An MRI-Compatible robotic aspiration device has been developed with the goal of improving minimally invasive treatment for intracerebral hemorrhage (ICH). Current minimally invasive approaches have demonstrated promising clinical outcomes in preliminary trials when compared to conservative treatment or surgery. However, these approaches do not allow for hemorrhage evacuation while monitoring for evacuation progress and brain tissue involvement under MRI. The robotic aspiration device has a concentric tube mechanism which consists of a straight outer tube and an elastic inner aspiration cannula to allow for access to hematomas when deployed. We started evaluating the robot in MRI-guided human brain phantom studies. As a next step, we assessed the workflow of the robot system in an MRI-guided sheep brain phantom study. The phantom was created using Humimic Medical gel that was melted and poured into a 3D-printed sheep brain model. The gel was left to solidify, and a cavity was created for a clot. The measured clot volume prior to evacuation was 9.04mL. The robot was advanced into the clot and aspiration was performed with real-time intraoperative MR imaging. The volume of clot was reduced by 83% and the phantom did not have any unexpected damage when it was physically analyzed after the procedure. Our long-term goal is to develop a safe MRI-compatible minimally invasive robotic procedure for ICH evacuation. We are currently preparing for live sheep animal studies.
Existing methods to improve the accuracy of tibiofibular joint reduction present workflow challenges, high radiation exposure, and a lack of accuracy and precision, leading to poor surgical outcomes. To address these limitations, we propose a method to perform robot-assisted joint reduction using intraoperative imaging to align the dislocated fibula to a target pose relative to the tibia. The approach (1) localizes the robot via 3D-2D registration of a custom plate adapter attached to its end effector, (2) localizes the tibia and fibula using multi-body 3D-2D registration, and (3) drives the robot to reduce the dislocated fibula according to the target plan. The custom robot adapter was designed to interface directly with the fibular plate while presenting radiographic features to aid registration. Registration accuracy was evaluated on a cadaveric ankle specimen, and the feasibility of robotic guidance was assessed by manipulating a dislocated fibula in a cadaver ankle. Using standard AP and mortise radiographic views registration errors were measured to be less than 1 mm and 1° for the robot adapter and the ankle bones. Experiments in a cadaveric specimen revealed up to 4 mm deviations from the intended path, which was reduced to ⪅2 mm using corrective actions guided by intraoperative imaging and 3D-2D registration. Preclinical studies suggest that significant robot flex and tibial motion occur during fibula manipulation, motivating the use of the proposed method to dynamically correct the robot trajectory. Accurate robot registration was achieved via the use of fiducials embedded within the custom design. Future work will evaluate the approach on a custom radiolucent robot design currently under construction and verify the solution on additional cadaveric specimens.
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