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Lord, Helen Elizabeth. "A randomised controlled equivalence trial comparing tension-free vaginal tape (TVT) with suprapubic urethral support sling (SPARC)." University of Western Australia. Faculty of Medicine and Dentistry and Health Sciences, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0086.
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[Truncated abstract] Approximately 35% of women worldwide have stress incontinence, which is defined as involuntary leakage of urine on effort, exertion, or on sneezing and coughing. There are various surgical techniques for stress incontinence; however, minimally invasive operations are increasingly being chosen by surgeons and their patients. Of these procedures, tension-free vaginal tape (TVT) has a cure rate of approximately 90% and is now perceived as the standard technique for stress incontinence. Reported complications of TVT include arterial laceration, bladder perforation, bowel perforation, de novo urgency, dyspareunia, excessive blood loss, haematoma, nerve injuries, urethral erosion, urge incontinence, urinary tract infection, vascular injury, vaginal mesh erosion, voiding dysfunction and death. Suprapubic urethral support sling (SPARC) is a very similar minimally invasive operation and early indications suggested that the success rate for treating stress incontinence was expected to be identical or better than those obtained with the earlier TVT approach, with possibly fewer adverse perioperative events. Our trial sought to establish equivalence between TVT and SPARC in relation to short-term complications and efficacy. OBJECTIVES The primary outcome was bladder perforation. Secondary outcomes were blood loss, voiding difficulty, urgency, and cure of stress incontinence symptoms. METHOD A randomised controlled one-sided equivalence trial (RCT) was conducted in Perth, Western Australia during 2003 and 2004 by researchers in the School of Population Health, University of Western Australia (UWA) and King Edward Memorial Hospital (KEMH). Patients were recruited from the public Urology/Urogynaecology Clinic at the primary women's hospital and the consultant surgeons' private practices. ... However, acute urinary retention requiring a return to theatre to loosen the tape (TVT 0%, SPARC 6.5%; OR: [infinity], 95% CL: 2.2, [infinity]; p=0.002) and subjective short-term cure (TVT 87.1%, SPARC 76.5%; OR: 2.07, 95% CL: 1.13, 3.81; p=0.03) were statistically significantly different. CONCLUSIONS The results are consistent with clinical equivalence between TVT and SPARC in relation to the incidence of bladder perforation. No statistically significant difference was found between TVT and SPARC in blood loss, urgency or short-term objective cure of stress incontinence at the six week post-discharge visit to the surgeon. However, the tapes were more difficult to adjust correctly in SPARC procedures and a statistically significant number of patients required a return to theatre for loosening of the tape (TVT 0/147, 0% and SPARC 10/154, 6.5%, p=0.002). Compared with SPARC, TVT was statistically significantly higher for subjective short-term cure. In ii relation to vaginal mesh erosion, TVT was lower than SPARC, though not statistically significantly. Overall, voiding difficulty (loosening of the tape), urgency and vaginal mesh erosion were the most important clinical problems. This randomised controlled trial demonstrates the importance of testing new devices which appear to be similar, but which may have clinically relevant differences. A follow up study to assess the long-term efficacy of tension-free vaginal tape and suprapubic urethral support sling and associated complications is planned.
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Bringman, Sven. "Minimally invasive hernia surgery /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-466-6/.
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Lo, Benny Ping Lai. "Activity profiling for minimally invasive surgery." Thesis, Imperial College London, 2007. http://hdl.handle.net/10044/1/11809.
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Smith, Ralph. "Stereoscopic vision and minimally invasive surgery." Thesis, University of Surrey, 2016. http://epubs.surrey.ac.uk/809808/.
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Minimally invasive surgery has been a major advance in the practice of medicine as it reduces the morbidity associated with larger incisions required for open surgery. A videoscopic system is used to capture and transmit two-dimensional images of the patient during a procedure. In open surgery, the binocular configuration of the human visual system is used to generate key depth information. Minimally invasive surgery requires interpretation of monocular visual cues to perform visuospatial judgments and complex psychomotor skills. The absence of binocular depth cues extends the learning curve during which there is an increased risk of surgical error. Stereoendoscopes produce binocular visual cues by presenting horizontally disparate images of the operative field to each eye. Stereoscopic surgery is associated with improvements in surgical performance but historical projection mechanisms generated intolerable viewing conditions resulting in visual fatigue. Time-parallel passive polarising stereoscopic displays use polarising filters to simultaneously designate alternate pixel rows of horizontally disparate images. Circular polarising eyewear corresponding to the display surface filters allows disparate images to be viewed separately by each eye. The difference between these images is interpreted as a binocular depth cue. This thesis aims to identify the potential impact and tolerance of time-parallel passive polarising stereoscopic displays for minimally invasive surgery. Accommodative dynamic responses were used to objectively measure visual fatigue following stereoscopic viewing. Visual perception of stereoscopic stimuli was investigated by psychophysical performance during visual search and by quantifying attention deployment while viewing stereoscopic surgery. This work provides insight into the future role of stereoscopic visualisation for minimally invasive surgery. It indicates that time-parallel passive polarising displays improve performance of surgical skills and are well tolerated by experienced minimally invasive surgeons under stereoscopic conditions. Novice surgeons may experience increased visual fatigue while learning minimally invasive surgery due to disturbance of normal visual attention mechanisms. This thesis forms the basis for future clinical trials to evaluate the impact of this technology on the performance of minimally invasive surgery.
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Ortmaier, Tobias Johannes Ortmaier Tobias Johannes Ortmaier Tobias Johannes. "Motion compensation in minimally invasive robotic surgery." [S.l.] : [s.n.], 2003. http://deposit.ddb.de/cgi-bin/dokserv?idn=967534860.
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Ortmaier, Tobias Johannes. "Motion compensation in minimally invasive robotic surgery." [S.l. : s.n.], 2003. http://deposit.ddb.de/cgi-bin/dokserv?idn=967534860.
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King, Rachel C. "Hand gesture recognition for minimally invasive surgery." Thesis, Imperial College London, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.497748.
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Du, X. "Visual tracking in robotic minimally invasive surgery." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10047149/.
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Intra-operative imaging and robotics are some of the technologies driving forward better and more effective minimally invasive surgical procedures. To advance surgical practice and capabilities further, one of the key requirements for computationally enhanced interventions is to know how instruments and tissues move during the operation. While endoscopic video captures motion, the complex appearance dynamic effects of surgical scenes are challenging for computer vision algorithms to handle with robustness. Tackling both tissue and instrument motion estimation, this thesis proposes a combined non-rigid surface deformation estimation method to track tissue surfaces robustly and in conditions with poor illumination. For instrument tracking, a keypoint based 2D tracker that relies on the Generalized Hough Transform is developed to initialize a 3D tracker in order to robustly track surgical instruments through long sequences that contain complex motions. To handle appearance changes and occlusion a patch-based adaptive weighting with segmentation and scale tracking framework is developed. It takes a tracking-by-detection approach and a segmentation model is used to assigns weights to template patches in order to suppress back- ground information. The performance of the method is thoroughly evaluated showing that without any offline-training, the tracker works well even in complex environments. Finally, the thesis proposes a novel 2D articulated instrument pose estimation framework, which includes detection-regression fully convolutional network and a multiple instrument parsing component. The framework achieves compelling performance and illustrates interesting properties includ- ing transfer between different instrument types and between ex vivo and in vivo data. In summary, the thesis advances the state-of-the art in visual tracking for surgical applications for both tissue and instrument motion estimation. It contributes to developing the technological capability of full surgical scene understanding from endoscopic video.
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White, Alan Daniel. "Visual-motor learning in minimally invasive surgery." Thesis, University of Leeds, 2016. http://etheses.whiterose.ac.uk/17321/.
