Development and Validation of a Mixed Reality Configuration of a Simulator for a Minimally Invasive Spine Surgery Using the Workspace of a Haptic Device and Simulator Users

Most surgical simulators leverage virtual or bench models to simulate reality. This study proposes and validates a method for workspace configuration of a surgical simulator which utilizes a haptic device for interaction with a virtual model and a bench model to provide additional tactile feedback based on planned surgical manoeuvers. Numerical analyses were completed to determine the workspace and position of a haptic device, relative to the bench model, used in the surgical simulator, and the determined configuration was validated using device limitations and user data from surgical and nonsurgical users. For the validation, surgeons performed an identical surgery on a cadaver prior to using the simulator, and their trajectories were then compared to the determined workspace for the haptic device. The configuration of the simulator was determined appropriate through workspace analysis and the collected user trajectories. Statistical analyses suggest differences in trajectories between the participating surgeons which were not affected by the imposed haptic workspace. This study, therefore, demonstrates a method to optimally position a haptic device with respect to a bench model while meeting the manoeuverability needs of a surgical procedure. The validation method identified workspace position and user trajectory towards ideal configuration of a mixed reality simulator.

Design and slip prevention control of a multi-sensory anthropomorphic prosthetic hand

Purpose The purpose of this paper is to design a multi-sensory anthropomorphic prosthetic hand and a grasping controller that can detect the slip and automatically adjust the grasping force to prevent the slip. Design/methodology/approach To improve the dexterity, sensing, controllability and practicability of a prosthetic hand, a modular and multi-sensory prosthetic hand was presented. In addition, a slip prevention control based on the tactile feedback was proposed to improve the grasp stability. The proposed controller identifies slippages through detecting the high-frequency vibration signal at the sliding surface in real time and the discrete wavelet transform (DWT) was used to extract the eigenvalues to identify slippages. Once the slip is detected, a direct-feedback method of adjusting the grasp force related with the sliding times was used to prevent it. Furthermore, the stiffness of different objects was estimated and used to improve the grasp force control. The performances of the stiffness estimation, slip detection and slip control are experimentally evaluated. Findings It was found from the experiment of stiffness estimation that the accuracy rate of identification of the hard metal bottle could reach to 90%, while the accuracy rate of identification of the plastic bottles could reach to 80%. There was a small misjudgment rate in the identification of hard and soft plastic bottles. The stiffness of soft plastic bottles, hard plastic bottles and metal bottles were 0.64 N/mm, 1.36 N/mm and 32.55 N/mm, respectively. The results of slip detection and control show that the proposed prosthetic hand with a slip prevention controller can fast and effectively detect and prevent the slip for different disturbances, which has a certain application prospect. Practical implications Due to the small size, low weight, high integration and modularity, the prosthetic hand is easily applied to upper-limb amputees. Meanwhile, the method of the slip prevention control can be used for upper-limb amputees to complete more tasks stably in daily lives. Originality/value A multi-sensory anthropomorphic prosthetic hand is designed, and a method of stable grasps control based on slip detection by a tactile sensor on the fingertip is proposed. The method combines the stiffness estimation of the object and the real-time slip detection based on DWT with the design of the proportion differentiation robust controller based on a disturbance observer and the force controller to achieve slip prevention and stable grasps. It is verified effectively by the experiments and is easy to be applied to commercial prostheses.

Soft Pneumatic Fingertip Actuator Incorporating a Dual Air Chamber to Generate Multi-Mode Simultaneous Tactile Feedback

A complete set of diverse haptic feedbacks is essential for a highly realistic and immersive virtual environment. In this sense, a multi-mode haptic interface that simultaneously generates multiple kinds of haptic signals is highly desirable. In this paper, we propose a new silicone-made pneumatically controlled fingertip actuator to render pressure and vibrotactile feedback concurrently to offer a realistic and effective haptic sensation. A new silicone-based stacked dual-layer air chamber was designed. The volume of the chambers is controlled by pneumatic valves with compressed air tanks. The top/upper air chamber renders vibration feedback, whereas the bottom/lower air chamber renders pressure feedback. The proposed silicone-made fingertip actuator is designed so that it can be easily worn at the fingertips. To demonstrate the potential of the system, a virtual environment for rendering three different types of haptic textures was implemented. Extensive performance evaluation and user studies were carried out to demonstrate the proposed actuator’s effectiveness compared to an actuator with single vibrotactile feedback.

