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Review of surgical robotic systems for keyhole and endoscopic procedures: state of the art and perspectives

Yuyang Chen, Shu’an Zhang, Zhonghao Wu, Bo Yang, Qingquan Luo, Kai Xu

《医学前沿（英文）》 2020年 第14卷 第4期   页码 382-403 doi: 10.1007/s11684-020-0781-x

摘要： Minimally invasive surgery, including laparoscopic and thoracoscopic procedures, benefits patients in terms of improved postoperative outcomes and short recovery time. The challenges in hand–eye coordination and manipulation dexterity during the aforementioned procedures have inspired an enormous wave of developments on surgical robotic systems to assist keyhole and endoscopic procedures in the past decades. This paper presents a systematic review of the state-of-the-art systems, picturing a detailed landscape of the system configurations, actuation schemes, and control approaches of the existing surgical robotic systems for keyhole and endoscopic procedures. The development challenges and future perspectives are discussed in depth to point out the need for new enabling technologies and inspire future researches.

关键词： surgical robots     keyhole surgery     endoscopic surgery    

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Development of a novel hand−eye calibration for intuitive control of minimally invasive surgical robot

《机械工程前沿（英文）》 2022年 第17卷 第3期 doi: 10.1007/s11465-022-0698-y

摘要： Robotic-assisted surgical system has introduced a powerful platform through dexterous instrument and hand−eye coordination intuitive control. The knowledge of laparoscopic vision is a crucial piece of information for robot-assisted minimally invasive surgery focusing on improved surgical outcomes. Obtaining the transformation with respect to the laparoscope and robot slave arm frames using hand−eye calibration is essential, which is a key component for developing intuitive control algorithm. We proposed a novel two-step modified dual quaternion for hand−eye calibration in this study. The dual quaternion was exploited to solve the hand−eye calibration simultaneously and powered by an iteratively separate solution. The obtained hand−eye calibration result was applied to the intuitive control by using the hand−eye coordination criterion. Promising simulations and experimental studies were conducted to evaluate the proposed method on our surgical robot system. We extensively compared the proposed method with state-of-the-art methods. Results demonstrate this method can improve the calibration accuracy. The effectiveness of the intuitive control algorithm was quantitatively evaluated, and an improved hand−eye calibration method was developed. The relationship between laparoscope and robot kinematics can be established for intuitive control.

关键词： minimally invasive surgery     hand−eye calibration     intuitive control     surgical robot     dual quaternion    

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Cutting performance of surgical electrodes by constructing bionic microstriped structures

《机械工程前沿（英文）》 2023年 第18卷 第1期 doi: 10.1007/s11465-022-0728-9

摘要： Surgical electrodes rely on thermal effect of high-frequency current and are a widely used medical tool for cutting and coagulating biological tissue. However, tissue adhesion on the electrode surface and thermal injury to adjacent tissue are serious problems in surgery that can affect cutting performance. A bionic microstriped structure mimicking a banana leaf was constructed on the electrode via nanosecond laser surface texturing, followed by silanization treatment, to enhance lyophobicity. The effect of initial, simple grid-textured, and bionic electrodes with different wettabilities on tissue adhesion and thermal injury were investigated using horizontal and vertical cutting modes. Results showed that the bionic electrode with high lyophobicity can effectively reduce tissue adhesion mass and thermal injury depth/area compared with the initial electrode. The formation mechanism of adhered tissue was discussed in terms of morphological features, and the potential mechanism for antiadhesion and heat dissipation of the bionic electrode was revealed. Furthermore, we evaluated the influence of groove depth on tissue adhesion and thermal injury and then verified the antiadhesion stability of the bionic electrode. This study demonstrates a promising approach for improving the cutting performance of surgical electrodes.

