Robot assisted surgery has been widely accepted by the medical community. Surgeons utilize robots in many different procedures worldwide. However, cardiothoracic surgeons do not regularly use robotic tools to aid them in performing even simple, catheter based procedures such as cardiac ablation or mapping. Some cardiac Monophasic Action Potentials (MAPs) and ablation catheters require a specific window of force to either effectively characterize or scar cardiac tissue. This is challenging to maintain through the cardiac cycle, so the application of a constant force is not a trivial task for surgeons. Robotic assistance to control the force applied to a catheter through ablation and mapping procedures is needed to improve the outcome for patients. The purpose of this work is to develop a single degree of freedom robot that controls the force applied to a beating swine heart. Rather than trying to predict the motion and timing of the heartbeat, or tracking its movement this robot senses and reacts to the force produced by the myocardium. Through the cardiac cycle, the robot applies a constant force to the surface of a beating heart. The kinematics of the cardiac tissue were characterized by utilizing piezoelectric transducers. Hardware to control the catheter motion was designed to fit most commercially available devices. The controller was designed by first building a mathematical model using measured data, and then a control law was implemented considering the heartbeat as disturbances to the system. Finally, testing was completed with dry runs, and in situ and ex-vivo testing in the Visible Heart ® Laboratory.

The human hand has extraordinary dexterity with more than 20 degrees of freedom (DOF) actuated by lightweight and efficient biological actuators (i.e., muscles). The average weight of human hand is only 400g [1]. Over the last few decades, research and commercialization effort has been dedicated to the development of novel robotic hands for humanoid or prosthetic application towards dexterous and biomimetic design [2]. However, due to the limitations of existing electric motors in terms of torque density and energy efficiency, the design of humanoid hands has to compromise between dexterity and weight. For example, commercial prosthetic terminal devices i-Limb [3] and Bebionic [4] prioritize the lightweight need (450g) and use 5-DOF motors to under-actuated 11 joints, which is only able to realize a few basic grasp postures. On the other hand, some humanoid robot hand devices like DLR-HIT I & II hands [5] prioritize the dexterity need (15 DOF), but weigh more than four times than their biological counterpart (2200g and 1500g, respectively).

This study is aimed at the design of a novel task-based knee rehabilitation device. The desired trajectories of the knee have been obtained through a vision-based motion capture system. The collected experimental kinematic data has been used as an input to a spatial mechanism synthesis procedure. Parallel mechanisms with single degree-of-freedom (DOF) have been considered to generate the complex 3D motions of the lower leg. An exact workspace synthesis approach is utilized, in which the parameterized forward kinematics equations of each serial chains of the parallel mechanisms are to be converted into implicit equations via elimination. The implicit description of the workspace is made to be a function of the structural parameters of the serial chain, making it easy to relate those parameters to the desired trajectory. The selected mechanism has been verified for the accuracy of its trajectory through CAD modeling and simulations. This design approach reduces alignment and fitting challenges in an exoskeleton as the mechanism does not require alignment of each robotic joint axis with its human counterpart.

Most robots for minimally invasive surgery (MIS) are large, bulky devices which mimic the paradigm of manual MIS by manipulating long, rigid instruments from outside the body [1]. Some of these incorporate “wristed” instruments to place some local dexterity at or near the tool tip [2]. In contrast, a small number of MIS robot designs place all of the degrees of freedom inside the patient’s body in order to increase the local dexterity [3].

