Human-centred Automation, Robotics and Monitoring

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• Journal article
  Runciman M, Darzi A, Mylonas GP, 2020,

  Soft robotics in minimally invasive surgery (Part 2)

  , Galvanotechnik, Vol: 111, Pages: 1236-1237, ISSN: 0016-4232

  Soft-Robotik Geräte haben viele wünschenswerte Eigenschaften für Anwendungen in der minimalinvasiven Chirurgie (MIC), jedoch bleiben viele interdisziplinäre Herausforderungen ungelöst. Um den gegenwärtigen Stand der Technologien zu verstehen, wurde eine Stichwortsuche mit Hilfe der Datenbanken Web of Science und Scopus durchgeführt.

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• Journal article
  Kinross JM, Mason SE, Mylonas G, Darzi Aet al., 2020,

  Next-generation robotics in gastrointestinal surgery

  , Nature Reviews Gastroenterology and Hepatology, Vol: 17, Pages: 430-440, ISSN: 1759-5045

  The global numbers of robotic gastrointestinal surgeries are increasing. However, the evidence base for robotic gastrointestinal surgery does not yet support its widespread adoption or justify its cost. The reasons for its continued popularity are complex, but a notable driver is the push for innovation — robotic surgery is seen as a compelling solution for delivering on the promise of minimally invasive precision surgery — and a changing commercial landscape delivers the promise of increased affordability. Novel systems will leverage the robot as a data-driven platform, integrating advances in imaging, artificial intelligence and machine learning for decision support. However, if this vision is to be realized, lessons must be heeded from current clinical trials and translational strategies, which have failed to demonstrate patient benefit. In this Perspective, we critically appraise current research to define the principles on which the next generation of gastrointestinal robotics trials should be based. We also discuss the emerging commercial landscape and define existing and new technologies.

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• Journal article
  Zhao M, Oude Vrielink TJC, Kogkas A, Runciman M, Elson D, Mylonas Get al., 2020,

  LaryngoTORS: a novel cable-driven parallel robotic system for transoral laser phonosurgery

  , IEEE Robotics and Automation Letters, Vol: 5, Pages: 1516-1523, ISSN: 2377-3766

  Transoral laser phonosurgery is a commonly used surgical procedure in which a laser beam is used to perform incision, ablation or photocoagulation of laryngeal tissues. Two techniques are commonly practiced: free beam and fiber delivery. For free beam delivery, a laser scanner is integrated into a surgical microscope to provide an accurate laser scanning pattern. This approach can only be used under direct line of sight, which may cause increased postoperative pain to the patient and injury, is uncomfortable for the surgeon during prolonged operations, the manipulability is poor and extensive training is required. In contrast, in the fiber delivery technique, a flexible fiber is used to transmit the laser beam and therefore does not require direct line of sight. However, this can only achieve manual level accuracy, repeatability and velocity, and does not allow for pattern scanning. Robotic systems have been developed to overcome the limitations of both techniques. However, these systems offer limited workspace and degrees-of-freedom (DoF), limiting their clinical applicability. This work presents the LaryngoTORS, a robotic system that aims at overcoming the limitations of the two techniques, by using a cable-driven parallel mechanism (CDPM) attached at the end of a curved laryngeal blade for controlling the end tip of the laser fiber. The system allows autonomous generation of scanning patterns or user driven freepath scanning. Path scan validation demonstrated errors as low as 0.054±0.028 mm and high repeatability of 0.027±0.020 mm (6×2 mm arc line). Ex vivo tests on chicken tissue have been carried out. The results show the ability of the system to overcome limitations of current methods with high accuracy and repeatability using the superior fiber delivery approach.

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• Journal article
  Runciman M, Avery J, Zhao M, Darzi A, Mylonas GPet al., 2020,

  Deployable, variable stiffness, cable driven robot for minimally invasive surgery

