Lung cancer is the leading cause of cancer deaths worldwide. In order to determine if lung nodules are cancerous, a biopsy needs to be taken. There is a need to be able to perform more of these biopsies through a transbronchial approach in order to reduce the risk of pneumothorax that is associated with transthoracic biopsies. This is particularly the case at the periphery of the lung where the bronchioles become too small for a traditional bronchoscope. The proposed biopsy tool incorporates a compact coaxial camera and illumination configuration to make it more compact than a traditional bronchoscope. It also includes a new flexible needle design that allows a biopsy to be taken adjacent to a radial ultrasound transducer. The navigation and tissue biopsy capabilities of the proposed device are demonstrated through benchtop and animal testing.

Needle-based surgical procedures for diagnostic and therapeutic purposes such as biopsy and brachytherapy has significantly contributed in minimally invasive surgeries. Percutaneous interventions demand precise navigation of surgical needles in soft tissue. Active needle steering increases the target placement accuracy, and consequently improves the clinical outcome. In this work, a novel 3D steerable active surgical needle with three Shape Memory Alloy (SMA) actuators is proposed. The actuation capabilities of SMAs were used to realize a 3D motion at the needle tip. The feasibility of 3D steerability was demonstrated through active control of multiple SMA actuators.

Wearable environment perception system has the great potential for improving the autonomous control of mobility aids [1]. A visual perception system could provide abundant information of surroundings to assist the task-oriented control such as navigation, obstacle avoidance, object detection, etc., which are essential functions for the wearers who are visually impaired or blind [2, 3, 4]. Moreover, a vision-based terrain sensing is a critical input to the decision-making for the intelligent control system. Especially for the users who find difficulties in manually achieving a seamless control model transition.

Computer-assisted interventions (CAI) — which offer advantages such as increased accuracy, reduction of complications, and decreased intervention time — have increased in prevalence in recent years. A type of CAI called image-guided therapy (IGT) can be used to provide navigation for freehand procedures or guidance for localization of medical devices. Electromagnetic (EM) tracking technology can track instruments such as needle tips inside the patient body without the need for a line-of-sight, allowing for minimally invasive imaging-guided procedures [1–3].

Shape memory alloy (SMA) based active needles [1] have shown the potential to introduce remarkable improvements to many percutaneous needle-based procedures such as thermal ablation, brachytherapy and breast biopsy. Brachytherapy for instance is a common procedure to treat early stage prostate cancer because its superior clinical outcome. Prostate cancer is sex specific and only affects males; it is more prevalent in elderly males, ages 65–74 years old [2]. There is projected to be a 24% increase in cancer cases for men by 2020, this would mean approximately 1 million new cases each year [3]. There was a study in 2015 [4] that examined the needle placement accuracy for brachytherapy procedure while implementing the use of a 3D navigation system, Surgical Planning and Orientation Computer System. The study examined the Target Registration Error (TRE) for single and multiple needle placements. Analysis of the 250 different targets showed a mean Target Registration Error for single needle applications of (1.1 ± 0.4 mm), (0.9 ± 0.3 mm), and (0.7 ± 0.3 mm) in the x, y, and z directions, respectively. The maximum deviation was found 2.3 mm. In another study by Podder et al. [5], the effects of dose distribution has been discussed which has a high influence on the clinical outcome. The study shows that the curvilinear approach by the active needle would introduce the potential for improving dose distribution, reducing number of needles and resulting is better clinical outcome. Actuating the surgical needles for higher accuracy, SMAs are considered as suitable actuators [6] because of their lightweight, high force and energy density. However, SMA actuated needle will be more complex and may incur additional inaccuracy; thereby after development of a robust active needle, control studies sound very necessary. The focus of this work is to introduce an innovative design of an active needle, and to fabricate the device to demonstrate its capability of creating a high maneuverability at the needle tip. This design of the active needle privileges from actuation of a comparatively long SMA wire to create a considerable amount of deflection, while minimizing the tissue rupture. Most of the needles today are made of stainless steel, titanium or Nitinol; they are ensured to be sturdy enough to puncture the tissue and overcome its resistance during insertion. This would limit the flexibility of the needles. In our previous designs [7,8], a joint element was included in design to provide more dexterity to the needle’s structure. Despite of the fact that this soft element increased the needle’s flexibility; the design introduced a high tissue rupture during actuation because of the gap between the body of the needle and the SMA actuator. The amount of rupture was increasing with larger deflection of the needle. This work decreases the rupture to a reasonable amount while even a higher deflection compared to our previous design is achieved. Table 1 lists general specifications and approximations of dimensions and requirements that have been tried to be addressed in the current design as much as possible. There will be still future work to meet some other factors discussed at the end of this study.

