IEEE ICRA 2010 Full Day Workshop Snakes, Worms and Catheters: Continuum and Serpentine Robots for Minimally Invasive Surgery Monday May 3, 2010 Anchorage, Alaska USA Organizers: Pierre E. Dupont Mohsen Mahvash Workshop Contents 1- Introduction 2- Abstract of Invited Talks • Neal Tanner, Hansen Medical (commercialization) 3 • David Camarillo, Hansen Medical (robotic catheters) 5 • Howie Choset, Carnegie Mellon University (snakes) 6 • Pierre Dupont, Children’s Hospital Boston, HMS (continuum robots) 8 • Koji Ikuta, Nagoya University (robotic catheters) 9 • Joseph Madsen, MD, Children’s Hospital, Harvard Med (clinical perspective) 11 • Mohsen Mahvash, Children’s Hospital Boston, HMS (continuum robots) 12 • Rajni Patel, University of Western Ontario (robotic catheters) 14 • Cameron Riviere, Carnegie Mellon University (worm robots) 16 • Nabil Simaan, Columbia University (NOTES) 17 • Russell Taylor, Johns Hopkins University (snake robots) 19 • Robert Webster, Vanderbilt University (continuum robots) 20 • Guang-Zhong Yang, Imperial College (snake robots) 23 3- Short Papers • A Highly Articulated Robotic System (CardioARM) is Safer than a Rigid System for Intrapericardial Intervention in a Porcine Model 24 • Towards a Minimally Invasive Neurosurgical Intracranial Robot 27 • Uncertainty Analysis in Continuum Robot Kinematics 30 • Ultrasound Image-Controlled Robotic Cardiac Catheter System 33 • Steerable Continuum Robot Design for Cochlear Implant Surgery 36 • Modular Needle Steering Driver for MRI-guided Transperineal Prostate Intervention 39 • Distributed Parameter Statics of Magnetic Catheters 42 • A Pilot Study on Using a Flexible Cannula Robot for Micro-Vascular Stenting 45 • Closed-Loop Control of Needle Steering for Percutaneous Kidney Access 48 • Stochastic Modeling and Path Planning for Steerable Needles 51 • A 4-DOF Bendable Endoscope Mechanism For Single Port Access Surgery 54 • Robotization of a Ureteroscope for Efficient Semi-automatic Vaporization of Kidney Stones 57 1 Introduction Abstract: A broad variety of serpentine and continuum robots have been developed for minimally invasive surgical applications. These vary in size from less than a millimeter to several centimeters in diameter and include flexible needles, robotic catheters, multi-segmented sheaths for NOTES applications, snake-like robots capable of suturing and inchworm devices that can move over the heart. While these devices share many common features, little effort has been devoted to exploring and exploiting these commonalities. This workshop focuses on bringing together interested researchers in academia and industry to identify unifying research questions and approaches for these types of devices. Motivation: Many surgical applications require reaching tissue deep within the body. Examples include surgery in the throat, inside the heart and in the stomach. Achieving minimally invasive access to these locations imposes unique constraints on robot design. Many ingenious serpentine and continuum robot mechanisms have been developed to satisfy these constraints. Some of these designs consist of multiple miniaturized stages that are connected in series. Many others employ flexible links that function as both link and joint. Developing any of these robots for clinical use poses a common set of problems: design optimization, choice of sensing, kinematic modeling, procedure planning and real-time control. To date, however, researchers interested in a particular design have pursued solutions to these problems independently. This workshop will bring researchers together to identify unifying themes and solution strategies for this class of medical robots. What methods can be shared to enhance telemanipulation capabilities, access to confined surgical spaces and safety? Is there a general kinematic modeling framework that encompasses steerable catheters and snake-like robots? What are the common challenges to clinical acceptance and commercial success for such robots? The goals of the workshop will be to identify such common themes and strategies, to build new partnerships between researchers and to spark new ideas for moving the field forward. Topics: • Active catheters • Continuum robots • Serpentine robots • Snake-like robots • Worm-like robots Intended Audience: The primary audience of the workshop consists of those researchers and their students who are currently investigating serpentine and continuum robots for surgical applications. The secondary audience consists of those researchers who are interested in applying this class of robots to medical applications. Pierre E. Dupont Mohsen Mahvash Director of Pediatric Cardiac Bioengineering Instructor of Surgery Visiting Professor of Surgery Children’s Hospital Boston, Harvard Medical