Towards a Wristed Percutaneous Robot With Variable Stiffness for Pericardiocentesis

Pericardiocentesis is the drainage of excessive fluid in the pericardium surrounding the heart under ultrasound guidance. The percutaneous procedure comes with the risk of cardiac perforation since the needle is inserted towards the beating heart. This letter presents a novel percutaneous robot that features a flexible wrist made of shape memory alloy (SMA) spring which can vary its stiffness through temperature variation. The SMA spring can be heated and thus stiffened to allow insertion. At lower temperature, it behaves like a spring backbone that allows the needle to be bent away from the heart and thus minimizing the chance of cardiac perforation. A heating tube made of nichrome wire and PTFE tube was developed to be the heat source for the SMA spring. The robot has an outer diameter of 4 mm, similar to the dilator used in pericardiocentesis, and a lumen to pass a guidewire through. A stiffness model and kinematics model were developed and verified through experiments. The surface temperature of the SMA-based wrist was evaluated to be less than the tissue necrosis temperature. Lastly, we demonstrated that the robot could be inserted into gelatin phantoms of different stiffnesses and produce a wristed motion under ultrasound guidance.

[1]  Jessica Burgner-Kahrs,et al.  Stiffening Sheaths for Continuum Robots. , 2018, Soft robotics.

[2]  Yue Chen,et al.  MR-conditional steerable needle robot for intracerebral hemorrhage removal , 2018, International Journal of Computer Assisted Radiology and Surgery.

[3]  Y. Adler,et al.  Management of pericardial effusion. , 2013, European heart journal.

[4]  Shuxin Wang,et al.  A linear stepping endovascular intervention robot with variable stiffness and force sensing , 2018, International Journal of Computer Assisted Radiology and Surgery.

[5]  Carlos Rossa,et al.  A Hand-Held Assistant for Semiautomated Percutaneous Needle Steering , 2017, IEEE Transactions on Biomedical Engineering.

[6]  Robert J. Webster,et al.  A Flexure-Based Steerable Needle: High Curvature With Reduced Tissue Damage , 2013, IEEE Transactions on Biomedical Engineering.

[7]  D. Caleb Rucker,et al.  A bimanual teleoperated system for endonasal skull base surgery , 2011, 2011 IEEE/RSJ International Conference on Intelligent Robots and Systems.

[8]  R. Siegel,et al.  Echo Guided Pericardiocentesis , 2016 .

[9]  F.R.C.P. F.A.C.P. F.A.C.C. Ralph Shabetai M.D..  The Pericardium , 2003, Developments in Cardiovascular Medicine.

[10]  Peter K. Allen,et al.  System design of an Insertable Robotic Effector Platform for Single Port Access (SPA) Surgery , 2009, 2009 IEEE/RSJ International Conference on Intelligent Robots and Systems.

[11]  Robert Rohling,et al.  Hand-held steerable needle device , 2003, IEEE/ASME Transactions on Mechatronics.

[12]  Jaydev P. Desai,et al.  A Novel Discretely Actuated Steerable Probe for Percutaneous Procedures , 2010, ISER.

[13]  L. Brinson.  One-Dimensional Constitutive Behavior of Shape Memory Alloys: Thermomechanical Derivation with Non-Constant Material Functions and Redefined Martensite Internal Variable , 1993 .

[14]  Thomas Looi,et al.  A 3 mm Wristed Instrument for the da Vinci Robot: Setup, Characterization, and Phantom Tests for Cleft Palate Repair , 2020, IEEE Transactions on Medical Robotics and Bionics.

[15]  Arianna Menciassi,et al.  A variable stiffness mechanism for steerable percutaneous instruments: integration in a needle , 2018, Medical & Biological Engineering & Computing.

[16]  L Frasson,et al.  STING: a soft-tissue intervention and neurosurgical guide to access deep brain lesions through curved trajectories , 2010, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[17]  Allison M. Okamura,et al.  Highly Articulated Robotic Needle Achieves Distributed Ablation of Liver Tissue , 2017, IEEE Robotics and Automation Letters.

[18]  M. Dewhirst,et al.  Thresholds for thermal damage to normal tissues: An update , 2011, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[19]  Jaydev P. Desai,et al.  Towards high frequency actuation of SMA spring for the neurosurgical robot - MINIR-II , 2015, 2015 IEEE International Conference on Robotics and Automation (ICRA).

[20]  Dimitra Dodou,et al.  Design of an ultra-thin steerable probe for percutaneous interventions and preliminary evaluation in a gelatine phantom , 2019, PloS one.

[21]  Jin Seob Kim,et al.  Nonholonomic Modeling of Needle Steering , 2006, Int. J. Robotics Res..

[22]  F. Achilli,et al.  Safety, Efficacy, and Complications of Pericardiocentesis by Real-Time Echo-Monitored Procedure. , 2016, The American journal of cardiology.

[23]  Jaydev P. Desai,et al.  Active Stiffness Tuning of a Spring-Based Continuum Robot for MRI-Guided Neurosurgery , 2018, IEEE Transactions on Robotics.

[24]  Kyu-Jin Cho,et al.  Design of an Optically Controlled MR-Compatible Active Needle , 2015, IEEE Transactions on Robotics.

[25]  Jian S. Dai,et al.  Geometric constraint-based modeling and analysis of a novel continuum robot with Shape Memory Alloy initiated variable stiffness , 2020, Int. J. Robotics Res..

[26]  Jaydev P. Desai,et al.  Towards the Development of a Steerable and MRI-Compatible Cardiac Catheter for Atrial Fibrillation Treatment , 2018, IEEE Robotics and Automation Letters.

[27]  Robert J. Webster,et al.  A wrist for needle-sized surgical robots , 2015, 2015 IEEE International Conference on Robotics and Automation (ICRA).

[28]  H. Fujita,et al.  Effect of the composition and thermal annealing on the transformation temperatures of sputtered TiNi shape memory alloy thin films , 2001 .

[29]  Dimitra Dodou,et al.  Buckling prevention strategies in nature as inspiration for improving percutaneous instruments: a review , 2016, Bioinspiration & biomimetics.

[30]  Philippe Poignet,et al.  Robot-assisted automatic insertion of steerable needles with closed-loop imaging feedback and intraoperative trajectory replanning , 2013 .

[31]  Kyle B. Reed,et al.  Evaluation of robotic needle steering in ex vivo tissue , 2010, 2010 IEEE International Conference on Robotics and Automation.

[32]  Mamoru Mitsuishi,et al.  Compact 4DOF robotic forceps with 3.5 mm in diameter for neurosurgery based on a synthetic elastic structure , 2017, 2017 International Symposium on Micro-NanoMechatronics and Human Science (MHS).

[33]  Ewout A. Arkenbout,et al.  Classification of Joints Used in Steerable Instruments for Minimally Invasive Surgery—A Review of the State of the Art , 2015 .

[34]  Dario Floreano,et al.  A variable stiffness catheter controlled with an external magnetic field , 2017, 2017 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS).