Linear actuation is a basic need in robotized manipulation of surgical instruments, that must comply with a challenging environment in terms of safety, compactness and now often compatibility with imaging modalities like CT or MRI. In this paper, we focus on needle manipulation for interventional radiology. We propose a needle driver, i.e. a linear actuator for needle insertion, based on the inchworm principle combined with pneumatic energy. Our first contribution is to propose, model and implement the device using a so-called auxetic structure. Its use increases achievable displacement under pressure and provides sufficient off-axis stiffness to use the actuator without additional guidance. Simplified modeling is introduced for the actuator synthesis. Our second contribution is to implement the actuator with multimaterial additive manufacturing combining rigid and flexible materials to increase compactness. As a third contribution, initial assessment of component sterilization and compatibility with X-ray and MRI imaging modalities is presented.

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Purpose This study aims to investigate the potential of using polymer multi-material additive manufacturing (MMAM) to produce miniature hydraulic piston actuators combining rigid structures and flexible seals. Such actuators offer great potential for medical robots in X-ray and magnetic resonance environments, where conventional piston actuators cannot be used because of safety issues caused by metal components. Design/methodology/approach Hydraulic pistons with two different integrated flexible seal shapes are designed and manufactured using MMAM. Design 1 features a ring-shaped seal made from a flexible material that is printed on the surface of the rigid piston shaft. Design 2 appears identical from the outside, yet an axial opening in the piston shaft is added to enable self-reinforced sealing as fluid pressure increases. For both designs, samples with three different outer diameters are fabricated leading to a total of six different piston versions. The pistons are then evaluated regarding leakage, friction and durability. Findings Measurement results show that the friction force for Design 2 is lower than that of Design 1, making Design 2 more suitable for the intended application. None of the versions of Design 2 shows leakage for pressures up to 1.5 MPa. For Design 1, leak-tightness varies with the outer diameter, yet none of the versions is consistently leak-tight at 1.5 MPa. Furthermore, the results show that prolonged exposure to water decreases the durability of the flexible material significantly. The durability the authors observe may, however, be sufficient for short-term or single-use devices. Originality/value The authors investigate a novel design approach for hydraulic piston actuators based on MMAM. These actuators are of particular interest for patient-specific medical devices used in radiological interventions, where metal-free components are required to safely operate in X-ray and magnetic resonance environments. This study may serve as a basis for the development of new actuators, as it shows a feasible solution, yet pointing out critical aspects such as the influence of small geometry changes or material performance changes caused by water absorption.

To compare robotic-assisted needle insertions performed under CBCT-guidance to standard manual needle insertions. MATERIALS AND METHODS A homemade robotic prototype was used by two operators to perform robotic and manual needle insertions on a custom-made phantom. Both the operators had no experience with the prototype before starting the trial. The primary endpoint was accuracy (i.e. the minimal distance between the needle tip and the centre of the target) between robotic and manual insertions. Secondary endpoints included total procedure time and operators' radiation exposure. The Wilcoxon test was used. A P value less than 0.05 was considered statistically significant. RESULTS Thirty-three (17 manual, 16 robotic) needle insertions were performed. Mean accuracy for robotic insertion was 2.3 ± 0.9 mm (median 2.1; range 0.8-4.2) vs 2.3 ± 1 mm (median 2.1; range 0.7-4.4) for manual insertion (p=0.84). Mean procedure time was 683 ± 57 sec (median 670; range 671-849) for the robotic group vs 552 ± 40 sec (median 548; range 486-62) for the manual group (p=0.0002). Mean radiation exposure was 3.25 times less for the robotic insertion on comparison to manual insertion for the operator 1 (0.4 vs 1.3 µGy); and 4.15 times less for the operator 2 (1.9 vs 7.9 µGy). CONCLUSION The tested robotic prototype showed accuracy comparable to that achieved with manual punctures coupled to a significant reduction of operators' radiation exposure. Further in-vivo studies are necessary to confirm the efficiency of the system.