31A Minimally Invasive Tendril Robot for In-Space Inspection

合集下载

Minimally Invasive Approaches for Surgical Management of Primary Liver Cancers

Minimally Invasive Approaches for Surgical Management of Primary Liver Cancers

ReviewMinimally Invasive Approaches for SurgicalManagement of Primary Liver CancersRachel E.Beard,MD1and Allan Tsung,MD1AbstractThe benefits of minimally invasive approaches in oncologic surgery are increasingly recognized,and laparoscopic liver surgery has become increasingly widespread.In light of the complexity and technical challenges of hepatobiliary procedures,robotic approaches are also employed.The utility,safety,and oncologic integrity of these methods in the management of primary liver cancers are reported.PubMed was used to search the medical literature for studies and articles pertaining to laparoscopic and robotic liver surgery.Studies that particularly addressed hepatocellular carcinoma and cholangiocarcinoma were identified and paroscopic liver surgery,including for major resections,has been shown to be safe in experienced hands without any compromise of oncologic outcomes for either hepatocellular carcinoma or intrahepatic cholangiocarcinoma.Some studies show improved clinical outcomes including shorter hospital stays and lower complication rates when compared to open surgery, particularly for patients with cirrhosis.Robotic liver surgeries seem to have equally acceptable clinical outcomes;however,there is limited data regarding oncologic integrity and considerable additional paroscopic and robotic liver resections are both feasible and safe for the management of primary liver tumors.Future studies should aim to clarify specific indications and optimize applications of these approaches.Keywordsminimally invasive liver surgery,liver resection,robotic hepatectomy,laparoscopic liver resectionReceived September26,2016.Accepted for publication November04,2016.IntroductionThe benefits of minimally invasive surgery in enhanced patient recovery and reduced morbidity are increasingly recognized.This is especially important in oncologic surgery where time to recovery postoperatively can impact the initia-tion of adjuvant chemotherapy.Colorectal surgeons were among the earliest practitioners to widely adopt minimally invasive approaches,and studies in that field have shown decreased complication rates,decreased to time to chemother-apy,and decreased margin positivity for patients with color-ectal cancer who underwent minimally invasive surgery as compared to open procedures.1-4None of these studies demonstrated a significant difference in time to initiation of chemotherapy between patients undergoing robotic or laparoscopic surgery;however,rates of conversion from a minimally invasive approach to an open approach were significantly lower with a robotic approach.2,5,6The introduction of the da Vinci Surgical System(Intuitive Surgical,Inc,Sunnyvale,California)in the early2000s aimed to address some of the technical limitations of laparoscopic surgery.This alternative minimally invasive approach offers a greater range of motion,enhanced instrument dexterity,mini-mization of surgeon tremor,and a3-dimensional view of the surgical field.Several early series demonstrated its safety and success when employed in abdominal surgery to treat a variety of diseases including antireflux operations,cholecystectomy, 1Division of Hepatobiliary and Pancreatic Surgery,Department of Surgery, University of Pittsburgh School of Medicine,Pittsburgh,PA,USACorresponding Author:Allan Tsung,Division of Hepatobiliary and Pancreatic Surgery,Department of Surgery,University of Pittsburgh School of Medicine,Pittsburgh,PA,USA. Email:tsunga@Cancer Control2017,Vol.24(3)1–6ªThe Author(s)2017Reprints and permission:/journalsPermissions.navDOI:10.1177/1073274817729234/home/ccxCreative Commons CC BY-NC:This article is distributed under the terms of the Creative Commons Attribution-NonCommercial4.0License(/licenses/by-nc/4.0/)which permits non-commercial use,reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages(https:///en-us/nam/open-access-at-sage).bariatric procedures,and colonic,gastric,and adrenal resec-tions.7-9Although a few of these studies described robotic liver resections—7out of153procedures in one study,3of207in another—they constituted a small minority of robotic surgeries performed.8,9This trend has continued with colorectal,baria-tric,foregut,cholecystectomy,and,more recently,pancreatic procedures being the most commonly approached with a robotic technique and the most widely studied within the field of general surgery.10,11Given the predominantly positive outcomes observed in other fields,minimally invasive techniques are increasingly employed in hepatobiliary surgery and for the resection of primary liver tumors.The liver presents significant technical challenges for the application of minimally invasive tech-niques.The need to mobilize the liver attachments including those that are very posterior,the limited space in which to maneuver,the complex and variant hepatic vascular and biliary anatomy,and the friable or fibrotic parenchyma,in patients with steatosis or cirrhosis,all present significant challenges. Laparoscopic liver resections are increasingly being performed and reported,and the theoretical benefits of robotic surgery in liver resections are apparent.Many studies comparing out-comes after minimally invasive liver resection to those after open resection demonstrate encouraging results.A recent large comparative analysis of the National Surgical Quality Improvement Program database by Bagante et al reviewed 3064patients undergoing hepatectomy and compared609open resections to609minimally invasive resections,including laparoscopic and robotic cases,with propensity matching.12 The incidence of wound infection,blood transfusions,pulmon-ary embolism,liver failure,and biliary leakage were all lower after minimally invasive resections when compared to open procedures.Hospital stays were shorter and30-day mortality and readmission rates were comparable.Laparoscopic Liver ResectionLaparoscopy in liver surgery was initially employed for pre-dominantly benign lesions and nonanatomic resections in part due to fear that oncologic outcomes may be compromised with a laparoscopic approach and that port site seeding may occur. One large literature review in2009by Nguyen et al13,14looked at over2800cases and found that45%of the procedures were wedge or single-segment resections with an additional20% reported as left lateral segmentectomies,all technically easier resections to perform laparoscopically.Early laparoscopic liver surgery was well tolerated and safe,with reported mortality rates of0%to0.3%and morbidity reported at10.5%to12%. Eventually,its application became more widespread and larger, and anatomic resections were performed.One study looked exclusively at laparoscopic major hepatectomies at6major international centers and reported on210cases performed between1997and2008.Overall complications were low with liver-specific complications being even lower,13.8%and 8.1%,respectively,and only2patients died in the postopera-tive period.15In2008,an international consensus conference was held to address the topic of laparoscopic liver surgery,and the Louis-ville Statement was issued in2009.16They concluded that(1) currently acceptable indications for laparoscopic liver surgery include solitary lesions of5cm or less and located in seg-ments2to6;(2)laparoscopic left lateral sectionectomy should be considered standard of care;(3)major laparoscopic liver resections should be performed exclusively by experi-enced surgeons;(4)conversion to an open procedure should be readily considered for reasons of patient safety,long oper-ating times,and difficulty of resections;and(5)a hand-assisted or hybrid approach may be beneficial.Although the feasibility and safety of laparoscopic liver resection has been shown,multiple studies have shown the learning curve for laparoscopic to be significant,with45to75cases needed for competency.17-21This is a potentially limiting factor in its widespread adoption and implementation.Robotic Liver ResectionWith the safety of minimally invasive liver surgery well estab-lished,robotic approaches were increasingly employed to address the technical difficulties of laparoscopy.An additional appeal was the possibility of reducing the significant learning curve that had been demonstrated in laparoscopic liver surgery. One recent review by Ocuin et al22summarized14major series22-36in the literature that included439patients who underwent robotic-assisted liver resection.An overall conver-sion rate of7%was reported,which was slightly higher than the4%conversion rate reported in the large review of laparo-scopic liver resection by Nguyen et al.13The overall complica-tion rate was reported to be21%with individual series ranging from0%to43%.The most common complications were bile leak and intra-abdominal collections,and no perioperative mortality was reported in any study.Operative times ranged from90to812minutes and blood loss ranged from50to413 mL;and as reported by Tsung et al,26both of these parameters seemed to downtrend as the surgeons and operative teams gained more experience.26Studies have compared outcomes after robotic liver resec-tion to both open and laparoscopic approaches.One study from Memorial Sloan Kettering37reported on a case-matched series of64patients undergoing open hepatectomy compared to64 patients undergoing robotic hepatectomy.They found signifi-cantly shorter operative times,lower blood loss,and shorter hospital stays with the robotic cohort.Ocuin et al22summar-ized8series that statistically compare robotic to laparoscopic liver resections published between2010and2014.23,25-27,33-36 Some studies such as Tsung et al26and Spampinato et al33 showed longer operative times with robotic surgeries,though this seemed to improve with experience.The majority of stud-ies did not demonstrate a difference in operative times,blood loss,complications,or length of hospital stay between the2 cohorts.A few studies such as Troisi et al35had a higher con-version rate(20%vs8%)with robotic approach than with laparoscopy,but again the majority of studies did not show a2Cancer Control24(3)difference.A more recent review and meta-analysis by Qiu et al38included9studies and774patients and compared robotic to laparoscopic liver resection.They found signifi-cantly longer operative times with robotic procedures but no significant differences in blood loss,hospital stay,morbidity, mortality,or surgical margins.Oncologic and Clinical Outcomes for Primary Liver TumorsHepatocellular CarcinomaA plethora of studies have largely allayed fears that oncologic outcomes would be compromised with a laparoscopic approach to liver surgery.Both meta-analyses and case-controlled series have shown similar rates of margin positivity,recurrence,and survival when comparing laparoscopic and open liver resec-tions for hepatocellular carcinoma(HCC),with several show-ing improved clinical outcomes with laparoscopic approaches. One meta-analysis examined9studies and550patients,234 who had undergone laparoscopic liver resection and316who had open liver resection.No difference in tumor recurrence or margin positivity was demonstrated and patients who under-went laparoscopic surgery were found to have significantly lower blood transfusion requirements,shorter hospital stays, and lower rates of liver failure and ascites postoperatively.39 Another large,case-matched analysis looked at436patients undergoing laparoscopic resection and2969patients under-going open liver resection for HCC from2000and2010at 31Japanese centers.This study also demonstrated no signifi-cant difference in survival or disease-free survival between the 2groups but showed lower median blood loss,shorter median hospital stays,and lower complication rates in patients under-going laparoscopic liver resection.40One criticism that is often raised with such studies is that open surgery,rather than minimally invasive,is still more widely employed for larger,more difficult to access tumors, which may affect the clinical outcomes when comparing the 2groups.A study from China specifically looked at HCC arising in the posterosuperior segments of the liver,for which open surgery is traditionally used due to difficult accessibility. When comparing41laparoscopic resections to86open resec-tions for such tumors,they also found significantly shorter hospital stays,lower complication rates,and lower intraopera-tive blood loss after laparoscopic surgery,with no difference in overall or disease-specific survival at1and3years.41Another study more specifically addressed the issue of large tumor size by comparing97laparoscopic liver resections to178open resec-tions,all done for HCC tumors between5and10cm.They also showed lower rates of complications and shorter hospital stays for the laparoscopic group,with similar rates of recurrence and overall and disease-free survival at1and3years.42 Concerns have also been raised about the safety of minimally invasive approaches in patients with cirrhosis.Port site access can be more challenging due to recanalized veins in the abdominal wall,and there are concerns that the friable liver parenchyma may be more prone to bleed during mobilization and transection.Additional studies looked exclusively at laparoscopic versus open liver resections for HCC in patients with established cirrhosis and showed similarly improved clin-ical outcomes following laparoscopic surgery without a nega-tive impact on oncologic outcomes.One study from Japan compared63laparoscopic to99open HCC resections in cir-rhosis and showed lower rates of morbidity and ascites and shorter hospital stays following laparoscopic compared to open resection,without a demonstrable difference in survival.43 Another study from France compared patients with cirrhosis undergoing laparoscopic versus open HCC resection with 45patients in each group and again showed lower rates of morbidity and ascites,shorter hospital stays,and shorter opera-tive times after laparoscopic procedures.Survival at1,5,and 10years was not significantly different,and interestingly, higher rates of R0resections were actually observed following laparoscopic compared to open procedures(95vs85%;P¼.03).44Another French study45looked specifically at peripheral HCC tumors in patients with cirrhosis and compared36patients undergoing laparoscopic resection to53who underwent open resection,with similar resection margins and survival rates at 5years and shorter hospital stays in the laparoscopic group.A recent literature review and meta-analysis46summarized 4cohort studies including420patients with cirrhosis under-going HCC resection and demonstrated several improved out-comes after laparoscopic compared to open surgery including significantly less blood loss,reduced transfusions,wider resec-tion margins,shorter hospital stays,and lower morbidity in the laparoscopic cohort.Less data exist on the application of robotic surgery for HCC;however,a recent study47from Korea compared99mini-mally invasive resections to198open resections using a1:2 propensity-score matched analysis,and their minimally inva-sive cohort included83laparoscopic resections and16robotic resections.Similar to purely laparoscopic cohorts,they found less blood loss,lower complication rates,and shorter hospital stays after minimally invasive approach,without a difference in disease-free or overall survival.In the review summarizing 14major series of robotic liver resections by Ocuin et al,22the indication for surgery for147of the439cases reported was HCC.Most series reported on a mix of tumor types,but2 studies23,24reported almost exclusively on HCC.One series24 from China reported on41patients with consecutive HCC who underwent42robotic liver resections.The majority were wedge resections,segmentectomies,or left lateral sectionec-tomies,but10procedures were major hepatectomies.The R0 resection rate was93%and the inhospital mortality and mor-bidity were0%and7%,respectively.At2years,the overall and disease-free survival rates were94%and74%,respec-tively.In a subgroup analysis of the minor robotic liver resec-tions as compared to laparoscopic resections,they found similar blood loss,morbidity,mortality,and R0resection rates between the2groups.Another study by Wu et al23compared 69laparoscopic liver resections to52robotic resections at a single Taiwanese center.Forty-one(59%)of the laparoscopicBeard and Tsung3cases were done for HCC as were38(73%)of the robotic cases. In looking specifically at the HCC subgroup,they found the conversion rate,length of hospital stay,morbidity,and mortal-ity to be comparable between the2groups,though robotic cases did have significantly more blood loss and longer opera-tive times than did laparoscopic cases,and the tumor sizes and resections performed in the robotic cohort were also signifi-cantly larger.CholangiocarcinomaThe overall published data for minimally invasive resections of cholangiocarcinoma is far less than what is reported for HCC. This is likely owing to both the much lower incidence of cho-langiocarcinoma compared to HCC and the technical chal-lenges associated with cholangiocarcinoma resections including the need for major liver resection and lymphadenect-omy.The available studies,however,suggest that laparoscopic approaches to liver resection for intrahepatic cholangiocarci-noma have also shown comparable clinical outcomes with no difference in oncologic outcomes.One small study48out of Korea compared23open to14laparoscopic resections for intrahepatic cholangiocarcinomas and found comparable complication rates and length of hospital stays between the 2groups.Oncologic outcomes were also similar with no sta-tistical difference in the number of lymph nodes harvested, overall survival,and recurrence-free survival at3years. Another small Korean study49looked specifically at patients with T stage T2b or lower cholangiocarcinomas undergoing open resection,26cases,versus laparoscopic resection, 11cases,and showed no differences in resection margins,opera-tive times,transfusions,mortality,or length of hospital stay. Recurrence rates and3-and5-year overall and disease-free sur-vival rates were similar.A case-matched analysis50from Italy compared20patients with cholangiocarcinoma undergoing laparoscopic resection to60patients undergoing open resections and found that less blood loss and faster functional recovery were observed in the laparoscopic group.Disease-free and over-all survival rates were comparable,and number of lymph nodes harvested was not significantly different.The technical challenges of cholangiocarcinoma resection make a robotic approach to these cases theoretically very appealing,especially when there is extrahepatic disease spread requiring dissection of the portal triad and biliary reconstruc-tion.This approach is not yet widely employed,however.In the review by Ocuin et al,22intrahepatic cholangiocarcinoma was the indication for only7of the439reported robotic liver resec-tions.One recent study51from China described an initial single institution series of10fully robotic radical resections for hilar cholangiocarcinoma and compared them to32contemporary patients undergoing open surgery.Robotic surgeries took lon-ger time,were significantly more expensive,and had higher morbidity rates(90%vs50%;P¼.031).Additionally,3of10 patients in the robotic group had serious complications (Clavien-Dindo grade III or higher),and1patient in that group died of liver failure in the postoperative period.Finally,recurrence-free survival for the robotic group was significantly lower than for the open group(P¼.029)with higher rates of peritoneal and multisite metastasis in the robotic group,though these values did not reach statistical significance(60%vs25%; P¼.059).Hilar cholangiocarcinomas have also been approached laparoscopically,with1small series52of5patients from Korea showing negative margins in4of5patients and only1serious complication of biliary leak that resolved spon-taneously.More studies are needed to determine whether mini-mally invasive techniques are appropriate for hilar cholangiocarcinoma resections.Cost of Minimally Invasive SurgeryIn2009,the cost of the da Vinci robotic surgical system was reported at US$1.2million,with an additional yearly cost of US$138000for maintenance.53,54A number of studies have compared the expense of robotic liver resection to that of open and laparoscopic approaches.One recent single institution ret-rospective study55from the University of Washington com-pared cost data for71robotic hepatectomies to88open procedures and found that despite higher perioperative costs for the robotic procedures,the postoperative costs and subse-quent direct hospital costs were lower when compared with open procedures(US$14754vs US$18998;P¼.001),per-haps owing to a2-day shorter hospital stay on average after robotic procedures(4.2vs6.5days;P<.001).A Chinese series32published in2011compared the cost of13robotic-assisted laparoscopic hepatectomies to20traditional laparo-scopic and32open resections.They found that combined cost of the robotic procedures(US$12046)was higher than the cost of both the laparoscopic(US$7618)and open procedures (US$10548).Hospital stays were shortest after laparoscopic procedures(5.2days),followed by robotic procedures(6.7 days)and longest after open procedures(9.6days).Yu et al36 examined cost data from their Korean series comparing laparo-scopic to robotic liver resections and found that when compar-ing13patients who underwent robotic liver resection with17 patients who underwent laparoscopic liver resection,the cost of robotic procedures was significantly higher(US$11475vs US$6762;P<.001),despite a trend toward shorter hospital stay(7.8vs9.5days;P¼.053).The increased cost of mini-mally invasive techniques is certainly significant,but data thus far are inconsistent and are likely to change as the market surrounding this technology evolves.Conclusion and Future AimsThe safety and utility of laparoscopic surgery for HCC have been well established,and many studies have demonstrated improved clinical outcomes following laparoscopic surgery even when applied for tumors that are large,difficult to access, or in the setting of cirrhosis.Studies consistently show equiva-lent or improved perioperative parameters with laparoscopy when compared to open surgery including lower estimated blood loss,fewer transfusions requirements,fewer complications4Cancer Control24(3)including liver failure and ascites,and shorter hospital stays. Outcomes after resection of intrahepatic cholangiocarcinoma are similar with clinical outcomes either equivalent or better when compared to open surgeries,with no compromise in oncologic results.For both pathologies,oncologic outcomes including overall and disease-free survival remain the comparable between laparoscopic and open cohorts,and quality measures such as R0 margin status and adequate staging with lymph node harvest are not compromised with laparoscopy.It may even be reasonable to consider laparoscopy the standard of care for liver resection in appropriate patients,with the overarching caveat being that both the surgeon and the operative team must have adequate training and expertise with such approaches and technology.The data on robotic surgery for resection of primary liver tumors are more limited and results are more mixed.The considerable expense incurred with this technology,which several studies show is not compensated for even with shorter hospital stays,cannot be ignored.In moving ahead,the challenge will be to continue to clarify indications for different surgical approaches based on patient and tumor characteristics and surgeon expertise,in order to optimize perioperative parameters,postoperative recovery, long-term oncologic outcomes,and health-care costs.Authors’NoteNo significant relationships exist between the authors and the compa-nies/organizations whose products or services may be referenced in this article.Declaration of Conflicting InterestsThe author(s)declared no potential conflicts of interest with respect to the research,authorship,and/or publication of this article.FundingThe author(s)received no financial support for the research,author-ship,and/or publication of this article.References1.Jung YB,Kang J,Park EJ,Baik SH,Lee KY.Time to initiation ofadjuvant chemotherapy in colon cancer:comparison of open, laparoscopic,and robotic surgery.J Laparoendosc Adv Surg Tech A.2016;26(10):799-805.2.Moghadamyeghaneh Z,Hanna MH,Carmichael JC,Pigazzi A,Stamos MJ,Mills parison of open,laparoscopic,and robotic approaches for total abdominal colectomy.Surg Endosc.2016;30(7):2792-2798.3.Midura EF,Hanseman DJ,Hoehn RS,et al.The effect of surgicalapproach on short-term oncologic outcomes in rectal cancer sur-gery.Surgery.2015;158(2):453-459.4.Trastulli S,Cirocchi R,Listorti C,et paroscopic vs openresection for rectal cancer:a meta-analysis of randomized clinical trials.Colorectal Dis.2012;14(6):e277-e296.5.Speicher PJ,Englum BR,Ganapathi AM,Nussbaum DP,MantyhCR,Migaly J.Robotic low anterior resection for rectal cancer:a national perspective on short-term oncologic outcomes.Ann Surg.2015;262(6):1040-1045.6.Trastulli S,Farinella E,Cirocchi R,et al.Robotic resection com-pared with laparoscopic rectal resection for cancer:systematic review and meta-analysis of short-term outcome.Colorectal Dis.2012;14(4):e134-e156.7.Hanly EJ,Talamini MA.Robotic abdominal surgery.Am J Surg.2004;188(4A suppl):19S-26S.8.Tomulescu V,Stanciulea O,Balescu I,et al.First year experienceof robotic-assisted laparoscopic surgery with153cases in a gen-eral surgery department:indications,technique and results.Chir-urgia(Bucur).2009;104(2):141-150.9.Giulianotti PC,Coratti A,Angelini M,et al.Robotics in generalsurgery:personal experience in a large community hospital.Arch Surg.2003;138(7):777-784.10.Jung M,Morel P,Buehler L,Buchs NC,Hagen ME.Roboticgeneral surgery:current practice,evidence,and n-genbecks Arch Surg.2015;400(3):283-292.11.Ballantyne GH.Telerobotic gastrointestinal surgery:phase2—safety and efficacy.Surg Endosc.2007;21(7):1054-1062.12.Bagante F,Spolverato G,Strasberg SM,et al.Minimally invasivevs open hepatectomy:a comparative analysis of the National Surgical Quality Improvement Program database.J Gastrointest Surg.2016;20(9):1608-1617.13.Nguyen KT,Gamblin TC,Geller DA.World review of laparoscopicliver resection:2,804patients.Ann Surg.2009;250(5):831-841. 14.Nguyen KT,Laurent A,Dagher I,et al.Minimally invasive liverresection for metastatic colorectal cancer:a multi-institutional, international report of safety,feasibility,and early outcomes.Ann Surg.2009;250(5):842-848.15.Dagher I,O’Rourke N,Geller DA,et paroscopic majorhepatectomy:an evolution in standard of care.Ann Surg.2009;250(5):856-860.16.Buell JF,Cherqui D,Geller DA,et al.The international positionon laparoscopic liver surgery:the Louisville Statement,2008.Ann Surg.2009;250(5):825-830.17.Lin CW,Tsai TJ,Cheng TY,et al.The learning curve of laparo-scopic liver resection after the Louisville statement2008:will it be more effective and smooth?Surg Endosc.2016;30(7):2895-2903.18.Kluger MD,Vigano L,Barroso R,Cherqui D.The learning curvein laparoscopic major liver resection.J Hepatobiliary Pancreat Sci.2013;20(2):131-136.19.Brown KM,Geller DA.What is the learning curve for laparoscopicmajor hepatectomy?J Gastrointest Surg.2016;20(5):1065-1071.20.Vigano L,Laurent A,Tayar C,Tomatis M,Ponti A,Cherqui D.The learning curve in laparoscopic liver resection:improved fea-sibility and reproducibility.Ann Surg.2009;250(5):772-782. 21.Nomi T,Fuks D,Kawaguchi Y,Mal F,Nakajima Y,Gayet B.Learning curve for laparoscopic major hepatectomy.Br J Surg.2015;102(7):796-804.22.Ocuin LM,Tsung A.Robotic liver resection for malignancy:current status,oncologic outcomes,comparison to laparoscopy, and future applications.J Surg Oncol.2015;112(3):295-301. 23.Wu YM,Hu RH,Lai HS,Lee PH.Robotic-assisted minimallyinvasive liver n J Surg.2014;37(2):53-57.i EC,Yang GP,Tang CN.Robot-assisted laparoscopic liverresection for hepatocellular carcinoma:short-term outcome.Am J Surg.2013;205(6):697-702.Beard and Tsung5。

紧凑型微创手术机器人的设计与实现

紧凑型微创手术机器人的设计与实现

第50卷 第11期 2017年11月天津大学学报(自然科学与工程技术版)Journal of Tianjin University (Science and Technology )V ol. 50 No. 11Nov. 2017收稿日期:2017-03-09;修回日期:2017-04-11.作者简介:孔 康(1987— ),男,博士研究生. 通讯作者:王树新,shuxinlab@.基金项目:国家自然科学基金重大项目(51290293);国家国际科技合作项目(2014DFA70710).Supported by the Major Program of the National Natural Science Foundation of China (No.51290293)and the International S&T CooperationProgram of China (No.2014DFA70710).DOI:10.11784/tdxbz201703017紧凑型微创手术机器人的设计与实现孔 康1, 2,王树新1, 2,张淮锋1, 2,李建民1, 2(1. 天津大学机械工程学院,天津 300350;2. 天津大学机构理论与装备设计教育部重点实验室,天津 300350)摘 要:紧凑型微创手术(MIS )机器人的开发对微创手术技术的推广具有重要意义.在深入分析造成da Vinci 微创机器人体积庞大的原因的基础上,开发了一种紧凑型微创手术机器人系统.通过添加双被动关节的方式实现了机器人从操作手的紧凑设计,并提出了与该从操作手相匹配的运动支点预估算法;针对从操作手的应用需求,设计出一种具有末端自转功能的新型微创器械,该器械有助于降低机器人辅助微创手术的操作难度;结合器械的构型特点,设计了机器人主操手,并建立了微创机器人主从运动映射模型,解决了传统微创手术中存在的眼手运动不一致问题.利用所开发的系统样机进行了系列验证性实验以及动物实验,充分验证了所提出的微创手术机器人设计方案的可行性.关键词:微创手术机器人;紧凑设计;丝鞘传动;运动映射;实验研究中图分类号:TP242.3 文献标志码:A 文章编号:0493-2137(2017)11-1131-09Design and Implementation of a Compact Minimally InvasiveSurgical RobotKong Kang 1, 2,Wang Shuxin 1, 2,Zhang Huaifeng 1, 2,Li Jianmin 1, 2(1.School of Mechanical Engineering ,Tianjin University ,Tianjin 300350,China ; 2.Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education ,Tianjin University ,Tianjin 300350,China )Abstract :The development of compact minimally invasive surgical (MIS )robot is of great significance to the popu-larization of MIS technology .Based on the analysis of the reasons for the large size of da Vinci MIS robot ,a compact MIS robot system was developed .The compact design of the robot’s slave manipulator was realized by adding double passive joints ,and an estimation method of motion fulcrum which matches the slave manipulator was proposed .For application of the robot’s slave manipu lator ,a novel MIS instru ment with distal rolling fu nction was designed ,which can make the operation easier .The robot’s master manipulator was designed to accommodate the configuration feature of the proposed instrument ,and a master-slave motion mapping model was established to solve the problem of inconsistent eye-hand motion in traditional MIS .Using the developed system prototype ,a series of verifying ex-periments and animal experiments were performed ,which fu lly verified the feasibility of the proposed MIS robot design.Keywords :MIS robot ;compact design ;cable conduit transmission ;motion mapping ;experiment study为突破微创手术固有的切口约束与限制,融合微创手术技术与机器人技术的微创手术机器人应运而生.机器人辅助微创手术具有3个方面的优势:①运动灵活性高;②动作稳定连续,有利于提高手术质量,降低安全风险;③具有三维立体视觉且能够实现眼手协调运动[1].这些优势促使越来越多的学者与研究机构致力于微创手术机器人的研究与开发工作.近20年以来,多种形式的微创手术机器人样机·1132·天津大学学报(自然科学与工程技术版)第50卷第11期相继开发出来,包括Computer Motion公司研发的Zeus微创手术机器人系统[2]、华盛顿大学研发的Raven手术机器人系统[3-4]以及由Intuitive Surgical公司开发的da Vinci系列微创手术机器人系统[5-6]等.这其中,da Vinci机器人是目前技术发展最为成熟、商业化水平最高的微创手术机器人系统.然而,尽管da Vinci微创手术机器人在临床应用方面取得了巨大突破,其仍存在体积庞大、结构复杂、成本高昂等问题,这也限制了该机器人在微创手术领域的推广与使用[7].为进一步推动微创手术机器人的发展,研究者们开始聚焦于紧凑型、低成本微创手术机器人的研究,并开发出了直接支撑于患者体表的MC2E微创手术机器人[8],支撑于手术床上的Sofie微创手术机器 人[9]、DLR MiroSurg e微创手术机器人[10]以及微型微创手术机器人系统[11-12]等.上述几种微创手术机器人虽然通过简化被动支撑形式等方法实现了紧凑型和低成本设计,但也降低了机器人的术前初始位姿调整能力,进而增加机器人辅助微创手术术前准备的难度与所需时间.此外,由于机器人本体(术中的机器人非无菌部分)与患者距离较近,也增加了微创手术机器人在临床应用中的消毒与封装难度.由上述情况可知,研究与开发可满足临床实用需求的紧凑型、低成本微创手术机器人对促进机器人辅助微创手术技术的发展具有重要的现实意义.本文以微创手术基本要求为切入点,进行了紧凑型微创手术机器人的研究与开发.首先,采用双被动关节构型实现了机器人从操作手的紧凑设计;其次,结合从操作手的应用需求,提出一种具有“自转-偏转-末端自转”式腕部关节构型的微创器械;随后,设计了末端同构式主手,并建立了机器人主从运动映射模型;最后,开发了系统样机并进行了实验研究,系统地验证了所提出的微创手术机器人设计方案的可行性.1 系统组成概述为使操作者能以较为舒适的姿势进行手术操作,本文所设计的紧凑型微创手术机器人采用主从操作模式,其系统组成如图1所示.所设计的主从式微创手术机器人主要包括主操作手端和从操作手端两部分. 其中,主操作手端集成有主操作手和图像显示器;从操作手端包含从操作手、微创器械和内窥镜.主操作手是微创手术机器人的运动输入单元,而从操作手与微创器械则是机器人的手术执行单元.下文将对微创手术机器人主、从操作手、微创器械以及相匹配的主从运动映射模型的设计进行详细描述.图1紧凑型微创手术机器人系统组成Fig.1System composition of compact MIS robot2 基于双被动关节的从操作手微创手术机器人的从操作手用以支撑并驱动手术器械完成各项手术任务.因此,如何使手术器械在微创手术操作过程中始终通过微小切口,即满足切口约束要求,是从操作手设计的关键.2.1 从操作手结构设计如图2所示,da Vinci Si机器人的从操作手由被动调整部分、从操作手主动部分以及器械进给与快换部分组成.其从操作手主动部分采用基于双平行四边形的机构自约束方式[13-14]来满足切口约束要求,使器械杆在运动中能够始终通过一个不动点.在术前准备时,采用机构自约束方式的微创手术机器人需灵活调整从操作手,使机构不动点与切口位置重合.为此,da Vinci Si机器人在每条从操作手主动部分后端均添加了6自由度的被动调整部分,这正是造成该机器人体积庞大、结构复杂的主要原因,也是机构自约束方式的一个固有缺陷.此外,采用该方式的微创手术机器人通常需要额外增加直线副来实现器械沿体表切口的进给运动,然而,直线副的存在不仅极大地增加了从操作手的尺寸与重量,还容易导致机器人多条臂之间碰撞与干涉.图2da Vinci Si微创手术机器人从操作手Fig.2Slave manipulator of da Vinci Si MIS robot2017年11月 孔 康等:紧凑型微创手术机器人的设计与实现 ·1133·为实现紧凑设计的目标,微创手术机器人以采用添加冗余被动关节的方式来满足切口约束要求.机器人从操作手主动部分的构型如图3所示,其由3个主动关节和2个被动关节组成,器械快换装置安装在第2个被动关节处.3个主动关节用以执行快换装置的位置调整运动,其串联式布局使从操作手具有大范围空间运动能力;在主动关节的前端设计添加了2个旋转轴线正交的被动关节,主动关节运动时,由于这2个被动关节的存在,微创器械会以切口为支点发生运动,进而实现器械末端的位置调整.在上述5个主、被动关节处均装有位置传感器,用于对机器人进行运动安全监测.图3 从操作手主动部分Fig.3 Active part of slave manipulator由于从操作手主动部分具有对切口自适应特性以及大范围空间运动能力,在术前准备时,通过对主动部分进行手动(反向驱动)调整即可实现机器人的初始摆位,而不需要再借助6自由度的被动调整来完成,从而极大地降低了对被动调整结构的设计要求.机器人从操作手被动部分结构如图4所示,其本身具备升降、旋转2个自由度.机器人的3条从操作手主动单元则集成在同一个旋转台上.与da Vinci 微创手术机器人相比,本文所开发的微创手术机器人明图4 从操作手被动部分Fig.4 Passive part of slave manipulator显具有更为简单且紧凑的结构.2.2 运动支点预估对添加双被动关节的微创手术机器人而言,从操作手运动支点(即患者体表切口)相对于机器人参考坐标系的位置信息是运动学计算与控制算法建立的基础.通过在切口处添加传感器可以直接获得该信息,但该方式存在需要额外的设备、使消毒灭菌变得复杂等缺点.为解决这一问题,本文提出一种运动支点预估算法,该算法可以利用微创手术机器人从操作手各关节处位置传感器所获得的关节角信息,通过计算得出运动支点的位置信息.建立机器人从操作手主动部分的运动学模型,如图5所示.Q 表示切口点,G 表示从操作手对微创器械的支撑点,M 表示微创器械末端参考点,Oxyz 表示机器人从手参考坐标系.在切口点Q 处建立坐标系Q Q Q Q x y z ,其各坐标轴方向与参考坐标系Oxyz 定义的坐标轴方向相同.图5 操作从手主动部分运动学模型Fig.5Kinematics model of the active part of slave ma -nipulator在i t 时刻,3个主动关节与2个被动关节的转角值为()j i t θ,{}1,2,3,4,5i ∈,则此时微创器械夹持点G 在参考坐标系Oxyz 中的位置矢量Gi r 表达式为112233Gi i i i l l l =++r w w w (1)式中1l ~3l 、1i w ~3i w 分别表示从操作手主动部分各连杆的长度以及单位方向矢量.则在i t 时刻,器械长杆轴线i L 的表达式为i L :Gi i i k =+s r u i k ∈R (2)式中s 、i u 分别表示器械长杆轴线上任意一点的位置矢量以及单位方向矢量.同理,在+1i t 时刻,器械长杆轴线的表达式为 +1i L :(+1)11G i i i k ++=+s r u 1i k +∈R (3)式中(+1)G i r 、+1i u 分别表示+1i t 时刻器械夹持点G 的位置矢量以及器械杆轴线的单位方向矢量.在i t 、+1i t 时刻相继算得的器械长杆轴线i L 、+1i L·1134· 天津大学学报(自然科学与工程技术版) 第50卷 第11期的交点理论上应与切口位置重合.然而,由于患者呼吸及心跳等生理运动的影响,切口位置会随时发生变化,即两直线i L 、+1i L 可能为异面直线.为预估机器人运动支点的位置,假设切口点始终位于直线i L 上,而在i L 上距离直线+1i L 最短的点即为近似的机器人运动支点.至此,运动支点的预估计算即变为求解两直线i L 、+1i L 的公垂线g L 与直线i L 的交点问题.直线g L 的单位方向向量v 可表示为11i i i i ++×=×u u v u u(4)直线g L 和+1i L 所确定的平面S 可表示为S :()()T10G i +−=s r n(5)式中n 表示平面S 的法向量,其表达式为 11i i ++×=×u vn u v(6)直线i L 与平面S 的交点即为所要计算的运动支点.