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The purpose of this thesis was to develop an in-depth understanding of motor control in surgery. This was achieved by applying current theories of sensorimotor learning and developing a novel experimental approach. A survey of expert opinion and a review of the existing literature identified several issues related to human performance and MIS. The approach of this thesis combined existing surgical training tools with state-of-the-art technology and adapted rigorous experimental psychology techniques (grounded in the principles of sensorimotor learning) within a controlled laboratory environment. Existing technology was incorporated into surgical scenarios via the Kinematic Assessment Tool - an experimentally validated, powerful and portable system capable of providing accurate and repeatable measures of visual-motor performance. The Kinematic Assessment Tool (KAT) was first established as an appropriate means of assessing visual-motor performance, subsequently the KAT was assessed as valid when assessing MIS performance. Following this, the system was used to investigate whether the principles of ‘structural learning’ could be applied to MIS. The final experiment investigated if there is any benefit of a standardised, repeatable laparoscopic warm-up to MIS performance. These experiments demonstrated that the KAT system combined with other existing technologies, can be used to investigate visual-motor performance. The results suggested that learning the control dynamics of the surgical instruments and variability in training is beneficial when presented with novel but similar tasks. These findings are consistent with structural learning theory. This thesis should inform current thinking on MIS training and performance and the future development of simulators with more emphasis on introducing variability within tasks during training. Further investigation of the role of structural learning in MIS is required.
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Panahi, Ali. "MUSCLE FATIGUE ANALYSIS IN MINIMALLY INVASIVE SURGERY." OpenSIUC, 2016. https://opensiuc.lib.siu.edu/dissertations/1320.
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Due to its inherent complexity such as limited work volume and degree of freedom, minimally invasive surgery (MIS) is ergonomically challenging to surgeons than traditional open surgery. Specifically, MIS can expose performing surgeons to excessive ergonomic risks including muscle fatigue that may lead to critical errors in surgical procedures. Therefore, detecting the vulnerable muscles and time-to-fatigue during MIS is of great importance in order to prevent these errors. In this research, different surgical skill and ergonomic assessment methods are reviewed and their advantages and disadvantages are studied. According to the literature review, which is included in chapter 1, some of these methods are subjective and those that are objective provide inconsistent results. Muscle fatigue analysis has shown promising results for skill and ergonomic assessments. However, due to the data analysis issues, this analysis has only been successful in intense working conditions. The goal of this research is to apply an appropriate data analysis method to minimally invasive surgical setting which is considered as a low-force muscle activity. Therefore, surface electromyography is used to record muscle activations of subjects while they performed various real laparoscopic operations and dry lab surgical tasks. The muscle activation data is then reconstructed using Recurrence Quantification Analysis (RQA), which has been proven to be a reliable analysis, to detect possible signs of muscle fatigue on different muscle groups. The results of this data analysis method is validated using subjective fatigue assessment method. In order to study the effect of muscle fatigue on subject’s performance, standard Fundamental of Laparoscopic Surgery (FLS) tasks performance analysis is used.
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Gaffney, Leah. "Cardiac Catheter Brace for Minimally Invasive Surgery." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17417586.
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Cardiac disease is common and many cases require invasive surgical intervention. Most cardiac surgeries, for example, require stopping the patient’s heart. A percutaneous, beating heart, catheter-based system has been proposed as a less invasive option. Toward this goal, a mechanical device for bracing cardiac catheters against safe structures in the heart has been developed to allow more robust probing of heart tissue. The device presented here is rigid in its bracing conformation to support a catheter inside of the cardiac chambers, but is compliant enough to be delivered to the heart via the patient’s vasculature. This brace aims to provide comparable surgical dexterity in a less invasive protocol.Engineering Sciences
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Sodergren, Mikael Hans. "Perception and orientation in minimally invasive surgery." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/6989.
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During the last two decades, we have seen a revolution in the way that we perform abdominal surgery with increased reliance on minimally invasive techniques. This paradigm shift has come at a rapid pace, with laparoscopic surgery now representing the gold standard for many surgical procedures and further minimisation of invasiveness being seen with the recent clinical introduction of novel techniques such as single-incision laparoscopic surgery and natural orifice translumenal endoscopic surgery. Despite the obvious benefits conferred on the patient in terms of morbidity, length of hospital stay and post-operative pain, this paradigm shift comes at a significantly higher demand on the surgeon, in terms of both perception and manual dexterity. The issues involved include degradation of sensory input to the operator compared to conventional open surgery owing to a loss of three-dimensional vision through the use of the two-dimensional operative interface, and decreased haptic feedback from the instruments. These changes have led to a much higher cognitive load on the surgeon and a greater risk of operator disorientation leading to potential surgical errors. This thesis represents a detailed investigation of disorientation in minimally invasive surgery. In this thesis, eye tracking methodology is identified as the method of choice for evaluating behavioural patterns during orientation. An analysis framework is proposed to profile orientation behaviour using eye tracking data validated in a laboratory model. This framework is used to characterise and quantify successful orientation strategies at critical stages of laparoscopic cholecystectomy and furthermore use these strategies to prove that focused teaching of this behaviour in novices can significantly increase performance in this task. Orientation strategies are then characterised for common clinical scenarios in natural orifice translumenal endoscopic surgery and the concept of image saliency is introduced to further investigate the importance of specific visual cues associated with effective orientation. Profiling of behavioural patterns is related to performance in orientation and implications on education and construction of smart surgical robots are drawn. Finally, a method for potentially decreasing operator disorientation is investigated in the form of endoscopic horizon stabilization in a simulated operative model for transgastric surgery. The major original contributions of this thesis include: Validation of a profiling methodology/framework to characterise orientation behaviour Identification of high performance orientation strategies in specific clinical scenarios including laparoscopic cholecystectomy and natural orifice translumenal endoscopic surgery Evaluation of the efficacy of teaching orientation strategies Evaluation of automatic endoscopic horizon stabilization in natural orifice translumenal endoscopic surgery The impact of the results presented in this thesis, as well as the potential for further high impact research is discussed in the context of both eye tracking as an evaluation tool in minimally invasive surgery as well as implementation of means to combat operator disorientation in a surgical platform. The work also provides further insight into the practical implementation of computer-assistance and technological innovation in future flexible access surgical platforms.
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Yao, Hsin-Yun 1974. "Touch magnifying instrument applied to minimally invasive surgery." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=81578.
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The MicroTactus is an instrument designed to detect signals arising from the interaction of a tip with soft or hard objects and to magnify them for haptic and auditory reproduction. An enhanced arthroscopic surgical probe was developed using an accelerometer and a custom-designed actuator for haptic feedback. Measurements were made to characterize the device and the results showed that numerous factors such as gripping method and gripping force influenced the system response in a complicated manner. The device was tested with the task of detecting surface defects of a cartilage-like material. Subjects were asked to detect the cuts of different depths under four conditions: no amplification, with haptic feedback, with sound feedback, and with passive touch. Both haptic and auditory feedback was found to significantly improve detection performance, which demonstrated that an enhanced arthroscopic probe provided useful information for the detection of small cuts in tissue-like materials.
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Evangelidis, Alexander E. "A robotic system for minimally invasive orthopaedic surgery." Thesis, Imperial College London, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.444136.
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Mountney, Peter Edward. "simultaneous localisation and mapping for minimally invasive surgery." Thesis, Imperial College London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.530462.
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Shetty, Kunal. "Motor learning induced neuroplasticity in minimally invasive surgery." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/56079.
