Robotic colorectal surgery training: Portsmouth perspective.

This study aims to discuss the principles and pillars of robotic colorectal surgery training and share the training pathway at Portsmouth Hospitals University NHS Trust. A narrative review is presented to discuss all the relevant and critical steps in robotic surgical training. Robotic training requires a stepwise approach, including theoretical knowledge, case observation, simulation, dry lab, wet lab, tutored programs, proctoring (in person or telementoring), procedure-specific training, and follow-up. Portsmouth Colorectal has an established robotic training model with a safe stepwise approach that has been demonstrated through perioperative and oncological results. Robotic surgery training should enable a trainee to use the robotic platform safely and effectively, minimize errors, and enhance performance with improved outcomes. Portsmouth Colorectal has provided such a stepwise training program since 2015 and continues to promote and augment safe robotic training in its field. Safe and efficient training programs are essential to upholding the optimal standard of care.

Emerging Technologies in Hand Orthopedic Surgery: Current Trends and Future Directions.

Emerging technologies are changing hand surgery by improving surgical precision, minimizing tissue disruption, and expediting patient recovery. These advancements have the potential to revolutionize surgical procedures, patient outcomes, and rehabilitation processes. However, there are still challenges that need to be addressed before these technologies can be widely adopted. These challenges include the learning curve for surgeons, high costs, and ethical considerations. Future research should focus on addressing the limitations of these technologies, exploring their long-term effects, and evaluating their cost-effectiveness. To successfully implement them, a collaborative approach involving clinicians, researchers, engineers, and policymakers is necessary. This review provides an overview of current and future trends in emerging technologies for hand orthopedic surgery.

Brain-inspired biomimetic robot control: a review.

Complex robotic systems, such as humanoid robot hands, soft robots, and walking robots, pose a challenging control problem due to their high dimensionality and heavy non-linearities. Conventional model-based feedback controllers demonstrate robustness and stability but struggle to cope with the escalating system design and tuning complexity accompanying larger dimensions. In contrast, data-driven methods such as artificial neural networks excel at representing high-dimensional data but lack robustness, generalization, and real-time adaptiveness. In response to these challenges, researchers are directing their focus to biological paradigms, drawing inspiration from the remarkable control capabilities inherent in the human body. This has motivated the exploration of new control methods aimed at closely emulating the motor functions of the brain given the current insights in neuroscience. Recent investigation into these Brain-Inspired control techniques have yielded promising results, notably in tasks involving trajectory tracking and robot locomotion. This paper presents a comprehensive review of the foremost trends in biomimetic brain-inspired control methods to tackle the intricacies associated with controlling complex robotic systems.

Disability 4.0: bioethical considerations on the use of embodied artificial intelligence.

Robotics and artificial intelligence have marked the beginning of a new era in the care and integration of people with disabilities, helping to promote their independence, autonomy and social participation. In this area, bioethical reflection assumes a key role at anthropological, ethical, legal and socio-political levels. However, there is currently a substantial diversity of opinions and ethical arguments, as well as a lack of consensus on the use of assistive robots, while the focus remains predominantly on the usability of products. The article presents a bioethical analysis that highlights the risk arising from using embodied artificial intelligence according to a functionalist model. Failure to recognize disability as the result of a complex interplay between health, personal and situational factors could result in potential damage to the intrinsic dignity of the person and human relations with healthcare workers. Furthermore, the danger of discrimination in accessing these new technologies is highlighted, emphasizing the need for an ethical approach that considers the social and moral implications of implementing embodied AI in the field of rehabilitation.

Socially assistive walker for daily living assistance in older adults.

Introduction: This paper addresses the growing healthcare needs of an ageing population and the lack of advanced technologies with social capabilities that are cost effective, user friendly, and readily adopted. In response to this motivation, a socially assistive walker is designed to provide physical and cognitive support in activities of daily living for older adults. Methods: Physical and cognitive support is provided by walker's structure, sensors, and feedback interfaces to assist users daily living activities, as well as, in navigating environment safely and efficiently. The walker's design arises from semi-structured interviews conducted with ageing experts, leading to the development of two levels or modes of social interaction, namely low and high interaction. Results and discussion: In a cohort of 14 adults, the study found the device easy to use regardless of the interaction mode, with 78.5% expressing a preference for the version featuring embodiment, verbal feedback, and more proactive cues (p < 0.05). The results also prompted ideas and suggestions for new designs based on insights gleaned from the user. This research contributes to the field of socially assistive robotics by offering an example of a user centred approach to address the healthcare challenges an ageing population poses.