将式(2)代入式(5),可得系数i k 的值为 T T (1)G i Gi i i k +−=r n r nw n(7)则从操作手运动支点在机器人参考坐标系中的位置矢量i s 的表达式为i Gi i i k =+s r w(8)为减小预估误差,可以取N 次计算的平均值11Ni i m N ==∑s s(9)运动支点预估算法中用到的从操作手主动部分各连杆及器械杆的单位方向矢量1i w ~3i w 、i u 等均可以通过简单的从操作手正运动学计算得到,在此不再赘述.为保证微创手术机器人主从控制系统的顺利启动与运行,运动支点计算过程需要在机器人开启后、手术实施前完成.需要指出的是,在运动支点预估前,应先对机器人进行术前初始位置调整,使从操作手摆在合适的操作位姿.在获取运动支点位置信息后,尽量不再调整机器人位置.如确需调整,则在调整后应重新获取运动支点位置信息.为安全起见,在进行夹持内窥镜的从操作手运动支点预估时,内窥镜不宜插入体内过深,以免入体部分长度变化对患者造成意外伤害.而随后进行夹持器械的从操作手运动支点预估时,器械的运动应在内窥镜图像下进行,且手术器械末端也不宜插入体内过深.3 具有末端自转功能的微创器械微创器械是微创手术机器人的末端执行单元,在机器人辅助微创手术中,器械与患者身体直接接触并对病变组织执行手术操作.因此,器械设计是机器人开发过程中的重要环节之一. 3.1 微创手术中的缝合操作微创手术的基本动作主要包括夹持、剪切、分离以及缝合、打结等,其中缝合操作是最为重要也是对机器人操作性能要求最高的手术操作之一.作为最有效的术中止血方式,缝合操作也是在手术中被执行频率最高的手术操作类型.因此,本文以缝合操作需求为切入点,对微创机器人手术器械进行设计与研究.缝合操作如图6所示,微创器械夹持缝合针所做出的穿刺动作近似为开合关节两钳体沿其角平分线的转动R 加上器械末端沿两钳体所构成平面H 法线方向的移动P .为保证缝合针能够顺利地穿透病变组织,开合关节两钳体的角平分线应始终与组织伤口走向保持平行.图6 微创手术中的缝合操作示意 Fig.6 Diagram of suture action in MIS3.2 微创手术器械设计da Vinci 机器人器械采用“自转-偏转-俯仰”式关节布局(开合关节未包括在内)[15],并通过6轴联动的控制方式来实现复杂手术操作,这种器械构型及对应的控制方式对机器人整体精度及控制系统的要求很高.然而,由前文可知,基于双被动关节的微创机器人的器械在手术中以切口为支点发生运动,由于患者的呼吸、心跳等生理原因,切口在术中并不严格固定,这可能会导致机器人操作精度的降低.因此,“自转-偏转-俯仰”式微创器械并不适用于该机 器人.为使所开发的微创手术机器人能够有效地实施缝合操作,本文提出一种具有末端自转功能的微创机器人手术器械,如图7所示.手术器械的腕部采用2017年11月 孔 康等:紧凑型微创手术机器人的设计与实现 ·1135·“自转-偏转-末端自转”式结构布局,使其在机器人驱动下可以执行7自由度的运动(从操作手3自由度位置调整运动、器械腕部3自由度姿态调整运动以及器械开合运动).在微创手术过程中,当调整器械自转、偏转关节使末端自转关节轴线与组织伤口走向平行后,只需转动末端自转关节,并借助从操作手的位置调整运动便可完成缝合动作.与6轴联动方式相比,上述关节运动方式极大地降低了缝合操作对机器人整体精度与控制系统的要求,这正是在器械末端设计添加自转关节的意义所在.图7 微创手术机器人多自由度手术器械Fig.7 Multi -DOF instrument of MIS robot为实现微创器械的紧凑型与轻量化设计,其各关节的动力传递均通过丝传动实现.微创器械的丝传动结构如图8所示,其中,腕部3个关节的动力传递采用闭环丝传动形式实现;开合关节位于器械末端,为简化该关节传动路径与结构,钢丝经穿末端自转关节中轴线后与传动接口相连,为避免出现钢丝纠缠,开合传动结构采用开环丝传动形式实现,由于受到偏转关节结构尺寸的限制,该关节钢丝绳的导向采用丝鞘方式实现.图8 微创器械的丝传动结构示意Fig.8 Structure sketch of cable transmission of the in -strument在器械传动结构设计完成以后,建立器械传动模型是控制器械实现精准复杂手术操作的基础.由前文可知,器械腕部采用闭环丝传动结构,需要指出的是,末端自转关节的丝传动受到偏转运动的影响.器械腕部传动方程可以表示为1r r 2p p3d d dp pi i i i αθαθαθθ⎧=⎪=⎨⎪=+⎩ (10)式中:1α、2α和3α分别表示对应腕部各关节的器械接口的转动角度;r θ、p θ和d θ分别表示腕部各关节的转动角度;r i 、p i 和d i 分别表示腕部各关节的传动比,即关节与对应器械接口的直径比;dp i 表示末端自转导向轮与器械接口的直径比.器械开合关节与传动接口的传动关系如图9所示.丝鞘后端被固定,其前端受到偏转关节的导向约束,在此约束作用下,丝鞘可以随着器械偏转运动而发生均匀弯曲.图9 器械开合关节与传动接口的传动关系Fig.9Transmission relation between open & close jointand transmission interface of the instrument丝鞘在偏转关节内的弯曲段长度p ()s θ为p p p pp p 0tan(2)()20r s θλθθθθλθ⎧=≠⎪=⎨⎪=⎩ (11)式中:r 为丝鞘的弯曲半径;p θ为偏转关节的转动角度;λ为丝鞘固定端(或约束端)到偏转关节旋转轴线的距离.钳体开合引起的钢丝末端位移g ()l θΔ为 g c c ()sin l s θθΔ=⋅c g c g011sin(/2)sin(/2)θθθθ⎡⎤−⎢++⎣⎦ (12)式中:c s 与c θ为滑槽的初始结构尺寸;g0θ与g θ分别为两钳体的初始与当前张开角度,g0θ的取值应根据实际手术需要初始设定.为简化器械传动模型,钢丝绳在丝鞘传动中的微小变形量忽略不计,则开合关节传动方程为 4g 1c =[2()()]/s l r αλθθ+Δ-(13)·1136· 天津大学学报(自然科学与工程技术版) 第50卷 第11期式中4α、1r 分别为对应开合关节的器械传动接口的转动角度与转轴半径.4 基于末端同构的主从映射模型微创器械的“自转-偏转-末端自转”式腕部构型与人的手部结构高度吻合,尤其末端自转关节的运动与人手拇指与食指的灵活“捻动”动作极为相似.为充分发挥器械的自由度布局优势,本文设计开发了与器械末端同构式主操作手,并建立了机器人主从映射策略.4.1 末端同构式主操作手为实现对器械末端关节的一一对应控制,进而简化控制算法复杂程度,主操作手末端同样采用“自转-偏转-末端自转”式自由度布局.器械末端与主操作手末端的关节对应关系如图10所示.图10 器械末端与主操作手末端的关节对应关系 Fig.10 Corresponding relationship between the end of theinstrument and the master manipulator基于上述基本映射原理,本文设计开发的微创手术机器人主操作手如图11所示.主操作手包括主操作手腕和位置调整臂,为使主操作手腕第1关节轴线始终与器械杆轴线平行,在主手腕与位置调整臂之间设计了2个主动关节,这2个主动关节以及主手腕3个被动关节的轴线交于一点.3自由度的位置调整臂用以实现对主手腕的位置调整运动.图11 微创手术机器人主操作手Fig.11 Master manipulator of MIS robot4.2 主从运动映射模型机器人辅助微创手术的优势之一就是可以实现直觉运动.直觉运动即指医生在患者体外所做出的手术动作与在图像中观察到的器械在体内执行的动作协调一致,而实现机器人直觉运动控制的基础就是建立合理的主从运动映射模型.首先,建立微创手术机器人系统各坐标系之间的映射关系,如图12所示.各参考坐标系的定义分别为:在主操作手端,坐标系M M M Mx y z 表示主操作手基础坐标系,D D D Dx y z 表示图像显示器坐标系,H H H Hx y z 表示主操作手末端坐标系;在从操作手端,坐标系S S S Sx y z 表示从操作手基础坐标系,E E E Ex y z 表示内窥镜坐标系,T T T Tx y z 表示器械末端坐标系.图12 微创手术机器人坐标系之间的运动映射关系 Fig.12Motion mapping relationship among coordinatesystems of MIS robot主从运动一致是实现直觉运动映射的基本要求,在所建立的坐标系中可以描述为:主操作手末端的运动方向和姿态在图像显示器坐标系D D D Dx y z 下的描述,与器械末端的运动方向和姿态在内窥镜坐标系E E E Ex y z 下的描述保持一致.此外,考虑到当主操作手运动至极限位置或操作不舒适位置时,会给医生的手术操作带来诸多不便.为避免上述情况发生,可在运动一致性基础上引入增量控制模式,即当主操作手运动至不当位置时,可通过外部输入切断主从映射,待完成主操作手重定位后再恢复主从映射.引入增量控制模式的机器人主从一致性运动在机器人坐标系中可以表示为()1T H S E DM S M k Δ=⋅⋅Δr R R r - (14)式中:T S Δr 为器械末端的位置增量T Δr 在坐标系S S S Sx y z 下的描述;H M Δr 为主操作手末端的位置增量H Δr 在坐标系M M M Mx y z 下的描述;ES R 为从坐标系S S S Sx y z 到坐标系E E E Ex y z 的转换矩阵;DM R 为从坐标系M M M Mx y z 到坐标系D D D Dx y z 的转换矩阵;k 为比例因子,取值范围为01k <<,通过添加该因子可将主操作手末端的运动按一定比例缩小后映射为器械末端的运动,从而提高微创手术机器人执行精细手术操作的能力.需要指出的是,在主从运动中主操作手和器械末端的姿态应始终保持一致,因此,增量和比例控制不适用主从姿态映射,即式(14)仅为机器人主从2017年11月 孔 康等:紧凑型微创手术机器人的设计与实现 ·1137·位置映射模型.由前文可知,保持主从姿态一致的前提是使主操作手腕部第1关节轴线与器械杆轴线保持平行.其在坐标系中的描述为:主操作手腕部第1关节轴线在坐标系D D D Dx y z 下的描述,与器械杆轴线在坐标系E E E Ex y z 下的描述相平行.两轴线平行关系的数学表达式为112M D ES M S =⋅⋅e R R e - (15)式中:1M e 为主操作手腕部第1关节轴线的单位方向矢量1e 在坐标系M M M Mx y z 下的描述;2S e 为器械杆轴线的单位方向矢量2e 在坐标系S S S Sx y z 下的描述.需要指出的是,使两轴线保持平行的运动映射是反向的,即主操作手关节轴线在主从操作中去跟随器械杆的轴线,而这一功能是通过主操作手那2个轴线垂直相交的主动关节实现的.2个主动关节的转动角度可以通过主操作手逆运动学计算得到,由于主操作手运动学构型较为简单,本文不再赘述.在主操作手腕部第1关节轴线与器械杆轴线保持平行的前提下,通过腕部关节的同构控制,即可实现机器人的主从姿态映射.其数学表达式为 r rp p dd θβθβθβ=⎧⎪=⎨⎪=⎩(16)式中:r θ、p θ、d θ分别为器械腕部3个关节的转动角度;r β、p β、d β分别为主手腕部3个关节的转动角度.式(14)~(16)组成了微创机器人的主从位姿映射模型.由式(16)可知,主从腕部姿态映射不需要通过运动学计算实现,极大地简化了机器人主从运动的控制算法,进而有助于降低控制系统的复杂程度. 由前文可知,当切口位置因患者的剧烈生理运动等因素变化幅度增大时,器械虽因自适应特性而不会对体表造成损伤,但器械末端可能会对体内组织造成损伤.为避免这种情况的发生,应采取如下安全措施:当切口位置变化幅值增大时,器械末端通过式(14)与通过正运动学所算出的位置量之间的偏差,即从操作手跟随误差会随之增大;当该跟随误差值在一个主从映射周期内超出一定范围(该范围可根据实际手术情况设定)时,则器械沿着此时杆轴线方向迅速退出患者体内,从而保证机器人在实际操作中的安 全性.5 实验研究为验证所提出的微创手术机器人设计方案的可行性,天津大学开发出了微创手术机器人系统样机,并在此基础上设计开展了系列验证性实验. 5.1 运动支点预估算法验证本实验是通过对比微创手术机器人运动支点位置的测量值及估算值,来验证所提出的预估算法的可行性.实验过程如图13所示,首先将器械装入机器人快换装置,并将器械杆插入人体模型切口处的Trocar 内.在机器人正常运行过程中,依次将人体模型移动至2个不同的位置,在每个位置手动调整从操作手至3个不同的位形,分别记录下机器人估算出的运动支点的位置.利用磁感应装置测量运动支点(即切入点)实际位置.预估及实测的位置坐标均是在从操作手基础坐标系S S S Sx y z 下的描述.图13 运动支点预估与测量实验Fig.13Estimation and measurement experiment of mo -tion fulcrum运动支点位置的预估值与测量值如表1所示.通过预估及测量数据的对比可以看出,机器人控制系统基于所提出的预估算法估算出的运动支点位置坐标与实际测量得到的运动支点(即切入点)位置坐标之间的误差很小.由此证明,本文所建立的算法是一种有效的运动支点位置预估方法.表1 运动支点位置的预估值与测量值Tab.1Estimated and measured values of location of mo -tion fulcrums mm位置预估值测量值1(236.42,-131.67,82.32) (235.83,-131.05,81.90) (236.17,-130.79,82.73) (236.03,-130.91,81.85)2(38.36,55.17,42.87) (37.95,54.81,42.55) (38.10,54.62,43.11)(38.53,55.09,43.03)5.2 缝合穿针实验本实验旨在利用微创机器人模拟缝合操作来验证所设计的微创器械以及主从映射模型的可行性.实验如图14所示,首先使器械末端靠近组织模型的待缝合区域,随后调整器械腕部使末端自转轴线与切口走向平行,最后完成缝合穿针操作.在穿针过。