There is a trend towards miniaturization in surgical robotics with the objective of making surgeries less invasive [1]. There has also been increasing recent interest in hand-held robots because of their ability to maintain the current surgical workflow [2, 3]. We have previously presented a system that integrates small-diameter concentric tube robots [4, 5] into a hand-held robotic device [3], as shown in Figure 1. This robot was designed for transurethral laser surgery in the prostate. It provides the surgeon with two dexterous manipulators through a 5mm port in a traditional transurethral endoscope. This system enables the surgeon to retract tissue and aim a fiber optic laser simultaneously to resect prostate tissue. This robot provides the surgeon with a total of ten degrees of freedom (DOF) that must be simultaneously coordinated, including endoscope orientation (3 DOF), endoscope insertion (1 DOF), as well as the tip position of each concentric tube manipulator (3 DOF per manipulator). In [3], a simple user interface was employed that involved thumb joysticks (which also had pushbutton capability) and a unidirectional index finger trigger, as shown in Figure 2 (Left). The thumb joysticks were mapped to manipulator tip motion in the plane of the endoscope image, and the trigger was used for motion perpendicular to the plane. Whether the finger trigger extended or retracted the tip of the concentric tube manipulator was toggled via the pushbutton capability of the thumb joystick. While surgeons could learn this mapping with some effort, and were able to use it to accomplish a cadaver study, the experiments made clear that further work was needed in creating an intuitive user interface — particularly with respect to how motion perpendicular to the image plane is controlled. This paper describes a first step toward improving the user interface; we integrate a bidirectional dial input in place of the unidirectional index finger trigger, so that extension and retraction perpendicular to the image plane can be controlled without the need for a pushbutton toggle. In this paper we describe the design of this dial input and present the results of a user study comparing it to the interface in [3].

Flexible endoscopy, a procedure during which an operator pushes a semi-rigid endoscope through a patient’s gastrointestinal tract, has been the gold-standard screening method for colon cancer screening (colonoscopy) for over 50 years. Owing to the large amounts of tissue stress that result from the need for transmitting a force to the tip of the endoscope while the device wraps through the bowel, implementing a front-actuated endoscopy system has been a popular area of research [1]. The pursuit of such a concept was accelerated by the advent of ingestible capsule endoscopes, which, since then, have been augmented by researchers to include therapeutic capabilities, modalities for maneuverability, amongst other diagnostic functions [2]. One of the more common approaches investigated has been the use of magnetic fields to apply forces and torques to steer the tip of an endoscope [3]. Recent efforts in magnetic actuation have resulted in the use of robot manipulators with permanent magnets at their end effectors that are used to manipulate endoscopes with embedded permanent magnets. Recently, we implemented closed loop control of a tethered magnetic capsule by using real-time magnetic localization and the linearization of a magnetic wrench applied to the capsule by the actuating magnet [4]. This control was implemented in 2 degrees-of-freedom (DoF) in position (in the horizontal plane) and 2 DoF in orientation (panning and tilting). One DoF in position is lost owing to the tethered capsule being actuated in air and thus lacking a restoring force to counter the high field gradient. The 3 rd orientation DoF is lost owing to the axial symmetry of the permanent magnet in the capsule; this prevents the application of torque in the axial direction and thus controlled roll and introduces a singularity in the capsule’s actuation. Although another dipole could be used to eliminate this singularity, this would complicate both the actuation and localization methods. In this manuscript, we consider the consequences of the embedded magnet (EM) being radially offset from the center of the capsule while being manipulated by an external actuating magnet (AM). We have developed a tethered capsule endoscope that contains a cylindrical EM (11.11 mm in length and diameter) with a residual flux density of 1.48 T that is offset by 1.85 mm from the center of the capsule; a distance that is less than 10% of the capsule diameter. Our investigation into the topic results from repeated observation of the capsule’s preference to align such that the internal magnet is closest to the actuating magnet (AM). The AM is a cylindrical magnet (101.6 mm in length and diameter) with a residual flux density of 1.48 T that is mounted at the end effector of a 6 DoF manipulator, as seen in Figure 1. In this manuscript, we evaluate the torqueing effects of the presence of this magnet offset with the goal of determining whether the torque effect is negligible, or impacts capsule motion and thus can potentially be used for the benefit of endoscope manipulation. A concept schematic of this effect is shown in Figure 2. A discussion of how to use this torque is beyond the scope of this manuscript. To the authors’ knowledge, the use of such concept in permanent-magnet based control has not been investigated.