关键词： surgical electrodes     tissue adhesion     thermal injury     bionic structures     cutting performance     medical tools    

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Comparison of surgical indications for hysterectomy by age and approach in 4653 Chinese women

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《医学前沿（英文）》 2014年 第8卷 第4期   页码 464-470 doi: 10.1007/s11684-014-0338-y

摘要：

Approximately one million hysterectomies are performed each year in China. However, national data regarding the indications and the surgical approaches for hysterectomy are lacking. The aim of this study was to examine the surgical indications for hysterectomy in different age groups and the relative merits of different surgical approaches for hysterectomy in Chinese women. Clinical data from 4653 cases of hysterectomy performed in Tongji Hospital from 2004 to 2009 were analysed. Hysterectomy was most commonly performed among women aged 40--49 years (2299; 49.4%). Overall, colporrhagia and abdominal pain were the two most common indications for hysterectomy. The most common indications by age groups were as follows: malignant ovarian tumour,<20 years; malignant uterine tumour, 20--29 and 30--39 years; uterine myoma, 40--49 and 50--59 years; and uterine prolapse, 60--69 and>70 years. The proportion of malignant aetiology also varied by age, being the highest in women aged<20 years (75.0%) and the lowest in those aged 40--49 years (19.9%). Approximately 35% women who had hysterectomies also had concomitant bilateral oophorectomy. The lowest rate of oophorectomy occurred in women aged 30--39 years (15.8%), whereas the highest rate was in those aged 50--59 years (75.9%). The abdominal surgical approach was used in 84% of all hysterectomies. Surgeries using the vaginal approach required a significantly shorter operating time (118 min average) than all other approaches (P<0.05). Both the amount of bleeding and the blood transfusion volume required were smaller in vaginal approaches, with no significant differences between the others. The surgical approaches used were also related to the scope of surgery. Both the surgical indications and the rates of bilateral oophorectomy varied by age. In terms of both operating time and the amount of bleeding and blood transfusion volume required, the vaginal approach was superior to all other surgical approaches.

关键词： hysterectomy     surgical indications     surgical approach     bilateral oophorectomy    

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Potential indicators predict progress after surgical resection of gastrointestinal stromal tumors

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《医学前沿（英文）》 2012年 第6卷 第3期   页码 317-321 doi: 10.1007/s11684-012-0203-9

摘要：

In order to find out the potential indicators predicting prognosis of malignant gastrointestinal stromal tumors (GISTs) after surgical resection, we collected clinical records of 80 patients with malignant GISTs. Tumor location, size, mitotic index, necrosis were compared with the prognosis of malignant GISTs by Kaplan-Meier method and log-rank test. After a median follow-up of 844 days (52–2 145), we found that as National Institutes of Health suggested, tumors with intermediate risk had more favorable prognosis than that with high risk. Their 3-year survival rate were 65.3% and 41.3%, respectively (P<0.001). Moreover, tumor size and mitotic index were associated with free survival. The 3-year survival rate for patients with tumor size≤10 cm and>10 cm were 62.3% and 41.8%, respectively (P = 0.002), Tumors with mitotic index≤5/50 HPF had a higher 3-year survival rate than tumors with mitotic index>5/50 HPF (67.1% versus 40.7%, P = 0.005). The presence of necrosis was directly related to the malignant behavior. The 3-year survival rate for presence and absence necrosis were 50.8% and 64.8% (P = 0.008). From the present study, we can conclude that besides tumors size and mitotic index, tumor location and necrosis also influence on the long-term survival of patient with malignant GISTs after surgical resection.

关键词： gastrointestinal stromal tumors     surgery     survival    

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State-of-the-art of intelligent minimally invasive surgical robots

Masakatsu G. Fujie, Bo Zhang

《医学前沿（英文）》 2020年 第14卷 第4期   页码 404-416 doi: 10.1007/s11684-020-0743-3

摘要： A number of developed countries are rapidly turning into super-aged societies. Consequently, the demand for reduced surgical invasiveness and enhanced efficiency in the medical field has increased due to the need to reduce the physical burden on older patients and shorten their recovery period. Intelligent surgical robot systems offer high precision, high safety, and reduced invasiveness. This paper presents a review of current intelligent surgical robot systems. The history of robots and three types of intelligent surgical robots are discussed. The problems with current surgical robot systems are then analyzed. Several aspects that should be considered in designing new surgical systems are discussed in detail. The paper ends with a summary of the work and a discussion of future prospects for surgical robot development.