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Technical skills in surgery have become more complex and challenging to acquire since the introduction of technological aids, particularly in the arena of Minimally Invasive Surgery. Additional challenges posed by reforms to surgical careers and increased public scrutiny, have propelled identification of methods to assess and acquire MIS technical skills. Although validated objective assessments have been developed to assess motor skills requisite for MIS, they poorly understand the development of expertise. Motor skills learning, is indirectly observable, an internal process leading to relative permanent changes in the central nervous system. Advances in functional neuroimaging permit direct interrogation of evolving patterns of brain function associated with motor learning due to the property of neuroplasticity and has been used on surgeons to identify the neural correlates for technical skills acquisition and the impact of new technology. However significant gaps exist in understanding neuroplasticity underlying learning complex bimanual MIS skills. In this thesis the available evidence on applying functional neuroimaging towards assessment and enhancing operative performance in the field of surgery has been synthesized. The purpose of this thesis was to evaluate frontal lobe neuroplasticity associated with learning a complex bimanual MIS skill using functional near-infrared spectroscopy an indirect neuroimaging technique. Laparoscopic suturing and knot-tying a technically challenging bimanual skill is selected to demonstrate learning related reorganisation of cortical behaviour within the frontal lobe by shifts in activation from the prefrontal cortex (PFC) subserving attention to primary and secondary motor centres (premotor cortex, supplementary motor area and primary motor cortex) in which motor sequences are encoded and executed. In the cross-sectional study, participants of varying expertise demonstrate frontal lobe neuroplasticity commensurate with motor learning. The longitudinal study involves tracking evolution in cortical behaviour of novices in response to receipt of eight hours distributed training over a fortnight. Despite novices achieving expert like performance and stabilisation on the technical task, this study demonstrates that novices displayed persistent PFC activity. This study establishes for complex bimanual tasks, that improvements in technical performance do not accompany a reduced reliance in attention to support performance. Finally, least-squares support vector machine is used to classify expertise based on frontal lobe functional connectivity. Findings of this thesis demonstrate the value of interrogating cortical behaviour towards assessing MIS skills development and credentialing.
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Allan, M. H. "Visual tracking of instruments in minimally invasive surgery." Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/1542475/.
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Reducing access trauma has been a focal point for modern surgery and tackling the challenges that arise from new operating techniques and instruments is an exciting and open area of research. Lack of awareness and control from indirect manipulation and visualization has created a need to augment the surgeon's understanding and perception of how their instruments interact with the patient's anatomy but current methods of achieving this are inaccurate and difficult to integrate into the surgical workflow. Visual methods have the potential to recover the position and orientation of the instruments directly in the reference frame of the observing camera without the need to introduce additional hardware to the operating room and perform complex calibration steps. This thesis explores how this problem can be solved with the fusion of coarse region and fine scale point features to enable the recovery of both the rigid and articulated degrees of freedom of laparoscopic and robotic instruments using only images provided by the surgical camera. Extensive experiments on different image features are used to determine suitable representations for reliable and robust pose estimation. Using this information a novel framework is presented which estimates 3D pose with a region matching scheme while using frame-to-frame optical flow to account for challenges due to symmetry in the instrument design. The kinematic structure of articulated robotic instruments is also used to track the movement of the head and claspers. The robustness of this method was evaluated on calibrated ex-vivo images and in-vivo sequences and comparative studies are performed with state-of-the-art kinematic assisted tracking methods.
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Chapman, Gregg James. "High Energy Gamma Detection for Minimally Invasive Surgery." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1500525997308215.
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Fujii, Kenko. "Gaze contingent robotic control in minimally invasive surgery." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/24562.
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Recent advances in minimally invasive surgery (MIS) have allowed patients to benefit from reduced trauma, faster recover times, and shorter hospitalisation. As a result, surgeons operate in a less-than-comfortable posture which is both physically and mentally challenging. This has led to a more demanding training scheme to acquire the relevant surgical skills. Navigating and operating with flexible instruments such as endoscopes can also induce spatial disorientation within the surgeon, where such instances are associated with increased pain for the patient and more critically, risk of perforating delicate patient tissue. Furthermore, the increased physical separation between the surgeon and the operative site and newly introduced surgical instruments have significantly changed the ergonomics and surgical workflow, which in turn increases the cognitive burden on the surgeon. The perceptual and ergonomic challenges during flexible endoscope based MIS are investigated through using the wealth of perceptual information the gaze can provide. In particular, the visualisation, navigation and ergonomic issues during MIS procedures are studied. A gaze parameter based framework is introduced to assess the use of a new field-of-view expansion technique for improved visualisation and camera trajectory comprehension when disorientated. Flexible instruments such as endoscopes suffer from disorientation inducing perceptual-motor misalignment. A misalignment quantification approach and a classification method based on gaze to infer varying perceptual-motor misalignment are developed to enable ergonomic assessment during endoscopic procedures. A novel robotic assisted gaze controlled camera system is developed to improve camera navigation where the user's control intentions are conveyed to the robotic laparoscope via real-time gaze gestures. To further improve the ergonomics of the gaze contingent system, an online calibration algorithm is integrated into the system. Throughout the thesis, detailed validation and discussion of the results are conducted to demonstrate the potential clinical value of the work.
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Mylonas, George P. "Gaze-Contingent Perceptual Docking for Minimally Invasive Robotic Surgery." Thesis, Imperial College London, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.511834.
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Madhani, Akhil J. (Akhil Jiten) 1968. "Design of teleoperated surgical instruments for minimally invasive surgery." Thesis, Massachusetts Institute of Technology, 1998. http://hdl.handle.net/1721.1/10097.
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Kwok, Ka Wai. "Dynamic active constraints for robot assisted minimally invasive surgery." Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/9489.
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In recent years, robot assisted Minimally Invasive Surgery (MIS) is playing an increasingly important role in surgery. Although the benefit of reduced patient trauma and hospitalisation with improved prognosis has been achieved through the enhanced dexterity and accuracy of instrument manipulation by the introduction of robotic assistance, the use of current master-slave platform has inevitably imposed the increased physical separation that deteriorates the hand-eye coordination due to a lack of haptic feedback. To this end, the concept of Virtual Fixtures (VFs) and Active Constraints has attracted significant research interests. It provides in situ effective guidance of access routes to the target anatomy safely. However, its clinical potential is only well established for procedures such as orthopaedic surgery, which are conducted under a static frame-of-reference due to the relatively rigid anatomy involved. The main focus of this thesis is concerned with modelling spatial constraints that are adaptive to tissue deformation. These constraints define safe manipulation margins for an entire robot rather than just its end-effector. An analytical framework is proposed to control an articulated flexible robotic device. Provided with these dynamic active constraints, the framework enables the operator to perform smooth articulation or steady navigation along curved anatomical pathways even under rapid tissue deformation. The challenges induced by hyper-kinematic redundancy of the robot and increased computational burden of real-time haptic rendering are addressed so that they facilitate seamless interaction with the robot by using lower degree-of-freedom (DoF) haptic interfacing device. Furthermore, the use of a gaze contingent paradigm is also investigated to enhance the human-robot interaction by linking the manipulation constraints with visual track. To demonstrate the practical nature of the proposed framework, detailed quantitative validations were conducted on groups of subjects. Future directions and potential improvements to the proposed techniques are finally outlined.
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Wood, Nathan A. "Organ-Mounted Robots for Minimally Invasive Beating-Heart Surgery." Research Showcase @ CMU, 2015. http://repository.cmu.edu/dissertations/612.
