Human-centred Automation, Robotics and Monitoring

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• Conference paper
  Alian A, Mylonas G, Avery J, 2023,

  Soft Continuum Actuator Tip Position and Contact Force Prediction, Using Electrical Impedance Tomography and Recurrent Neural Networks

  Enabling dexterous manipulation and safe human-robot interaction, soft robots are widely used in numerous surgical applications. One of the complications associated with using soft robots in surgical applications is reconstructing their shape and the external force exerted on them. Several sensor-based and model-based approaches have been proposed to address the issue. In this paper, a shape sensing technique based on Electrical Impedance Tomography (EIT) is proposed. The performance of this sensing technique in predicting the tip position and contact force of a soft bending actuator is highlighted by conducting a series of empirical tests. The predictions were performed based on a data-driven approach using a Long Short-Term Memory (LSTM) recurrent neural network. The tip position predictions indicate the importance of using EIT data along with pressure inputs. Changing the number of EIT channels, we evaluated the effect of the number of EIT inputs on the accuracy of the predictions. The least RMSE values for the tip position are 3.6 and 4.6 mm in Y and Z coordinates, respectively, which are 7.36% and 6.07% of the actuator's total range of motion. Contact force predictions were conducted in three different bending angles and by varying the number of EIT channels. The results of the predictions illustrated that increasing the number of channels contributes to higher accuracy of the force estimation. The mean errors of using 8 channels are 7.69%, 2.13%, and 2.96% of the total force range in three different bending angles.

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• Conference paper
  Avery J, Runciman M, Fiani C, Monfort Sanchez E, Akhond S, Liu Z, Aristovich K, Mylonas Get al., 2022,

  Lumen shape reconstruction using a soft robotic balloon catheter andelectrical impedance tomography

  , IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Publisher: IEEE, ISSN: 2153-0866

  Incorrectly sized balloon catheters can lead to increased post-surgical complications, yet even with preoperative imaging, correct selection remains a challenge. With limited feedback during surgery, it is difficult to verify correct deployment. We propose the use of integrated impedance measurements and Electrical Impedance Tomography (EIT) imaging to assess the deformation of the balloon and determine the size and shape of the surrounding lumen. Previous work using single impedance measurements, or pressure data and analytical models, whilst demonstrating high sizing accuracy, have assumed a circular cross section. Here we extend these methods by adding a multitude of electrodes to detect elliptical and occluded lumen and obtain EIT images to localise deformations. Using a 14 Fr (5.3 mm) catheter as an example, numerical simulations were performed to find the optimal electrode configuration of two rings of 8 electrodes spaced 10 mm apart. The simulations predicted that the maximum detectable aspect ratio decreased from 0.9 for a 14mm balloon to 0.5 at 30mm. The sizing and ellipticity detection results were verified experimentally. A prototype robotic balloon catheter was constructed to automatically inflate a compliant balloon while simultaneously recording EIT and pressure data. Data were collected in experiments replicating stenotic vessels with an elliptical and asymmetrical profile, and the widening of a lumen during angioplasty. After calibration, the system was able to correctly localise the occlusion and detect aspect ratios of 0.75. EIT images further localised the occlusion and visualised the dilation of the lumen during balloon inflation.

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• Journal article
  Naik R, Kogkas A, Ashrafian H, Mylonas G, Darzi Aet al., 2022,

  The Measurement of Cognitive Workload in Surgery Using Pupil Metrics: A Systematic Review and Narrative Analysis

  , JOURNAL OF SURGICAL RESEARCH, Vol: 280, Pages: 258-272, ISSN: 0022-4804
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  • Citations: 4
• Journal article
  Hardon SF, Rahimi AM, Postema RR, Willuth E, Mintz Y, Arezzo A, Dankelman J, Nickel F, Horeman T, EAES Technology Committee Study Groupet al., 2022,

  Safe implementation of hand held steerable laparoscopic instruments: a survey among EAES surgeons.

  , Updates Surg, Vol: 74, Pages: 1749-1754

  The complexity of handheld steerable laparoscopic instruments (SLI) may impair the learning curve compared to conventional instruments when first utilized. This study aimed to provide the current state of interest in the use of SLI, the current use of these in daily practice and the type of training which is conducted before using SLI in the operating room (OR) on real patients. An online survey was distributed by European Association of Endoscopic Surgery (EAES) Executive Office to all active members, between January 4th and February 3rd, 2020. The survey consisted of 14 questions regarding the usage and training of steerable laparoscopic instruments. A total of 83 members responded, coming from 33 different countries. Twenty three percent of the respondents using SLI, were using the instruments routinely and of these 21% had not received any formal training in advance of using the instruments in real patients. Of all responding EAES members, 41% considered the instruments to potentially compromise patient safety due to their complexity, learning curve and the inexperience of the surgeons. The respondents reported the three most important aspects of a possible steerable laparoscopic instruments training curriculum to be: hands-on training, safe tissue handling and suturing practice. Finally, a major part of the respondents consider force/pressure feedback data to be of significant importance for implementation of training and assessment of safe laparoscopic and robotic surgery. Training and assessment of skills regarding safe implementation of steerable laparoscopic instruments is lacking. The respondents stressed the need for specific hands-on training during which feedback and assessment of skills should be guaranteed before operating on real patients.