MINIMALLY INVASIVE NEUROSURGICAL INTRACRANIAL ROBO

MINIMALLY INVASIVE NEUROSURGICAL INTRACRANIAL ROBO

专利名称:MINIMALLY INVASIVE NEUROSURGICALINTRACRANIAL ROBOT SYSTEM ANDMETHOD发明人:JAYDEV P. DESAI,MINGYEN HO,J. MARCSIMARD,RAO GULLAPALLI申请号:US13763284申请日:20130208公开号:US20130218005A1公开日:20130822专利内容由知识产权出版社提供专利附图:摘要:Minimally invasive neurosurgical intracranial robot system is introduced to theoperative site by a neurosurgeon through a narrow surgical corridor. The robot is passed through a cannula and is attached to the cannula by a latching mechanism. The robot has several links interconnected via revolute joints which are tendon-driven by tendons routed through channels formed in the walls of the links. The robot is teleoperatively guided by the neurosurgeon based on real-time images of the intracranial operative site and tracking information of the robot position. The robot body is equipped with a tracking system, tissue liquefacting end-effector, at as well as irrigation and suction tubes. Actuators for the tendon-driven mechanism are positioned at a distance from the imaging system to minimize distortion to the images. The tendon-actuated navigation of the robot permits an independent control of the revolute joints in the robot body.申请人:UNIVERSITY OF MARYLAND, COLLEGE PARK,UNIVERSITY OF MARYLAND, BALTIMORE地址:US,US国籍:US,US更多信息请下载全文后查看。

