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.

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Abstract-Effective employment of piezoelectric actuators in microscale dynamic trajectory-tracking applications is limited by two factors: 1) the intrinsic hysteretic behavior of piezoelectric ceramic and 2) structural vibration as a result of the actuator's own mass, stiffness, and damping properties. While hysteresis is rate-independent, structural vibration increases as the piezoelectric actuator is driven closer to its resonant frequency. Instead of separately modeling the two interacting dynamic effects, this work treats their combined effect phenomenologically and proposes a rate-dependent modified Prandtl-Ishlinskii operator to account for the hysteretic nonlinearity of a piezoelectric actuator at varying actuation frequency. It is shown experimentally that the relationship between the slope of the hysteretic loading curve and the rate of control input can be modeled by a linear function up to a driving frequency of 40 Hz.

Abstract-This paper describes research in active instruments for enhanced accuracy in microsurgery. The aim is to make accuracy enhancement as transparent to the surgeon as possible. Rather than using a robotic arm, we have taken the novel approach of developing a handheld instrument that senses its own movement, distinguishes between desired and undesired motion, and deflects its tip to perform active compensation of the undesired component. The research has therefore required work in quantification and modeling of instrument motion, filtering algorithms for tremor and other erroneous movements, and development of handheld electromechanical systems to perform active error compensation. The paper introduces the systems developed in this research and presents preliminary results.

As flexible bevel tip needles are inserted into tissue, a deflection force causes the needle to bend with a curvature dependent on relative stiffness and bevel angle. By constantly spinning the needle during insertion, the bevel angle is essentially negated and a straight trajectory can be achieved. Incorporating duty-cycled spinning during needle insertion provides proportional control of the curvature of the needle trajectory through tissue. This paper proposes a kinematic model for needle steering via duty-cycled spinning. Validation using experimental results is also presented.

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This paper presents the design and actuation of a six-degree-of-freedom (6-DOF) manipulator for a handheld instrument, known as “Micron,” which performs active tremor compensation during microsurgery. The design incorporates a Gough-Stewart platform based on piezoelectric linear motor, with a specified minimum workspace of a cylinder 4 mm long and 4 mm in diameter at the end-effector. Given the stall force of the motors and the loading typically encountered in vitreoretinal microsurgery, the dimensions of the manipulator are optimized to tolerate a transverse load of 0.2 N on a remote center of motion near the midpoint of the tool shaft. The optimization yields a base diameter of 23 mm and a height of 37 mm. The fully handheld instrument includes a custom-built optical tracking system for control feedback, and an ergonomic housing to serve as a handle. The manipulation performance was investigated in both clamped and handheld conditions. In positioning experiments with varying side loads, the manipulator tolerates side load up to 0.25 N while tracking a sinusoidal target trajectory with less than 20 μm error. Physiological hand tremor is reduced by about 90% in a pointing task, and error less than 25 μm is achieved in handheld circle-tracing.

Abstract-Applied force was measured in vivo during vitreoretinal surgery in rabbits, in three types of task: membrane peeling, vessel puncture/cannulation, and vessel dissection. Quantitative results are presented and compared with similar measurements taken in vitro in a porcine retina, in which no scleral interaction is present.