Endoscopic procedures have transformed minimally invasive surgery as they allow the examination and intervention on a patient’s anatomy through natural orifices, without the need for external incisions. However, the complexity of anatomical pathways and the limited dexterity of existing instruments, limit such procedures mainly to diagnosis and biopsies. This paper proposes a new robotic platform: the Intuitive imaging sensing navigated and kinematically enhanced () robot that aims to improve the field of endoscopic surgery. The proposed robotic platform includes a snake-like robotic endoscope equipped with a camera, a light-source and two robotic instruments, supported with a robotic arm for global positioning and for insertion of the and a master interface for master–slave teleoperation. The proposed robotic platform design focuses on ergonomics and intuitive control. The control workflow was first validated in simulation and then implemented on the robotic platform. The results are consistent with the simulation and show the clear clinical potential of the system. Limitations such as tendon backlash and elongation over time will be further investigated by means of combined hardware and software solutions. In conclusion, the proposed system contributes to the field of endoscopic surgical robots and could allow to perform more complex endoscopic surgical procedures while reducing patient trauma and recovery time.

PurposeIn microsurgery, accurate recovery of the deformation of the surgical environment is important for mitigating the risk of inadvertent tissue damage and avoiding instrument maneuvers that may cause injury. The analysis of intraoperative microscopic data can allow the estimation of tissue deformation and provide to the surgeon useful feedback on the instrument forces exerted on the tissue. In practice, vision-based recovery of tissue deformation during tool–tissue interaction can be challenging due to tissue elasticity and unpredictable motion.MethodsThe aim of this work is to propose an approach for deformation recovery based on quasi-dense 3D stereo reconstruction. The proposed framework incorporates a new stereo correspondence method for estimating the underlying 3D structure. Probabilistic tracking and surface mapping are used to estimate 3D point correspondences across time and recover localized tissue deformations in the surgical site.ResultsWe demonstrate the application of this method to estimating forces exerted on tissue surfaces. A clinically relevant experimental setup was used to validate the proposed framework on phantom data. The quantitative and qualitative performance evaluation results show that the proposed 3D stereo reconstruction and deformation recovery methods achieve submillimeter accuracy. The force–displacement model also provides accurate estimates of the exerted forces.ConclusionsA novel approach for tissue deformation recovery has been proposed based on reliable quasi-dense stereo correspondences. The proposed framework does not rely on additional equipment, allowing seamless integration with the existing surgical workflow. The performance evaluation analysis shows the potential clinical value of the technique.

Abstract-The field of robotic surgery increasingly advances towards highly articulated and continuum robots, requiring new kinematic strategies to enable users to perform dexterous manipulation in confined workspaces. This development is driven by surgical interventions accessing the surgical workspace through natural orifices such as the mouth or the anus. Due to the long and narrow nature of these access pathways, external triangulation at the fulcrum point is very limited or absent, which makes introducing multiple degrees of freedom at the distal end of the instrument necessary. Additionally, high force and miniaturization requirements make the control of such instruments particularly challenging. This paper presents the kinematic considerations needed to effectively manipulate these novel instruments and allow their dexterous control in confined spaces. A non-linear calibration model is further used to map joint to actuator space and improve significantly the precision of the instrument's motion. The effectiveness of the presented approach is quantified with bench tests, and the usability of the system is assessed by three user studies simulating the requirements of a realistic surgical task.

Abstract-This paper introduces a single-port robotic platform for Transanal Endoscopic Micro-Surgery (TEMS). Two robotically controlled articulated surgical instruments are inserted via a transanal approach to perform submucosal or fullthickness dissection. This system is intended to replace the conventional TEMS approach that uses manual laparoscopic instruments. The new system is based on master-slave robotically controlled tele-manipulation. The slave robot comprises a support arm that is mounted on the operating table, supporting a surgical port and a robotic platform that drives the surgical instruments. The master console includes a pair of haptic devices, as well as a 3D display showing the live video stream of a stereo endoscope inserted through the surgical port. The surgical instrumentation consists of energy delivery devices, graspers and needle drivers allowing a full TEMS procedure to be performed. Results from benchtop tests, ex-vivo animal tissue evaluation and in-vivo studies demonstrate the clinical advantage of the proposed system.

Abstract-Concentric tube robots are catheter-sized robots that can navigate natural pathways to reach deep anatomical locations. Their intraoperative telemanipulation in dynamic environments requires on-line computation of inverse kinematics with simultaneous avoidance of anatomical collisions. Moreover, unstable configurations, which arise for elongated curved robots that navigate extremely tortuous paths, must be avoided. This paper leverages state-of-the-art multi-core computer architectures to deliver real-time inverse kinematics solutions that avoid robot instabilities and anatomical collisions. Furthermore, it introduces frictional active constraints to concentric tube robots for intraoperative assistance in navigation. Our framework is evaluated in silico through clinical scenarios from heart surgery and neurosurgery.