关键词： robot history     medical robot     surgical robot     radiofrequency ablation     organ model    

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Comprehensive kinetostatic modeling and morphology characterization of cable-driven continuum robots

《机械工程前沿（英文）》 2023年 第18卷 第3期 doi: 10.1007/s11465-023-0756-0

摘要： In-situ maintenance is of great significance for improving the efficiency and ensuring the safety of aero-engines. The cable-driven continuum robot (CDCR) with twin-pivot compliant mechanisms, which is enabled with flexible deformation capability and confined space accessibility, has emerged as a novel tool that aims to promote the development of intelligence and efficiency for in-situ aero-engine maintenance. The high-fidelity model that describes the kinematic and morphology of CDCR lays the foundation for the accurate operation and control for in-situ maintenance. However, this model was not well addressed in previous literature. In this study, a general kinetostatic modeling and morphology characterization methodology that comprehensively contains the effects of cable-hole friction, gravity, and payloads is proposed for the CDCR with twin-pivot compliant mechanisms. First, a novel cable-hole friction model with the variable friction coefficient and adaptive friction direction criterion is proposed through structure optimization and kinematic parameter analysis. Second, the cable-hole friction, all-component gravities, deflection-induced center-of-gravity shift of compliant joints, and payloads are all considered to deduce a comprehensive kinetostatic model enabled with the capacity of accurate morphology characterization for CDCR. Finally, a compact continuum robot system is integrated to experimentally validate the proposed kinetostatic model and the concept of in-situ aero-engine maintenance. Results indicate that the proposed model precisely predicts the morphology of CDCR and outperforms conventional models. The compact continuum robot system could be considered a novel solution to perform in-situ maintenance tasks of aero-engines in an invasive manner.

关键词： kinetostatic modeling     morphology characterization     variable friction     continuum robots     in-situ maintenance    

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Advances in the management of the surgical complications for congenital cataract

null

《医学前沿（英文）》 2012年 第6卷 第4期   页码 360-365 doi: 10.1007/s11684-012-0235-1

摘要：

The greatest concern in children with cataracts is irreversible visual loss. The timing of congenital cataract surgery is critical for the visual rehabilitation. Cataract surgery in children remains complex and challenging. The incidence of complications during or after operation is higher in children than adults. Some complications could be avoided by meticulous attention to surgical technique and postoperative care, and others were caused by more exuberant inflammatory response associated with surgery on an immature eye or the intrinsic eyes abnormalities. Utilizing of advanced techniques and timely applying topical corticosteroids and cycloplegic agents can reduce the occurrence of visual axis opacification. Operation on children with strabismus or nystagmus, and applying occlusion therapy on amblyopic eyes can balance the visual inputs to the two eyes. Diagnosis of glaucoma following congenital cataract surgery requires lifelong surveillance and continuous assessment of the problem. So cataract surgeries in children are not the end of journey, but one step on the long road to visual rehabilitation. This paper describes recent evidence from the literature regarding the advance of management after congenital cataract surgery.

关键词： cataract/congenital     surgery     cataract/complication    

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Vibration suppression of speed-controlled robots with nonlinear control

Paolo BOSCARIOL,Alessandro GASPARETTO

《机械工程前沿（英文）》 2016年 第11卷 第2期   页码 204-212 doi: 10.1007/s11465-016-0380-3

摘要：

In this paper, a simple nonlinear control strategy for the simultaneous position tracking and vibration damping of robots is presented. The control is developed for devices actuated by speed-controlled servo drives. The conditions for the asymptotic stability of the closed-loop system are derived by ensuring its passivity. The capability of achieving improved trajectory tracking and vibration suppression is shown through experimental tests conducted on a three-axis Cartesian robot. The control is aimed to be compatible with most industrial applications given the simplicity of implementation, the reduced computational requirements, and the use of joint position as the only measured signal.