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In the push to improve patient outcomes in cardiac interventions, minimally invasive beating-heart surgery is a major field of surgical research. However, interventions on a soft tissue organ under continuous motion through remote incisions pose a significant challenge. Endoscopic approaches eliminate the associated morbidity of median sternotomy, but they require either mechanical immobilization of the heart or robotic motion compensation of the tools, both of which have serious drawbacks. While mechanical immobilization may cause electrophysiological and hemodynamic changes in the performance of the heart, active compensation requires high-bandwidth manipulators to track the complex motion of the heart. In this thesis, we address the issue of physiological motion during minimally invasive beating-heart surgery through the use of organ-mounted robots. These devices eschew the high dexterity and actuation effort required of traditional surgical robots in favor of miniature robots that adhere directly to the operating site using vacuum pressure. Unlike mechanical stabilizers these devices are not fixed in the world frame and therefore do not immobilize the heart but instead move in unison with the heart providing a stable platform from which interventions may be administered. This thesis is built around two main contributions to the state of the art in robotic MIS. The first major contribution of this work is the development of spatiotemporal registration methods to improve positioning accuracy under virtual image guidance for organ-mounted robots. These efforts rely on frequencybased models, which capture the periodic motion of the heart, and anatomical models constructed from preoperative imaging. Using these models we estimate when in the physiological cycles the images were captured and the pose of the robot at that time to spatially align the models. Finally, we introduce a method for localizing these robots on the beating heart using function approximation that provides more accurate estimates over short time horizons. The second major contribution is the design and construction of new robots that provide a wider array of interventions using the organ-mounted paradigm. These efforts use emerging therapies as motivation for the design of an active cooling system for minimally invasive delivery of thermosensitive materials and a new parallel wire robot, known as Cerberus, for therapies that require coverage over large areas of the surface of the heart. Both of these new capabilities are demonstrated successfully in closed-chest beating-heart procedures. Overall, our contributions take a holistic approach to the advancement of the capabilities of organ-mounted robots. New form-factors provide specialized capabilities, while new approaches to registration improve our ability to accurately position these robots on the beating heart. Most importantly, everything presented in this thesis is demonstrated in closed-chest beating-heart procedures, or on data recorded in such a procedure.
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Sluis-Cremer, Timothy Richard. "Minimally invasive CT-guiding excision of benign bone tumours." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29681.
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Background: The management of osteoid osteoma (OO) and other small primary benign lesions of bone has evolved over the past 50 years from open surgery with wide resection margins to less invasive surgical techniques such as image guided intralesional excision and percutaneous radiofrequency ablation. We aim to evaluate the outcomes of patients treated with computerised tomography (CT guided) intralesional excision and bone grafting of small benign lesions of bone. Method: A retrospective folder review of patients treated in a large academic hospital in Cape Town, South Africa, between March 2012 and May 2016 was performed. Patient demographics, details of presentation, clinical information and outcome following treatment were analysed descriptively. Pre-operative diagnosis based on radiological examination was compared with histological diagnosis. Result: Eleven patients (5 male) with a median age of 16 years (range 5-33) were included. Pain was the most common presenting feature. A histological diagnosis of OO was confirmed in 5 of 9 patients with a suspected diagnosis of OO preoperatively. Of the 4 patients whose diagnosis changed after the procedure the diagnoses included a benign spindle cell lesion, a benign fibrous histiocytoma, subacute osteitis and an osteochondral defect with geode cyst formation. Of the 2 patients where OO was not suspected preoperatively, chondroblastoma was confirmed in one while a benign spindle cell lesion was reported in the other. Overall histological yield was thus 100%. There were no complications or repeat procedures at a median follow up of 42 months (range 30-52 months). Conclusion: CT guided intralesional curettage is a safe and minimally invasive technique. This is especially useful in less accessible regions of the skeleton as it provides a means of accurately locating the lesion with minimal risk of complications and morbidity to the patient. We consider this to be the optimal method of treatment in our setting as it provides high success rates, few complications and a histological diagnosis without the need for any additional and expensive equipment.
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Christiane, Peter-John. "Development of a minimally invasive robotic surgical manipulator /." Link to the online version, 2008. http://hdl.handle.net/10019/2249.
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Samper, Victor D. "An electromechanical microactuator for minimally invasive medical applications." Thesis, Heriot-Watt University, 1996. http://hdl.handle.net/10399/693.
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Salleh, Rosli. "Minimally invasive surgery training and tele-surgery system using VR and haptic techniques." Thesis, University of Salford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365996.
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Christiane, Peter-John. "Development of a minimally invasive robotic surgical manipulator." Thesis, Stellenbosch : Stellenbosch University, 2009. http://hdl.handle.net/10019.1/4497.
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Thesis (MScEng)--Stellenbosch University, 2009.ENGLISH ABSTRACT: Minimal invasive surgery (MIS) enables surgeons to operate through a few small incisions made in the patient’s body. Through these incisions, long rigid instruments are inserted into the body and manipulated to perform the necessary surgical tasks. Conventional instruments, however, are constrained by having only five degrees of freedom (DOF), as well as having scaled and mirrored movements, thereby limiting the surgeon’s dexterity. Surgeons are also deprived of depth perception and hand-eye coordination due to only having two-dimensional visual feedback. Surgical robotics attempt to alleviate these drawbacks by increasing dexterity, eliminating the fulcrum effect and providing the surgeon with three-dimensional visualisation. This reduces the risks to the patient as well as to the surgeon. However, existing MIS systems are extremely expensive and bulky in operating rooms, preventing their more widespread adoption. In this thesis, a new, inexpensive seven-DOF primary slave manipulator (PSM) is presented. The four-DOF wrist is actuated through a tendon mechanism driven by five 12 VDC motors. A repeatability study on the wrist’s joint position was done and showed a standard deviation of 0.38 degrees. A strength test was also done and demonstrated that the manipulator is able to resist a 10 N opposing tip force and is capable of a theoretical gripping force of 15 N.
AFRIKAANSE OPSOMMING: Minimale indringende chirurgie (MIC) maak dit vir chirurge moontlik om operasies uit te voer deur ’n paar klein insnydings wat op die pasiënt se liggaam gemaak word. Deur hierdie insnydings word lang onbuigsame instrumente in die liggaam ingesit en gemanipuleer om die nodige chirurgiese take uit te voer. Konvensionele instrumente is egter beperk vanweë die feit dat hulle net vyf vryheidsgrade het, asook afgeskaalde bewegings en spieëlbewegings, en gevolglik die chirurg se handvaardigheid beperk. Chirurge word ook ontneem van dieptewaarneming en hand-oog-koördinasie, want hulle is beperk tot tweedimensionele visuele terugvoer. Chirurgiese robotika poog om hierdie nadele aan te spreek deur handvaardigheid te vermeerder, die hefboomeffek uit te skakel en die chirurg driedimensionele visualisering te bied. Dit verminder die risiko’s vir die pasiënt én vir die chirurg. Bestaande MIC-stelsels is egter uiters duur en neem baie plek op in teaters, wat verhoed dat hulle op ’n groter skaal gebruik word. In hierdie tesis word ’n nuwe, goedkoop sewevryheidsgrade- primêre slaafmanipuleerder (PSM) voorgelê. Die viervryheidsgrade-pols word beweeg deur ’n tendonmeganisme wat aangedryf word deur vyf 12 VDC-motors. ’n Herhaalbaarheidstudie is op die pols se gewrigsposisie gedoen, wat ’n standaardafwyking van 0.38 grade aangetoon het. ’n Sterktetoets is ook gedoen en het gewys dat die manipuleerder in staat is om ’n 10 N-teenkantelkrag te weerstaan en dat dit oor ’n teoretiese greepsterkte van 15 N beskik.
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Feng, Chuan. "A Situational Awareness Enhancing System for Minimally Invasive Surgery Training." Diss., The University of Arizona, 2007. http://hdl.handle.net/10150/195776.