School Children’s Hospital Boston, Harvard Medical School mohsen.mahvash- [email protected] [email protected] 2 Robotic Catheter-based Minimally Invasive Procedures: The Sensei X Case Study Neal Tanner, PhD Engineering Fellow Hansen Medical, Inc. Abstract: While traditionally used for simple tasks, such as fluid administration, catheters have evolved into powerful tools for diagnosis and therapy delivery. This is mainly due to their minimally invasive nature, which allows them to reach patients' anatomy through natural ducts and vessels. While this can be an advantage for the patient, it often translates into a more complicated procedure for the physician, which in turn may affect outcomes. Robotics may be able to play a role in facilitating such procedures by creating more capable flexible tools as well as more intuitive interfaces to control them. The talk will focus on some of the opportunities and challenges one may be faced with when building such a system. Relevant Web Links: http://www.hansenmedical.com/home.aspx http://ai.stanford.edu/~barbagli/ The Sensei X Robotic Catheter System 3 Control of Robotic Catheters for Cardiac Ablation David B. Camarillo UCSF, Dept of Biochemistry and Biophysics Stanford University, Depts of ME, CS, SURG, & BIOE Hansen Medical, Inc. Abstract: Atrial fibrillation affects 4% of adults over age 60 and puts these patients at risk for stroke. Cardiac catheter ablation can cure this disease, but it is technically very difficult to achieve continuous lesions with manual catheter control. A robotic system may simplify, shorten, and ultimately improve effectiveness of this procedure by providing an intuitive user interface and a precisely controllable catheter. Hansen Medical, Inc. has developed a catheter control system for atrial fibrillation and other electrophysiology applications. One of the major challenges in this endeavor was to design a catheter that would be sufficiently repeatable so that a relatively simple model could achieve precise control. The result has been one of the most sophisticated catheters in commercial production, and a new modeling framework that accounts for the multiple compliant modes found in a catheter. In this talk, I will discuss the approach taken by Hansen Medical and collaborators to achieve precise catheter control. In addition, I will reflect on the clinical feedback for the performance of this system and lessons learned in the process. Artisan Extend™ Control Catheter 4 References: 1. Camarillo DB, Carlson CR, Salisbury JK. "Configuration Tracking for Continuum Manipulators with Coupled Tendon Drive." IEEE Transactions on Robotics. vol. 25, no. 4, pp 798-808, 2009. 2. Camarillo DB, Milne CF, Carlson CR, Zinn MR, Salisbury JK. "Mechanics Modeling of Tendon Driven Continuum Manipulators." IEEE Transactions on Robotics. vol. 24, no. 6, pp 1262-1273, 2008. 3. Camarillo DB, Krummel TM, Salisbury JK. "Robotic Technology in Surgery: Past, Present and Future." American Journal of Surgery. vol. 188. no. 4A, pp. 2S-15S, 2004. 4. Camarillo DB, Carlson CR, Salisbury JK. "Task-space Feedback Control of Continuum Manipulators with Coupled Tendon Drive." Springer Tracts in Advanced Robotics. vol. 54 pp. 270-280. Athens, Greece. 2008 5. Camarillo DB, Loewke KE, Salisbury JK. "Vision Based 3-D Shape Sensing of Flexible Manipulators." Proceedings of the IEEE International Conference on Robotics and Automation, Pasadena, CA, 2008. Relevant Web Links: www.hansenmedical.com/ 5 Enabling Medical Robotics for the Next Generation of Minimally Invasive Procedures Howie Choset Robotics Institute, Carnegie Mellon University Marco Zenati, M.D. Department of Surgery, University of Pittsburgh Abstract: Minimally invasive surgery is the greatest advance to the art and science of surgery since Lister introduced antiseptic techniques 150 years ago. By accessing anatomical targets through a small incision with specialized tools, the clinical benefits to patients are profound: less soft tissue disruption, reduced pain, faster healing and recovery, and fewer complications. However, despite their proven track record, minimally invasive devices are still quite limited in that they are rigid or only reach superficial regions in the body. One reason for this is that they are mechanical, lacking true computational capabilities that we have enjoyed in other fields. By developing and combining the mechanical and computational, the robotics field can make true advances to all medical interventions. Already, we have seen robotics enter the operating room. Without a doubt, the da Vinci™ surgical robot by Intuitive Surgical represents the greatest success in medical robotics with hundreds of systems installed throughout the world. Ultimately, however, we envision future medical