Prostate cancer is the most common cancer among males, leading to approximately 27,000 deaths in the United States [1]. Focal laser ablation (FLA) has been shown to be a promising approach for prostate cancer treatment with the advantage of efficiently ablating the cancer cells while inflicting less damage on the surrounding tissues. In current FLA procedures, a rigid template — with holes spacing of 5mm — guides the FLA catheter to the target position. Drawbacks of the conventional approach for catheter targeting are 1) limited degrees of freedom (DoF) and 2) a low insertion resolution. In addition, the targeting capability of the rigid template is compromised when the pubic arch or nerve bundles intersect the catheter trajectory. We hypothesized that a compact design of an MRI-conditional robot with two active planar DoFs, one passive rotation DoF, and remote catheter insertion capacities could enhance the clinical workflow required for MRI-guided FLA prostate procedures.

Bioprinting technology has been rapidly increasing in popularity in the field of tissue engineering. Potential applications include tissue or organ regeneration, creation of biometric multi-layered skin tissue, and burn wound treatment [1]. Recent work has shown that living cells can be successfully applied using inkjet heads without damaging the cells [2]. Electrostatically driven inkjet systems have the benefit of not generating significant heat and therefore do not damage the cell structure. Inkjets have the additional benefit of depositing small droplets with micrometer resolution and therefore can be used to build up tissue like structures. Previous attempts at tracking and drawing on a hand include either direct contact with the hand [3] or tracking the hand only in two degrees of freedom [4]. In this work we present an approach to track a hand with three degrees of freedom and accurately apply a substance contact free to the hand in a desired pattern using a bioprinting compatible inkjet. The third degree of freedom, in this case depth from the hand surface, provides improved control over the distance between the inkjet head and object, thus increasing deposition accuracy.

Over the past decade, natural orifice transluminal endoscopic surgery (NOTES) has developed out of a merger of endoscopy and surgery [1]. NOTES offers the advantages of avoiding external incisions and scars, reducing pain, and shortening recovery time by using natural body orifices as the primary portal of entry for surgeries [2]. The NOTES platform consists of a flexible, hollow body — enabling travel in the interior of the human body — and the distal end (head), the mechanical structure of which is based off of the snake bone. After the distal end passes through a natural orifice, through a transluminal opening of the stomach, vagina, bladder, or colon, and reaches the target working place in the peritoneal cavity, several therapeutic and imaging tools can be passed through the hollow conduit of the NOTES’ body for surgeries [3]. The traditional snake bone design presents two major problems. First, the movement is constrained to two bending degrees-of-freedom (DOF). A need to reorient the tool then often requires the entire body to be rotated by the physician, an unwieldly manipulation that both hinders convenience and results in imprecise control. Second, the traditional fabrication process is tedious and therefore lends to higher manufacturing costs; the bending joints must be first individually machined then assembled together piece-by-piece using rotation pins. We propose a novel design for the snake bone that introduces an additional DOF via rotation and is simple and cost-effective to machine. The revised snake bone design features rotation segments controlled by wires that a physician can readily manipulate for increased control and convenience. Further, because surgical tools that pass through the NOTES body conduit are also installed on snake bone structures, the introduction of rotation to the snake bone design increases each tool’s mobility and manipulation. This advance therefore presents the potential to decrease both the number of required tools and the overall diameter of the NOTES body. Finally, the body is machined as a single element and therefore minimizes the work of assembly.

