A modular, multi-arm concentric tube robot system with application to transnasal surgery for orbital tumors

Abstract

In the development of telemanipulated surgical robots, a class of continuum robots known as concentric tube robots has drawn particular interest for clinical applications in which space is a major limitation. One such application is transnasal surgery, which is used to access surgical sites in the sinuses and at the skull base. Current techniques for performing these procedures require surgeons to maneuver multiple rigid tools through the narrow confines of the nasal passages, leaving them with limited dexterity at the surgical site. In this article, we present a complete robotic system for transnasal surgery featuring concentric tube manipulators. It illustrates a bagging concept for sterility, and intraoperatively interchangeable instruments that work in conjunction with it, which were developed with operating room workflow compatibility in mind. The system also includes a new modular, portable surgeon console, a variable view-angle endoscope to facilitate surgical field visualization, and custom motor control electronics. Furthermore, we demonstrate elastic instability avoidance for the first time on a physical prototype in a geometrically accurate surgical scenario, which facilitates use of higher curvature tubes than could otherwise be used safely in this application. From a surgical application perspective, this article presents the first robotic approach to removing tumors growing behind the eyes in the orbital apex region, which has not been attempted previously with a surgical robot.

Continuum robots for endoscopic sinus surgery: Recent advances, challenges, and prospects

“…At a further development stage, the endoscope should be replaced with a higher resolution one. (4) Although the instrument exchanges of some CRs 42,49 can be achieved, a fast and efficient method still needs to be studied.…”

“…Moreover, the distance between the two channels was fixed at 35 mm, limiting its application to sinus surgery through one nostril. In, 42 a multi‐arm concentric tube robotic system, shown in Figure 9B, was proposed with application to transnasal surgery for orbital tumors. The main contribution of this system was that the centric tube instruments could be exchanged as single units.…”

“…(A) A telerobotic system for transnasal surgery 41 (Copyright ⓒ 2013, IEEE). (B) A multi‐arm concentric tube CR for orbital tumors 42 (Copyright ⓒ 2021, SAGE). (C) A multi‐arm concentric tube robot system for transnasal surgery 43 (Copyright ⓒ 2020, International Federation for Medical and Biological Engineering).…”

“…Through the master‐slave control algorithm, the control input of the master device is transformed to the motion input of the actuation unit 61 . The commonly used master devices are Geomagic Touch (3D Systems Inc.), 42,47 Falcon (Novint Technologies Inc.), 46,62 omega.x haptic devices (Force Dimension Inc.) 63 . Sidesticks or joysticks can also be used as master devices in ESS 49,61 .…”

Design and Modeling of a Bio-Inspired Compound Continuum Robot for Minimally Invasive Surgery

“…The surgical instruments can be made smaller in size. This special continuum robot has been used in skull base tumor resection [23], cardiac intervention [24], lung biopsy [25], etc. Although the CTR can achieve a satisfactory diameter, Alfalahi et al [26] pointed out an apparent trade-off between the stiffness of the CTR and the working space.…”