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Minimally Invasive Surgery (MIS) is a surgical technique involving small incisions performed by an endoscope and several long, thin instruments. Because of its minimally invasive nature, MIS minimizes complications and speeds up recovery time compared to the traditional surgery. Unfortunately, from a surgeon's perspective, MIS is much more challenging than conventional surgery. Because the limited vision and sensing feedbacks, MIS a difficult skill for medical students and residents to master.There has been some research on the effectiveness of different kinds of training and guidance. Surgical simulation is increasingly perceived as a valuable addition to traditional medical training methods, although most existing simulators have limitations stemming from either a lack of objective performance assessment or an insufficient relation to the operating room reality.The objective of this research is to design and realize a novel prototype that advances the state of the art in surgical training, assessment, and guidance for MIS. The prototype features micro-sensors embedded into the instruments employed for simulation training. The system provides multiple training scenarios, a high fidelity training environment, repeatable, structured exercises, and objective performance assessment capabilities.The proposed Situational Awareness Enhancing System (SAES) uses a unified framework incorporating perception, comprehension, and projection software modules that provide feedback during the exercises and enable evaluation of the training procedure.A multiple sensor data fusion method was developed to help surgeons efficiently acquire information in real time. The output, "Hybridview", is produced by fusing the information from digital camera and magnetic position sensors, and shows an overlay of the positions of organs and objects with the trajectory of instruments. An intelligent inference engine was designed to formulate an objective standard based on the expertise of senior surgeons and to provide an accurate scoring method. A multi-level fuzzy inference engine and new performance metrics were implemented.To demonstrate the feasibility of the proposed training system, numerous experiments were conducted. The results show that the situational awareness training system for MIS is useful and efficient.
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Noonan, David. "A flexible access platform for robot-assisted minimally invasive surgery." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/9113.
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Advances in Minimally Invasive Surgery (MIS) are driven by the clinical demand to reduce the invasiveness of surgical procedures so patients undergo less trauma and experience faster recoveries. These well documented benefits of MIS have been achieved through parallel advances in the technology and instrumentation used during procedures. The new and evolving field of Flexible Access Surgery (FAS), where surgeons access the operative site through a single incision or a natural orifice incision, is being promoted as the next potential step in the evolution of surgery. In order to achieve similar levels of success and adoption as MIS, technology again has its role to play in developing new instruments to solve the unmet clinical challenges of FAS. As procedures become less invasive, these instruments should not just address the challenges presented by the complex access routes of FAS, but should also build on the recent advances in pre- and intraoperative imaging techniques to provide surgeons with new diagnostic and interventional decision making capabilities. The main focus of this thesis is the development and applications of a flexible robotic device that is capable of providing controlled flexibility along curved pathways inside the body. The principal component of the device is its modular mechatronic joint design which utilises an embedded micromotor-tendon actuation scheme to provide independently addressable degrees of freedom and three internal working channels. Connecting multiple modules together allows a seven degree-of-freedom (DoF) flexible access platform to be constructed. The platform is intended for use as a research test-bed to explore engineering and surgical challenges of FAS. Navigation of the platform is realised using a handheld controller optimised for functionality and ergonomics, or in a "hands-free" manner via a gaze contingent control framework. Under this framework, the operator's gaze fixation point is used as feedback to close the servo control loop. The feasibility and potential of integrating multi-spectral imaging capabilities into flexible robotic devices is also demonstrated. A force adaptive servoing mechanism is developed to simplify the deployment, and improve the consistency of probe-based optical imaging techniques by automatically controlling the contact force between the probe tip and target tissue. The thesis concludes with the description of two FAS case studies performed with the platform during in-vivo porcine experiments. These studies demonstrate the ability of the platform to perform large area explorations within the peritoneal cavity and to provide a stable base for the deployment of interventional instruments and imaging probes.
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Totz, Johannes. "Appearance modelling and reconstruction for navigation in minimally invasive surgery." Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/10531.
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Minimally invasive surgery is playing an increasingly important role for patient care. Whilst its direct patient benefit in terms of reduced trauma, improved recovery and shortened hospitalisation has been well established, there is a sustained need for improved training of the existing procedures and the development of new smart instruments to tackle the issue of visualisation, ergonomic control, haptic and tactile feedback. For endoscopic intervention, the small field of view in the presence of a complex anatomy can easily introduce disorientation to the operator as the tortuous access pathway is not always easy to predict and control with standard endoscopes. Effective training through simulation devices, based on either virtual reality or mixed-reality simulators, can help to improve the spatial awareness, consistency and safety of these procedures. This thesis examines the use of endoscopic videos for both simulation and navigation purposes. More specifically, it addresses the challenging problem of how to build high-fidelity subject-specific simulation environments for improved training and skills assessment. Issues related to mesh parameterisation and texture blending are investigated. With the maturity of computer vision in terms of both 3D shape reconstruction and localisation and mapping, vision-based techniques have enjoyed significant interest in recent years for surgical navigation. The thesis also tackles the problem of how to use vision-based techniques for providing a detailed 3D map and dynamically expanded field of view to improve spatial awareness and avoid operator disorientation. The key advantage of this approach is that it does not require additional hardware, and thus introduces minimal interference to the existing surgical workflow. The derived 3D map can be effectively integrated with pre-operative data, allowing both global and local 3D navigation by taking into account tissue structural and appearance changes. Both simulation and laboratory-based experiments are conducted throughout this research to assess the practical value of the method proposed.
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Lin, Bingxiong. "Visual SLAM and Surface Reconstruction for Abdominal Minimally Invasive Surgery." Scholar Commons, 2015. http://scholarcommons.usf.edu/etd/5849.
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Depth information of tissue surfaces and laparoscope poses are crucial for accurate surgical guidance and navigation in Computer Assisted Surgeries (CAS). Intra-operative Three Dimensional (3D) reconstruction and laparoscope localization are therefore two fundamental tasks in CAS. This dissertation focuses on the abdominal Minimally Invasive Surgeries (MIS) and presents laparoscopic-video-based methods for these two tasks.
Different kinds of methods have been presented to recover 3D surface structures of surgical scenes in MIS. Those methods are mainly based on laser, structured light, time-of-flight cameras, and video cameras. Among them, laparoscopic-video-based surface reconstruction techniques have many significant advantages. Specifically, they are non-invasive, provide intra-operative information, and do not introduce extra-hardware to the current surgical platform. On the other side, laparoscopic-video-based 3D reconstruction and laparoscope localization are challenging tasks due to the specialties of the abdominal imaging environment. The well-known difficulties include: low texture, homogeneous areas, tissue deformations, and so on. The goal of this dissertation is to design novel 3D reconstruction and laparoscope localization methods and overcome those challenges from the abdominal imaging environment.
Two novel methods are proposed to achieve accurate 3D reconstruction for MIS. The first method is based on the detection of distinctive image features, which is difficult in MIS images due to the low-texture and homogeneous tissue surfaces. To overcome this problem, this dissertation first introduces new types of image features for MIS images based on blood vessels on tissue surfaces and designs novel methods to efficiently detect them. After vessel features have been detected, novel methods are presented to match them in stereo images and 3D vessels can be recovered for each frame. Those 3D vessels from different views are integrated together to obtain a global 3D vessel network and Poisson reconstruction is applied to achieve large-area dense surface reconstruction.
The second method is texture-independent and does not rely on the detection of image features. Instead, it proposes to mount a single-point light source on the abdominal wall. Shadows are cast on tissue surfaces when surgical instruments are waving in front of the light. Shadow boundaries are detected and matched in stereo images to recover the depth information. The recovered 3D shadow curves are interpolated to achieve dense reconstruction of tissue surfaces.