Minimally invasive surgery (MIS), including laparoscopy, endoscopy and colonoscopy, refers to performance of diagnostic or surgical intervention in the internal body cavity through small incisions (or no incisions) to reduce the recovery time and minimize scarring [1]. It has gained worldwide popularity since the first report of laparoscopic cholecystectomy in the mid-1980s due to lower complications, cosmetic benefits and quick recovery [2] and has grown to include robotic approaches. One of the main challenges for this type of surgery is to provide sufficient real-time visual feedback using cameras. To address issues of narrow visual field and limited workspace in surgical visual feedback, existing devices may use onboard motors to provide pan and tilt orientation for the camera [3, 4], which makes the system bulky and expensive. (Here we draw a distinction from wire-driven steerable laparoscopes and constrain the discussion to robotic devices.) In this paper, we present a novel camera system with a parallel structure and elastic platform which has three active degrees of freedom (DOFs) to increase the visual field and implement a mechanical zoom function. This camera head can be mounted on various surgical robots (e.g. [5]) or can be inserted as a standalone device. The novelty of this device lies in its elastic platform, and the authors are unaware of this type of design or its kinematic analysis being presented previously.

Natural orifice transluminal endoscopic surgery (NOTES) is a method in which tools are passed through a natural orifice to the surgical site. This removes the need for external incisions, which can allow patients to recover more quickly without any visible abdominal scarring. This surgical method also has several limitations including limited space, complex lumen geography, and difficult visualization [1]. To address these problems, researchers have developed various tools, including endoscope-based robots [2], and insertable bimanual robots [3]. However, some of the aforementioned constraints/limitations remain, and consideration of accessories for use with these tools remains relevant. Our lab designed a multifunctional NOTES robot, which consists of a snakelike linkage driven by cables that are attached to motors in an external housing to navigate through the lumen geometry; it also includes a bimanual end effector with interchangeable tool tips [4]. This paper introduces the design of an adjustable table mount to address the limitations related to transluminal insertion. It provides four passive degrees of freedom (DOFs) to grossly place the robot, and enables the robot to be fixed on surgical tables with different sizes. Benchtop testing on a surgical table with a patient mannequin demonstrates its functionality.

The human ankle plays a major role in locomotion as it the first major joint to transfer the ground reaction torques to the rest of the body while providing power for locomotion and stability. One of the main causes of the ankle impedance modulation is muscle activation [1, 2], which can tune the ankle’s stiffness and damping during the stance phase of gait. The ankle’s time-varying impedance is also task dependent, meaning that different activities such as walking at different speeds, turning, and climbing/descending stairs would impose different profiles of time-varying impedance modulation. The impedance control is commonly used in the control of powered ankle-foot prostheses; however, the information on time-varying impedance of the ankle during the stance phase is limited in the literature. The only previous study during the stance phase, to the best of the authors knowledge, reported the human ankle impedance at four points of the stance phase in dorsiflexion-plantarflexion (DP) [1] during walking. To expand previous work and estimate the impedance in inversion-eversion (IE), a vibrating platform was fabricated (Fig. 1) [3]. The platform allows the ankle impedance to be estimated at 250 Hz in both DP and IE, including combined rotations in both degrees of freedom (DOF) simultaneously. The results can be used in a 2-DOF powered ankle-foot prosthesis developed by the authors, which is capable of mimicking the ankle kinetics and kinematics in the frontal and sagittal planes [4]. The vibrating platform can also be used to tune the prosthesis to assure it properly mimics the human ankle dynamics. This paper describes the results of the preliminary experiments using the vibrating platform on 4 male subjects. For the first time, the time-varying impedance of the human ankle in both DP and IE during walking in a straight line are reported.

