Smart Medical Devices

End-effectors at mm scale

The small scale of minimally-invasive surgical procedures presents significant challenges to developing robust, smart, and dexterous tools and end-effectors for manipulating millimeter and sub-millimeter anatomical structures (e.g. vessels or nerves) and surgical equipment (e.g. sutures or staples). To meet the demand, we are developing a versatile fabrication process, based on printed circuit board manufacturing techniques, to create monolithic, kinematically complex, three-dimensional machines in parallel at the millimeter to centimeter scales. During lamination, precisely aligned material layers are combined in different ways to create functional layers that serve a specific purpose, including structural layers, flexure layers that enable rotary joints and articulated structures, printed circuit board (PCB) layers, metal spring layers, or low-friction sliding bearing layers. Finally, various functional layers combine to create multi-structure, multi-material, quasi-2D laminates capable of folding into complex 3D structures.

Assured safety drill

We have developed an assured safety drilling mechanism that is compatible with a large range of bit diameters and provides safe, reliable access to the inside of the skull. This is accomplished through a dynamic bi-stable linkage that supports drilling when force is applied against the skull but retracts upon penetration when the reaction force is diminished. In the initial design retraction was achieved when centrifugal forces from rotating masses overpower the axial forces, thus changing the state of the bi-stable mechanism. The current design iteration features a torsional spring loaded mechanism that overpowers axial forces upon penetration, thus triggering the change in the bi-stable mechanism. Testing on ex-vivo animal structures has demonstrated that the device can withdraw the drill bit in sufficient time to eliminate the risk of soft tissue damage. Ease of use and portability of the device will enable its use in unregulated environments such as hospital emergency rooms and emergency disaster relief areas.

Associated Papers

A Light-Reflecting Balloon Catheter for Atraumatic Tissue Defect Repair
E. T. Roche, et al., “A Light-Reflecting Balloon Catheter for Atraumatic Tissue Defect Repair,” Science Translational Medicine, vol. 7, no. 306, pp. 306ra149, 2015. Publisher's VersionAbstract

Closing small defects in the body typically requires stitching of tissues during surgery. Toward a minimally invasive approach, Roche et al. engineered a balloon catheter with a reflective surface coating that could be used to adhere biodegradable patches to tissues. The device unfolds the patch and its adhesive, delivers ultraviolet (UV) light, and then applies pressure to stabilize the adhesive as the light cures the polymer. The authors demonstrated catheter-mediated application of the photocurable polymer patch in vivo in rat tissue, with minimal inflammation and complete animal survival, as well as in a challenging septal defect in the beating hearts of pigs. The device was also used to seal porcine stomach ulcers and abdominal hernias ex vivo, suggesting versatility of this approach in repairing defects more easily and atraumatically than sutures.A congenital or iatrogenic tissue defect often requires closure by open surgery or metallic components that can erode tissue. Biodegradable, hydrophobic light-activated adhesives represent an attractive alternative to sutures, but lack a specifically designed minimally invasive delivery tool, which limits their clinical translation. We developed a multifunctional, catheter-based technology with no implantable rigid components that functions by unfolding an adhesive-loaded elastic patch and deploying a double-balloon design to stabilize and apply pressure to the patch against the tissue defect site. The device uses a fiber-optic system and reflective metallic coating to uniformly disperse ultraviolet light for adhesive activation. Using this device, we demonstrate closure on the distal side of a defect in porcine abdominal wall, stomach, and heart tissue ex vivo. The catheter was further evaluated as a potential tool for tissue closure in vivo in rat heart and abdomen and as a perventricular tool for closure of a challenging cardiac septal defect in a large animal (porcine) model. Patches attached to the heart and abdominal wall with the device showed similar inflammatory response as sutures, with 100% small animal survival, indicating safety. In the large animal model, a ventricular septal defect in a beating heart was reduced to <1.6 mm. This new therapeutic platform has utility in a range of clinical scenarios that warrant minimally invasive and atraumatic repair of hard-to-reach defects.