Social Assistive Robotics: An Ethical and Political Inquiry Through the Lens of Freedom.

The development of social assistive robots for supporting healthcare provision faces a lack of an ethical approach that adequately addresses the normatively relevant challenges regarding its deployment. Current ethical reflection is primarily informed by an individual-centered perspective focused on robots' implications for their end-users and thereby limited to the dyadic human-robot interaction sphere. Considering that this is tightly correlated to the restricted understanding of core ethical concepts upon which reflection stands, this paper delves into the concept of freedom from a philosophical perspective to unfold its full normative breadth for a critical assessment of technological development. By bringing to the fore the political-structural dimension of freedom and, in turn, elaborating the political dimension of technology, the undertaken philosophical approach discloses freedom as a transversal ethical concept for a normative reflection on technology. Thereby, it broadens the scope of ethical attention beyond the sphere of human-robot interaction and turns attention to the so far overlooked structural dimension of human-robot relations. Drawing on conceptions of freedom as non-domination, among others, the paper approaches social assistive robotics and reexamines the terrain of relevant issues for its development. Since freedom is one major issue upon which current concerns revolve, the undertaken analysis substantially enriches the ongoing ethical discussion on social assistive robotics' implications for human freedom. In this way, this work contributes to going beyond the current individual-centered ethical perspective by laying conceptual grounds for a comprehensive ethical approach to social assistive robotics' development.

Cutaneous Electrohydraulic (CUTE) Wearable Devices for Pleasant Broad-Bandwidth Haptic Cues.

By focusing on vibrations, current wearable haptic devices underutilize the skin's perceptual capabilities. Devices that provide richer haptic stimuli, including contact feedback and/or variable pressure, are typically heavy and bulky due to the underlying actuator technology and the low sensitivity of hairy skin, which covers most of the body. This article presents a system architecture for compact wearable devices that deliver salient and pleasant broad-bandwidth haptic cues: Cutaneous Electrohydraulic (CUTE) devices combine a custom materials design for soft haptic electrohydraulic actuators that feature high stroke, high force, and electrical safety with a comfortable mounting strategy that places the actuator in a non-contact resting position. A prototypical wrist-wearable CUTE device produces rich tactile sensations by making and breaking contact with the skin (2.44 mm actuation stroke), applying high controllable forces (exceeding 2.3 N), and delivering vibrations at a wide range of amplitudes and frequencies (0-200 Hz). A perceptual study with 14 participants achieves 97.9% recognition accuracy across six diverse cues and verifies their pleasant and expressive feel. This system architecture for wearable devices gives unprecedented control over the haptic cues delivered to the skin, providing an elegant and discreet way to activate the user's sense of touch.

Remote Control: Electrochemically Driving EGaIn@Fe Liquid Metal for Application of Soft Robotics.

This study introduces magnetized EGaIn@Fe, an innovative material synthesized by incorporating iron powder into the eutectic gallium-indium alloy (EGaIn). Unlike traditional methods requiring electrolyte environments for electrical control, EGaIn@Fe can be manipulated using external magnetic fields, expanding control from 2D to 3D spaces. The material exhibits both active and passive splitting capabilities under magnetic and electrical control, demonstrating exceptional deformability, precision, and flexibility. EGaIn@Fe shows significant promise in applications such as microfluidic channels, circuit repair, and soft robotics. Specifically, 5 wt.% EGaIn@Fe is optimal for microfluidic tasks and circuit repairs in confined spaces, while higher concentrations (10 and 15 wt.%) enhance 3D control and reduce material usage. Additionally, 20 wt.% EGaIn@Fe displays octopus-like movements for navigating impassable channels. EGaIn@Fe can enhance fluid manipulation in microfluidics, bridge gaps in circuit repairs, and enable flexible actuators in soft robotics, driving advancements in adaptive materials and technologies.

Soft ankle exoskeleton to counteract dropfoot and excessive inversion.