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• Journal article
  Liu T, Yang T, Xu W, Mylonas G, Liang Bet al., 2022,

  Efficient Inverse Kinematics and Planning of a Hybrid Active and Passive Cable-Driven Segmented Manipulator

  , IEEE TRANSACTIONS ON SYSTEMS MAN CYBERNETICS-SYSTEMS, Vol: 52, Pages: 4233-4246, ISSN: 2168-2216
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  • Citations: 7
• Journal article
  Robertson D, Sterke F, van Weteringen W, Arezzo A, Mintz Y, Nickel F, Technology committee of the European Association for Endoscopic Surgery EAES, Horeman Tet al., 2022,

  Characterisation of trocar associated gas leaks during laparoscopic surgery.

  , Surg Endosc, Vol: 36, Pages: 4542-4551

  BACKGROUND: During laparoscopy, the abdominal cavity is insufflated with carbon dioxide (CO2) that could become contaminated with viruses and surgical smoke. Medical staff is potentially exposed when this gas leaks into the operating room through the instruments and past trocar valves. No detailed studies currently exist that have quantified these leakage pathways. Therefore, the goal of this study was to quantify the gas leakages through trocars and instruments, during minimally invasive procedures. METHODS: A model of the surgical environment was created, consisting of a rigid container with an interface for airtight clamping of laparoscopic equipment such as trocars and surgical instruments. The model was insufflated to 15 mm Hg using a pressure generator and a pneumotachograph measured the equipment gas leak. A protocol of several use cases was designed to simulate the motions and forces the surgeon exerts on the trocar during surgery. RESULTS: Twenty-three individual trocars and twenty-six laparoscopic instruments were measured for leakage under the different conditions of the protocol. Trocar leakages varied between 0 L/min and more than 30 L/min, the instruments revealed a range of leakages between 0 L/min and 5.5 L/min. The results showed that leakage performance varied widely between trocars and instruments and that the performance and location of the valves influenced trocar leakage. CONCLUSIONS: We propose trocar redesigns to overcome specific causes of gas leaks. Moreover, an international testing standard for CO2 leakage for all new trocars and instruments is needed so surgical teams can avoid this potential health hazard when selecting new equipment.

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• Journal article
  Arezzo A, Kruusmaa M, Mylonas G, 2022,

  Guest Editorial From Bench to Bedside

  , IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS, Vol: 4, Pages: 297-299
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• Journal article
  Nakajima K, Mintz Y, Nickel F, Arezzo A, EAES Technology Committeeet al., 2022,

  The EAES intellectual property awareness survey.

  , Surg Endosc, Vol: 36, Pages: 3340-3346

  INTRODUCTION: The protection of intellectual property (IP) is one of the fundamental elements in the process of medical device development. The significance of IP, however, is not well understood among clinicians and researchers. The purpose of this study was to evaluate the current status of IP awareness and IP-related behaviors among EAES members. METHODS: A web-based survey was conducted via questionnaires sent to EAES members. Data collected included participant demographics, level of understanding the need, new ideas and solutions, basic IP knowledge, e.g., employees' inventions and public disclosure, behaviors before and after idea disclosures. RESULTS: One hundred and seventy-nine completed forms were obtained through an email campaign conducted twice in 2019 (response rate = 4.8%). There was a dominancy in male, formally-trained gastrointestinal surgeons, working at teaching hospitals in European countries. Of the respondents, 71% demonstrated a high level of understanding the needs (frustration with current medical devices), with 66% developing specific solutions by themselves. Active discussion with others was done by 53%. Twenty-one percent of respondents presented their ideas at medical congresses, and 12% published in scientific journals. Only 20% took specific precautions or appropriate actions to protect their IPs before these disclosures. CONCLUSIONS: The current level of awareness of IP and IP-related issues is relatively low among EAES members. A structured IP training program to gain basic IP knowledge and skill should be considered a necessity for clinicians. These skills would serve to prevent the loss of legitimate IP rights and avoid failure in the clinical implementation of innovative devices for the benefit of patients.

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• Conference paper
  Golahmadi AK, Khan DZ, Mylonas G, Marcus Het al., 2021,

  Tool-tissue Forces in Surgery: A Systematic Review

  , Publisher: ELSEVIER SCIENCE INC, Pages: E70-E70, ISSN: 1072-7515
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• Journal article
  Runciman M, Avery J, Darzi A, Mylonas Get al., 2021,

  Open loop position control of soft hydraulic actuators for minimally invasive surgery

  , Applied Sciences-Basel, Vol: 11, Pages: 1-16, ISSN: 2076-3417

  Minimally invasive surgery (MIS) presents many constraints on the design of robotic devices that can assist medical staff with a procedure. The limitations of conventional, rigid robotic devices have sparked interest in soft robotic devices for medical applications. However, problems still remain with the force exertion and positioning capabilities of soft robotic actuators, in conjunction with size restrictions necessary for MIS. In this article we present hydraulically actuated soft actuators that demonstrate highly repeatable open loop positioning and the ability to exert significant forces in the context of MIS. Open loop position control is achieved by changing the actuator volume, which causes contraction. In one degree of freedom (DOF) configurations, root mean square error (RMSE) values of 0.471 mm, 1.506 mm, and 0.350 mm were recorded for a single actuator against gravity, a single actuator with a pulley, and a horizontal antagonistic configuration, respectively. Hysteresis values of 0.711 mm, 0.958 mm, and 0.515 mm were reported in these experiments. In addition, different numbers of soft actuators were used in configurations two and three DOFs to demonstrate position control. When deactivated, the soft actuators are low-profile and flexible as they are constructed from thin films. As such, a robot with a deployable structure and three soft actuators was constructed. The robot is therefore able to reversibly transition from low to high volume and stiffness, which has potential applications in MIS. A user successfully controlled the deployable robot in a circle tracing task.

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