Alperen Acemoglu

Intravenous Access (IVA) is the most common invasive medical procedure. Globally, it is estimated that over one billion IVA devices (needles/catheters) are used annually. However, the overall failure rate in this procedure is unacceptably high, reaching values between 35 and 50%. This has driven a great deal of research and technological development over recent decades, including the integration of different levels of autonomy in IVA medical devices to greatly improve this process. This paper will review these recent technical developments, including methods and systems for vein imaging and localization, needle insertion, venipuncture detection, catheter placement, and complete robotic IVA platforms. Furthermore, this paper explores emerging technical aspects, current limitations, and new research directions that may enable wider clinical translation and better acceptance of robotic IVA technologies.

Biomedical robotic systems continue to hold unlimited potential for surgical procedures. Robotized laser endoscopic tools provide surgeons with increased accuracy in the laser ablation of tissue and tumors. The research here catalogs the design and implementation of a new laser endoscopic tool for tissue ablation. A novel feature of this new device is the inclusion of a feedback loop that measures the position of the laser beam via a photodetector sensor. The scale of this new device was governed by the dimensions of the photodetector sensor. The tip of the laser's fiber optic cable is controlled by the torque interaction between permanent magnet rings surrounding the fiber-optic and the custom-designed solenoid coils. Prior to building the physical test-bed, the system was modeled and simulated using comsol software. In preclinical trials, the physical experimental results showed that the designed prototype laser scanner system accurately tracks different ablation patterns and gives a consistent output position for the laser beam; however, the heat diffusion into the tissue around the desired line of the geometric shape would give wider ablation margins than was desirable.

In cancer surgery, the correct localization of cancerous tissue is critical for the success of the surgery. Specifically, the surgical goal is to remove the malignant tissue completely while preserving the maximum amount of healthy tissue. Unfortunately, limited technologies are available for intra-operative assessment of tumor margin in Robotic Minimally Invasive Surgery (RMIS). This work presents a vision-based autonomous robotic scanning system for abnormal tissue detection. A stereo vision system, including dense 3D surface reconstruction and tissue tracking, is used to control the scanning motion to compensate for tissue motion and deformation. A high level control strategy allows to control a robot arm to scan autonomously the tissue by means of a monopolar forceps measuring the Electric Bio-Impedance (EBI) of the tissue. The acquired information is used for discriminating cancerous from healthy tissue in real-time, and this information is presented as an impedance map overlaid on the endoscopic video using Augmented Reality (AR). The proposed system performance is evaluated on ex-vivo animal tissues, through experiments simulating the identification and localization of hepatic cancer for resection surgery. Quantitative results show that the system is able to autonomously scan the area of interest and provide a tissue characterization with an accuracy over 82%.

Robotic telesurgery is a new concept in surgical care that has gained relevance over the past two decades. Now, with the introduction of 5G mobile networks, this concept is becoming practical. Here, we report that surgeons successfully performed complex transoral laser microsurgeries on the vocal cords of an adult human cadaver located 15 km away from them. This was possible thanks to a high bandwidth and ultra-low latency 5G telecommunication system, which allowed for precise remote control of robotic instruments and full HD (1920×1280 pixels) 3D visualization of the surgical site. During the operation, the mean video transmission latency was 102±9 ms with the maximum latency being 140 ms, but this was observed during less than 1% of the operation time. This latency did not cause any deterioration in surgeons’ performance. Our results demonstrate that surgical expertise can be exploited and shared efficiently using the new 5G telecommunication standard. This is critical for highly specialized operations such as the microsurgeries demonstrated here, which require surgical expertise that are not widely available. Therefore, the possibility to operate from a distance can bring significant benefits to healthcare systems, reducing costs and enhancing treatment quality for patients. In addition, it makes telementoring a reality, allowing expert surgeons to be present virtually in multiple operating rooms to guide and train less experienced colleagues.