevented. Additionally, the robot system employs a haptic function to replicate the physician’s tactile sensing in vascular intervention. In this study, the effectiveness of the steering catheter and haptic function was demonstrated experimentally in comparison with a conventional catheter.

Design and evaluation of sensorized robot for minimally vascular interventional surgery

Remote-controlled vascular interventional robots (RVIRs) are being developed to reduce the occupational risk of the intervening physician, such as radiation, chronic neck and back pain, and increase the accuracy and stability of surgery operation. The collision between the catheter/guidewire tip and blood vessels during the surgery practice is important for minimally invasive surgery because the success of the surgery mainly depends on the detection of collisions. In this study, we propose a novel sensing principle and fabricate a sensorized RVIR. The proposed sensorized RVIR can accurately detect force and reconstruct force feedback. The performance of the proposed sensorized RVIR is evaluated through experiments. The experiment results show that it can accurately measure static force and time-varying force. Subtle force changes caused by changes of movement direction in surgeries can also be detected. In addition, the proposed sensorized RVIR has higher operation efficiency than our previous prototype.

Endovascular intervention robot with multi-manipulators for surgical procedures: Dexterity, adaptability, and practicability

Abstract In this research, a novel vascular intervention robot with four manipulators that mimic the four hands of a physician and an assistant was designed for peripheral vessels. Each manipulator has three DOFs (degrees of freedom), namely, clamping, rotation, and push–pull of a guide wire and catheters. Manipulation is accomplished by four corresponding joysticks. A distributed control system is used to coordinate complex motions with high accuracy in real time. This robot can not only manipulate intervention devices but also deploy stents. We performed in-vitro experiments to verify the precise velocity and driving force. A complete endovascular intervention procedure in an in-vivo pig with the successful deployment of three stents and zero radiation damage to the surgeon validated the design. Results showed that the robot had high dexterity, precision, and efficiency, thereby meeting the demands of endovascular intervention surgical procedures.

Compensatory force measurement and multimodal force feedback for remote-controlled vascular interventional robot

Minimally invasive vascular interventional surgery is widely used and remote-controlled vascular interventional surgery robots (RVIRs) are being developed to reduce the occupational risk of the intervening physician in minimally invasive vascular interventional surgeries. Skilled surgeon performs surgeries mainly depending on the detection of collisions. Inaccurate force feedback will be difficult for surgeons to perform surgeries or even results in medical accidents. In addition, the surgeon cannot quickly and easily distinguish whether the proximal force exceeds the safety threshold of blood vessels or not, and thus it results in damage to the blood vessels. In this paper, we present a novel method comprising compensatory force measurement and multimodal force feedback (MFF). Calibration experiments and performance evaluation experiments were carried out. Experimental results demonstrated that the proposed method can measure the proximal force of catheter/guidewire accurately and assist surgeons to distinguish the change of proximal force more easily. This novel method is suitable for use in actual surgical operations.

Operation evaluation in-human of a novel remote-controlled vascular interventional robot.

Remote-controlled vascular interventional robots (RVIRs) are being developed to increase the accuracy of surgical operations and reduce the number of occupational risks sustained by intervening physicians, such as radiation exposure and chronic neck/back pain. However, complex control of the RVIRs improves the doctor's operation difficulty and reduces the operation efficiency. Furthermore, incomplete sterilization of the RVIRs will increase the risk of infection, or even cause medical accidents. In this study, we introduced a novel method that provides higher operation efficiency than a previous prototype and allows for complete robot sterilization. A prototype was fabricated and validated through laboratory setting experiments and an in-human experiment. The results illustrated that the proposed RVIR has better performance compared with the previous prototype, and preliminarily demonstrated that the proposed RVIR has good safety and reliability and can be used in clinical surgeries.

A cooperation of catheters and guidewires-based novel remote-controlled vascular interventional robot.

Remote-controlled vascular interventional robots (RVIRs) are being developed to increase the overall accuracy of surgical operations and reduce the occupational risks of intervening physicians, such as radiation exposure and chronic neck/back pain. Several RVIRs have been used to operate catheters or guidewires accurately. However, a lack of cooperation between the catheters and guidewires results in the surgeon being unable to complete complex surgery by propelling the catheter/guidewire to the target position. Furthermore, it is a significant challenge to operate the catheter/guidewire accurately and detect their proximal force without damaging their surfaces. In this study, we introduce a novel method that allows catheters and guidewires to be operated simultaneously in complex surgery. Our method accurately captures force measurements and enables precisely controlled catheter and guidewire operation. A prototype is validated through various experiments. The results demonstrate the feasibility of the proposed RVIR to operate a catheter and guidewire accurately, detect the resistance forces, and complete complex surgical operations in a cooperative manner.

Research on motion signal capture accuracy of master manipulator for vascular interventional robot

Research on motion signal capture accuracy of master manipulator for vascular interventional robot