  , Frontiers in Robotics and AI, Vol: 6, Pages: 1-16, ISSN: 2296-9144

  Minimally Invasive Surgery (MIS) imposes a trade-off between non-invasive access and surgical capability. Treatment of early gastric cancers over 20 mm in diameter can be achieved by performing Endoscopic Submucosal Dissection (ESD) with a flexible endoscope; however, this procedure is technically challenging, suffers from extended operation times and requires extensive training. To facilitate the ESD procedure, we have created a deployable cable driven robot that increases the surgical capabilities of the flexible endoscope while attempting to minimize the impact on the access that they offer. Using a low-profile inflatable support structure in the shape of a hollow hexagonal prism, our robot can fold around the flexible endoscope and, when the target site has been reached, achieve a 73.16% increase in volume and increase its radial stiffness. A sheath around the variable stiffness structure delivers a series of force transmission cables that connect to two independent tubular end-effectors through which standard flexible endoscopic instruments can pass and be anchored. Using a simple control scheme based on the length of each cable, the pose of the two instruments can be controlled by haptic controllers in each hand of the user. The forces exerted by a single instrument were measured, and a maximum magnitude of 8.29 N observed along a single axis. The working channels and tip control of the flexible endoscope remain in use in conjunction with our robot and were used during a procedure imitating the demands of ESD was successfully carried out by a novice user. Not only does this robot facilitate difficult surgical techniques, but it can be easily customized and rapidly produced at low cost due to a programmatic design approach.

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• Conference paper
  Zhao M, Oude Vrielink J, Kogkas A, Runciman M, Elson D, Mylonas Get al., 2020,

  LaryngoTORS: A Novel Cable-Driven Parallel Robot for Transoral Laser Surgery

  , International Conference on Robotics and Automation (ICRA)
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• Conference paper
  Zhao M, Zhang H, Mylonas GP, Elson DSet al., 2020,

  Cable-driven parallel robot assisted confocal imaging of the larynx

  , Biophotonics Congress: Biomedical Optics 2020, Publisher: Optica Publishing Group, Pages: 1-2

  LaryngoTORS, a transoral laryngeal surgery robot, can manipulate instruments accurately. Confocal imaging has potentials in laryngeal cancer diagnosis but suffer from high scanning requirement. This work studies using LaryngoTORS to assist confocal imaging of larynx.

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• Book chapter
  Vrielink TJCO, Vitiello V, Mylonas GP, 2020,

  Robotic surgery in cancer

  , BIOENGINEERING INNOVATIVE SOLUTIONS FOR CANCER, Editors: Ladame, Chang, Publisher: ACADEMIC PRESS LTD-ELSEVIER SCIENCE LTD, Pages: 245-269, ISBN: 978-0-12-813886-1
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• Conference paper
  Ezzat A, Thakkar R, Kogkas A, Mylonas Get al., 2019,

  Perceptions of surgeons and scrub nurses towards a novel eye-tracking based robotic scrub nurse platform

  , International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY, Pages: 81-82, ISSN: 0007-1323
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• Conference paper
  Avery J, Runciman M, Darzi A, Mylonas GPet al., 2019,

  Shape sensing of variable stiffness soft robots using electrical impedance tomography

  , International Conference on Robotics and Automation (ICRA), Publisher: IEEE, Pages: 9066-9072, ISSN: 1050-4729

  Soft robotic systems offer benefits over traditional rigid systems through reduced contact trauma with soft tissues and by enabling access through tortuous paths in minimally invasive surgery. However, the inherent deformability of soft robots places both a greater onus on accurate modelling of their shape, and greater challenges in realising intraoperative shape sensing. Herein we present a proprioceptive (self-sensing) soft actuator, with an electrically conductive working fluid. Electrical impedance measurements from up to six electrodes enabled tomographic reconstructions using Electrical Impedance Tomography (EIT). A new Frequency Division Multiplexed (FDM) EIT system was developed capable of measurements of 66 dB SNR with 20 ms temporal resolution. The concept was examined in two two-degree-of-freedom designs: a hydraulic hinged actuator and a pneumatic finger actuator with hydraulic beams. Both cases demonstrated that impedance measurements could be used to infer shape changes, and EIT images reconstructed during actuation showed distinct patterns with respect to each degree of freedom (DOF). Whilst there was some mechanical hysteresis observed, the repeatability of the measurements and resultant images was high. The results show the potential of FDM-EIT as a low-cost, low profile shape sensor in soft robots.

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• Journal article
  Runciman M, Darzi A, Mylonas G, 2019,

  Soft robotics in minimally invasive surgery

  , Soft Robotics, Vol: 6, Pages: 423-443, ISSN: 2169-5172

  Soft robotic devices have desirable traits for applications in minimally invasive surgery (MIS) but many interdisciplinary challenges remain unsolved. To understand current technologies, we carried out a keyword search using the Web of Science and Scopus databases, applied inclusion and exclusion criteria, and compared several characteristics of the soft robotic devices for MIS in the resulting articles. There was low diversity in the device designs and a wide-ranging level of detail regarding their capabilities. We propose a standardised comparison methodology to characterise soft robotics for various MIS applications, which will aid designers producing the next generation of devices.

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