关键词： industrial robot     nonlinear control     vibration damping     model-free control     motion control    

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Prevention of surgical site infection under different ventilation systems in operating room environment

Zhijian Liu, Haiyang Liu, Hang Yin, Rui Rong, Guoqing Cao, Qihong Deng

《环境科学与工程前沿（英文）》 2021年 第15卷 第3期 doi: 10.1007/s11783-020-1327-9

摘要： Abstract • The effectiveness of four different ventilation systems was compared in depth. • Airflow and bacteria-carrying particles concentration were quantitatively analyzed. • Vertical laminar airflow with high airflow rate could not achieve desired effect. • Temperature-controlled airflow ventilation could guarantee air cleanliness. Biological particles in the operating room (OR) air environment can cause surgical site infections (SSIs). Various ventilation systems have been employed in ORs to ensure an ultraclean environment. However, the effect of different ventilation systems on the control of bacteria-carrying particles (BCPs) released from the surgical staff during surgery is unclear. In this study, the performance of four different ventilation systems (vertical laminar airflow ventilation (VLAF), horizontal laminar airflow ventilation (HLAF), differential vertical airflow ventilation (DVAF), and temperature-controlled airflow ventilation (TAF)) used in an OR was evaluated and compared based on the spatial BCP concentration. The airflow field in the OR was solved by the Renormalization Group (RNG) k-e turbulence model, and the BCP phase was calculated by Lagrangian particle tracking (LPT) and the discrete random walk (DRW) model. It was found that the TAF system was the most effective ventilation system among the four ventilation systems for ensuring air cleanliness in the operating area. This study also indicated that air cleanliness in the operating area depended not only on the airflow rate of the ventilation system but also on the airflow distribution, which was greatly affected by obstacles such as surgical lamps and surgical staff.

关键词： Operating room (OR)     Bacteria-carrying particles (BCPs)     Surgical site infections (SSIs)     Ventilation    

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Footholds optimization for legged robots walking on complex terrain

《机械工程前沿（英文）》 2023年 第18卷 第2期 doi: 10.1007/s11465-022-0742-y

摘要： This paper proposes a novel continuous footholds optimization method for legged robots to expand their walking ability on complex terrains. The algorithm can efficiently run onboard and online by using terrain perception information to protect the robot against slipping or tripping on the edge of obstacles, and to improve its stability and safety when walking on complex terrain. By relying on the depth camera installed on the robot and obtaining the terrain heightmap, the algorithm converts the discrete grid heightmap into a continuous costmap. Then, it constructs an optimization function combined with the robot’s state information to select the next footholds and generate the motion trajectory to control the robot’s locomotion. Compared with most existing footholds selection algorithms that rely on discrete enumeration search, as far as we know, the proposed algorithm is the first to use a continuous optimization method. We successfully implemented the algorithm on a hexapod robot, and verified its feasibility in a walking experiment on a complex terrain.

关键词： footholds optimization     legged robot     complex terrain adapting     hexapod robot     locomotion control    

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Identification of surgical patients at high risk of OSAS using the Berlin Questionnaire to detect potential

null

《医学前沿（英文）》 2018年 第12卷 第2期   页码 189-195 doi: 10.1007/s11684-017-0533-8

摘要：

Obstructive sleep apnea syndrome (OSAS) increases the risk of post-surgery complications. This study uses Berlin Questionnaire (BQ) to identify Chinese adult surgical patients who are at a high risk of OSAS and to determine if the BQ could be used to detect potential high risk of adverse respiratory events in the post anesthesia care unit (PACU). Results indicated that only 11.4% of the patients were considered at a high risk of OSAS. Age and body mass index are the key factors for the risk of OSAS prevalence in China and also gender specific. Furthermore, the incidence of adverse respiratory events in the PACU was higher in patients with high risk of OSAS than others (6.8% vs. 0.9%, <0.001). They also stayed longer than others in the PACU (95±28 min vs. 62±19 min, <0.001). Age, high risk for OSAS, and smoking were independent risk factors for the occurrence of adverse respiratory events in the PACU. The BQ may be adopted as a screening tool for anesthesiologists in China to identify patients who are at high risk of OSAS and determine the potential risk of developing postoperative respiratory complications in the PACU.

