From a Disposable Ureteroscope to an Active Lightweight Fetoscope—Characterization and Usability Evaluation

Legrand, J; Ourak, Mouloud; Javaux, Allan; Gruijthuijsen, Caspar; Ahmad, Awais; Cleynenbreugel, Ben Van; Vercauteren, Tom; Deprest, Jan; Ourselin, Sébastien; Poorten, Emmanuel Vander

doi:10.1109/lra.2018.2866204

Cited by 17 publications

(26 citation statements)

References 16 publications

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“…A maximum unidirectional bending angle, equal to 180°, was foreseen. The unidirectional feature of the distal tip was asked by fetal surgeons in order to simplify as much as possible the manipulation of the instrument (Legrand et al, 2018 ). This does not restrict the instrument's number degree of freedom, since the surgeon can always twist the instrument along its longitudinal axis.…”

Section: Methodsmentioning

confidence: 99%

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Handheld Active Add-On Control Unit for a Cable-Driven Flexible Endoscope

et al. 2019

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The instruments currently used by surgeons for in utero treatment of the twin-to-twin transfusion syndrome (TTTS) are rigid or semi-rigid. Their poor dexterity makes this surgical intervention risky and the surgeon's work very complex. This paper proposes the design, assembly and quantitative evaluation of an add-on system intended to be placed on a commercialized cable-driven flexible endoscope. The add-on system is lightweight and easily exchangeable thanks to the McKibben muscle actuators embedded in its system. The combination of the flexible endoscope and the new add-on unit results in an easy controllable flexible instrument with great potential use in TTTS treatment, and especially for regions that are hard to reach with conventional instruments. The fetoscope has a precision of 7.4% over its entire bending range and allows to decrease the maximum planar force on the body wall of 6.15% compared to the original endoscope. The add-on control system also allows a more stable and precise actuation of the endoscope flexible tip.

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Section: Methodsmentioning

confidence: 99%

“…The designed add-on system is lightweight and allows an active one-handed manipulation of the endoscope. A first version has been presented on a LithoVue which is a disposable ureteroscope system from Boston Scientific (Natick, USA, Legrand et al, 2018 ). This validated the feasibility of such a single-handed add-on system.…”

Section: Introductionmentioning

confidence: 99%

Handheld Active Add-On Control Unit for a Cable-Driven Flexible Endoscope

et al. 2019

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“…The instrument has a chip-on-tip camera, a fiber-optic light source and a working channel for laser fiber. The design, usability and shared control approaches have been discussed in [ 1 , 14 ]. Due to usability issues and steep learning curves, a shared control approach was proposed where the surgeon was in charge of the gross instrument motion and the distal tip moved autonomously.…”

Section: Introductionmentioning

confidence: 99%

Deep learning-based monocular placental pose estimation: towards collaborative robotics in fetoscopy

et al. 2020

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Purpose Twin-to-twin transfusion syndrome (TTTS) is a placental defect occurring in monochorionic twin pregnancies. It is associated with high risks of fetal loss and perinatal death. Fetoscopic elective laser ablation (ELA) of placental anastomoses has been established as the most effective therapy for TTTS. Current tools and techniques face limitations in case of more complex ELA cases. Visualization of the entire placental surface and vascular equator; maintaining an adequate distance and a close to perpendicular angle between laser fiber and placental surface are central for the effectiveness of laser ablation and procedural success. Robot-assisted technology could address these challenges, offer enhanced dexterity and ultimately improve the safety and effectiveness of the therapeutic procedures. Methods This work proposes a 'minimal' robotic TTTS approach whereby rather than deploying a massive and expensive robotic system, a compact instrument is 'robotised' and endowed with 'robotic' skills so that operators can quickly and efficiently use it. The work reports on automatic placental pose estimation in fetoscopic images. This estimator forms a key building block of a proposed shared-control approach for semi-autonomous fetoscopy. A convolutional neural network (CNN) is trained to predict the relative orientation of the placental surface from a single monocular fetoscope camera image. To overcome the absence of real-life ground-truth placenta pose data, similar to other works in literature (Handa et al. in: Proceedings of the IEEE conference on computer vision and pattern recognition, 2016; Gaidon et al. in: Proceedings of the IEEE conference on computer vision and pattern recognition, 2016; Vercauteren et al. in: Proceedings of the IEEE, 2019) the network is trained with data generated in a simulated environment and an in-silico phantom model. A limited set of coarsely manually labeled samples from real interventions are added to the training dataset to improve domain adaptation. Results The trained network shows promising results on unseen samples from synthetic, phantom and in vivo patient data. The performance of the network for collaborative control purposes was evaluated in a virtual reality simulator in which the virtual flexible distal tip was autonomously controlled by the neural network. Conclusion Improved alignment was established compared to manual operation for this setting, demonstrating the feasibility to incorporate a CNN-based estimator in a real-time shared control scheme for fetoscopic applications.

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“…M CKIBBEN pneumatic artificial muscles are increasingly being used as actuators in surgical instruments [1][2][3][4][5]. These artificial muscles consist of an internal bladder, surrounded by a non-extensible braided mesh.…”

Section: Introductionmentioning

confidence: 99%

Integrated Capacitance Sensing for Miniature Artificial Muscle Actuators

et al. 2020

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The use of McKibben pneumatic artificial muscles in surgical instruments is increasing due to their light weight, miniaturization potential, compliance and large actuation force. However, precise position and force control is still challenging due to the intrinsic muscle hysteresis. The present work proposes an easy-to-make integrated capacitance sensor for miniature artificial muscles by replacing two strands of the muscle braid with two conductive wires. By measuring the capacitance at high excitation frequency between both wires, the length of the muscle can be deduced. This new integrated sensor still allows the miniaturization of McKibben muscles. The miniature muscle with integrated capacitance sensing only loses 3% of its contraction length with regard to an original McKibben muscle. The sensor can predict the muscle length with a 0.31mm precision over 80% of the muscle total achievable contraction range in average.

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From a Disposable Ureteroscope to an Active Lightweight Fetoscope—Characterization and Usability Evaluation

Cited by 17 publications

References 16 publications

Handheld Active Add-On Control Unit for a Cable-Driven Flexible Endoscope

Handheld Active Add-On Control Unit for a Cable-Driven Flexible Endoscope

Deep learning-based monocular placental pose estimation: towards collaborative robotics in fetoscopy

Integrated Capacitance Sensing for Miniature Artificial Muscle Actuators

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