Magnetically Assisted Robotic Fetal Surgery for the Treatment of Spina Bifida

Gervasoni, Simone; Lussi, Jonas; Viviani, Silvia; Boehler, Quentin; Ochsenbein, Nicole; Moehrlen, Ueli; Nelson, Bradley J.

doi:10.1109/tmrb.2022.3146351

Cited by 14 publications

(16 citation statements)

References 33 publications

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“…We control the magnetic field in a closed loop, so inaccuracies coming from the model are rejected by the controller. Previous work with this [ 40 ] and other eMNSs have shown that this simplification generates satisfying results. [ 36,38,39,50 ] During the experiments, the field magnitude

| | {boldb}_{normald} | |

was constant at

b_{mag} = 18 mT

, which is approximately two orders of magnitude smaller than a clinical magnetic resonance imaging (MRI) system.…”

Section: Resultsmentioning

confidence: 83%

“…[28][29][30][31] While this technology is well established in clinical settings for cardiac ablation procedures, [32] researchers have only recently investigated other applications, such as navigating through the neurovascular system, [33,34] magnetic guidance for steering a catheter to a biopsy target within a pig brain, [35] steering a magnetic catheter for ophthalmic applications, [36][37][38][39] and manipulating magnetic tools for fetal surgery. [40] Other research has focused on the vascular system, [41,42] colonoscopies, [43] the cochlea, [44] or the nose. [45] Here, we use a flexible, magnetic fetoscope with an integrated high-resolution camera and a working channel for a laser fiber.…”

Section: Doi: 101002/aisy202200182mentioning

confidence: 99%

“…During the experiments, this reference table was interpolated online to apply the correct input field for the desired orientation of the fetoscope, as shown in our previous work. [40] The insertion length of the catheter can be adjusted with buttons located on the Phantom Omni's stylus. Furthermore, the gravity of the stylus was haptically compensated to make it virtually weightless for the user.…”

Section: Teleoperationmentioning

confidence: 99%

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Magnetically Guided Laser Surgery for the Treatment of Twin‐to‐Twin Transfusion Syndrome

Lussi

Gervasoni

Mattille

et al. 2022

Advanced Intelligent Systems

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In the past 40 years, the percentage of twin pregnancies has increased by almost a third as a result of a rise in medically assisted reproduction and delayed childbearing. [1] Of the 1.6 million twin pairs born around the globe every year, %15% are monochorionic (MC), i.e., they share the same placenta. [2] These pregnancies present more frequent complications than dichorionic twins that develop with separate placentas. [3] One of these complications arises from vascular anastomoses that connect the blood circulation systems of both fetuses to the placenta. Twin-to-twin transfusion syndrome (TTTS) affects 10-15% of MC multiple pregnancies and is characterized by a chronic, imbalanced blood flow from the donor to the recipient twin, which results in a disproportionate nutrient supply. [4] If left untreated, the consequences of TTTS are severe, leading to a mid-trimester mortality rate of up to 95%. [5] State-of-the-art treatment of TTTS involves fetoscopic laser coagulation of the placental anastomoses. Under ultrasound guidance, the surgeon identifies a safe entry site in the maternal abdomen from which a fetoscope is inserted through a trocar (typically 2.2-4 mm in diameter; 7-12 French [6] ) into the recipient's amniotic sac. The fetoscope consists of a camera and a working channel to deliver laser light through an optical fiber at the desired location. Before the surgeon ablates the vessels, the vascular architecture is scrutinized and the connecting vessels are identified. Subsequently, all identified anastomoses are coagulated with a neodymium-doped yttrium aluminum garnet (Nd:YAG) or diode laser such that the MC circulation is converted into two independent vascular systems. [7] To ensure no small vessels are missed, the laser is repeatedly fired along a line connecting all the coagulation points from one placental border to the other (known as the Solomon technique). [5,8,9] Mortality rates still range from 20% to 48% after this surgical procedure and significant complications are reported in 6-18% of surviving newborns. [10] Neurological damage to the fetus is also more likely to occur in technically difficult cases. [8] As the procedure is demanding, outcomes are also dependent on the surgeon experience. [7,10] Cases with anterior placentas (i.e., located on the abdominal side of the uterus) constitute a major challenge, even for experienced surgeons. Good access and visualization of anterior placentas are difficult with rigid endoscopes. [11] This can prevent complete coagulation, which,

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| | {boldb}_{normald} | |

was constant at

b_{mag} = 18 mT

, which is approximately two orders of magnitude smaller than a clinical magnetic resonance imaging (MRI) system.…”