One novel stereoscope localization method is designed specifically for the abdominal environment. The method relies on RANdom SAmple Consensus (RANSAC) to differentiate rigid points and deforming points. Since no assumption is made on the tissue deformations, the proposed methods is able to handle general tissue deformations and achieve accurate laparoscope localization results in the abdominal MIS environment.
With the stereoscope localization results and the large-area dense surface reconstruction, a new scene visualization system, periphery augmented system, is designed to augment the peripheral areas of the original video so that surgeons can have a larger field of view. A user-evaluation system is designed to compare the periphery augmented system with the original MIS video. 30 subjects including 4 surgeons specialized in abdominal MIS participate the evaluation and a numerical measure is defined to represent their understanding of surgical scenes. T-test is performed on the numerical errors and the null hypothesis that the periphery augmented system and the original video have the same mean of errors is rejected. In other words, the results validate that the periphery augmented system improves users' understanding and awareness of surgical scenes.
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Tholey, Gregory Desai Jaydev Prataprai. "A teleoperative haptic feedback framework for computer-aided minimally invasive surgery /." Philadelphia, Pa. : Drexel University, 2007. http://hdl.handle.net/1860/1314.
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Seehusen, Ashley Elizabeth. "Haptic information in minimally invasive surgery tools for use in simulation." Thesis, University of Bristol, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.247222.
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Gemmill, Elizabeth H. "Minimally invasive gastro-oesophageal surgery for cancer : current evidence and practice." Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/55424/.
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Background Since its introduction in the early 1990s, minimally invasive gastro-oesophageal surgery for cancer has been growing in popularity. Despite this, published evidence on this type of technique is weak and its role in the management of gastric and oesophageal cancer remains controversial. Aims The aim of this thesis was to test the hypothesis that: minimally invasive gastro- oesophageal cancer surgery has superior outcomes compared to control studies of conventional open surgery; but current studies are methodologically inadequate to confirm this. Methods The first study (chapter 3) is a systematic review of the literature on minimally invasive gastro-oesophageal cancer surgery, outlining the differences between literature published in Eastern and Western countries. The following 3 chapters outline and use a phase II surgical study to obtain data on minimally invasive gastro-oesophageal cancer (MIGOCS.) The MIGOCS group was set up in 2005 amongst UK surgeons. An online database was developed to enable data collection and comprises 5 sections: demographics; pre-operative staging and assessment; surgical intervention; post-operative course; pathology and clinical outcome. The first study is retrospective collecting data up to December 2006; the second study is prospective with data obtained between December 2006- July 2008 from centres around the UK utilising the MIGOCS database. Chapter 7 involves analysis of the learning curve in laparoscopic gastro-oesophageal cancer surgery using CUSUM (continuous surveillance monitoring) assessment. By studying operative time at each centre, improvement or deterioration in quality were detected. Results The systematic review of minimally invasive gastro-oesophageal surgery consists in the majority of case reports, with no randomised controlled trials of oesophagectomies and 4 (low quality) randomised controlled trials of gastrectomies. It demonstrates a mortality and morbidity of 2.3% and 46.2% respectively for oesophagectomies; 0.1% and 12.7% respectively for gastrectomies. Data from this review suggests that the minimally invasive approach is beneficial compared to open surgery in terms of reduced mortality, respiratory complications, blood loss and quicker return to a good quality of life (but not reduced hospital stay as expected.) There are currently 60 MIGOCS member consultant surgeons from over 40 UK centres. The retrospective study obtained data from 7 UK centres with an overall mortality and morbidity of 6.0% and 57% respectively for oesophagectomies and 7.7% and 13% respectively for gastrectomies. The prospective study collected data from 7 UK centres, comprising a total of 258 minimally invasive oesophagectomies and 33 minimally invasive gastrectomies. Overall mortality and morbidity were 2.5% and 56.6% respectively for oesophagectomies and 10.8% and 27.3% respectively for gastrectomies. CUSUM analysis varied considerably between centres. The two larger volume centres however demonstrated an improvement in their operative time with experience, with a possible pateau at around 30 procedures. Conclusions Published data suggests that the minimally invasive approach to gastro-oesophageal cancer has advantages over conventional open surgery. Data collected in this thesis does not overwhelmingly support published evidence, but does demonstrate that this technique is both safe and feasible even during the early part of a surgeon's learning curve. It is the first study to provide an insight into outcomes of this type of surgery in a multicentre setting in the UK; and has made progress towards a randomised controlled trial.
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Samant, Chinmay. "Ultrasound laparoscopic guidance for minimally invasive surgery, biopsy, and ablation procedures." Thesis, Strasbourg, 2019. http://www.theses.fr/2019STRAD054.
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La chirurgie laparoscopique minimalement invasive guidée par l'image permet la réduction de la durée des séjours à l'hôpital pour le patient, réduisant ainsi les traumatismes postopératoires et accélérant le temps de guérison. Avec les progrès récents des techniques d'imagerie, les chirurgiens peuvent planifier une chirurgie de manière efficace et en toute confiance en utilisant différentes modalités d'image telles que la tomodensitométrie / IRM, les images échographiques, etc. Les techniques de fusion d'images en temps réel permettent la superposition de différents types d'images pour fournir une vue complète au chirurgien. Un aspect important de la fusion en temps réel est que l'instrument laparoscopique est suivi en temps réel à l'aide de capteurs. Dans cette thèse, nous présentons une analyse détaillée de ces technologies de suivi tout en fournissant une nouvelle configuration de capteurs pour le suivi d'images par laparoscope à ultrasons. Nous présentons une chaîne cinématique pour la configuration des capteurs et nous fournissons une solution pour la réduction du bruit présent dans les données des capteurs en utilisant la technique de moyennage des rotations. Le Hand-Eye calibration (étalonnage main-œil) est également un élément fondamental des systèmes de suivi hybrides. Nous présentons une révision détaillée de cette technique. Nous présentons également une méthode déterministe, robuste et précise pour résoudre le problème d'étalonnage main-œil, même pour de grandes quantités de valeurs aberrantes et des niveaux élevés de bruit de mesure. La méthode proposée est basée sur une reformulation d'un problème de programmation semi-définie à contraintes de rang où la robustesse est renforcée via une approche d'optimisation pondérée de façon itérativeMinimally invasive image-guided laparoscopic surgery allows shorter hospital stays for the patient reducing post-operative trauma and faster healing time. With the recent advances in imaging techniques, surgeons can efficiently and confidently plan a surgery by using different image modalities such as CT/MRI scans, ultrasound images etc. Real-time image fusion techniques can overlay the images from different modalities together to provide a comprehensive view to the surgeon. An important aspect of real-time fusion is that the laparoscopic instrument is tracked in real-time using sensors. In this thesis, we present a detailed analysis of such tracking technologies while providing a novel sensor setup for ultrasound laparoscope image tracking. We present a kinematic chain for the sensor setup and provide a solution for noise reduction in the sensor data using rotation averaging technique. Hand-Eye calibration is also a fundamental part of hybrid tracking systems. We present a detailed review of this technique. We also present a deterministic, robust and accurate method for solving Hand-Eye calibration problem even for large amounts of outliers and high levels of measurement noise. The proposed method is based on a reformulation of a rank-constrained semi-definite programming problem allowing for robustness to be enforced via an iteratively re-weighted optimization approach
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Visentini, Scarzanella Marco. "3D reconstruction from stereo and photometric cues in minimally invasive surgery." Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/9583.