关键词： obstructive sleep apnea     Berlin Questionnaire     Chinese surgical patients     adverse respiratory event    

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Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical

《医学前沿（英文）》 2021年 第15卷 第3期   页码 416-437 doi: 10.1007/s11684-021-0852-7

摘要： Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.

关键词： surgical aortic valve replacement     trans-catheter aortic valve implantation     left ventricular hypertrophy and fibrosis     myocardial force-velocity relationship     His-Purkinje pacing     renin-angiotensin system inhibitors     coronary access impairment    

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Modular crawling robots using soft pneumatic actuators

Nianfeng WANG, Bicheng CHEN, Xiandong GE, Xianmin ZHANG, Wenbin WANG

《机械工程前沿（英文）》 2021年 第16卷 第1期   页码 163-175 doi: 10.1007/s11465-020-0605-3

摘要： Crawling robots have elicited much attention in recent years due to their stable and efficient locomotion. In this work, several crawling robots are developed using two types of soft pneumatic actuators (SPAs), namely, an axial elongation SPA and a dual bending SPA. By constraining the deformation of the elastomeric chamber, the SPAs realize their prescribed motions, and the deformations subjected to pressures are characterized with numerical models. Experiments are performed for verification, and the results show good agreement. The SPAs are fabricated by casting and developed into crawling robots with 3D-printing connectors. Control schemes are presented, and crawling tests are performed. The speeds predicted by the numerical models agree well with the speeds in the experiments.

关键词： soft robot     soft pneumatic actuator     kinematic model     crawling robot     modular design    

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The evolution of surgical and medical treatment of aortic root aneurysm

null

《医学前沿（英文）》 2014年 第8卷 第4期   页码 427-432 doi: 10.1007/s11684-014-0385-4

摘要：

Since first report of aortic root replacement in 1968, the surgical risk and long term outcome of patients with aortic root aneurysm have been continuously improving. In the last 30 years, the surgical approach is also evolving towards more valve conservation with prophylactical intervention at an earlier clinical stage. Translational research has also led to emerging surgical innovation and new drug therapy. Their efficacies are currently under vigorous clinical trials and evaluations.

关键词： aortic root aneurysm     aortic root replacement     valve sparing root replacement     personalised external aortic root support    

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标题 作者 时间 类型 操作

Review of surgical robotic systems for keyhole and endoscopic procedures: state of the art and perspectives

Yuyang Chen, Shu’an Zhang, Zhonghao Wu, Bo Yang, Qingquan Luo, Kai Xu

期刊论文

Development of a novel hand−eye calibration for intuitive control of minimally invasive surgical robot

期刊论文

Cutting performance of surgical electrodes by constructing bionic microstriped structures

期刊论文

Comparison of surgical indications for hysterectomy by age and approach in 4653 Chinese women

null

期刊论文

Potential indicators predict progress after surgical resection of gastrointestinal stromal tumors

null

期刊论文

State-of-the-art of intelligent minimally invasive surgical robots

Masakatsu G. Fujie, Bo Zhang

期刊论文

Comprehensive kinetostatic modeling and morphology characterization of cable-driven continuum robots

期刊论文

Advances in the management of the surgical complications for congenital cataract

null

期刊论文

Vibration suppression of speed-controlled robots with nonlinear control

Paolo BOSCARIOL,Alessandro GASPARETTO

期刊论文

Prevention of surgical site infection under different ventilation systems in operating room environment

Zhijian Liu, Haiyang Liu, Hang Yin, Rui Rong, Guoqing Cao, Qihong Deng

期刊论文

Footholds optimization for legged robots walking on complex terrain

期刊论文

Identification of surgical patients at high risk of OSAS using the Berlin Questionnaire to detect potential

null

期刊论文

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical

期刊论文

Modular crawling robots using soft pneumatic actuators

Nianfeng WANG, Bicheng CHEN, Xiandong GE, Xianmin ZHANG, Wenbin WANG

期刊论文

The evolution of surgical and medical treatment of aortic root aneurysm

null

期刊论文