Force adaptive robotically assisted endomicroscopy for intraoperative tumour identification

Abstract

Purpose: For effective tumour margin definition for cancer surgery, there is an increasing demand for the development of real-time intraoperative tissue biopsy techniques. Recent advances in miniaturized biophotonics probes have permitted the development of endomicroscopy techniques that are clinically attractive. With these approaches, cellular-level imaging can be achieved through millimetre-scale flexible probes, and be performed in real-time, in vivo and in situ. Due to the limited field-of-view and flexibility of these probes, however, large area tissue coverage for acquiring histology-like images over complex three-dimensional surfaces is challenging. This is particularly the case because current surgical robots, such as the Da Vinci®, lack haptic feedback, making it difficult to maintain optimum tissue contact when these probes are deployed in vivo.Methods: This paper proposes a simple force-controlled pick-up probe that can be integrated with the Da Vinci instruments for intraoperative endomicroscopy imaging. The device uses a new lowfriction air bearing with adaptive axial force control to maintain constant contact between the tissue and the imaging probe, facilitating microscopy scans over complex surfaces. Detailed ex vivo user experiments have been conducted to demonstrate the effectiveness of the technique.Results: The adaptive probe mount could achieve consistent low magnitude probe-sample contact forces compared to a rigid mount. In the user study, the adaptive probe combined with a high frame rate endomicroscopy system allowed larger mosaics to be generated over curved surfaces.Conclusion: The device can improve the performance of large area mosaicking over complex 3D surfaces with improved handling and intraoperative control.

Endomicroscopy for Computer and Robot Assisted Intervention

“…Coupled with the context of the imaging environment, and real-time methods are necessary Elad et al [66] Mixed L1/L2 optimisation methods to promote sparsity Molina et al [67] Hierarchical variational Bayesian methods to approximate the posterior Pickup et al [68] Integration of registration uncertainty Noonan et al [87] Force adaptive with an embedded 6-axis force/torque sensor (ATI Nano17) Giataganas et al [88] Force-contact probe for integration with surgical robot platforms(da Vinci) Latt et al [89,90] Embedded force sensing into imaging probe Gilbertson et al [91] Incorporate intelligent force control schemes for imaging probe Ang et al [92], Becker et al [93], Maclachlan et al [94] Incorporating tremor cancellation by using piezoelectric actuators combined with visual servoing…”

“…A force-contact probe for integration with surgical robot platforms such as the da Vinci was developed by Giataganas et al [88]. This paper proposed a force-controlled pick-up probe that can be integrated with the Da Vinci instruments for intraoperative endomicroscopy imaging.…”

Imaging breast cancer morphology using probe-based confocal laser endomicroscopy: towards a real-time intraoperative imaging tool for cavity scanning

“…Future work to ascertain the appropriate balance between magnification and field of view is required in order to optimize the economy of movement for intraoperative cavity assessment whilst minimizing the impact on pCLE image interpretation. Additionally, devising a pCLE probe movement pathway to facilitate time-optimized assessment of cavity walls may be required to prevent surgeons' fatigue arising from excessive probe micromanipulations and this may require collaborative efforts from the integration of robotic technology with pCLE [47][48][49][50]. Whilst cavity wall scanning would be the 'ideal' intraoperative assessment, we envisaged that the next crucial step in clinical translation would be focused on initial application and assessment of feasibility of in vivo in situ robotic-assisted, real-time pCLE imaging on localized and quadrant-based image acquisition of cavity wall margins guided by intraoperative clinical suspicion or specimen radiography.…”

The role of technology in minimally invasive surgery: state of the art, recent developments and future directions

“…Recent efforts have focused on developing robotically actuated tools to achieve intraoperative multimodal fusion. For instance, endomicroscopy and ultrasound imaging have been combined in order to scan large areas of tissue in real time and perform 3D reconstruction of complex structures during an intervention 101 102…”