Minimally invasive bioactivated endoprosthesis for

Minimally invasive bioactivated endoprosthesis for

专利名称:Minimally invasive bioactivatedendoprosthesis for vessel repair 发明人:DAYTON, MICHAEL, P.申请号:US45785095申请日:19950601公开号:US5578075B1公开日:20000208专利内容由知识产权出版社提供摘要:A minimally invasive bioactivated endoprosthesis device for vessel repair. The device comprises a stent which is formed from metal or polymers into a predetermined shape which may include a plurality of holes patterned with a desired size, shape and number. The stent is then coated with a polymer or is formed from a polymer which contains a bioactive substance which achieves an equilibrium with the surrounding body tissues or fluids, with the equilibrium being controlled by charge distribution, concentration and molecular weight of the bioactive substance in relation to the pore size of the polymeric carrier for controlled prolonged release of said bioactive substance. The bioactive substance may be selected from the group of heparin, hirudin, prostacyclenes and analogs thereof, antithrombogenic agents, steroids, ibuprofen, antimicrobials, antibiotics, tissue plasma activators, rifamicin, monoclonal antibodies, snake venom protein by-products, antifibrosis agents, hyaluronte, cyclosporine and mixtures of these bioactive substances for simultaneous multiple treatments. The stent itself may take several distinct configurations. Preferred is a stent which comprises a substructure selected from flat sheets, flat sheets having holes therein, meshes and stent frames having a sheath thereon, and the substructure is coated with a polymerembedded with a bioactive substance. The stent may be either self-expandable or mechanically expandable, such as by a balloon or other device.申请人:DAYNKE RESEARCH, INC.更多信息请下载全文后查看。

MINIMALLY-INVASIVE DEVICE, KIT, AND METHOD FOR BON

MINIMALLY-INVASIVE DEVICE, KIT, AND METHOD FOR BON

专利名称:MINIMALLY-INVASIVE DEVICE, KIT, AND METHOD FOR BONE GRAFT HARVESTING 发明人:KHANNA, Akhil Jay,TRUSKEY, Peter Hwa-Ming,BUDYANSKY, Maxim,DEKEL,Shoval,GOTTFRIED, Haim,SHAH,Neil,KEBAISH, Khaled M.,RILEY III, LeeHunter申请号:US2012/024761申请日:20120210公开号:WO2012/109620A3公开日:20130110专利内容由知识产权出版社提供专利附图:摘要:A minimally-invasive bone graft harvesting device, kit, and method are provided. The device includes a hollow cutting element and an extraction element. The hollow cutting element may define a longitudinal axis and includes a distal end, a proximal end adapted to be coupled to a powered or manual-operated rotary tool, and an inner lumen extending longitudinally between the distal and proximal ends. The hollow cutting element may also include one or more blades protruding from an outer surface of the cutting element. Each blade may be arranged adjacent to an opening extending between the outer surface and the inner lumen to allow cancellous bone material cut by each blade during use to pass through the opening into the inner lumen. The extraction element may be removably received within the inner lumen of the hollow cutting element to allow withdrawal of the bone material in the inner lumen.申请人:THE JOHNS HOPKINS UNIVERSITY,KHANNA, Akhil Jay,TRUSKEY, Peter Hwa-Ming,BUDYANSKY, Maxim,DEKEL, Shoval,GOTTFRIED, Haim,SHAH, Neil,KEBAISH, Khaled M.,RILEY III, Lee Hunter地址:3400 North Charles Street Baltimore, Maryland 21218 US,1245 Harbor IslandWalk Baltimore, Maryland 21230 US,116 West University Apt 331 Baltimore, Maryland 21210 US,4 East 32nd Street Apt. 307 Baltimore, Maryland 21218 US,3101 St. Paul Street Apt. 5 Baltimore, Maryland 21218 US,3101 St. Paul Street Apt. 5 Balitimore, Maryland 21218 US,3501 St. Paul Street Apt. 347 Baltimore, Maryland 21218 US,3400 North Charles Street Baltimore, Maryland 21218 US,211 Woodlawn Road Baltimore, Maryland 21210 US 国籍:US,US,US,US,US,US,US,US,US代理人:FLANDRO, Ryan M.更多信息请下载全文后查看。

MINIMALLY-INVASIVE DEVICE, KIT, AND METHOD FOR BON

MINIMALLY-INVASIVE DEVICE, KIT, AND METHOD FOR BON

专利名称:MINIMALLY-INVASIVE DEVICE, KIT, AND METHOD FOR BONE GRAFT HARVESTING 发明人:KHANNA, Akhil Jay,TRUSKEY, Peter Hwa-Ming,BUDYANSKY, Maxim,DEKEL,Shoval,GOTTFRIED, Haim,SHAH,Neil,KEBAISH, Khaled M.,RILEY III, LeeHunter申请号:US2012/024761申请日:20120210公开号:WO2012/109620A2公开日:20120816专利内容由知识产权出版社提供专利附图:摘要:A minimally-invasive bone graft harvesting device, kit, and method are provided. The device includes a hollow cutting element and an extraction element. The hollow cutting element may define a longitudinal axis and includes a distal end, a proximal end adapted to be coupled to a powered or manual-operated rotary tool, and an inner lumen extending longitudinally between the distal and proximal ends. The hollow cutting element may also include one or more blades protruding from an outer surface of the cutting element. Each blade may be arranged adjacent to an opening extending between the outer surface and the inner lumen to allow cancellous bone material cut by each blade during use to pass through the opening into the inner lumen. The extraction element may be removably received within the inner lumen of the hollow cutting element to allow withdrawal of the bone material in the inner lumen.申请人:THE JOHNS HOPKINS UNIVERSITY,KHANNA, Akhil Jay,TRUSKEY, Peter Hwa-Ming,BUDYANSKY, Maxim,DEKEL, Shoval,GOTTFRIED, Haim,SHAH, Neil,KEBAISH, Khaled M.,RILEY III, Lee Hunter地址:21218 US,21230 US,21210 US,21218 US,21218 US,21218 US,21218 US,21218US,21210 US国籍:US,US,US,US,US,US,US,US,US 代理人:FLANDRO, Ryan M.更多信息请下载全文后查看。

微创通道下肌间隙入路内固定融合术治疗巨大型腰椎椎间盘突出症

微创通道下肌间隙入路内固定融合术治疗巨大型腰椎椎间盘突出症

•临床研究•微创通道下肌间隙入路内固定融合术治疗巨大型腰椎椎间盘突出症曾忠友,张建乔,宋永兴,范时洋,俞伟,裴斐,王海峰武警海警总队医院骨二科,嘉兴314000【摘要】目的探讨微创通道下肌间隙入路单侧椎弓根螺钉联合对侧椎板关节突螺钉内固定并椎间融合术治疗巨大型腰椎椎间盘突出症(LDH)的可行性。

方法回顾性分析2012年6月—2017年12月收治的47例巨大型LDH患者临床资料,均采用单侧椎弓根螺钉联合对侧椎板关节突螺钉内固定并椎间植骨融合术治疗,其中采用正中切口入路22例(正中切口组),采用微创通道下肌间隙入路25例(肌间隙组)。

观察并对比2组患者围手术期指标、影像学参数、疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分及并发症发生情况。

结果所有手术顺利完成,无切口感染,2组手术时间差异无统计学意义(P>0.05)。

所有患者随访12-48(26.50±7.45)个月。

与正中切口组相比,肌间隙组切口较短、术中出血量较少、术后引流量较少、术后72h腰部切口VAS评分较低,差异均有统计学意义(P<0.05)。

2组患者椎弓根螺钉位置不良率差异无统计学意义(P>0.05)。

椎板关节突螺钉位置不良率,肌间隙组高于正中切口组,差异有统计学意义(P<0.05)o2组患者术后椎间隙高度较术前明显恢复,但末次随访时较术后3~5d出现丢失,差异均有统计学意义(P<0.05);2组间各时间点比较差异均无统计学意义(P>0.05)。

末次随访时2组患者腰椎冠状面和矢状面平衡较术前获得改善,差异均有统计学意义(P<0.05)o肌间隙组术后12个月多裂肌面积和等级与正中切口组比较,差异有统计学意义(P<0.05)o2组患者随访期间均无内固定松动、断裂或融合器移位。

正中切口组椎间融合率为95.5%,肌间隙组为92.0%,差异无统计学意义(P>0.05)o末次随访时2组JOA评分较术前明显改善,差异均有统计学意义(P<0.05);组间比较差异无统计学意义(P>0.05)。

我的奇思妙想会作手术的机器人作文

我的奇思妙想会作手术的机器人作文

我的奇思妙想会作手术的机器人作文英文回答:In the futuristic realm of medical advancements, my ingenuity envisions a groundbreaking innovation that will revolutionize the healthcare landscape: the surgical robot. This marvel of science and innovation possesses the dexterity and precision of a skilled surgeon, enabling it to perform intricate procedures with unparalleled accuracy.The surgical robot is equipped with an array of advanced sensors, cameras, and surgical instruments. These tools provide the robot with a comprehensive view of the surgical site, allowing it to make precise incisions, manipulate delicate tissues, and repair damaged organs with the utmost care. Its advanced algorithms and machine learning capabilities enable it to adapt to real-time changes during surgery, ensuring the safest and most effective outcomes.The surgical robot offers several key advantages over traditional human-performed surgeries. Firstly, its steady hand and unwavering precision minimize the risk of human error, leading to safer and more successful procedures. Secondly, its ability to perform minimally invasive surgeries reduces scarring, pain, and recovery time for patients.Moreover, the surgical robot's tireless nature allows it to operate for extended periods, reducing the risk of surgical fatigue and ensuring consistent performance throughout the procedure. This is particularly advantageous in complex or time-consuming surgeries, where human surgeons may experience physical limitations.The implementation of surgical robots in healthcare settings has the potential to democratize access to high-quality surgical care. By automating complex procedures, surgical robots can reduce the need for specialized surgeons, making it possible to provide expert surgical care in remote or underserved areas.However, the ethical implications of surgical robots must be carefully considered. It is crucial to establish clear guidelines for their use, ensuring that the decisions made by the robot are always guided by human oversight and ethical principles.中文回答:我的奇思妙想——会作手术的机器人。

