New approaches to intracerebral hemorrhage management are motivated by its high incidence and 40% mortality rate. Surgery is sometimes attempted to decompress the brain, although patient outcomes are similar regardless of whether surgery occurs. We hypothesize that surgical decompression is not more effective because current open surgical techniques disrupt healthy brain tissue to access the clot formed by the hemorrhage, offsetting the benefits of surgery. To address this, we propose a less invasive needle-based approach in which the clot is debulked from within using a superelastic, precurved aspiration cannula that is deployed from a needle. The tip of this aspiration cannula is controlled by coordinated insertion and retraction of the cannula and needle, as well as axial rotation of the cannula. We describe the design of a sterilizable and biocompatible robot that can control the three degrees of freedom of the needle and cannula. Image guidance is achieved by adapting an approach originally developed for brain biopsy. We provide an optimization method for the selection of the precurvatures of one or more sequentially used aspiration cannulas to maximize hemorrhage evacuation, based on preoperative medical image data. In vitro experiments demonstrate the feasibility of evacuating 83-92% of hemorrhage volume, depending on the number of tubes and deployment method used.

Introduction Conventional manual laparoscopic instruments for minimally invasive surgery have limited dexterity within the patient, making procedures challenging. Surgical robotic systems offer enhanced articulation, but at substantial financial costs. This has motivated the development of high-dexterity, low-cost laparoscopic instruments. Areas covered This article reviews both commercial and academic results on creating fully mechanical (i.e. non-robotic) laparoscopic instruments that provide wrists or wrist-like dexterity within the patient. We review the state of the art in the development of these mechanical instruments, focusing on the surgeon interface, wrist mechanism, and the kinematic mapping between the two. Expert commentary Current articulated mechanical laparoscopic instruments exhibit a wide range of designs, with no clear consensus on what makes such devices easy to use. As these technologies mature, user studies are needed to determine surgeon preferences. Articulated, low-cost instruments have the potential to impact the minimally invasive surgery market if they provide compelling benefits to surgeons.

Recent advances in registration have extended intra-surgical image guidance from its origins in bone-based procedures to new applications in soft tissues, thus enabling visualization of spatial relationships between surgical instruments and subsurface structures before incisions begin. Preoperative images are generally registered to soft tissues through aligning segmented volumetric image data with an intraoperatively sensed cloud of organ surface points. However, there is currently no viable noncontact minimally invasive scanning technology that can collect these points through a single laparoscopic port, which limits wider adoption of soft-tissue image guidance. In this paper, we describe a system based on conoscopic holography that is capable of minimally invasive surface scanning. We present the results of several validation experiments scanning ex vivo biological and phantom tissues with a system consisting of a tracked, off-the-shelf, relatively inexpensive conoscopic holography unit. These experiments indicate that conoscopic holography is suitable for use with biological tissues, and can provide surface scans of comparable quality to existing clinically used laser range scanning systems that require open surgery. We demonstrate experimentally that conoscopic holography can be used to guide a surgical needle to desired subsurface targets with an average tip error of less than 3 mm.

Background Registered medical images can assist with surgical navigation and enable image-guided therapy delivery. In soft tissues, surface-based registration is often used and can be facilitated by laser surface scanning. Tracked conoscopic holography (which provides distance measurements) has been recently proposed as a minimally invasive way to obtain surface scans. Moving this technique from concept to clinical use requires a rigorous accuracy evaluation, which is the purpose of our paper. Methods We adapt recent non-homogeneous and anisotropic point-based registration results to provide a theoretical framework for predicting the accuracy of tracked distance measurement systems. Experiments are conducted a complex objects of defined geometry, an anthropomorphic kidney phantom and a human cadaver kidney. Results Experiments agree with model predictions, producing point RMS errors consistently < 1 mm, surface-based registration with mean closest point error < 1 mm in the phantom and a RMS target registration error of 0.8 mm in the human cadaver kidney. Conclusions Tracked conoscopic holography is clinically viable; it enables minimally invasive surface scan accuracy comparable to current clinical methods that require open surgery.

The da Vinci Surgical System offers a natural user interface and wrist articulation, which enable suturing and other complex surgical actions in confined spaces. However, both the one-time cost of the system and the recurring cost of the limited-use instruments remain high. This has motivated the development of several hand-held alternatives—some partially motorized, some fully mechanical—in recent years. While a few of these have been commercialized, none have yet met with broad commercial success comparable to the da Vinci robot. In this letter, we suggest a user interface-based explanation for this, and describe a new mechanical instrument that provides wrist articulation with a novel user interface. We provide results of a single-user pilot study with an experienced laparoscopic surgeon to compare the new device with a traditional wristless laparoscopic tool, a prior commercial wristed mechanical tool (the RealHand), and the da Vinci robot, in the context of suturing at challenging angles. We observe better targeting of desired suture needle entry and exit points with the new device in comparison to prior wristed and wristless mechanical instruments, with the da Vinci only slightly outperforming the new tool.