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During the last decade, an increasing number of advanced platforms for robotic assisted Minimally Invasive Surgery (MIS) have been translated from research concepts to practical systems used in routine clinical settings. Such systems have defined their own niche in the market place and are gaining increasing acceptance by the surgical community. More importantly, they improve surgeons' dexterity and intra-operative visualisation together with the benefits of improved procedural time, safety, consistency and patient outcome. Some of the new technical features integrated within current robotic systems include higher degrees of freedom for more agile manoeuvring, tremor filtering and haptic feedback. Where the next frontier lies in terms of novel means of surgical assistance is in navigation systems that would enable intra-operative surgical guidance, imposing dynamic active constraints and high fidelity augmented reality environments. At the foundation of all navigation systems lies an accurate 3D reconstruction algorithm. To overcome the current limitations of feature-based matching and reconstruction systems, this thesis investigates a method to integrate depth information from conventional stereo 3D reconstruction with photometric cues from Shape-from-Shading techniques. This is further enhanced with a gaze-contingent framework suitable for intra-operative navigation during MIS. The resulting system is suitable for applications with existing MIS platforms without the need of additional hardware, ensuring increased accuracy in areas without salient anatomical landmarks or artificially introduced fiducials. Furthermore, a multi-scale feature detector is proposed for intra-operative stereo telestration required for telementoring and remote collaboration of robotic assisted MIS. An improved formulation of the current state-of-the-art in Shape-from-Shading is integrated with intra-operative scenes for accurate metric depth recovery. The potential clinical application of the technique is demonstrated for autonomous navigation of wireless capsule endoscopes. Future research directions and preliminary results of integrating photometric stereo constraints for reliable reconstruction of featureless, non- Lambertian deforming tissue surfaces are provided and all methods proposed have been validated with either in vivo or phantom experiments to justify their potential clinical values in MIS.
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Takashima, Kazuto. "Development of tactile sensor and surgical simulator for minimally invasive surgery." 京都大学 (Kyoto University), 2006. http://hdl.handle.net/2433/143969.
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Cristancho, Sayra Magnolia. "Quantitative modelling and assessment of surgical motor actions in minimally invasive surgery." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/2835.
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The goal of this research was to establish a methodology for quantifying performance of
surgeons and distinguishing skill levels during live surgeries. We integrated three
physical measures (kinematics, time and movement transitions) into a modeling
technique for quantifying performance of surgical trainees. We first defined a new
hierarchical representation called Motor and Cognitive Modeling Diagram for
laparoscopic procedures, which: (1) decomposes ‘tasks’ into ‘subtasks’ and at the very detailed level into individual movements ‘actions’; and (2) includes an explicit cognitive/motor diagrammatic representation that enables to take account of the operative variability as most intraoperative assessments are conducted at the ‘whole procedure’ level and do not distinguish between performance of trivial and complicated aspects of the procedure. Then, at each level of surgical complexity, we implemented specific mathematical techniques for providing a quantitative sense of how far a performance is located from a reference level:
(1) The Kolgomorov-Smirnov statistic to describe the similarity between two
empirical cumulative distribution functions (e.g., speed profiles)
(2) The symmetric normalized Jensen-Shannon Divergence to compare transition
probability matrices
(3) The Principal Component Analysis to identify the directions of greatest variability in a multidimensional space and to reduce the dimensionality of the data using a weight space.
Two experimental studies were completed in order to show feasibility of our proposed
assessment methodology by monitoring movements of surgical tools while: (1) dissecting mandarin oranges, and (2) performing laparoscopic cholecystectomy procedures at the operating room to compare residents and expert surgeons when executing two surgical tasks: exposing Calot’s Triangle and dissecting the cystic duct and artery.
Results demonstrated the ability of our methodology to represent selected tasks using the Motor and Cognitive Modeling Diagram and to differentiate skill levels. We aim to use our approach in future studies to establish correspondences between specific surgical tasks and the corresponding simulations of these tasks, which may ultimately enable us to do validated assessments in a simulated setting, and to test its reliability in differentiating skill levels at the operating room as the number of subjects and procedures increase.
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Ray, Jerry DeWane. "Design of an articulated manipulator for enhanced dexterity in minimally invasive surgery /." Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 1996. http://handle.dtic.mil/100.2/ADA322192.
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Thesis (M.S. in Mechanical Engineering) Naval Postgraduate School, September 1996.Thesis advisor(s): Ranjan Mukherjee. "September 1996." Includes bibliographical references (p. 51). Also available online.
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Ray, Jerry DeWane II. "Design of an articulated manipulator for enhanced dexterity in minimally invasive surgery." Thesis, Monterey, California. Naval Postgraduate School, 1996. http://hdl.handle.net/10945/8230.
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Approved for public release; distribution is unlimited.A current limitation in minimally invasive surgical (MIS) procedures is the lack of an articulated mechanism which will provide dexterity inside the torso while supporting a surgical tool. The tool could be a pair of scissors or an optical device such as a camera, or both. To overcome this limitation we have designed an Articulated Manipulator for Minimally Invasive Surgery (AMMIS). The AMMIS is expected to provide surgeons with improved dexterity during MIS procedures and be ideally suited for tele-surgery. This design may also be used in non-medical applications such as aviation maintenance, and engine inspection.
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Guiatni, Mohamed Kheddar Abderrahmane. "Design and control of a haptic device for minimally invasive surgery simulation." S. l. : S. n, 2009. http://www.biblio.univ-evry.fr/theses/2009/2009EVRY0008.pdf.
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Guiatni, Mohamed. "Design and control of a haptic device for minimally invasive surgery simulation." Thesis, Evry-Val d'Essonne, 2009. http://www.theses.fr/2009EVRY0008/document.
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L'objectif principal de cette thèse est de développer une nouvelle interface pour la simulation des procédures de chirurgie mini-invasive. L'interface développée introduit les modalités visuelle, haptique et thermique pour les futures générations de simulateurs et de robots chirurgicaux. La particularité de cette recherche réside dans l'utilisation de la stimulation thermique dans une perspective d'application pour la chirurgie. Dans ce cadre, plusieurs modèles de transfert de chaleur ont été développés, implémentés et évalués pour des applications de téléprésence et de réalité virtuelle. Des sensations intéressantes ont été enregistrées, ce qui a une conséquence directe sur la capacité de distinguer entre des objets dans l'environnement et particulièrement dans le domaine médical où la sensation thermique est en corrélation avec la présence d'anomalies dans certaines maladies. Un nouveau dispositif haptique est conçu et réalisé en analysant les tâches chirurgicales en termes de dextérité, d'espace de travail, de force et de couple exigés. Nous avons tenu compte des exigences générales de conception mécaniques des interfaces haptiques à partir de ce qui a été établi dans la littérature de l'haptique. Le dispositif complet a été interfacé avec un logiciel de simulation en réalité virtuelle (SOFA). Nous avons intégré dans SOFA le module nécessaire pour la simulation thermique. L'intégration était réussie et un scénario de simulation réaliste avec le retour d'information visuel que thermique a été réalisé. Des résultats préliminaires utilisant la simulation complète sont présentésThe main objective of this thesis focuses on the construction of a new interface for Minimally Invasive Surgery training. This interface incorporates novel broad band sensory modalities that include visual, haptic and thermal technology, into the evolution of the next generation of surgical robotic and surgical simulator. Our particular novelty in this research is in using of thermal stimulation in a MIS applied perspectives. Several thermal exchange models have been designed, implemented and evaluated for telepresence and virtual reality applications. Interesting sensations have been recorded which have a direct bearing on the ability to distinguish between objects in the surrounding environment and particularly in the medical field where temperature sensing correlates with anomalies in some know diseases. A new haptic device is designed and realized by analyzing surgical tasks in terms of required dexterity, workspace, force and torque. The mechanical design constraints have been considered with respect to the general requirements for haptic interface design from what has been well established in the haptics literature. The overall device has been interfaced with an open source VR simulator (SOFA). We added in SOFA the necessary software dealing with thermal simulation using built-in data structure and methods. The integration was successful and a realistic simulation scenario with both visual and thermal feedback was achieved. Preliminary results using the overall simulation are presented
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Barrett, Adrian. "Computer assisted image-based training and monitoring systems for minimally invasive surgery." Thesis, Imperial College London, 2003. http://hdl.handle.net/10044/1/11833.