发明微缩机器人作文

发明微缩机器人作文

发明微缩机器人作文英文回答:In the rapidly evolving landscape of technology, the advent of miniaturized robots holds immense promise for revolutionizing various industries and addressing pressing global challenges. These minuscule machines, oftenoperating at the micro or nanoscale, possess unique capabilities that enable them to navigate complex and confined environments, perform intricate tasks, and deliver unparalleled precision.The development of microbots has been driven by advancements in materials science, microfluidics, and microfabrication techniques. These robots can be fabricated from a diverse range of materials, including metals, polymers, and ceramics, each offering distinct properties tailored to specific applications. Microfluidics enablesthe precise manipulation and control of fluids at the microscale, providing essential functionality for microbots.Advanced microfabrication techniques allow for the creation of complex microstructures with high precision and resolution, enabling the design and construction ofintricate microbots.Microbots exhibit a wide array of locomotion mechanisms, including crawling, swimming, and flying. Crawlingmicrobots utilize friction and adhesion to move across surfaces, while swimming microbots propel themselvesthrough fluids using cilia or flagella. Flying microbots employ aerodynamic principles to navigate the air. The choice of locomotion mechanism depends on the intended environment and application of the microbot.Powering microbots presents a unique set of challenges due to their small size and limited energy resources. Researchers are actively exploring various power sources, including batteries, fuel cells, and wireless power transmission. Micro-batteries offer high energy density but can be bulky and have limited lifespans. Fuel cells provide longer operation times but require a continuous fuel supply. Wireless power transmission eliminates the need for onboardbatteries but requires specialized infrastructure.Microbots have the potential to transform a diverse array of fields, including medicine, manufacturing, and environmental remediation. In medicine, microbots canassist in minimally invasive surgeries, targeted drug delivery, and diagnostic procedures. They offer the ability to navigate intricate anatomical structures and deliver treatments with greater precision and effectiveness. In manufacturing, microbots can perform complex assembly tasks, inspect and repair microstructures, and enhance production efficiency. In environmental remediation, microbots can sense and remove pollutants, monitor environmental conditions, and facilitate cleanup operations in hazardous environments.The development and application of microbots raise important ethical and legal considerations. It is crucialto establish guidelines and regulations to ensure the responsible use of these technologies. Issues such as privacy, liability, and the potential for misuse must be carefully addressed. International collaboration andtransparent dialogue are essential to foster a responsible and ethical approach to the development and deployment of microbots.中文回答:微型机器人的发明。

发明微缩机器人作文

发明微缩机器人作文

发明微缩机器人作文英文回答:The invention of micro-robots has revolutionized the field of robotics and opened up new possibilities for various industries. These tiny machines, measuring just a few millimeters in size, are designed to perform tasks that are either too dangerous or too small for humans to handle. They are equipped with advanced sensors, actuators, and communication systems, allowing them to navigate through complex environments and carry out specific tasks with precision.Micro-robots have found numerous applications in fields such as healthcare, manufacturing, and environmental monitoring. In healthcare, these robots can be used for targeted drug delivery, minimally invasive surgeries, and even for exploring the human body for diagnostic purposes. Their small size enables them to access hard-to-reach areas with minimal damage to surrounding tissues. This hasgreatly improved the efficiency and safety of medical procedures.In the manufacturing industry, micro-robots have revolutionized assembly lines and production processes. They can be programmed to perform intricate tasks such as soldering, welding, and quality control with unmatched precision. Their small size allows them to work in tight spaces and reduces the risk of human error. This has led to increased productivity and improved product quality.Micro-robots also play a crucial role in environmental monitoring and disaster management. They can be deployed in hazardous environments such as nuclear power plants or oil spills to gather data and perform necessary repairs. Their ability to withstand extreme conditions and navigate through narrow passages makes them invaluable in these situations. They can also be used for search and rescue missions in disaster-stricken areas, where human access is limited or dangerous.中文回答:微缩机器人的发明彻底改变了机器人学领域,并为各个行业开辟了新的可能性。

奇思妙想的机器人英语作文

奇思妙想的机器人英语作文

奇思妙想的机器人英语作文英文回答:The realm of robotics has witnessed a surge in imaginative creations that push the boundaries of innovation. From the intricate designs of snake-like robots that navigate treacherous terrains to the human-like capabilities of humanoid robots, engineers and scientists are continuously redefining the possibilities of robotic technology.One particularly captivating area of robotic exploration involves the development of robots that exhibit unconventional locomotion methods. For instance, researchers at EPFL have engineered a quadrupedal robotthat employs four independently actuated legs to achieve exceptional agility and maneuverability. Dubbed ANYmal,this robot can traverse challenging environments, including stairs and uneven surfaces, with remarkable dexterity.Another captivating innovation is the emergence of modular robots, which consist of interconnected units capable of reconfiguring their form and functionality. This versatility enables them to adapt to diverse tasks and environments. For example, self-assembling robots can transform their shape to negotiate obstacles or manipulate objects, demonstrating their potential in areas such as construction and disaster response.In parallel with the advancement of hardware capabilities, significant strides have been made inartificial intelligence (AI) for robotics. By equipping robots with advanced processing algorithms and machine learning techniques, engineers are unlocking new levels of autonomy and decision-making. These robots can perceive their surroundings, learn from experiences, and make intelligent decisions, enabling them to operate in increasingly complex environments.Moreover, the field of bio-inspired robotics has garnered considerable interest. Inspired by the marvels of nature, scientists are creating robots that mimic themovement and capabilities of living organisms. For instance, researchers have developed soft-bodied robots capable of graceful locomotion and subtle manipulation, reminiscent of octopuses and other soft-bodied creatures.As the horizons of robotic technology continue to expand, we can anticipate even more extraordinary creations in the years to come. From robots that seamlessly interact with humans to nanorobots capable of performing intricate medical procedures within the human body, the future of robotics promises boundless opportunities for innovationand societal transformation.中文回答:奇思妙想的机器人。

关于医疗机器人特点的作文

关于医疗机器人特点的作文

关于医疗机器人特点的作文英文回答:Medical robots have emerged as innovative tools that are transforming healthcare delivery. These advanced machines offer numerous unique characteristics that differentiate them from traditional medical devices. Here are some of the key features of medical robots:Precision and Accuracy: Medical robots are equipped with high-precision sensors and actuators that allow them to perform complex tasks with exceptional precision and accuracy. This precision enables them to perform delicate surgical procedures, such as minimally invasive surgery, with greater precision than human hands.Minimally Invasive: The small size and dexterity of medical robots make them ideal for minimally invasive procedures. These robots can access hard-to-reach areas of the body through small incisions, reducing the risk ofinfection and scarring.Enhanced Visualization: Medical robots are often equipped with advanced imaging systems, such as cameras and ultrasound, that provide real-time visualization of the surgical site. This enhanced visualization enables surgeons to navigate complex anatomical structures and make informed decisions during procedures.Remote Operation: Some medical robots can be operated remotely by surgeons located in different locations. This feature allows for the provision of specialized surgical services to patients in remote or underserved areas.Data Collection and Analysis: Medical robots are equipped with sensors that can collect valuable data during procedures. This data can be analyzed to improve surgical techniques, optimize patient outcomes, and advance medical knowledge.Customization and Adaptability: Medical robots can be customized and adapted to meet the specific needs ofdifferent surgical procedures. This versatility makes them suitable for a wide range of applications, from general surgery to highly specialized interventions.Safety and Reliability: Medical robots are designed with stringent safety protocols to ensure the well-being of patients. They are equipped with advanced safety features, such as collision avoidance systems and redundant control mechanisms, to minimize risks during procedures.中文回答:医疗机器人的特点。

发明微缩机器人作文

发明微缩机器人作文

发明微缩机器人作文英文回答:In the realm of technology, the advent of micro-robotics promises to revolutionize various sectors, from healthcare and manufacturing to exploration and environmental conservation. These minuscule machines, with their intricate designs and advanced capabilities, hold the potential to perform tasks that are beyond the reach of larger robots or human hands.One of the most promising applications of micro-robotics lies in the field of medicine. Micro-robots, equipped with sensors and actuators, can navigate through the human body with precision, delivering drugs directly to targeted areas, performing minimally invasive surgeries, and monitoring vital functions. Their ability to navigate the intricate vasculature and reach inaccessible regions opens up new possibilities for treating diseases and improving patient outcomes.In the industrial sector, micro-robots offer a means of automation and precision manufacturing. Their small size and dexterity enable them to manipulate and assemble delicate components with high accuracy, reducing production costs and increasing efficiency. Furthermore, they can perform tasks in hazardous or confined spaces, minimizing risks to human workers.Micro-robots also hold great promise for exploration and scientific research. Their ability to traverse extreme environments, such as deep-sea trenches or the interior of other planets, allows scientists to gather valuable data and make discoveries that would otherwise be impossible. They can be equipped with cameras, sensors, and sampling devices to provide researchers with a detailed understanding of unexplored regions.Moreover, micro-robots play a vital role in environmental conservation. Their small size and maneuverability make them ideal for monitoring and cleaning up pollution. They can be deployed in remote areas or inecosystems that are too delicate for larger machines. By removing pollutants and restoring habitats, micro-robots contribute to preserving biodiversity and protecting the environment.中文回答:微型机器人的发明。

小型机械臂 英语

小型机械臂 英语

小型机械臂英语English:A small robotic arm, also known as a compact or mini robotic arm, is a multi-joint manipulator designed to perform a variety of tasks in a small workspace. These small robotic arms are often used in industries such as electronics manufacturing, medical devices assembly, and laboratory automation. They are typically equipped with advanced sensors, precision motors, and intelligent control systems to ensure precise and accurate movement. Despite their small size, these machines are capable of handling delicate and intricate tasks with high repeatability and precision. In addition, small robotic arms are often designed with a lightweight and compact structure, making them highly versatile and adaptable to different working environments.中文翻译:小型机械臂,又称紧凑型或迷你型机械臂,是一种多关节操作器,旨在在狭小的工作空间内执行各种任务。

这些小型机械臂通常用于电子制造、医疗器械组装和实验室自动化等行业。

单足跳跃式仿袋鼠机器人的动力学优化设计

单足跳跃式仿袋鼠机器人的动力学优化设计

单足跳跃式仿袋鼠机器人的动力学优化设计近年来,仿生机器人技术在机器人领域取得了显著的进展。

袋鼠作为一种优秀的跳跃动物,其独特的跳跃方式吸引了众多研究者的关注。

借鉴袋鼠的跳跃机理,研发出单足跳跃式仿袋鼠机器人具有广阔的应用前景。

本文旨在对单足跳跃式仿袋鼠机器人的动力学进行优化设计。

在设计过程中,首先需要对袋鼠的跳跃方式进行深入研究。

袋鼠通过将身体重心移到腿部,利用腿部的弹性能量储存和释放实现高效的跳跃。

因此,在仿袋鼠机器人的设计中,需要考虑到腿部的弹性特性,并通过合理的机械结构设计实现能量的储存和释放。

同时,还需要考虑到机器人的稳定性和控制策略。

通过对袋鼠跳跃过程的分析,可以发现其身体在跳跃过程中保持平衡的关键在于尾部的作用。

因此,在仿袋鼠机器人的设计中应添加类似尾部的结构,以提高机器人的稳定性。

其次,需要对仿袋鼠机器人的动力学进行优化。

通过对机器人跳跃过程的深入研究,可以发现机器人的跳跃高度和距离与多个因素相关。

其中最重要的因素之一是腿部的弹性特性。

通过调整腿部的弹性系数和刚度,可以实现不同高度和距离的跳跃。

另外,机器人的质量和能量的储存和释放方式也对跳跃性能有着重要影响。

因此,在动力学优化设计中,需要综合考虑这些因素,并通过合理的参数选择和控制策略来实现机器人的最优跳跃性能。

最后,需要进行仿真和实验验证。

通过建立仿真模型,可以对优化设计进行评估和验证。

通过仿真实验,可以优化机器人的设计参数和控制策略,以实现更好的跳跃性能。

同时,还需要进行实际的物理实验,验证仿袋鼠机器人的跳跃性能和稳定性。

通过与实际袋鼠的跳跃数据进行对比,可以评估仿袋鼠机器人的仿真模型的准确性和优化设计的有效性。

综上所述,单足跳跃式仿袋鼠机器人的动力学优化设计具有重要的研究意义和应用价值。

通过对袋鼠跳跃方式的研究,可以设计出具有高效跳跃性能的仿袋鼠机器人。

通过动力学优化设计和仿真实验验证,可以不断改进机器人的跳跃性能和稳定性,为机器人在特定环境中的应用提供有力支撑。

微创技术在肾移植中的应用

微创技术在肾移植中的应用

第13卷 第1期2022年1月Vol. 13 No.1Jan. 2022器官移植Organ Transplantation作者简介:侯小飞,医学博士,北京大学第三医院泌尿外科主任医师、硕士研究生导师。

美国明尼苏达大学附属医院访问学者。

从事泌尿外科常见疾病临床诊治工作二十余年,尤其在肾移植的术前、术中、术后管理上具备丰富的临床经验,多次荣获北京大学第三医院临床疑难病例诊治奖和临床医疗技术创新奖。

兼任中华医学会器官移植学分会委员、中国医疗保健国际交流促进会肾移植学分会委员、北京医学奖励基金会委员、北京大学医学部远程医疗中心特聘专家、北京市医疗事故和职业病鉴定专家。

兼任《器官移植》杂志通讯编委,《中国微创外科杂志》《现代泌尿外科杂志》微创技术在肾移植中的应用张启鸣 侯小飞【摘要】 进入21世纪以来,微创技术成为外科学发展的一大主线,其临床应用早已渗透到各个外科学分支。