C. J. Payne, et al., “Soft robotic ventricular assist device with septal bracing for therapy of heart failure,” Science Robotics, vol. 2, no. 12, 2017. Publisher's VersionAbstract
Previous soft robotic ventricular assist devices have generally targeted biventricular heart failure and have not engaged the interventricular septum that plays a critical role in blood ejection from the ventricle. We propose implantable soft robotic devices to augment cardiac function in isolated left or right heart failure by applying rhythmic loading to either ventricle. Our devices anchor to the interventricular septum and apply forces to the free wall of the ventricle to cause approximation of the septum and free wall in systole and assist with recoil in diastole. Physiological sensing of the native hemodynamics enables organ-in-the-loop control of these robotic implants for fully autonomous augmentation of heart function. The devices are implanted on the beating heart under echocardiography guidance. We demonstrate the concept on both the right and the left ventricles through in vivo studies in a porcine model. Different heart failure models were used to demonstrate device function across a spectrum of hemodynamic conditions associated with right and left heart failure. These acute in vivo studies demonstrate recovery of blood flow and pressure from the baseline heart failure conditions. Significant reductions in diastolic ventricle pressure were also observed, demonstrating improved filling of the ventricles during diastole, which enables sustainable cardiac output.
C. J. Walsh, A. H. Slocum, and R. Gupta, “Preliminary evaluation of robotic needle distal tip repositioning,” Proc. SPIE, vol. 7901. pp. 790108, 2011. Publisher's VersionAbstract
Advances in medical imaging now provide detailed images of solid tumors inside the body and miniaturized energy delivery systems enable tumor destruction through local heating powered by a thin electrode. We have developed a robot for accurately repositioning the distal tip of a medical instrument such an ablation probe to adjacent points within tissue. The position accuracy in ballistics gelatin was evaluated in a 2D experimental setup with a digital SLR camera that was fixed to a rig that also contained the gelatin. The robot was mounted to the rig in such a way that the stylet was deployed in a plane parallel the camera's lens. A grid paper attached to the back of the box containing the gelatin provided a stationary reference point for each of the pictures taken and also served as a coordinate system for making measurements. The measurement repeatability error was found by taking a stylet tip position measurement five times for two different pictures and found to be 0.26 mm. For a stylet with a radius of curvature of 31.5 mm and a diameter of 0.838 mm, the targeting accuracy was found to be 2.5 ± 1.4 mm at points that were approximately 38 mm lateral from the cannula axis.
J. B. Gafford, H. Aihara, C. Thompson, R. J. Wood, and C. J. Walsh, “Distal Proprioceptive Sensor for Motion Feedback in Endoscope-Based Modular Robotic Systems,” IEEE Robotics and Automation Letters, vol. PP, 2017. Publisher's VersionAbstract
Modular robotic systems that integrate with commercially-available endoscopic equipment have the potential to improve the standard-of-care in therapeutic endoscopy by granting clinicians with capabilities not present in commercial tools, such as precision dexterity and motion sensing. With the desire to integrate both sensing and actuation distally for closed-loop position control in fully-deployable, endoscope-based robotic modules, commercial sensor and actuator options that acquiesce to the strict form-factor requirements are sparse or nonexistent. Herein we describe a proprioceptive angle sensor for potential closed-loop position control applications in distal robotic modules. Fabricated monolithically using printed-circuit MEMS, the sensor employs a kinematic linkage and the principle of light intensity modulation to sense the angle of articulation with a high degree of fidelity. On-board temperature and environmental irradiance measurements, coupled with linear regression techniques, provide robust angle measurements that are insensitive to environmental disturbances. The sensor is capable of measuring +/-45 degrees of articulation with an RMS error of 0.98 degrees. An integrated demonstration shows that the sensor can give real-time proprioceptive feedback when coupled with an actuator module, opening up the possibility of fully-distal closed-loop control.
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