We describe the design and performance of a hand-held actively stabilized tool to increase accuracy in micro-surgery or other precision manipulation. It removes involuntary motion such as tremor by actuating the tip to counteract the effect of the undesired handle motion. The key components are a three-degree-of-freedom piezoelectric manipulator that has 400 μm range of motion, 1 N force capability, and bandwidth over 100 Hz, and an optical position measurement subsystem that acquires the tool pose with 4 μm resolution at 2000 samples/s. A control system using these components attenuates hand motion by at least 15 dB (a fivefold reduction). By considering the effect of the frequency response of Micron on the human visual feedback loop, we have developed a filter that reduces unintentional motion, yet preserves intuitive eye-hand coordination. We evaluated the effectiveness of Micron by measuring the accuracy of the human/machine system in three simple manipulation tasks. Handheld testing by three eye surgeons and three non-surgeons showed a reduction in position error of between 32% and 52%, depending on the error metric.

Airway secretions and infections are common in cerebral palsy and neuromuscular diseases. Chest physiotherapy is standard therapy but effort is substantial. High-frequency chest wall oscillation is used in cystic fibrosis but tolerability and safety data in cerebral palsy and neuromuscular disease are limited. A prospective, randomized, controlled trial of high-frequency chest wall oscillation and standard chest physiotherapy was performed in participants with neuromuscular disease or cerebral palsy. Outcome measures included respiratory-related hospitalizations, antibiotic therapy, chest radiographs, and polysomnography. Care-givers were questioned regarding therapy adherence. A total of 28 participants enrolled, 23 completed (12 chest physiotherapy, mean study period 5 months). No adverse outcomes were reported. Adherence to prescribed regimen was higher with high-frequency chest wall oscillation (P = .036). Our data suggest safety, tolerability, and better compliance with high-frequency chest wall oscillation. Improvement in airway clearance may help prevent hospitalizations. Larger controlled trials are required to confirm these results.

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Background and Objective-In laser retinal photocoagulation, hundreds of dot-like burns are applied. We introduce a robot-assisted technique to enhance the accuracy and reduce the tedium of the procedure.Materials and Methods-Laser burn locations are overlaid on preoperative retinal images using common patterns such as grids. A stereo camera/monitor setup registers and displays the planned burn locations overlaid on real-time video. Using an active handheld micromanipulator, a 7×7 grid of burns spaced 650 μm apart is applied to both paper slides and porcine retina in vitro using 30 ms laser pulses at 532 nm. Two scenarios were tested: unaided, in which the micromanipulator is inert and the laser fires at a fixed frequency, and aided, in which the micromanipulator actively targets burn locations and the laser fires automatically upon target acquisition. Error is defined as the distance from the center of the observed burn mark to the preoperatively selected target location.Results-An experienced retinal surgeon performed trials with and without robotic assistance, on both paper slides and porcine retina in vitro. In the paper slide experiments at an unaided laser repeat rate of 0.5 Hz, error was 125±62 μm with robotic assistance and 149±76 μm without (p < 0.005), and trial duration was 70±8 s with robotic assistance and 97±7 s without (p < 0.005). At a repeat rate of 1.0 Hz, error was 129±69 μm with robotic assistance and 166±91 μm without (p < 0.005), and trial duration was 26±4 s with robotic assistance and 47±1 s without (p < 0.005). At a repeat rate of 2.0 Hz on porcine retinal tissue, error was 123±69 μm with robotic assistance and 203±104 μm without (p < 0.005).Conclusion-Robotic assistance can increase the accuracy of laser photocoagulation while reducing the duration of the operation.

Performing micromanipulation and delicate operations in submillimeter workspaces is difficult because of destabilizing tremor and imprecise targeting. Accurate micromanipulation is especially important for microsurgical procedures, such as vitreoretinal surgery, to maximize successful outcomes and minimize collateral damage. Robotic aid combined with filtering techniques that suppress tremor frequency bands increases performance; however, if knowledge of the operator’s goals is available, virtual fixtures have been shown to further improve performance. In this paper, we derive a virtual fixture framework for active handheld micromanipulators that is based on high-bandwidth position measurements rather than forces applied to a robot handle. For applicability in surgical environments, the fixtures are generated in real-time from microscope video during the procedure. Additionally, we develop motion scaling behavior around virtual fixtures as a simple and direct extension to the proposed framework. We demonstrate that virtual fixtures significantly outperform tremor cancellation algorithms on a set of synthetic tracing tasks (p < 0.05). In more medically relevant experiments of vein tracing and membrane peeling in eye phantoms, virtual fixtures can significantly reduce both positioning error and forces applied to tissue (p < 0.05).

High-frequency chest wall oscillation was well tolerated, considered helpful by a majority of patients, and decreased symptoms of breathlessness. In patients with impaired breathing, high-frequency chest wall oscillation decreased fatigue and showed a trend toward slowing the decline of forced vital capacity.

Our contribution is utilizing data to evaluate several face overall performance for applica 2 describes our method for auto databases. Section 3 briefly ov known algorithms that section 4 metric of accuracy, speed, me size. Section 5 reports perfor suitability to an application l concludes and discusses future w Recognition Techniques for Application

Computer-aided intraocular surgery requires precise, real-time knowledge of the vasculature during retinal procedures such as laser photocoagulation or vessel cannulation. Because vitreoretinal surgeons manipulate retinal structures on the back of the eye through ports in the sclera, voluntary and involuntary tool motion rotates the eye in the socket and causes movement to the microscope view of the retina. The dynamic nature of the surgical workspace during intraocular surgery makes mapping, tracking, and localizing vasculature in real time a challenge. We present an approach that both maps and localizes retinal vessels by temporally fusing and registering individual-frame vessel detections. On video of porcine and human retina, we demonstrate real-time performance, rapid convergence, and robustness to variable illumination and tool occlusion.