Laparoscopic surgery is a practice of minimally invasive surgery (MIS) performed in the abdominal area. Prior to surgery, instead of exposing the target region to air as in a typical conventional open surgery, “key holes” are opened for positioning ports, through which surgical tools (e.g. laparoscope, needle drivers, etc.) are inserted. MIS therefore minimizes trauma and reduces the risk of hemorrhaging and infection. MIS also generates economic benefits such as shorter hospitalization time for patients and better utilization of operating rooms and wards for hospitals. MIS procedures, however, require extra dexterity from surgeons: they must use instruments with little to none haptic feedback to remotely manipulate tissue within a limited range of motion, assisted by an indirect view from laparoscope. Such unintuitive operations not only require additional training, but also increase the risk of medical errors. Thus, the development of novel surgical devices that can provide a better operating experience will allow surgeons to deliver safer and more effective surgeries. At the advent of MIS only rigid straight laparoscopic instruments were available. Therefore, surgeons used multiple incisions to position the tools and achieve triangulation. In single port laparoscopic surgeries (SPLS), only one incision is made for positioning a port. Two rigid straight instruments inserted through one incision cannot provide sufficient triangulation for operations. Rigid bent, or articulated, instruments can achieve triangulation, but the tools must intersect at a point. The mapping to control the end-effector, therefore, must be inverted such that the right hand controls the left end-effector, and vice versa [1]. Given this inverted mapping, surgeons need to undergo extra training to intuitively control the end-effector, and greater attention is required toward operating the device, which can potentially detract from the ability of surgeons to focus on procedures. The disadvantage of an inverted mapping can be overcome by providing additional mobility with flexible tools and actuating structures [2]. For example, Transenterix has developed a flexible laparoscopic device which utilizes a cable-driven system for articulation of the end-effectors. However, using flexible elements as the driving mechanism can result in new problems such as diminished force feedback [3]. In 2015, a novel design of an articulated single port laparoscopic device was presented with 6 degrees of freedom (DOF). The system provides intuitive control, accurate force feedback, and sufficient manipulation for laparoscopic procedures. The design proposed in this paper keeps much of the functional features in the previous model, including 1:1 mapping and force feedback, while incorporating flexible hydraulic graspers. The articulated mechanism was redesigned to have a symmetrical structure, which is more intuitive to control and provides better operating angles for surgeons. Joint structures are redesigned for enhanced robustness and misalignment prevention. Kinematic analysis is presented for the proposed mechanisms, which is used to determine the manipulator workspace.

The objective of this paper is to establish a concise structural model of the human musculoskeletal system (HMS) that can be applied to an exercise therapy that treats malfunctions or distortions of the human body. There exist a number of traditional exercise therapy methods in Japan and China, but any systematic approaches for learning, coaching or training are not found to the best of the author’s knowledge. Among such approaches, we deal with an exercise therapy called Somatic Balance Restoring Therapy (SBRT) in which a patient executes a series of non-invasive and painless motions in face-up/down laid posture. Although thousands of results have been piled up in a fixed-format data base, justification for the SBRT has not been provided in bio/mechanical engineering sense. The purpose of modeling is a first step for this holistic approach. For such reasons, the model must be useful and uncomplicated for therapists to identify the problematic areas of the human body with adequate visualization while maintaining a theoretical thoroughness in mechanics or dynamics. To bridge multi-body dynamics and the SBRT, we have utilized a human body model with a collection of joint connected 15 rigid bodies in a topological tree configuration as used for humanoid robot with 80 Degrees-of-Freedom (DOF). In order to achieve the purpose stated above, we have developed a static force/torque balance equation for each body element. In addition, we will describe modeling processes, derivation of static equations, and estimation of parameters/states and verification based on the analysis of the FPS experimental data, and contact forces are parameterized with quantitative values to be given by the Force Plate System (FPS), installed at CARIS at the University of British Columbia (UBC).

Laparoscopic surgery is a specific branch of minimally invasive surgery (MIS) that is performed on the abdomen and endoscopic tools are passed through the incision points and trocars on the abdominal wall, so they can reach the surgical site [1]. Robotic systems have been proved to be very useful as a cameraman in laparoscopic surgery; they are more stable with no fatigue and inattention and reduce the supernumerary staff required, provide excellent geometrical accuracy and improved personal control for the surgeon over the procedure, etc. The available robots for handling and control of laparoscopic lens include at least 4 actuators to fulfill the surgeon’s requirements [2]. The purpose of the present study was to develop a novel design for the laparoscope robotic arm in which while the systems move ability is maintained its active degrees of freedom are reduced.