在肾移植领域,微创技术的应用主要集中在活体供肾获取、肾移植手术及肾移植术后并发症的处理,不仅增加了供肾来源,也减少了术后并发症的发生率,改善了受者生活质量。

微创技术的应用也成为了肾移植领域的研究热点之一。

本文将就目前微创技术在活体供肾获取、肾移植手术及肾移植术后并发症处理中的应用进展作一介绍,以期为增加供肾来源、提高肾移植手术成功率及改善肾移植受者预后提供参考,促进微创技术在外科学中的进一步发展。

【关键词】 肾移植;微创技术;机器人辅助手术;供肾获取;术后并发症;腹腔镜;达芬奇机器人【中图分类号】 R617,R615 【文献标志码】A 【文章编号】1674-7445(2022)01-0006-06【Abstract 】 Since the 21st century, minimally invasive technique has become a main development direction of surgery, which has been widely applied in all branches of surgery. In the field of kidney transplantation, minimally invasive technique has been mainly applied in the procurement of living donor kidney, kidney transplantation and the management of complications after kidney transplantation. It not only increases the resource of donor kidney, but also reduces the incidence of postoperative complications and enhances the quality of life of the recipients. The application of minimally invasive technique has become one of the research hot spots in the field of kidney transplantation. In this article, research progresses on the application of minimally invasive technique in the procurement of living donor kidney, kidney transplantation and management of complications after kidney transplantation were reviewed, aiming to provide reference for increasing the resource of donor kidney, enhancing the success rate of kidney transplantation and improving clinical prognosis of kidney transplant recipients, thereby promoting the development of minimally invasive technique in surgery.【Key words 】 Kidney transplantation; Minimally invasive technique; Robot assisted surgery; Donor kidney procurement; Postoperative complication; Laparoscope; Da Vinci robotApplication of minimally invasive technique in kidney transplantation Zhang Qiming, Hou Xiaofei. Department of Urology, Peking University Third Hospital, Beijing 100191, ChinaCorresponding author: Hou Xiaofei, Email: houxf12@·专家论坛·DOI: 10.3969/j.issn.1674-7445.2022.01.006基金项目:卫生部国际交流与合作中心项目(IHECC08-201205)作者单位:100191 北京大学第三医院泌尿外科作者简介:张启鸣,男,1994年生,博士研究生,研究方向为肾移植、泌尿系肿瘤,Email: zhangqiming@ 通信作者:侯小飞,Email: houxf12@张启鸣等.微创技术在肾移植中的应用第1期·39·自1954年首例活体供肾肾移植成功实施以来,肾移植手术逐渐成为治疗终末期肾病的最佳选择,不但延续了患者的生命,同时也大大改善了患者的生存质量[1-2]。

  1. 1、下载文档前请自行甄别文档内容的完整性,平台不提供额外的编辑、内容补充、找答案等附加服务。
  2. 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
  3. 3、如文档侵犯您的权益,请联系客服反馈,我们会尽快为您处理(人工客服工作时间:9:00-18:30)。

