Robotics for surgical microscopy

Abstract

Advances in surgery have had a significant impact on cancer treatment and management. Recurrence, however, is still a major issue, and is often associated with incomplete tumour removal. Thus far, histopathological examination is still the “gold standard” for assessing tumour resection completeness. However, it is operator-dependent and too slow for intraoperative use. Recently developed endomicroscopy techniques enable the acquisition of high resolution images at a cellular level in situ, in vivo, thus significantly extending the information content available intraoperatively. The miniaturised imaging probes incorporate flexible fibre bundles and allow the ease of integration with surgical instruments. However, manual control of these probes is challenging, particularly in terms of maintaining consistent tissue contact and performing large area surveillance of complex, deformable, 3D structures.

This thesis explores the use of surgical robots and robotically-assisted probe manipulation to provide stable, precise, consistent and dexterous manipulation of endomicroscopy probes for surgical applications. Following a discussion of image enhancement techniques, a first approach towards robotically-assisted probe manipulation using existing surgical robotic platforms is demonstrated in the form of multi-purpose, pick-up probes. They also incorporate novel force adaptive mechanisms for consistent tissue contact.

The development of bespoke, mechatronically-enhanced robotic devices is then presented. Firstly, a handheld robotic scanning device is proposed for breast conserving surgery, allowing accurate, high speed scanning over wide deformable tissue areas. An energy delivery fibre is integrated into the scanning mechanism for image-guided ablation or intraoperative marking of tumour margins. Secondly, a dexterous 5-degree-of-freedom robotic instrument is proposed for use in endoluminal microsurgeries. The instrument offers increased flexibility and by using a master-slave control scheme, we demonstrate how efficient, large area scanning over curved endoluminal surfaces can be performed. Finally, the fusion of ultrasound imaging with endomicroscopy is investigated through the development of a robotically-actuated articulated instrument for multi-modality image fusion.