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Purpose The recently introduced tethered DROP-IN gamma probe has revolutionized the way robotic radioguided surgery is performed, fully exploiting the nature of steerable robotic instruments. Given this success, the current first-in-human study investigates if the DROP-IN can also provide benefit in combination with steerable non-robotic instruments during conventional laparoscopic surgery, showing equivalence or even benefit over a traditional rigid gamma probe. Methods The evaluation was performed in ten patients during laparoscopic cervical ( n  = 4) and endometrial ( n  = 6) cancer sentinel lymph node (SLN) procedures. Surgical guidance was provided using the hybrid, or bi-modal, SLN tracer ICG- 99m Tc-nanocolloid. SLN detection was compared between the traditional rigid laparoscopic gamma probe, the combination of a DROP-IN gamma probe and a steerable laparoscopic instrument (LaproFlex), and fluorescence imaging. Results The gynecologists experienced an enlarged freedom of movement when using the DROP-IN + LaproFlex combination compared to the rigid laparoscopic probe, making it possible to better isolate the SLN signal from background signals. This did not translate into a change in the SLN find rate yet. In both cervical and endometrial cancer combined, the rigid probe and DROP-IN + LaproFlex combination provided an equivalent detection rate of 96%, while fluorescence provided 85%. Conclusion We have successfully demonstrated the in-human use of steerable DROP-IN radioguidance during laparoscopic cervical and endometrial cancer SLN procedures, expanding the utility beyond robotic procedures. Indicating an improved surgical experience, these findings encourage further investigation and consideration on a path towards routine clinical practice and improved patient outcome. Trial registration HCB/2021/0777 and NCT04492995; https://clinicaltrials.gov/study/NCT04492995

As an alternative to the surgical robot, some medical companies have engineered new steerable devices that mimic the robot’s capacities. This study aimed to assess how steerable instruments ameliorate the efficacy of suturing in comparison with the traditional instrument, and a combination instruments, performed by experienced and novice surgeons. The study was performed by three experienced surgeons and three novice surgeons. The instruments employed were divided into three surgical sets: two steerable dissectors; one steerable dissector and one straight needle; two straight needle holders. The study supervisor recorded the total time for the procedure, the number of bites completed, the time for each bite, and the quality of the procedure. In our study, we found consistent data demonstrating that experienced laparoscopists completed the prescribed suture pattern with more bites in less time than novices. The use of two steerable instruments was more time consuming than standard straight instruments, but a combination of instruments was significantly less time consuming, as was the use of two straight needle holders. This result was even observed in novice surgeons. Combining a steerable instrument with a traditional straight needle holder provided more advantages in this study.

Background In the field of minimally invasive surgery, specifically in pathway surgery (i.e. minimal invasive procedures carried out transluminally or through instrument-created pathways), spatial disorientation is a common experience to endoscopists. In this article, two effects that may cause spatial disorientation in pathway surgery, ‘control-display compatibility’ and ‘local disorientation’, were studied. Method A custom-developed simulator Endo-PaC was developed and used for mimicking pathway surgical scenarios. In Study 1, two ways of control-display alignment, normal mapping and mirrored mapping, were tested in combination with two control devices, thumb control and wrist control, in an orienting task using Endo-PaC. In Study 2, a tethered viewpoint was added to the virtual instrument tip. It was hypothesized that the visible tip would provide a cue of orientating direction in the reference frame during the instrument navigation. In both studies, novice participants were involved, and their performance was evaluated with regard to task time, path length travelled by the virtual tip, time and number of warnings, and subjective workload and personal preference. Results In Study 1, normal-thumb and normal-wrist mapping yielded significantly lower means than mirrored-thumb and mirrored-wrist control for all investigated objective and subjective performance measurements. Out of 24 participants, 20 participants preferred normal control mapping. In Study 2, participants performed the task in shorter time and with shorter path length when the tip was visible tip on the monitor using a tethered viewpoint, but with a lower number and time of warnings without a visible tip. Conclusion The results of our studies show that eliminating the visual-display misalignment would greatly improve novice participants’ performance, reduce the training time and their cognitive workload. A visible tip on the monitor would provide strong direction cue and shorten the performance time, but might introduce collision errors to novices and therefore requires longer training time.

The goal of this study was to determine the preferred handle design for two degrees of freedom steerable arthroscopic cutter by performing a two-step development approach. The expected usefulness and usability of control components of three entirely different handles were defined by an on-line survey with 101 students and the actual control by a standardised laboratory study with mock-up models by 16 students. The preferred handle design was integrated in a full functional prototype and optimized by 10 experts performing a meniscectomy on human cadaver knees. Students (survey 70% and task 91%) expected the same control behaviour as the experts (60%): steering a wheel to the right should evoke tip steering to the right regardless the orientation of the beak and moving a ring lever towards the handle's centre point should evoke closure of the tip. Development of surgical instruments can benefit from expected control behavior based on daily life tools, but requires expert involvement for specific surgical tasks and context.

