To continue pushing the boundaries of healthcare, surgeons look to new tools that will help them perform quicker procedures and do so with the least amount of postprocedure trauma to the patient. [1] Safe interaction with healthy tissue is of great importance when it comes to regions of the body, such as the lungs or the brain, which require low-force interactions during surgery. [2] Minimally invasive surgery (MIS) has become a common technique in these regions of the body for its benefits of less patient pain, quicker recovery times, and less scarring. [3][4][5] Lung cancer is estimated to cause 130 180 deaths in the United States in 2022, continuing to make it the leading cause of cancer-related deaths. [6,7] Traditionally, a flexible bronchoscope is guided to the tumor site to perform tissue biopsy; however, there remains significant variability in diagnostic accuracy from 36% to 88%. Furthermore, the standard % 6mm diameter of the scope diminishes the capabilities of this technique as the majority of lesions lie in the periphery of the lung accessed only by small airways beyond the bronchoscope's reach. [8] The breathing motion, associated with normal bodily function, may contribute to variation in accuracy, changing the position of the target area throughout the entire procedure by an average of 17.6 mm depending on its location in the lungs. [9] This affects the diagnostic yield of the procedure to different degrees, with yields as low as 13.5% being common for tumors smaller than 2 cm. [9] Ultrathin, manually driven scopes have been developed at % 3mm diameters to reach deeper in the lungs; however, they require a flexible needle to be used in their single working channel, which sacrifices force transmission for the dexterity necessary to reach deeper into the lung. [10] To address the shortcomings of those traditional MIS techniques, advancements in robotic tools have been introduced over the past decade. [11] Continuum robots are employed for this task due to their added dexterity and ease of scaling. [12] Commercial platforms have been developed with these robots, such as the Auris Monarch (Auris Health Inc. CA, USA), Ion Endoluminal System (Intuitive Surgical CA, USA), Noah Medical Galaxy (Noah Medical, CA, USA), and Illumisite (Medtronic MN, USA) for bronchoscopies, and have eased procedures with image-guided teleoperation, alleviating the physical effort required by surgeons. [11,13,14] Commercial systems like these have proven scalability with diameters of 4.2 mm for the Monarch and 3.5 mm for the Ion and Noah Medical Galaxy (Noah Medical, CA, USA). [15] Concentric tube robots have been developed using individually controlled, precurved tubes as an easily scaled alternative that can transmit sufficient forces due to the use of metal materials. [16][17][18] Soft robots have recently been introduced as an alternative to traditional MIS robots due to their advantages of inherently safe

Metallic tools such as graspers, forceps, spatulas, and clamps have been used in proximity to delicate neurological tissue and the risk of damage to this tissue is a primary concern for neurosurgeons. Novel soft robotic technologies have the opportunity to shift the design paradigm for these tools towards safer and more compliant, minimally invasive methods. Here, we present a pneumatically actuated, origami-inspired deployable brain retractor aimed at atraumatic surgical workspace generation inside the cranial cavity. We discuss clinical requirements, design, fabrication, analytical modeling, experimental characterization, and in-vitro validation of the proposed device on a brain model.

Lung cancer has long been one of the deadliest forms of cancer in large part due to the difficulty in diagnosis when at its earlier stages [1]. Because of their large diameter (i.e., ≈ 6 mm) preventing them from navigating in the peripheral lung, traditional bronchoscopes used in minimally invasive biopsy encounter difficulty when trying to reach smaller, deep-seated lesions [2]. Robotic solutions have been developed to address these limitations in surgical navigation. Commercial robotic bronchoscopy systems, like the Auris Monarch™ and Intuitive Ion™ , con- sist of tendon-actuated continuum robots which focus on navigation and biopsy deeper into the lung periphery [3]. Soft robots present a promising alternative to these commercial robotic systems due to their scalability, in- herent flexibility, and potential for safer interactions with biological tissue, making them well-suited for procedures in the peripheral lung [4]. Furthermore, the materials used in soft robotics are generally more economical and allow seamless integration of soft robotic actuation and sensing mechanisms. Exploration of various actuation methods, such as magnetic and fluidic, have demonstrated navigation capabilities in hard-to-reach areas of the lung and the ability to integrate useful tools, such as needles and cameras [5], [6]. However, with miniaturization, the ability of soft robots to transmit forces and interact with the surrounding biological tissue diminishes. We propose a 3.5 mm diameter soft robot with em- bedded degrees of freedom (DOFs) for tip steering, tip stabilization, and needle deployment for tissue biopsy in bronchoscopy procedures (Fig. 1). Via soft actuators embedded in its continuum body, the robot can navigate through the lung branches to the target lesion and anchor itself within an anatomical channel. After anchoring, a needle may be deployed from the robot tip using an origami-inspired soft actuator to puncture the target lesion and take a biopsy. The fluidic actuated DOFs embedded in the proposed robot seek to reach deeper into the lungs, actively increase force transmission at the millimeter scale, and distally control the biopsy needle laying the framework for enhanced surgical capabilities in minimally invasive bronchoscopy procedures.