The traditional spinal surgery is often conducted by hand operation with the help of navigation system which is combined with medical image. Although a veteran surgeon has a good adaptability during surgeries, it will tend to decrease along with the increase in surgery time which causes fatigues and leads to low qualities. Many surgical robots have been developed to assist surgeons in operation, and some of them approved by doctors or researchers are DaVinci (Intuitive Surgical, America) [1], Renaissance (Mazor Robotics, Israel), etc. These robot systems have enhanced the accuracy of operation; however, the adaptabilities are still weakened at the same time. During the pedicle screw drilling, surgeons can well adapt to the spine movements mainly caused by respiration, while it is difficult for these robots to adapt to the movements, indicating that the accuracy might drop in the actual application. Respiratory compensation system is aimed to keep the region of operation stable or reduce the amplitude of fluctuation [2]. The rests of paper introduced the respiratory compensation system and its control algorithm based on infrared tracking data, and experiments were conducted to analyze the accuracy and stability.

Orthopaedic resident training has been, and continues to be, in a state of flux. Initially, there were limits placed on the number of hours a resident could work in a week [1]. Later, residency programs were required to provide laboratory-based training in basic surgical skill for first year residents [2]. Now there is a push towards a competency-based training program that graduates residents who demonstrate their acquisition of adequate surgical skills [3]. With each of these shifts in the training model, programs and institutions have looked increasingly to simulation-based training to ease the way. Simulation offers opportunities to train surgeons quickly, provide essential feedback to foster improvement, and assess skill acquisition. With the broad swath of requirements to satisfy in orthopaedic surgical skills training, a simulation platform must support an array of training capabilities for resident practice and performance assessment. Wire navigation is a central skill in orthopaedics that has a broad variety of applications. In this task, surgeons must use 2D intra-operative fluoroscopic images to visualize the 3D anatomy of a patient and place a wire along a specified path through bone. In some situations, placing the wire is the final task; in others the wire serves as a guide for subsequently placed cannulated implants. Regardless of the situation, the placement of the wire in the bone directly influences the surgical result for the patient. We previously presented the design of a wire navigation surgical simulator dedicated specifically to hip wire navigation [4]. Our experience with the dozens of surgeons and residents who have used the simulator suggest that they find the general skill of guiding a wire to be relatively abstract. They are more drawn to practicing specific surgeries rather than the general skill. To address this need, we have modified the simulator to present new surgical procedures, while still exercising the underlying skill of wire navigation. We also learned that the task of directing the fluoroscope in order to acquire appropriate view angles for making surgical decisions is integral to surgical wire navigation, so we extended the simulator to include this important aspect of surgical skill.

Brachytherapy is one the most effective treatment modalities for both gynecological (GYN) cancer and prostate cancer. The clinical outcome of brachytherapy, both high-dose-rate (HDR) and low-dose-rate (LDR), depends on the precision of the desired or planned dose distribution and delivery. In HDR procedure, the accuracy of reconstruction of catheters or needles (e.g. Syed catheter or Simon-Heyman capsule for GYN or needles for prostate) from CT images can significantly affect the accuracy of dose distribution in the treatment (dosimetric) plan, which can result in unwanted clinical outcome. In current practice, an authorized medical physicist manually reconstructs the catheters or needles for dosimetric plan, which determines the position and dwell time for the radiation source for delivering the prescription dose to the target volume sparing organs at risk (OARs) as much as possible. It is not only challenging but also time consuming for reconstructing all the catheters or needles (ranging 15–20) manually, slice-by-slice in CT images. As shown in Fig. 1, the needles on the right (HDR catheters) have created so much artifacts in CT images that it is almost impossible to reconstruct those applicators (catheters/ needles) manually. Additionally, the reconstruction can be operator dependent and can be inaccurate and inconsistent. In this study, we have investigated the applicability of electromagnetic (EM) sensor-based navigation for fast and accurate reconstruction of HDR catheters and needles.

The implementation of origami techniques into disposable surgical robotic tools is a promising research area with numerous clinical applications. Origami allows for flat foldable structures that can fit through small incisions, reducing patient scarring and recovery time as well as surgical costs. Devices that can provide tight navigation through curved anatomical pathways are crucial during these types of surgery, and can cost anywhere from hundreds to several thousands of dollars. It was hypothesized that an origami design based on a chain of deployable compliant rolling-contact elements (D-COREs) could be applied to design and fabricate a medical endoscope from a single sheet of 2D material (Fig. 1) to simplify fabrication and reduce the cost to under $100 [1–3]. We used software to model the physical actuation range of the endoscope and tested actuation of the D-COREs with shape-memory alloy (SMA).

Computer-Aided techniques have been deployed more commonly in recent years to assist with surgical procedures, particularly in the case of minimally invasive surgeries. Arthroscopy, as one of the most prevailing minimally invasive surgical procedures, increases surgical complexity due to the loss of joint visibility, but has many advantages. More obstacles are encountered during hip arthroscopy, given the tight socket-joint hip anatomy. Therefore, computer-aided techniques could be used to ease such difficulties during hip arthroscopy.

Colon cancer is estimated to be the third leading cause of cancer-related death in the US [1], with the cost of colorectal cancer treatment reaching $8.4 billion annually [2]. Though colonoscopy is the current standard for colon cancer screening and diagnosis, the procedure has disadvantages due from the near-blind navigation process used. During the procedure, endoscopists frequently lose sight of landmarks in the colon, losing track of their locations within the colon and becoming disoriented.