Design and development of a robotized system coupled to µCT imaging for intratumoral drug evaluation in a HCC mouse model.

Hepatocellular carcinoma (HCC) is one of the most common cancer related deaths worldwide. One of the main challenges in cancer treatment is drug delivery to target cancer cells specifically. Preclinical evaluation of intratumoral drugs in orthotopic liver cancer mouse models is difficult, as percutaneous injection hardly can be precisely performed manually. In the present study we have characterized a hepatoma model developing a single tumor nodule by implantation of Hep55.1C cells in the liver of syngeneic C57BL/6J mice. Tumor evolution was followed up by µCT imaging, and at the histological and molecular levels. This orthotopic, poorly differentiated mouse HCC model expressing fibrosis, inflammation and cancer markers was used to assess the efficacy of drugs. We took advantage of the high precision of a previously developed robotized system for automated, image-guided intratumoral needle insertion, to administer every week in the tumor of the Hep55.1C mouse model. A significant tumor growth inhibition was observed using our robotized system, whereas manual intraperitoneal administration had no effect, by comparison to untreated control mice.

Design and in vivo evaluation of a robotized needle insertion system for small animals.

The development of imaging devices adapted to small animals has opened the way to image-guided procedures in biomedical research. In this paper, we focus on automated procedures to study the effects of the recurrent administration of substances to the same animal over time. A dedicated system and the associated workflow have been designed to percutaneously position a needle into the abdominal organs of mice. Every step of the procedure has been automated: the camera calibration, the needle access planning, the robotized needle positioning, and the respiratory-gated needle insertion. Specific devices have been developed for the registration, the animal binding under anesthesia, and the skin puncture. Among the presented results, the system accuracy is particularly emphasized, both in vitro using gelose phantoms and in vivo by injecting substances into various abdominal organs. The study shows that robotic assistance could be routinely used in biomedical research laboratories to improve existing procedures, allowing automated accurate treatments and limited animal sacrifices.

Automatic tracking of an organ section with an ultrasound probe: compensation of respiratory motion.

In minimally invasive surgery or needle insertion procedures, the ultrasound imaging can easily and safely be used to visualize the target to reach. However the manual stabilization of the view of this target, which undergoes the physiological motions of the patient, can be a challenge for the surgeon. In this paper, we propose to perform this stabilization with a robotic arm equipped with a 2D ultrasound probe. The six degrees of freedom of the probe are controlled by an image-based approach, where we choose as visual feedback the image intensity. The accuracy of the control law is ensured by the consideration of the periodicity of the physiological motions in a predictive controller. Tracking tasks performed on a realistic abdominal phantom validate the proposed approach and its robustness to deformation is assessed on a gelatin-made deformable phantom.

An active cardiac stabilizer based on gyroscopic effect.

Active cardiac stabilization has a role to play in the development of minimally invasive techniques for beating heart surgery. We propose here a new active cardiac stabilization device based on gyroscopic actuation. This system allows to compensate for heart motion in high frequencies and is fully independant and pluggable on conventional stabilizers. The mechanical model and design are described. The system is controlled thanks to static state feedback, taking into account gyroscope specificities. Experiments results are presented. They highlight the effectiveness of this solution with a 48% reduction of the RMS excursion.

Motion prediction for computer-assisted beating heart surgery.

Off-pump totally endoscopic coronary artery bypass grafting is a milestone for cardiac surgery, and still a technical challenge. Indeed, the fast and complex cardiac motion makes this operating method technically demanding. Therefore, several robotic systems have been designed to assist the surgeons by compensating for the cardiac motion and providing a virtually motionless operating area. In the proposed systems, the servoing schemes often take advantage of a prediction algorithm that supplies the controller with some future heart motion. This prediction enlarges the control-loop bandwidth, thus allowing a better motion compensation. Obviously, improving the prediction accuracy will lead to better motion-compensation results. Thus, a current challenge in computer-assisted cardiac surgery research is the design of efficient heart-motion-prediction algorithms. In this paper, a detailed survey of the main existing prediction approaches is given and a classification is provided. Then, a novel prediction technique based on amplitude modulation is proposed, and compared with other techniques using in vivo collected datasets. A final discussion summarizes the main features of all the proposed approaches.

A patient-mounted robotic platform for CT-scan guided procedures.

In this paper, we present a novel robotic assistant dedicated to medical interventions under computed tomography scan guidance. This compact and lightweight patient-mounted robot is designed so as to fulfill the requirements of most interventional radiology procedures. It is built from an original 5 DOF parallel structure with a semispherical workspace, particularly well suited to CT-scan interventional procedures. The specifications, the design, and the choice of compatible technological solutions are detailed. A preclinical evaluation is presented, with the registration of the robot in the CT-scan.

Cardiolock: an active cardiac stabilizer. First in vivo experiments using a new robotized device.

Off-pump Coronary Artery Bypass Grafting (CABG) is still a technically difficult procedure. The mechanical stabilizers used for local suppression of the heart excursion have been demonstrated to exhibit significant residual motion, which could lead to a lack of accuracy in performing the surgical task, particularly when using a minimally invasive surgery (MIS) approach. We therefore propose a novel active stabilizer to compensate for the residual motion whose architecture is compatible with MIS. An experimental evaluation of a commercially available totally endoscopic stabilizer is first presented to demonstrate the unsatisfactory behavior of this device. Then, the interaction between the heart and a mechanical stabilizer is assessed in vivo using an animal model. Finally, the principle of active stabilization, based on the high-speed vision-based control of a piezo-actuated compliant mechanism, is presented, along with in vivo experimental results obtained using a prototype to demonstrate its efficiency.

Cardiolock: an active cardiac stabilizer. First in vivo experiments using a new robotized device.

Off-pump Coronary Artery Bypass Grafting (CABG) is still today a technically difficult procedure. In fact, the mechanical stabilizers used to locally suppress the heart excursion have been demonstrated to exhibit significant residual motion. We therefore propose a novel active stabilizer which is able to compensate for this residual motion. The interaction between the heart and a mechanical stabilizer is first assessed in vivo on an animal model. Then, the principle of active stabilization, based on the high speed vision-based control of a compliant mechanism, is presented. In vivo experimental results are given using a prototype which structure is compatible with a minimally invasive approach.

Towards robotized beating heart TECABG: assessment of the heart dynamics using high-speed vision.

Active robotic filtering is probably the solution for beating heart Totally Endoscopic Coronary Artery Bypass Grafting (TECABG). In this work, we assess the heart motion dynamics by simultaneous use of high-speed imaging of optical markers attached to the heart, ECG signals and ventilator airflow acquisitions. Our goal is to assess the heart motions (shape, velocity, acceleration) in order to be able to make more accurate specifications for a novel, dedicated robot that could follow these motions in real time. Furthermore, using two additional inputs (ECG and airflow), we propose a novel robust prediction algorithm that could be used with a predictive control algorithm to improve the tracking accuracy.

Toward robotized beating heart TECABG: assessment of the heart dynamics using high-speed vision.

Active robotic filtering is a promising solution for beating heart Totally Endoscopic Coronary Artery Bypass Grafting (TECABG). n this work, we assess the heart motion dynamics using simultaneously igh speed imaging of optical markers attached to the heart, ECG signals and ventilator airflow acquisitions. Our goal is to make an assessment of the heart motion (shape, velocity, acceleration) in order to be able to make more accurate specifications for a dedicated robot that could follow this motion in real-time. Furthermore, using the 2 additional inputs (ECG, airflow), we propose a prediction algorithm of the motion that could be used with a predictive control algorithm to improve the tracking accuracy.