Introduction: Wearable exoskeletons are emerging technologies for providing movement assistance and rehabilitation for people with motor disorders. In this study, we focus on the specific gait pathology dropfoot, which is common after a stroke. Dropfoot makes it difficult to achieve foot clearance during swing and heel contact at early stance and often necessitates compensatory movements. Methods: We developed a soft ankle exoskeleton consisting of actuation and transmission systems to assist two degrees of freedom simultaneously: dorsiflexion and eversion, then performed several proof-of-concept experiments on non-disabled persons. The actuation system consists of two motors worn on a waist belt. The transmission system provides assistive force to the medial and lateral sides of the forefoot via Bowden cables. The coupling design enables variable assistance of dorsiflexion and inversion at the same time, and a force-free controller is proposed to compensate for device resistance. We first evaluated the performance of the exoskeleton in three seated movement tests: assisting dorsiflexion and eversion, controlling plantarflexion, and compensating for device resistance, then during walking tests. In all proof-of-concept experiments, dropfoot tendency was simulated by fastening a weight to the shoe over the lateral forefoot. Results: In the first two seated tests, errors between the target and the achieved ankle joint angles in two planes were low; errors of <1.5° were achieved in assisting dorsiflexion and/or controlling plantarflexion and of <1.4° in assisting ankle eversion. The force-free controller in test three significantly compensated for the device resistance during ankle joint plantarflexion. In the gait tests, the exoskeleton was able to normalize ankle joint and foot segment kinematics, specifically foot inclination angle and ankle inversion angle at initial contact and ankle angle and clearance height during swing. Discussion: Our findings support the feasibility of the new ankle exoskeleton design in assisting two degrees of freedom at the ankle simultaneously and show its potential to assist people with dropfoot and excessive inversion.

Hardness changing tactile displays for simulating the feel of organic tissues.

Physical interaction with patients, for example conducted as part of a diagnostic examination or surgical procedure, provides clinicians with a wealth of information about their condition. Simulating this interaction is of great interest to researchers in both haptics and medical education, and the development of softness changing tactile interfaces is important in recreating the feel of different soft tissues. This paper presents designs for a variety of novel electromechanical and electromagnetic mechanisms for controlling particle jamming-based, hardness changing tactile displays, intended to allow medical trainees to experience these physical interactions in a range of simulation settings such as clinical skills teaching laboratories. Each design is then subjected to a battery of mechanical tests to evaluate its effectiveness compared to the state of the art, as well as their suitability for simulating the physical hardness of different types of soft tissues, previously characterised in established literature. These results demonstrate that all of the technologies presented are able to exhibit a measurable hardness change, with Shore hardness values between 3A and 57A achieved by the most effective constriction-based device. The electromechanical devices based on constriction and compression, and the state-of-the-art pneumatic device, were able to achieve hardness changes within a range that is useful for replicating the softness of organic tissue. The electromechanical and electromagnetic devices were also found to effect their full range of hardness change in less than a second, compared to several seconds for the state-of-the-art. These results show that the performance of softness changing tactile displays can be improved with the electromechanical actuation techniques proposed in this paper, and that such displays are able to replicate the physical characteristics of soft tissues and may therefore be of benefit in medical training and simulation scenarios.

Overtrust in AI Recommendations About Whether or Not to Kill: Evidence from Two Human-Robot Interaction Studies.

This research explores prospective determinants of trust in the recommendations of artificial agents regarding decisions to kill, using a novel visual challenge paradigm simulating threat-identification (enemy combatants vs. civilians) under uncertainty. In Experiment 1, we compared trust in the advice of a physically embodied versus screen-mediated anthropomorphic robot, observing no effects of embodiment; in Experiment 2, we manipulated the relative anthropomorphism of virtual robots, observing modestly greater trust in the most anthropomorphic agent relative to the least. Across studies, when any version of the agent randomly disagreed, participants reversed their threat-identifications and decisions to kill in the majority of cases, substantially degrading their initial performance. Participants' subjective confidence in their decisions tracked whether the agent (dis)agreed, while both decision-reversals and confidence were moderated by appraisals of the agent's intelligence. The overall findings indicate a strong propensity to overtrust unreliable AI in life-or-death decisions made under uncertainty.