A Minimally Invasive Tendril Robot for In-SpaceInspectionJoshua S. Mehling and Myron A. Diftler Mars Chu Michael Valvo Automation, Robotics, and Simulation Division TRAC Labs Division Robotics Department NASA / Johnson Space Center Metrica, Inc. Jacobs Sverdrup / ERC Houston, TX 77058 Houston, TX 77058 Houston, TX 77058 jmehling, mdiftler@ mchu@ mvalvo@Abstract– Current work at NASA’s Johnson Space Center is focusing on the identification and design of novel robotic archetypes to fill roles complimentary to current space robots during in-space assembly and maintenance tasks. Tendril, NASA’s latest robot designed for minimally invasive inspection, is one system born of this effort. Inspired by the biology of snakes, tentacles, and climbing plants, the Tendril robot is a long slender manipulator that can extend deep into crevasses and under thermal blankets to inspect areas largely inaccessible by conventional means. The design of the Tendril, with its multiple bending segments and 1 cm diameter, also serves as an initial step in exploring the whole body control known to continuum robots coupled with the small scale and dexterity found in medical and commercial minimally invasive devices. An overview of Tendril’s design is presented along with preliminary results from testing that seeks to improve Tendril’s performance through an iterative design process.Index Terms – tendril, minimally invasive, in-space inspection, continuum robot, space roboticsI.I NTRODUCTIONNASA has a history of augmenting human abilities and activities in space with robotic systems. For example, rovers from NASA’s Jet Propulsion Laboratory (JPL) are currently exploring the surface of Mars well prior to the design of a crew exploration vehicle for human transportation to the planet [1]. Also the shuttle and station remote manipulator systems (RMS’s) have proven invaluable in moving and mating together large modules during the construction of the International Space Station. The Canadian Space Agency (CSA) has also designed their Special Purpose Dexterous Manipulator (SPDM) to service robotically compatible Orbital Replacement Units (ORU’s) [2]. Designs such as these are examples of recognizing a specific need and then designing a system to meet that need. Just as in nature where there are different types of animals suited for specific purposes, robots too can be classified as specialized archetypes designed to perform in certain roles.Perhaps the most immediately useful robotic archetype for space would fill a niche as an assistant to human astronauts. A dexterous and anthropomorphic system such as NASA’s Robonaut, with two human-scale arms and five-fingered hands, is capable of working with an ever growing set of EVA tools and would be a valuable assistant to astronauts on orbit [3]. Robonaut’s fine motion ability matched with its 1:1 strength-to-weight ratio allow it to be a jack-of-all-trades when it comes to augmenting crew in construction, assembly, maintenance, or inspection tasks.While the jack-of-all-trades or all-purpose problem solver archetype filled by human astronauts and Robonaut is of paramount importance to future space activities, current work at NASA’s Johnson Space Center (JSC) is focusing on the identification of other important roles and the design of new robots to compliment existing systems. Having an array of varied archetypes working together, as opposed to a single class of robot working alone, provides more options to mission planners for accomplishing the future tasks NASA will face as a result of its new initiative to explore the Moon and Mars, build large-scale structures in space, and construct and maintain long-term habitats.In identifying and designing new robot archetypes, biology can be an important inspiration. It not only points to the various roles that new robots can play, but it can also inspire the forms that these new robots take. This thinking is apparent in the designs of JSC’s spider-like robot, a large eight-legged system that specializes in walking lightly across web-like truss structures [4], JPL’s LEMUR system that specializes in small-scale manipulation and dexterity [5], and NASA’s latest robot designed for minimally invasive inspection, Tendril.II.B ACKGROUNDThe Tendril robot, seen in Fig. 1, finds its inspiration in the biology of snakes, tentacles, and climbing plants. A long slender manipulator, Tendril has a diameter to length aspect ratio of 1:100 (1cm:1m) and, like its biological analogues, it can fit into tight spaces and through complex geometries. Built to compliment NASA’s Mini-AERCam, a free-flying surface inspector [6], and other similar systems, the Tendril robot will ultimately be used to inspect deep into crevasses, under thermal blankets, or down potential damage holes caused by MicroMeteoroid Orbital Debris (MMOD) or other impacts. Locations such as these are largely inaccessible to both astronauts and existing in-space inspection tools.Small-scale dexterity and operating within a confined workspace have already been extensively researched with minimally invasive surgery in mind. Commercial devices used in laparoscopic procedures, such as Intuitive Surgical’s DaVinci system, have dexterous wrists and a wide range of end effectors that can pass through small ports (~1cm) and work inside the body with reduced trauma to patients [7]. Additionally, actuation of tendril-like, high aspect ratio surgical tools has been investigated with various robotic endoscopes [8, 9]. Of particular interest is a 4mm diameter prototype for laryngeal surgery developed at Johns Hopkins [10]. Minimally invasive inspection using commercial articulating borescopes such as those designed by Olympus Corporation is also common in the aircraft and chemical industries [11].In addition to the small-scale tip articulation found in medical and commercial systems, the design of Tendril also finds inspiration from the current research being done on continuum robots of which Robinson and Davies provide a thorough survey [12]. “Invertebrate” robots such as Walker’s elephant’s trunk robot and tentacle robot provide excellent examples of the design and control of systems that have a continuous bending ability along their entire body lengths [13]. Currently, the majority of hyperredundant and continuum robots are larger in diameter and shorter in length than the Tendril robot. To begin to explore these ideas at the small scale of minimally invasive devices, the first generation Tendril has two active bending sections near its tip. The lessons learned from experimentation with this system will lead to the addition of longer and many more bending segments in future design iterations. Thus, Tendril can be seen as an initial step towards a new small-scale, hyperredundant, continuum robot. The following examines Tendril’s mechanical and electrical design in greater detail accompanied by an explanation of control techniques, system testing, and potential upgradesthat will be explored as part of an iterative design process.III.TENDRILThe first generation Tendril (Fig. 1) is comprised of three primary subsystems: the Tendril limb and its associated actuation mechanism, the body housing structure, and the avionics system. Each is designed for straightforward integration and to facilitate the accomplishment of the first generation system’s design requirements. These requirements include: the aforementioned 1:100 aspect ratio with video ability at the tip, two active bending sections along the body to begin to explore coupling and hyperredundancy at a small diameter scale, and active extension, retraction, and rotation of the Tendril limb. A.The Tendril LimbThe Tendril limb is constructed from a series of extension and compression springs that are joined together by threaded links (Fig. 2). The extension spring sections provide passive bending over the majority of the bodylength while the compression springs are used for actively controlled bending. This active bending is actuated by setsof antagonistic tendons that are attached at specific links, run the entire length of the limb, and are terminated at pulleys inside the body housing structure. Each of the Tendril’s two bending sections (Fig. 3) use two pairs of tendons routed perpendicular to each other. Thus, when a specific pulley rotates, one tendon in a pair is retracted and another is allowed to extend. This creates a compressive force on one side of a section’s spring causing bending tooccur in one of the controlled directions (positive or negative pitch and yaw) without causing excessive slack to form in any of the tendons.Figure 1: The Tendril robotFigure 3: Tendril’s two bending sections and tip mounted camera Figure 2: Tendril limb springs joined by threaded links (Inset shows threaded links)The tendons that control the distal bending section are offset 45 degrees from those that control proximal bending. This difference is easily compensated for in the kinematics control algorithm but it is valuable in preventing any variation in the diameter or force required to actuate different bending sections. The antagonistic way in which the tendons are used also has the added benefit of minimizing the number of actuators required to obtain two degree-of-freedom (DoF) motion across each bending section.In addition to all eight of the actuation tendons (four for each bending section) passing through the threaded links, each of the links also has a center bore for power and video wires to pass from a small CCD camera mounted at the Tendril’s tip (seen in Fig. 3) back into the housing structure and out to an external video monitor.Using external springs as opposed to an internal backbone is found to be effective at this size scale. The modular fashion in which individual spring sections attach to one another is also of benefit because it allows for easy adjustment of the length and location of the passive and active bending sections along the Tendril’s limb. This is valuable for testing various configurations in real-time as well as ensuring optimal performance in 1g of a system that is designed to primarily function in a 0g environment.The Tendril actuation assembly (shown as a 3D model in Fig. 4) consists of the four pulleys and brushless DC motors required to drive the eight internal tendons as well as a routing structure to direct the tendons from the actuators into the Tendril limb. Inside the conduits of this routing structure as well as in the limb itself, the tendons pass through Teflon tubing to ease friction down the system’s meter length. Both the material used for the tendons as well as the configuration of the tubing is a subject of current testing. The 2.5 cm diameter pulleys are sized such that their full range of motion allows for greater than ±90 degree travel in both pitch and yaw at each bending section. The Tendril limb actuators’ 0.4 Nm maximum torque, coupled with the pulley diameters, also provides sufficient strength to operate the system when hanging vertically, when gravity is most detrimental to Tendril’s bending motion.The entire length of the Tendril limb can be covered in a custom Teflon fabric sheath. This sheath, currently being integrated into the system, will aid in reducing friction between the limb and the housing structure during extension and retraction. More importantly, this novel covering will protect both the Tendril and any surface it might be operating on from damage due to materials rubbing or scratching against one another. B.Tendril Body HousingTendril’s body housing provides both infrastructure and operational support for the system. Its main purpose is to house the Tendril actuation assembly as well as the system’s avionics and to actuate the system’s extension/retraction and auxiliary rotation degrees-of-freedom. The housing’s overall dimensions are 23 cm in outside diameter and 13 cm in width and the volume of the housing is balanced such that each dimension is minimized while maintaining sufficient space to mount the other subsystems. The housing (shown in Fig 5 and Fig. 6) consists of three sections: the Tendril reel, a body rotation actuator, and an exterior structure.The Tendril reel is a drum of short axial length with the Tendril actuation assembly and avionics mounted inside its cavity. The reel rotates relative to the fixed reference of the exterior structure and either pushes or pulls the Tendril limb for extension or retraction. A spiral groove is formed into the circumference of the reel to guide the Tendril limb during this motion. Furthermore, the groove confines the limb to a single layer during multiple revolutions so that a complex reeling mechanism is not required to prevent binding. The Tendril reel is driven by a centrally located brushless DC actuator. This actuator can produce 1.7 Nm of continuous torque at 120 RPM which is more than sufficient to achieve the desired Tendril limb feed rate of 5 cm/s.The body rotation actuator provides an additional degree-of-freedom for the Tendril body housing. This DoF creates a roll axis for Tendril when the tip is straight and gives Tendril an auxiliary method of panning a full360 degrees when the Tendril’s limb is bending. TheFigure 4: 3-D model of the Tendril actuation assembly Figure 5: External view of the Tendril body housingactuator uses a brushless DC motor and can produce 2.5 Nm of continuous torque at 91 RPM. In the vertical orientation, the actuator only requires a minimum torque output for rotating the body housing. However, when the Tendril is placed in a non-vertical orientation, a much higher output torque is needed. The actuator can produce a holding torque of 24.5 Nm in these cases. The proximal (non-rotating) end of the body rotation actuator can be attached to a fixed base while the distal (rotating) end is attached to the exterior structure through a quick-disconnect locking ring.The exterior structure provides an enclosure for the mechanical and electrical components of the Tendril as well as the Tendril reel, and consists of a central spine with two flanking covers. The central spine supports the reel along coincident axes using a set of large bore bearings for relative rotation and stability. This component is generally cylindrical in shape with a tangential salient (see Fig. 6). On one side of the salient, an outlet port allows Tendril to extend its limb out from and retract it into the body housing. The other side of the salient attaches to the body rotation actuator for support to a fixed base and for an additional DoF as mentioned above.Several features are incorporated into the housing to both confine and guide the Tendril limb during extension and retraction. For example, the outlet port of the exterior structure is aligned tangentially to the reel. This allows the limb to extend and retract with minimal bend angles. Additionally, Tendril’s limb is guided through an internal conical channel formed into the central spine before exiting the housing. The distance between the outer diameter of the reel and the inner diameter of the central spine is also minimized such that the Tendril limb will not cross over the groove walls and create binding. Lastly, Teflon liners are installed along the inner diameter of the central spine to reduce friction between the limb and the adjacent surfaces to facilitate smoother operations.Absolute position sensing is an important component in the multi-turn Tendril extension and retraction system to ascertain current limb position during system initialization or in the case of a power loss. Conventional sensors, however, are not suitable due to size constraints within theTendril body housing. Therefore, an absolute position sensor was custom designed using an inductive sensor to measure the linear distance to a transducer disk. The transducer disk serves two purposes: relating rotational motion of the reel to the linear motion of the Tendril limb and providing a hard stop to prevent the limb from over-extending or over-retracting. The disk engages internal threads that correspond to the fixed reference of the exterior structure and pins that are attached to the reel. As the reel rotates the disk slides along the pins. Using calibrated data, the linear position of the disk can be converted into the current position of Tendril limb.C. AvionicsTendril’s power and avionics systems find their heritage in NASA’s Robonaut system [14]. Many of the same components and custom board designs were chosen for Tendril due to the success and continued functionality they have shown in other NASA robots. The CompactPCI computer, which is recognized by NASA as viable flight hardware, is used as the main processor for Tendril. The computer, along with a power system consisting of a rugged chassis with several modules to provide different power levels, a wireless emergency stop receiver, and a series of solid state relays for each motor are mounted inside a power box that is part of the Tendril’s mobile test stand.The six motors in the Tendril system are controlled using the same custom, embedded, three-axis motor amplifiers used in Robonaut. Also, two custom Field Programmable Gate Array (FPGA) boards handle motor commutation and encoder feedback. These avionics stacks are mounted inside the Tendril reel alongside the Tendril actuation assembly (Fig. 6).IV.C ONTROL S OFTWAREAs with the avionics, much of the control software used for Tendril has heritage in the existing Robonaut system. This makes software development and troubleshooting faster and more reliable. The RTI ControlShell software tool is used to provide a real-time control architecture [15]. ControlShell has the ability to run many C++ program blocks on one or more clocks, group these blocks together by functionality, and create different modes for specific applications. The development of the Robonaut system led to an extensive catalogue of software repositories, libraries, and drivers some of which have now been utilized in Tendril.Existing software blocks were modified to create both joint and Cartesian control software for Tendril. Unlike Robonaut, however, which uses a proportional-derivative (PD) controller, Tendril’s position control is based upon a proportional-integral (PI) control loop (Fig. 7).Another new addition in the Tendril control system is a washout filter (Fig. 7). While the actuators have sufficient power to bend the Tendril limb, this required power level, if left across the motors for longer durations can cause them to near their temperature limits. Thus, theFigure 6: Internal view of the Tendril body housing (starboard cover removed)Command Command PWM Rate PWMcontrol system takes advantage of the hysteretic friction inherent in a tendon drive design and uses what is in essence a high pass filter to maintain limb position and minimize motor power. When a high frequency command is entered, the system responds in an effort to reach the desired state, but as the system nears its goal and approaches steady state the now low frequency, steady, motor command is washed out to 20% of its original value. The Tendril is then relying on a small motor command aided by its inherent friction to maintain a desired limb position. In this configuration, it is, of course, important to have a cutoff frequency for the filter very close to zero to prevent a washout from occurring before steady state is reached.Tendril can be controlled from a remote computer using RTI’s network data delivery service (NDDS). Using this protocol, information can be sent and received via Ethernet on computers within a specified network. A graphical user interface (GUI) has been created to receive position data via NDDS and from the GUI a user can issue commands to control Tendril. Joystick control has also been implemented along with the GUI to give the user a more comfortable and intuitive way of operating Tendril.V.C URRENT T ESTINGAs is the case with any iterative design process, the design and performance of Tendril is constantly being tested and improvements are continually being made. While it is hard to analyze each individual modification in a development atmosphere such as NASA where getting the job done is of primary importance, recent testing has sought to quantify performance across two generations of Tendril limb after a series of modifications.The original Tendril limb (Unit 1) has two, 4 cm bending sections actuated by 0.66 mm diameter Teflon coated, braided steel cables. The tendons in this version run inside Teflon tubes that extend partially along the limb’s length. Additionally, links along the passive bending sections are spaced 45 cm apart.The latest version (Unit 2) has Teflon tubing that runs the entire length of the Tendril limb. This limb also has two, 8 cm bending sections that are actuated by 0.25 mm diameter Spectra gel spun polymer tendons. Links on this version’s passive sections are spaced only 4 cm apart.Using the test setup shown in Fig. 8, the applied force to bending angle relationship was compared between the two generations of Tendril limb. Each limb was mounted vertically and known masses varying from 100g to 500g were attached to the positive yaw tendon of each limb’s distal bending section. The angle of bend away from the neutral axis was then recorded. This test is of interest, as it is desirable to increase the efficiency of Tendril limb bending. Minimizing the force required to bend the limb and maximizing its range of motion will in turn increase the usefulness of the system in future applications. Results of this test are summarized in Table 1.Figure 7: The Tendril control systemIt is apparent from the data that the modifications made in the second version of the Tendril limb dramatically improve performance. The maximum deflection created by a 4.9 N applied force increased from 52 degrees to 138 degrees. The general trend of bend angle also appears somewhat more linear with respect to applied force in the second Tendril version. These results are, of course, preliminary but they suggest that the design modifications to this point are on the right track. Testing will continue in hopes that further improvements can be achieved.TABLE 1APPLIED FORCE VS. BEND ANGLE DATABend Angle of Tendril’s Tip Away fromNeutral Axis Applied ForceTest Unit 1Test Unit 2 0.98 N (100g mass) 25.5° 27.0° 1.96 N (200 g mass)31.5°55.0°2.94 N (300g mass) 40.0° 80.0°3.92 N (400g mass) 51.5° 110.0°4.91 N (500g mass) 52.0°138.0°VI.C ONCLUSION Tendril shows great promise for use in space as a minimally invasive inspector. Its slender aspect ratio and imaging system allow it to reach through small openings and survey areas that are inaccessible to most other systems. The combination of Tendril’s aspect ratio, novel housing structure, and multiple bending sections along itslimb represent a true advancement in state-of-the-artrobotics technology. With this combination of features,Tendril can be used as a baseline comparison and testbedas work continues to develop new techniques and technology to further reduce diameters and increase the degrees-of-freedom of slender manipulation systems. In fact, future generations of the Tendril robot will strive for limb diameters approaching 5mm, limb lengths as long as5m, and many more active bending segments.In the near term, Tendril will be involved incollaborative testing with other new NASA robots.Determining the breadth of tasks Tendril is capable ofperforming as well as developing cooperative teaming scenarios with other new robotic archetypes will aid in refining the eventual role Tendril will take during in-space assembly and maintenance tasks. A CKNOWLEDGMENTThis work was partially supported by NASA’sExploration Systems and Missions Directorate through the “In Space Robotic Assembly and Maintenance” project.R EFERENCES[1]Hubbard, G. S. “The Exploration of Mars; Historical Contextand Current Results.” 42nd Annual AIAA Aerospace Sciences Meeting and Exhibit. Reno, NV, January 2004.[2]Hunter, D. G. “The Space Station Freedom Special PurposeDexterous Manipulator (SPDM).” in proceedings of National Telesystems Conference (NTC 1991). Atlanta, GA, March 1991. pp. 371-376.[3]Bluethmann, W., et al. “Robonaut: A Robot Designed toWork with Humans in Space.” Autonomous Robots. Kluwer Academic Publishers, Hingham, MA. vol. 14, no. 2/3. 2003. pp. 179-197.[4]Rehnmark, F., et al. “Innovative Robot Archetypes for In-Space Construction and Maintenance.” in proceedings of Space Technology and Applications International F orum (STAIF 2005).February 2005. pp. 1070-1077.[5]Kennedy, B., et al. “LEMUR: Legged Excursion MechanicalUtility Rover.” Autonomous Robots. 11(3), pp. 201-205 (2001).[6]Fredrickson, S., Duran, S., and Mitchell, J. “Mini-AERCam Inspection Robot for Human Space Missions.” AIAA Space 2004 Conference and Exhibit. San Diego, CA, September 2004.[7]Guthart, G. S. and Salisbury, J. K., Jr. “The Intuitive™Telesurgery System: Overview and Application.” in proceedings of IEEE International Conference on Robotics and Automation (ICRA 2000). San Francisco, CA, April 2000. pp. 618-621.[8]Maeda, S., et al. “Active Endoscope with SMA (Shape Memory Alloy) Coil Springs.” in proceedings of IEEE International Workshop on Micro Electro MechanicalSystems (MEMS 1996). San Diego, California, 1996, pp. 290-295.Figure 8: Applied force vs. bend angle test setup. Clockwise from left:overall view, close-up of Tendril limb mounting, and close-up of theTendril tip. [9]Ikuta, K., Tsukamoto, M., and Hirose, S. “Shape MemoryAlloy Servo Actuator System with Electric ResistanceFeedback and Application for Active Endoscope.” in proceedings of IEEE International Conference on Robotics and Automation (ICRA 1988). Philadelphia, Pennsylvania, 1988, pp. 427-430.[10]Simaan, N., Taylor, R., and Flint, P. “A Dexterous Systemfor Laryngeal Surgery – Multi-Backbone Bending Snake-Like Slaves for Teleoperated Dexterous Surgical Tool Manipulation.” in proceedings of IEEE International Conference on Robotics and Automation (ICRA 2004). NewOrleans, Louisiana, 2004. pp. 351-357.[11]Mehan, A. “Remote Visual Inspection Equipment for Quality Control.” WESCON/94. ‘Idea/Microelectronics’. Conference Record. Anaheim, CA, 2004. pp. 214-216.[12]Robinson, G. and Davies, J.B.C. “Continuum Robots – AState of the Art.” in proceedings of IEEE International Conference on Robotics and Automation. Detroit, MI, May 1999. pp. 2849-2854.[13]Walker, I. D., “Some Issues in Creating ‘Invertebrate’ Robots,” in proceedings of International Symposium onAdaptive Motion of Animals and Machine s. Montreal,Canada, 2000.[14]Ambrose, R. O. et al. “Robonaut: NASA’s Space Humanoid.”IEEE Intelligent Systems and Their Applications .15(4), pp. 57-63 (2000).[15]ControlShell User’s Manual, Version 7.0. Sunnyvale, CA:Real-Time Innovations, Inc. January 2001.。

相关文档
最新文档