Abstract: Flexible endoscopes are still the gold standard in most natural orifice translumenal endoscopic surgery (NOTES) procedures; however their flexibility (necessary for navigating through the GI tract) limits their capabilities in terms of distal manipulation and stability. We propose a deployable endoscopic add-on aimed at locally counteracting forces applied at the tip of an endoscope. We analyze different designs: a fully soft version and two hybrid soft-folded versions. The hybrid designs exploit either an inextensible structure pressurized by a soft actuator or the stiffness provided by the unfolded “magic cube” origami structure. We focus on the fabrication and experimental characterization of the proposed structures and present some preliminary designs and integration strategies to mount them on top of current flexible endoscopes.
‘Snap-On’ robotic modules that can integrate distally with existing commercially-available endoscopic equipment have the potential to provide new capabilities such as enhanced dexterity, bilateral manipulation and feedback sensing with minimal disruption of the current clinical workflow. However, the desire for fully-distal integration of sensors and actuators and the resulting form factor requirements preclude the use of many off-the-shelf actuators capable of generating the relevant strokes and forces required to interact with tools and tissue. In this work, we investigate the use of millimeter-scale, optimally-packed helical shape memory alloy (SMA) actuators in an antagonistic configuration to provide distal actuation without the need for a continuous mechanical coupling to proximal, off-board actuation packages to realize a truly plug-and-play solution. Using phenomenological modeling, we design and fabricate antagonistic helical SMA pairs and implement them in an at-scale roboendoscopic module to generate strokes and forces necessary for deflecting tools passed through the endoscope working port, thereby providing a controllable robotic ‘wrist’ inside the body to otherwise passive flexible tools. Bandwidth is drastically improved through the integration of targeted fluid cooling. The integrated system can generate maximum lateral forces of 10N and demonstrates an additional 96 degrees of distal angulation, expanding the reachable workspace of tools passed through a standard endoscope.
We present a simple fabrication approach for anisotropically conductive stretchable composites, towards novel flexible pressure transducers. Flexible electronic systems have gained great interest in recent years, and within this space, anisotropic conducting materials have been explored for enhanced sensing performance. However, current methods for producing these materials are complex or are limited to small fabrication areas. Our method uses film applicator coating to render commercially available conductive RTVs anisotropically conductive. A ratio of in-plane surface resistance to through-thickness resistance of 1010 was achieved using our method. Furthermore, we show that when a normal pressure is applied to such films, the in-plane resistance can be reduced by seven orders of magnitude for an applied pressure of 10 kPa. Hence these materials show great promise for the development of novel, robust pressure transducers.
The soft exosuit is a new approach for applying assistive forces over the wearer's body through load paths configured by the textile architecture. In this paper, we present a body-worn lower-extremity soft exosuit and a new control approach that can independently control the level of assistance that is provided during negative- and positive-power periods at the ankle. The exosuit was designed to create load paths assisting ankle plantarflexion and hip flexion, and the actuation system transmits forces from the motors to the suit via Bowden cables. A load cell and two gyro sensors per leg are used to measure real-time data, and the controller performs position control of the cable on a step-by-step basis with respect to the power delivered to the wearer's ankle by controlling two force parameters, the pretension and the active force. Human subjects testing results demonstrate that the controller is capable of modulating the amount of power delivered to the ankle joint. Also, significant reductions in metabolic rate (11%-15%) were observed, which indicates the potential of the proposed control approach to provide benefit to the wearer during walking.
Burgeoning transendoscopic procedures, such as endoscopic submucosal dissection (ESD), provide a promising means of treating early-stage gastric neoplasia in a minimally-invasive way. However, the remote locations of these lesions, coupled with their origination in the submucosal layers of the gastrointestinal tract, often lead to extreme technical, cognitive and ergonomic challenges which combat the widespread applicability and adoption of these techniques. Among these challenges is achieving the in vivo dexterity required to retract and dissect tissue. By leveraging workspace and force data obtained through clinical studies, we developed a modular, disposable, distally-mounted actuator (an 'active endcap') that can augment an endoscopist's distal dexterity in ways that are not achievable with the endoscope's built-in degrees-of-freedom. The device consists of a flexible articulating 'exoskeleton' manufactured via printed-circuit MEMS (PCMEMS) which engages and deflects electrosurgical tools that are passed through the endoscopic working channel. Embedded proprioceptive sensing is implemented on-board using distributed LED/phototransistor pairs and the principle of light intensity modulation (LIM). The distal degree-of-freedom is actuated using shape memory alloy (SMA) technology, and the actuation transmission system is fully contained within a 1-inch-long end cap that can be mounted on the distal end of the endoscope, thereby obviating the need for a mechanical connection to a proximal source. Proof-of-concept tests demonstrate that the actuator adds over 50 degrees of distal articulation to existing tools and can generate 450 mN of lateral force which has been clinically determined to be sufficient for performing circumferential incisions in ESD.
This paper introduces a manufacturing technique which enables the integration of soft materials and soft fluidic micro-actuators in the Pop-up book MEMS paradigm. Such a technique represents a promising approach to the design and fabrication of low cost and scalable articulated mechanisms provided with sensing capabilities and on-board actuation with potential applications in the field of minimally invasive surgery. Design and integration of soft components in the rigid-flex laminates is described along with the resulting soft pop-up mechanisms realized at different scales. Prototype characterization is presented, demonstrating forces and dexterity in a range suitable for surgical applications, as well as the possibility to integrate sensing capabilities. Based on these results, a multi-articulated robotic arm is fabricated and mounted on top of an endoscope model to provide a proof of concept of simple robotic mechanisms that could be useful in a surgical scenario.
In this paper we describe an IMU-based iterative controller for hip extension assistance where the onset timing of assistance is based on an estimate of the maximum hip flexion angle. The controller was implemented on a mono-articular soft exosuit coupled to a lab-based multi-joint actuation platform that enables rapid reconfiguration of different sensors and control strategy implementation. The controller design is motivated by a model of the suit-human interface and utilizes an iterative control methodology that includes gait detection and step-by-step actuator position profile generation to control the onset timing, peak timing, and peak magnitude of the delivered force. This controller was evaluated on eight subjects walking on a treadmill at a speed of 1.5 m/s while carrying a load of 23 kg. Results showed that assistance could be delivered reliably across subjects. Specifically, for a given profile, the average delivered force started concurrently with the timing of the maximum hip flexion angle and reached its peak timing 22.7 ± 0.63% later in the gait cycle (desired 23%) with a peak magnitude of 198.2 ± 1.6 N (desired 200 N), equivalent to an average peak torque of 30.5 ± 4.7 Nm. This control approach was used to assess the metabolic effect of four different assistive profiles. Metabolic reductions ranging from 5.7% to 8.5% were found when comparing the powered conditions with the unpowered condition. This work enables studies to assess the biomechanical and physiological responses to different assistive profiles to determine the optimal hip extension assistance during walking.