Evaluation of Two Clinical Stem Fit Philosophies within the Femoral Canal Using a Preoperative Planning Tool: Could a Hybrid Approach Be Best?

BACKGROUND: Total hip arthroplasty (THA) has transformed patient lives, yet evolving expectations and the number of postoperative foot angle changes have underscored the need for precise component positioning. The objective of this study was to use three-dimensional (3D) preoperative planning to evaluate stem alignment and orientation for three THA systems using two different stem fit algorithms. It was hypothesized that the different stem alignments would yield similar changes in stem orientation and placement within the canal for all three systems. METHOD: This study introduced a novel 3D preoperative planning tool, comparing two different surgical stem fit philosophies within the canal: "canal fit" (CF) and "anatomical fit" (AF). We virtually implanted ten subjects with three different THA implant systems using both philosophies, evaluating 60 total fits within the canals. The "canal fit" philosophy aimed to minimize cortical bone removal. In contrast, the "anatomical fit" philosophy prioritized aligning the implanted head with the anatomical head center. RESULTS: Detailed analyses revealed that AF led to fixation occurring mainly on the medial aspect of the stem, while CF exhibited a more even distribution between medial and lateral sides. The AF philosophy achieved significantly closer placement of the implanted head to the anatomical center (2.0 to 2.1 mm) compared to the CF philosophy (3.0 to 6.0 mm) (P < 0.01). The AF resulted in neutral stem orientation (0°) across all stems, whereas the CF exhibited greater malrotation (2.0 to 7.0°) (P < 0.02). The AF required more bone removal (0.13 to 0.46 cm³) than the CF (0.02 to 0.06 cm³) (P < 0.01). CONCLUSION: The findings underscore the importance of 3D planning, emphasizing its potential to improve stem version alignment in THA. The results from this study may advocate 3D preoperative planning with robotic surgery to plan stem placement within the canal while maintaining anatomical femoral head restoration.

Turning machines: a simple algorithmic model for molecular robotics.

Molecular robotics is challenging, so it seems best to keep it simple. We consider an abstract molecular robotics model based on simple folding instructions that execute asynchronously. Turning Machines are a simple 1D to 2D folding model, also easily generalisable to 2D to 3D folding. A Turning Machine starts out as a line of connected monomers in the discrete plane, each with an associated turning number. A monomer turns relative to its neighbours, executing a unit-distance translation that drags other monomers along with it, and through collective motion the initial set of monomers eventually folds into a programmed shape. We provide a suite of tools for reasoning about Turning Machines by fully characterising their ability to execute line rotations: executing an almost-full line rotation of 5 π / 3 radians is possible, yet a full 2 π rotation is impossible. Furthermore, line rotations up to 5 π / 3 are executed efficiently, in O ( log n ) expected time in our continuous time Markov chain time model. We then show that such line-rotations represent a fundamental primitive in the model, by using them to efficiently and asynchronously fold shapes. In particular, arbitrarily large zig-zag-rastered squares and zig-zag paths are foldable, as are y-monotone shapes albeit with error (bounded by perimeter length). Finally, we give shapes that despite having paths that traverse all their points, are in fact impossible to fold, as well as techniques for folding certain classes of (scaled) shapes without error. Our approach relies on careful geometric-based analyses of the feats possible and impossible by a very simple robotic system, and pushes conceptional hardness towards mathematical analysis and away from molecular implementation.

A robotic left S6 and S1/2c segmentectomy using the lung-inverted approach.

In pulmonary segmentectomy, the dominant pulmonary arteries are traditionally divided at the fissure. However, this approach sometimes leads to inadvertent injury to the pulmonary artery and prolonged air leak when the fissure is fused. To overcome these problems, by taking advantage of the good visualization provided by robotic surgery, we have adopted the lung-inverted approach without fissure dissection for segmentectomy. We have successfully performed a robotic left S6 and S1+2c segmentectomy using the lung-inverted approach. In addition to a good postoperative course, the console time was 57 minutes, which was considered relatively short. This approach may have contributed to the short operating time because it did not require repeated rotation of the lung. A clear understanding of the anatomy was required to perform this approach properly, because each branch of the pulmonary vessels and bronchi was treated inverted at the hilum. A preoperative 3-dimensional computed tomography broncho-angiographic scan was considered useful because it allowed us to recognize the relative positions of the dominant pulmonary vessels, the bronchi and other structures that were preserved.