Fluorescence imaging is increasingly being implemented in surgery. One of the drawbacks of its application is the need to switch back-and-forth between fluorescence- and white-light-imaging settings and not being able to dissect safely under fluorescence guidance. The aim of this study was to engineer ‘click-on’ fluorescence detectors that transform standard robotic instruments into molecular sensing devices that enable the surgeon to detect near-infrared (NIR) fluorescence in a white-light setting. This NIR-fluorescence detector setup was engineered to be press-fitted onto standard forceps instruments of the da Vinci robot. Following system characterization in a phantom setting (i.e., spectral properties, sensitivity and tissue signal attenuation), the performance with regard to different clinical indocyanine green (ICG) indications (e.g., angiography and lymphatic mapping) was determined via robotic surgery in pigs. To evaluate in-human applicability, the setup was also used for ICG-containing lymph node specimens from robotic prostate cancer surgery. The resulting Click-On device allowed for NIR ICG signal identification down to a concentration of 4.77 × 10 –6  mg/ml. The fully assembled system could be introduced through the trocar and grasping, and movement abilities of the instrument were preserved. During surgery, the system allowed for the identification of blood vessels and assessment of vascularization (i.e., bowel, bladder and kidney), as well as localization of pelvic lymph nodes. During human specimen evaluation, it was able to distinguish sentinel from non-sentinel lymph nodes. With this introduction of a NIR-fluorescence Click-On sensing detector, a next step is made towards using surgical instruments in the characterization of molecular tissue aspects.

During frontal sinus surgery and endoscopic endonasal surgery, faraway locations in the skull have to be reached with minimal damage to healthy tissues. Starting at the DaVinci, this chapter describes the newest developments in the field of steerable and maneuverable surgical instrumentation allowing the surgeon to move along complex 3D pathways in the skull with entrance via narrow anatomic corridors. The chapter will end with the future perspective of multibranched, snakelike instrumentation suited for complex 3D motion along the dense and delicate anatomy in the skull. VoR

Conventional catheter-based interventions for treating peripheral artery disease suffer high failure and complication rates. The mechanical interactions with the anatomy constrain catheter controllability, while their length and flexibility limit their pushability. Also, the 2D X-ray fluoroscopy guiding these procedures fails to provide sufficient feedback about the device location relative to the anatomy. Our study aims to quantify the performance of conventional non-steerable (NS) and steerable (S) catheters in phantom and ex vivo experiments. In a 10 mm diameter, 30 cm long artery phantom model, with four operators, we evaluated the success rate and crossing time in accessing 1.25 mm target channels, the accessible workspace, and the force delivered through each catheter. For clinical relevance, we evaluated the success rate and crossing time in crossing ex vivo chronic total occlusions. For the S and NS catheters, respectively, users successfully accessed 69 and 31% of the targets, 68 and 45% of the cross-sectional area, and could deliver 14.2 and 10.2 g of mean force. Using a NS catheter, users crossed 0.0 and 9.5% of the fixed and fresh lesions, respectively. Overall, we quantified the limitations of conventional catheters (navigation, reachable workspace, and pushability) for peripheral interventions; this can serve as a basis for comparison with other devices.

In this article, a microwave (MW)/millimeter wave (MMW) aperture-sharing antenna is proposed. The antenna is constructed using two orthogonal columns of grounded vias from a 3.5 GHz slot-loaded half-mode substrate-integrated waveguide (HMSIW) antenna. These vias are reused to create two sets of 1 × 4 MMW substrate-integrated dielectric resonator antenna (SIDRA) arrays. With this proposed partial structure reuse strategy, the MW antenna and MMW arrays can be integrated in a shared-aperture manner, improving space utilization and enabling dual-polarized beam steering capability in the MMW band, which is highly desirable for multiple-input multipleoutput (MIMO) applications. The integrated antenna prototype was manufactured and measured for verification. The 3.5 GHz antenna has a relative bandwidth of 3.4% (3.44–3.56 GHz) with a peak antenna gain of 5.34 dBi, and the 28 GHz antenna arrays cover the frequency range of 26.5–29.8 GHz (11.8%) and attain a measured peak antenna gain of 11.0 dBi. Specifically, the 28 GHz antenna arrays can realize dual-polarization and ±45° beam steering capability. The dual-band antenna has a very compact structure, and it is applicable for 5G mobile communication terminals.

In drilling engineering, Toolface is an angle used to describe bit direction. It is a challenging task to accurately estimate Toolface while drilling because of the downhole harsh conditions, but it is a primary step for the dynamic point-the-bit rotary steerable system (DPRSS). A new dynamic Toolface estimator is present, which fuses measurements from two accelerometers and one gyro. A dual-accelerometer Toolface measuring method is designed to compensate the circumferential acceleration of DPRSS. A nonlinear Complementary Filter (CF) is used to suppress the effect of vibration and axial acceleration. The frequency-domain characteristics of nonlinear CF are analyzed and its natural frequency is determined adaptively based on real time drilling conditions. This new estimator is validated on a DPRSS prototype under typical drilling modes; it is demonstrated with high robustness and follows the references satisfactorily.

In this paper, we present a novel, low-cost approach to indoor localization that is capable of performing localization processes in real indoor environments and does not require calibration or recalibration procedures. To this end, we propose a single-anchor architecture and design based on an electronically steerable parasitic array radiator (ESPAR) antenna and Nordic Semiconductor nRF52840 utilizing Bluetooth Low Energy (BLE) protocol. The proposed algorithm relies on received signal strength (RSS) values measured by the receiver equipped with the ESPAR antenna for every considered antenna radiation pattern. The calibration-free concept is achieved by using inexpensive BLE nodes installed in known positions on the walls of the test room and acting as reference nodes for the positioning algorithm. Measurements performed in the indoor environment show that the proposed approach can successfully provide positioning results better than those previously reported for single-anchor ESPAR antenna localization systems employing the classical fingerprinting method and relying on time-consuming calibration procedures.