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Chen, Kehui. "Powering of endoscopic cutting tools for minimally invasive procedures." Digital WPI, 2013. https://digitalcommons.wpi.edu/etd-theses/887.
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" Sample cutting is an important minimally invasive medical procedure. Currently there are several types of medical devices used to cut a distal biological sample, for example, a video endoscope and TurboHawk Plaque Excision Systems. Directional Atherectomy (DA) with the TurboHawk Plaque Excision Systems is a catheter-based, minimally invasive treatment method for peripheral arterial disease (PAD). During a procedure, a catheter is directed toward an area of plaque buildup to remove the plaque from the body, restoring blood flow (Covidien, 2013). Endoscopy is an important procedure used in the medical field to study and diagnose different parts of a body without the need to undergo a major surgery. The major devices are a video endoscope with a flexible or rigid insertion tube and endoscopic therapy devices. Arrays of the devices, through the instrument channel in the insertion tube of endoscopes, to perform a variety of functions are offered. The biological sample cut is one of the important endoscopic therapies. Both of Directional Atherectomy and endoscopy procedures require a power transmission from the proximal tip of device to the distal end, where the cutter is located, for cutting a sample. However, the working length is up to meters, and the diameter of the devices is in millimeter scale in the minimally invasive surgery. Thus enough power transmitting to the distal end of the device for the biological sample cutting is crucial. This research presents the effort toward the investigation of the potential power mechanisms from the proximal tip to the cutter at the distal end of the device for rapid rotational cutting motion to improve the cutting efficiency and accuracy. In this thesis, the potential powering mechanisms including fluid, electrical, and torque coils are investigated. Since the transmission power is used for a rotational cutting action, and the cutting geometry has influence on the cutting power, thus this research also focuses on the analysis of the cutting geometry for the rotational sample cutting. The Hertz contact theory and von Mises yield criterion are used to find the influence of tool geometry on the material removing process, as well as Abaqus, a commercial FEM software, is used for the finite element analysis. Fiber-reinforced composite structures are the main characteristic of the representative biological sample, and their mechanical behavior is strongly influenced by the concentration and structural arrangement of constitute such as collagen and elastin. Researches show that the biological sample, for example, a soft biological sample, has hyperelastic properties and behave anisotropically, and there are a few publications about the plastic properties and cutting mechanics. Thus a linear elastic and linear plastic material model is defined for the finite element analysis of material removal. The analytical results and finite element results both show that as the tool rake angle increases or the tool angle decreases, the magnitude of cutting force decreases. A preliminary representative sample cutting experiment was conducted, and standard cutters with different cutting geometries were tested in order to find the characteristic of the biological sample cutting and the influence of tool geometry on the required cutting power. The experiments reveal the same conclusions as the analytical and finite element results. "
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Chun, Mei-yee Elke. "Comparing Hong Kong market experience with the market development in China in minimally invasive surgery /." Hong Kong : University of Hong Kong, 1998. http://sunzi.lib.hku.hk/hkuto/record.jsp?B19876671.
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Tanner, Jordan D. "Design and Analysis of Robotically-Controlled Minimally Invasive Surgical Instruments." BYU ScholarsArchive, 2014. https://scholarsarchive.byu.edu/etd/6249.
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Robot-assisted minimally invasive surgery is used to perform intricate surgical tasks through small incisions using long, slender instruments. The miniaturization of these instruments is advantageous to both surgeon and patient because smaller instruments reduce trauma to surrounding tissue, decrease patient recovery times, and can be used in confined spaces otherwise inaccessible using larger instruments. However, miniaturization of existing designs is limited by friction between moving parts, the volume occupied by the end effector, and manufacturing and assembly constraints. The objective of this work is to develop and analyze concepts that can be used in robot-assisted needlescopic surgery. The concepts are intended for instrument shafts no larger than 3 mm in diameter. An ideal concept is one with large ranges of wrist and gripping motion. Concepts should also minimize friction and swept volume while maintaining a focus on manufacturability and ease of assembly. Multiple concepts were generated and evaluated using a tree classification scheme, proof-of-concept prototypes, and simplified mathematical models. Three unique concepts were further developed and tested—the Split CORE Grips, the Inverted Flexure Grips, and the Crossed Cylinders Wrist. The two grip concepts are instruments that incorporate one rotational degree of freedom and one gripping degree of freedom. The wrist concept incorporates two rotational degrees of freedom and could be coupled with a single DOF grip mechanism to form a functional instrument. In addition to concept development, a variety of fabrication techniques were investigated to better understand the challenges that arise when designing and fabricating devices at the 3 mm scale. To augment existing techniques, a novel fabrication technique was developed which uses layers of lithographically patterned carbon nanotube (CNT) composite material to form a 3D part. This method was used to prototype some of the designs at a 1:1 size scale.
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Parekh, Jugal. "Minimally invasive approach for surgical treatment of proximal femur fractures." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3100/.
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Minimally invasive surgery (MIS) is fast becoming a preferred choice for patients and surgeons, due to its biological, aesthetic and commercial benefits. The dynamic hip screw (DHS) is the standard implant for the treatment of fractures of the proximal femur, which is considered to be the most frequent injury in the elderly. The aim of this research was to develop MIS for the treatment of these fractures utilising the principle and surgical technique of the DHS implant. During the research, a thorough medical device design process was conducted to develop three new medical devices 13 a new angle guide, a new ergonomic T-handle and a new implant. The design process for each of the new medical devices conformed to requirements of the relevant standards. The designs of the new medical devices were verified using methods such as risk analysis, finite element analysis and mechanical testing of manufactured prototype. Finally, an operative technique applying a minimally invasive approach with the new medical devices was developed to treat the fractures of the proximal femur.
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Mills, Benjamin Colin. "Regional Cerebral Oxygen Desaturations in Coronary Artery Bypass Surgery: A Minimally Invasive Approach." Thesis, The University of Arizona, 2013. http://hdl.handle.net/10150/293646.
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Cerebral oximetry has been shown to effectively identify declining regional cerebral oxygen saturations (rSO2) in coronary artery bypass graft (CABG) surgery. Prolonged intraoperative cerebral desaturations have been significantly associated with an increased risk of cognitive decline after CABG surgery. We compared conventional CABG to minimally invasive robotic coronary artery bypass surgery (r-CABG) using cerebral oximetry to determine the beneficial effects of the less invasive procedure. A retrospective study of 32 isolated CABG patients were treated for coronary artery disease (CAD) via conventional CABG (n=20) or r-CABG (n=12) with analysis of cerebral oximetry tracings and intraoperative data. Parameters, such as, blood loss, mean arterial pressure (MAP), partial pressure of carbon dioxide (PaCO2), cardiopulmonary bypass (CPB), and diabetes mellitus (DM) were analyzed against the area under the curve (AUC) from the cerebral oximetry tracing, an indicator of rSO2 desaturations. Many of these parameters showed statistical significance (p<0.05) between conventional CABG and r-CABG including a decreased mean AUC in the latter. In conclusion, minimally invasive r-CABG tends to show beneficial effects for patients by reducing the total mean AUC in comparison to conventional CABG, especially in the DM patient.
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Shahin, Osama [Verfasser]. "Minimally invasive navigated liver intervention : ultrasound-guided surgery and ablation validation / Osama Shahin." Lübeck : Zentrale Hochschulbibliothek Lübeck, 2014. http://d-nb.info/105431490X/34.
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