Initial Clinical Experience With a Novel Robotically Assisted Platform for Combined Mini-Percutaneous Nephrolithotomy and Flexible Ureteroscopic Lithotripsy.

PURPOSE: We sought to evaluate the technical feasibility of performing a combined robotically assisted mini-percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (URS) procedure by a single urologist using the MONARCH Platform, Urology (Johnson & Johnson MedTech, Redwood City, California). MATERIAL AND METHODS: In this prospective, first-in-human clinical trial, 13 patients underwent robotically-assisted PCNL for renal calculi at the University of California-Irvine, Department of Urology. Successful completion of the procedure was assessed as the primary endpoint. Postoperative adverse events were monitored for 30 days following the completion of the procedure. Stone ablation efficiency was evaluated on postoperative day 30 with low-dose 2-3 mm slice CT scans. Patients were classified according to the maximum length of their residual stone fragments as either absolute stone-free (Grade A), < 2 mm remnants (Grade B), or 2.1-4.0 mm remnants (Grade C). RESULTS: The combined robotic mini-PCNL and URS procedure was successfully completed in 12 of 13 procedures. No robotic device-related adverse events occurred. Preoperative stone burden was quantified by both maximum linear measurement (median 32.8 mm) as well as by CT-based volume (median 1645.9 mm3). Using the unique robotically assisted targeting system, percutaneous access was gained directly through the center of the renal papilla in a single pass in all cases. Median operative time was 187 minutes (range: 83-383 minutes). On postoperative day 30, a 98.7% (range: 72.9%-100.0%) volume reduction was achieved, with 5 Grade A (38.5%), 1 Grade B (7.7%), and 2 Grade C (15.4%). Three patients experienced complications (2 grade 1 and one grade 2 Clavien-Dindo). CONCLUSIONS: Our preliminary investigation demonstrates the safety, efficacy, and feasibility of a unique robotic-assisted combined mini-PCNL and URS platform.

The League: A person-centred approach to the development of social robotics for paediatric anxiety.

BACKGROUND: Social robots are promising tools to improve the quality of life of children and youth living with anxiety and should be developed based on the priorities of end users. However, pathways to include young people in patient-oriented research, particularly in the overlap between technology and mental health, have been historically limited. OBJECTIVE: In this work, we describe engagement with experts with lived experiences of paediatric anxiety in a social robotics research programme. We report the experiences of patient advisors in a co-creation process and identify considerations for other research groups looking to involve end users in technology development in the field of youth mental health. DESIGN: We engaged individuals with a lived experience of paediatric anxiety (current, recent past, or from a parent perspective) using three different models over the course of three years. Two initial patient partners were involved during project development, eight were engaged as part of an advisory panel ('the League') during study development and data analysis and four contributed as ongoing collaborators in an advisory role. League members completed a preparticipation expectation survey and a postparticipation experience survey. FINDINGS: Eight individuals from a range of anxiety-related diagnostic groups participated in the League as patient partners. Members were teenagers (n = 3), young adults aged 22-26 years who had connected with a youth mental health service as children within the past eight years (n = 3) or parents of children presently living with anxiety (n = 2). Preferred methods of communication, expectations and reasons for participating were collected. The League provided specific and actionable feedback on the design of workshops on the topic of social robotics, which was implemented. They reported that their experiences were positive and fairly compensated, but communication and sustained engagement over time were challenges. Issues of ethics and language related to patient-centred brain health technology research are discussed. CONCLUSIONS: There is an ethical imperative to meaningfully incorporate the voices of youth and young adults with psychiatric conditions in the development of devices intended to support their mental health and quality of life. PATIENT OR PUBLIC CONTRIBUTION: Six young people and two parents with lived experiences of paediatric anxiety participated in all stages of developing a research programme on social robotics to support paediatric mental health in a community context. They also provided input during the preparation of this manuscript.

Port Site Metastasis in Women with Low- or Intermediate-Risk Endometrial Carcinoma: A Systematic Review of Literature.