Esophageal Perforation after Using a Single-Use Disposable Duodenoscope

The Food and Drug Administration (FDA) has recently released a safety communication recommending transition to duodenoscopes with innovative designs that facilitate or eliminate the need for reprocessing. Thus, there has been a significant amount of development into disposable duodenoscope components and single-use duodenoscopes, with variable tactile feedback. We describe a case of esophageal perforation after using a single-use disposable duodenoscope (EXALT Model D; Boston Scientific Corporation, Marlborough, MA, USA). To our knowledge, this is the first reported case of an esophageal perforation since FDA approval of this device in December 2019. ERCP was performed with the EXALT Model D single-use duodenoscope (Boston Scientific Corporation) by an experienced gastroenterologist. During the procedure, gentle force applied through the gastroesophageal junction caused a liner perforation in the distal esophagus. An esophageal stent was placed with satisfactory wound healing and no fistula formation. There have been a few reports in the last 2 years showing promising results using this device; however, the differences in the tactile feedback, navigation, and pushability of the device may make it prone to unintended consequences.

A non-invasive wearable sensory leg neuroprosthesis: mechanical, electrical and functional validation

Objective. Lower limb amputees suffer from a variety of functional deficits related to the absence of sensory communication between the central nervous system and the lost extremity. Indeed, they experience high risk of falls, asymmetric walking and balance, and low prosthesis embodiment, that significantly decrease their quality of life. Presently, there are no commercially available devices able to provide sensory feedback to leg amputees. Recently, some invasive solutions (i.e. requiring a surgery) have been proposed by different research groups, however a non-invasive effective alternative exploitable in everyday life is still missing. Approach. To address this need we developed and tested a lightweight, non-invasive, wearable technology (NeuroLegs) providing sensory (i.e. knee angle joint and tactile) feedback to the users through electro-cutaneous stimulation. A user-friendly GUI and mobile App have been developed to easily calibrate and control the system. Standard mechanical and electrical tests were performed to assess the safety and reliability of the technology. Main results. No mechanical failures, stable communication among system parts and a long-lasting battery (>23h) were demonstrated. The NeuroLegs system was then verified in terms of accuracy in measuring relevant gait parameters in healthy participants. A high temporal reliability was found when detecting stride features (important for the real-time configuration) with a correct match to the walking cadence, in all assessed walking conditions. The effectiveness of the NeuroLegs system at improving walking of three transfemoral amputees was then verified in movement laboratory tests. Increased temporal gait symmetry and augmented confidence were found. Stepping outside from the lab, Neurolegs was successfully exploited by a transfemoral amputee in CYBATHLON Global Edition 2020 in several challenging situations related to daily-living activities. Significance. Our results demonstrate that the NeuroLegs system provides the user with useful sensory information that can be successfully exploited in different walking conditions of daily life.

Augmented Reality and Image-Guided Robotic Liver Surgery

Artificial intelligence makes surgical resection easier and safer, and, at the same time, can improve oncological results. The robotic system fits perfectly with these more or less diffused technologies, and it seems that this benefit is mutual. In liver surgery, robotic systems help surgeons to localize tumors and improve surgical results with well-defined preoperative planning or increased intraoperative detection. Furthermore, they can balance the absence of tactile feedback and help recognize intrahepatic biliary or vascular structures during parenchymal transection. Some of these systems are well known and are already widely diffused in open and laparoscopic hepatectomies, such as indocyanine green fluorescence or ultrasound-guided resections, whereas other tools, such as Augmented Reality, are far from being standardized because of the high complexity and elevated costs. In this paper, we review all the experiences in the literature on the use of artificial intelligence systems in robotic liver resections, describing all their practical applications and their weaknesses.