Soft continuum manipulators have the potential to replace traditional surgical catheters; offering greater dexterity with access to previously unfeasible locations for a wide range of interventions including neurological and cardiovascular. Magnetically actuated catheters are of particular interest due to their potential for miniaturization and remote control. Challenges around the operation of these catheters exist however, and one of these occurs when the angle between the actuating field and the local magnetization vector of the catheter exceeds 90°. In this arrangement, deformation generated by the resultant magnetic moment acts to increase magnetic torque, leading to potential instability. This phenomenon can cause unpredictable responses to actuation, particularly for soft, flexible materials. When coupled with the inherent challenges of sensing and localization inside living tissue, this behavior represents a barrier to progress. In this feasibility study we propose and investigate the use of helical fiber reinforcement within magnetically actuated soft continuum manipulators. Using numerical simulation to explore the design space, we optimize fiber parameters to enhance the ratio of torsional to bending stiffness. Through bespoke fabrication of an optimized helix design we validate a single, prototypical two-segment, 40 mm × 6 mm continuum manipulator demonstrating a reduction of 67% in unwanted twisting under actuation.

Flexible endoscopy involves the insertion of a long narrow flexible tube into the body for diagnostic and therapeutic procedures. In the gastrointestinal (GI) tract, flexible endoscopy plays a major role in cancer screening, surveillance, and treatment programs. As a result of gas insufflation during the procedure, both upper and lower GI endoscopy procedures have been classified as aerosol generating by the guidelines issued by the respective societies during the COVID-19 pandemic—although no quantifiable data on aerosol generation currently exists. Due to the risk of COVID-19 transmission to healthcare workers, most societies halted non-emergency and diagnostic procedures during the lockdown. The long-term implications of stoppage in cancer diagnoses and treatment is predicted to lead to a large increase in preventable deaths. Robotics may play a major role in this field by allowing healthcare operators to control the flexible endoscope from a safe distance and pave a path for protecting healthcare workers through minimizing the risk of virus transmission without reducing diagnostic and therapeutic capacities. This review focuses on the needs and challenges associated with the design of robotic flexible endoscopes for use during a pandemic. The authors propose that a few minor changes to existing platforms or considerations for platforms in development could lead to significant benefits for use during infection control scenarios.

Soft magnetic manipulators offer the prospect of improved surgical outcomes through their potential for miniaturization and inherently safe tissue interaction. However, independent actuation of multiple manipulators within the same confined workspace is limited by undesired simultaneous actuation and manipulator–manipulator interactions. Herein, for the first time, approaches for the independent magnetic actuation of two magnetic continuum manipulators within the same confined workspace are proposed. A novel modular magnetic soft robot segment design is proposed with modified geometry to provide preferential bending planes and high angles of deflection. This design is integrated into two dual‐segment magnetic manipulators which, when arranged in parallel, can deliver independent bending in two planes of motion. Two distinct independent control strategies are proposed, based on orthogonal manipulator magnetization profiles and local field gradient control, respectively. Each dual‐manipulator configuration is characterized over a sequence of applied magnetic fields and gradients, induced via a dual robotically controlled external permanent magnet system. Manipulator independence, bending range of motion, and twisting behaviors are evaluated as a function of control strategy and manipulator separation distance. To demonstrate the system's potential in clinical scenarios, a dual‐manipulator configuration is adapted to carry an endoscopic camera and optic fiber, respectively. The resultant bimanual system is deployed in the confined anatomy of a skull‐base phantom to simulate minimally invasive ablation of a pituitary adenoma. Independent motion of the camera and tool within the confined workspace demonstrate the potential for an independent magnetic tool manipulation for surgical applications.

Lung cancer remains one of the most life-threatening diseases and is currently managed through invasive approaches such as surgery, chemo- or radiotherapy. In this work, we introduce a novel method for the targeted delivery of a therapeutic laser for the treatment of tumors in peripheral areas of the lungs. The approach uses a 2.4 mm diameter, ultra-soft, patient-specific magnetic catheter delivered from the end of a standard bronchoscope to reach the periphery of the lungs. Integrated shape sensing facilitates supervised autonomous full-shape control for precise navigation into the sub-segmental bronchi, and an embedded laser fiber allows for treatment via localized energy delivery. We report the complete navigation of eight primary lumina in the bronchi of an anatomically accurate phantom (developed from computed tomography (CT) data) and successful laser delivery for photothermal ablation. We further evaluate the approach in three diverse branches of excised cadaveric lungs, showing a mean improvement in navigation depth of 37% with less tissue displacement when compared to a standard semi-rigid catheter and navigation depth repeatability across all tests of <1 mm.