Background: Port site metastasis (PSM) has been reported as a rare metastasis in women with endometrial carcinoma (EC). However, even more rarely, it has also been described in patients with low- or intermediate-risk EC. Unfortunately, knowledge appears limited on the topic. Objectives: Our objective was to systematically review the literature on PSM in low- or intermediate-risk EC. Search Strategy: A systematic review of the literature was performed by searching six electronic databases from their inception to January 2023. Selection Criteria: We included in our research all peer-reviewed studies which reported PSM in low- or intermediate-risk EC women. Data Collection and Analysis: Data on PSM were collected from the included studies and compared. Results: Seven studies with 13 patients (including our case) were included in the systematic review. PSM was reported in patients with low- or intermediate-risk EC independently from tumor histologic characteristics, endoscopic approach, lymph node staging type, number and site of the port, route of specimen removal, prevention strategies for PSM, and concomitant metastases. Among several proposed treatments, local resection and radiotherapy with or without chemotherapy might be the most appropriate ones. Nevertheless, the prognosis appears poor. Conclusions: In patients with low- or intermediate-risk EC, PSM can occur as a rare metastasis, regardless of tumor characteristics or surgical strategy. Unfortunately, no consensus has been reached regarding treatment, and the prognosis appears poor. Additional cases are needed in order to confirm and further explore this rare EC metastasis.

Social Type-Aware Navigation Framework for Mobile Robots in Human-Shared Environments.

As robots become increasingly common in human-populated environments, they must be perceived as social beings and behave socially. People try to preserve their own space during social interactions with others, and this space depends on a variety of factors, such as individual characteristics or their age. In real-world social spaces, there are many different types of people, and robots need to be more sensitive, especially when interacting with vulnerable subjects such as children. However, the current navigation methods do not consider these differences and apply the same avoidance strategies to everyone. Thus, we propose a new navigation framework that considers different social types and defines appropriate personal spaces for each, allowing robots to respect them. To this end, the robot needs to classify people in a real environment into social types and define the personal space for each type as a Gaussian asymmetric function to respect them. The proposed framework is validated through simulations and real-world experiments, demonstrating that the robot can improve the quality of interactions with people by providing each individual with an adaptive personal space. The proposed costmap layer is available on GitHub.

Robotic Grasping of Unknown Objects Based on Deep Learning-Based Feature Detection.

In recent years, the integration of deep learning into robotic grasping algorithms has led to significant advancements in this field. However, one of the challenges faced by many existing deep learning-based grasping algorithms is their reliance on extensive training data, which makes them less effective when encountering unknown objects not present in the training dataset. This paper presents a simple and effective grasping algorithm that addresses this challenge through the utilization of a deep learning-based object detector, focusing on oriented detection of key features shared among most objects, namely straight edges and corners. By integrating these features with information obtained through image segmentation, the proposed algorithm can logically deduce a grasping pose without being limited by the size of the training dataset. Experimental results on actual robotic grasping of unknown objects over 400 trials show that the proposed method can achieve a higher grasp success rate of 98.25% compared to existing methods.

Development and Investigation of a Grasping Analysis System with Two-Axis Force Sensors at Each of the 16 Points on the Object Surface for a Hardware-Based FinRay-Type Soft Gripper.

The FinRay soft gripper achieves passive enveloping grasping through its functional flexible structure, adapting to the contact configuration of the object to be grasped. However, variations in beam position and thickness lead to different behaviors, making it important to research the relationship between structure and force. Conventional research using FEM simulations has tested various virtual FinRay models but replicating phenomena such as buckling and slipping has been challenging. While hardware-based methods that involve installing sensors on the gripper and the object to analyze their states have been attempted, no studies have focused on the tangential contact force related to slipping. Therefore, we developed a 16-way object contact force measurement device incorporating two-axis force sensors into each of the 16 segmented objects and compared the normal and tangential components of the enveloping grasping force of the FinRay soft gripper under two types of contact friction conditions. In the first experiment, the proposed device was compared with a device containing a six-axis force sensor in one segmented object, confirming that the proposed device has no issues with measurement performance. In the second experiment, comparisons of the proposed device were made under various conditions: two contact friction states, three object contact positions, and two object motion states. The results demonstrated that the proposed device could decompose and analyze the grasping force into its normal and tangential components for each segmented object. Moreover, low friction conditions result in a wide contact area with lower tangential frictional force and a uniform normal pushing force, achieving effective enveloping grasping.