Section: Resultsmentioning

confidence: 83%

Section: Doi: 101002/aisy202200182mentioning

confidence: 99%

Section: Teleoperationmentioning

confidence: 99%

See 1 more Smart Citation

Magnetically Guided Laser Surgery for the Treatment of Twin‐to‐Twin Transfusion Syndrome

Lussi

Gervasoni

Mattille

et al. 2022

Advanced Intelligent Systems

Self Cite

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show abstract

“…For this method, the main body of the robot includes magnetic sources like permanent magnetic or ferromagnetic particles, and the robots are controlled using the external magnetic field generated by permanent magnets and electromagnets. In the work of Gervasoni et al [ 77 ] and Charreyron et al, [ 74 ] they implemented off‐board electromagnetic actuation to develop robots that aimed at performing laser‐assisted fetal surgery and ophthalmology surgery. Both surgeries require navigation within confined spaces, i.e., less than 4 mm cavity for fetal surgery and 1 mm cavity for ophthalmology surgery.…”

Section: Robotic Systems For Laser Surgerymentioning

confidence: 99%

“…To develop smaller scale fiber steering robots, several groups adopted off-board magnetic actuation strategies, [74,76,77] which use an external magnetic field to control a robot. For this method, the main body of the robot includes magnetic sources like permanent magnetic or ferromagnetic particles, and the robots are controlled using the external magnetic field generated by permanent magnets and electromagnets.…”

Section: Magnetic Actuator Driven Robotsmentioning

confidence: 99%

When the End Effector Is a Laser: A Review of Robotics in Laser Surgery

Lee

Pacheco

Fichera

et al. 2022

Advanced Intelligent Systems

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Combining laser technology with robotic precision and accuracy promises to introduce significant advances in minimally invasive surgical interventions. Lasers have already become a widespread tool in numerous surgical applications. They are proposed as a replacement for traditional tools (i.e., scalpels and electrocautery devices) to minimize surgical trauma, decrease healing times, and reduce the risk of postoperative complications. Compared to other energy sources, laser energy is wavelength‐dependent, allowing for preferential energy absorption in specific tissue types. This potentially leads to minimizing damage to healthy tissue and increasing surgical outcomes control and quality. Merging robotic control with laser techniques can help physicians achieve more accurate laser aiming and pave the way to automatic control of laser–tissue interactions in closed loop. Herein, a review of the state‐of‐the‐art robotic systems for laser surgery is presented. The goals of this paper are to present recent contributions in advanced intelligent systems for robot‐assisted laser surgery, provide readers with a better understanding of laser optics and the physics of laser–tissue interactions, discuss clinical applications of lasers in surgery, and provide guidance for future systems design.

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Magnetic Fiber Robots with Multiscale Functional Structures at the Distal End

Fan,

Ren,

Han

et al. 2023

Adv Funct Materials

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Magnetic fiber robots have revealed great potential for future minimally invasive robotic surgery. However, with the miniaturization of fiber robots, the integration of functional microtools at the distal end becomes extremely challenging, since it requires assembling multifunctional structures on the curved surfaces of fiber ends, which typically have very small curvature radii. In this study, a submillimeter fiber robot with integrated micro‐manipulation tool at the distal end is reported using a “Swiss roll” assembly strategy. This approach enables the one‐step assembly of multiscale structures (mm‐µm) from a 2D film to a 3D tool on the curved surface of the fiber robot. The multiscale structure consists of a millimeter‐scale (mm) magnetic thin film with integrated micrometer‐scale (µm) feature structures, which is inspired from the cat tongue covered by numerous little papillae. The fiber robot can perform multiple functions including endovascular clot grabbing, liquid delivery, and sampling under the manipulation of the magnetic field. The strategy provides a universal protocol for integrating and assembling functional components at the distal end of fiber robots, contributing significantly to the functionalization and miniaturization of interventional medical robots.

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Magnetically Assisted Robotic Fetal Surgery for the Treatment of Spina Bifida

Cited by 14 publications

References 33 publications

Magnetically Guided Laser Surgery for the Treatment of Twin‐to‐Twin Transfusion Syndrome

Magnetically Guided Laser Surgery for the Treatment of Twin‐to‐Twin Transfusion Syndrome

When the End Effector Is a Laser: A Review of Robotics in Laser Surgery

Magnetic Fiber Robots with Multiscale Functional Structures at the Distal End

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