Abstract--Achieving precise control of robotic tool paths is often challenged by inherent system misalignments, unmodeled dynamics, and actuation inaccuracies. This work introduces an Iterative Learning Control (ILC) strategy to enable precise rotational insertion of a tool during robotic surgery, improving penetration efficacy and safety compared to straight insertion tested in subretinal injection. A 4 degree of freedom (DOF) robot manipulator is used, where misalignment of the fourth joint complicates the simple application of needle rotation, motivating an ILC approach that iteratively adjusts joint commands based on positional feedback. The process begins with calibrating the forward kinematics for the chosen surgical tool to achieve higher accuracy, followed by successive ILC iterations guided by Optical Coherence T omography (OCT) volume scans to measure the error and refine control inputs. Experimental results, tested on subretinal injection tasks on ex vivo pig eyes, show that the optimized trajectory resulted in higher success rates in tissue penetration and subretinal injection compared to straight insertion, demonstrating the effectiveness of ILC in overcoming misalignment challenges. This approach offers potential applications for other high precision robot tasks requiring controlled insertions as well. Accurate and precise control of movement is fundamental to many scientific fields [1], but it becomes even more critical in surgical applications where even minor deviations can significantly impact outcomes. Surgical procedures often demand sub-millimeter accuracy, especially in areas involving delicate tissues and confined spaces, such as ophthalmology. However, consistently achieving this level of precision can be challenging due to the inherent limitations of human motor skills, such as involuntary tremors and fatigue [2]. These limitations are amplified in intraocular microsurgery, requiring not only steady hands, but also enhanced sensory feedback and hand-eye coordination.

Studying tissue samples obtained during autopsies is the gold standard when diagnosing the cause of death and for understanding disease pathophysiology. Recently, the interest in post mortem minimally invasive biopsies has grown which is a less destructive approach in comparison to an open autopsy and reduces the risk of infection. While manual biopsies under ultrasound guidance are more widely performed, robotic post mortem biopsies have been recently proposed. This approach can further reduce the risk of infection for physicians. However, planning of the procedure and control of the robot need to be efficient and usable. We explore a virtual reality setup with a digital twin to realize fully remote planning and control of robotic post mortem biopsies. The setup is evaluated with forensic pathologists in a usability study for three interaction methods. Furthermore, we evaluate clinical feasibility and evaluate the system with three human cadavers. Overall, 132 needle insertions were performed with an off-axis needle placement error of 5.30+-3.25 mm. Tissue samples were successfully biopsied and histopathologically verified. Users reported a very intuitive needle placement approach, indicating that the system is a promising, precise, and low-risk alternative to conventional approaches.

Tissue biopsy is the gold standard for diagnosing many diseases, involving the extraction of diseased tissue for histopathology analysis by expert pathologists. However, this procedure has two main limitations: 1) Manual sampling through tissue biopsy is prone to inaccuracies; 2) The extraction process is followed by a time-consuming pathology test. To address these limitations, we present a compact, accurate, and maneuverable robotic insertion platform to overcome the limitations in traditional histopathology. Our platform is capable of steering a variety of tools with different sizes, including needle for tissue extraction and optical fibers for vibrational spectroscopy applications. This system facilitates the guidance of end-effector to the tissue and assists surgeons in navigating to the biopsy target area for multi-modal diagnosis. In this paper, we outline the general concept of our device, followed by a detailed description of its mechanical design and control scheme. We conclude with the validation of the system through a series of tests, including positioning accuracy, admittance performance, and tool insertion efficacy.

Computed tomography (CT)-guided needle biopsies are critical for diagnosing a range of conditions, including lung cancer, but present challenges such as limited in-bore space, prolonged procedure times, and radiation exposure. Robotic assistance offers a promising solution by improving needle trajectory accuracy, reducing radiation exposure, and enabling real-time adjustments. In our previous work, we introduced a redundant robotic platform designed for dexterous needle insertion within the confined CT bore. However, its limited base mobility restricts flexible deployment in clinical settings. In this study, we present an improved 11-degree-of-freedom (DOF) robotic system that integrates a 6-DOF robotic base with a 5-DOF cable-driven end-effector, significantly enhancing workspace flexibility and precision. With the hyper-redundant degrees of freedom, we introduce a weighted inverse kinematics controller with a two-stage priority scheme for large-scale movement and fine in-bore adjustments, along with a null-space control strategy to optimize dexterity. We validate our system through both simulation and real-world experiments, demonstrating superior tracking accuracy and enhanced manipulability in CT-guided procedures. The study provides a strong case for hyper-redundancy and null-space control formulations for robot-assisted needle biopsy scenarios.

The multi-modality imaging system offers optimal fused images for safe and precise interventions in modern clinical practices, such as computed tomography - ultrasound (CT-US) guidance for needle insertion. However, the limited dexterity and mobility of current imaging devices hinder their integration into standardized workflows and the advancement toward fully autonomous intervention systems. In this paper, we present a novel clinical setup where robotic cone beam computed tomography (CBCT) and robotic US are pre-calibrated and dynamically co-registered, enabling new clinical applications. This setup allows registration-free rigid registration, facilitating multi-modal guided procedures in the absence of tissue deformation. First, a one-time pre-calibration is performed between the systems. To ensure a safe insertion path by highlighting critical vasculature on the 3D CBCT, SAM2 segments vessels from B-mode images, using the Doppler signal as an autonomously generated prompt. Based on the registration, the Doppler image or segmented vessel masks are then mapped onto the CBCT, creating an optimally fused image with comprehensive detail. To validate the system, we used a specially designed phantom, featuring lesions covered by ribs and multiple vessels with simulated moving flow. The mapping error between US and CBCT resulted in an average deviation of 1.72+-0.62 mm. A user study demonstrated the effectiveness of CBCT-US fusion for needle insertion guidance, showing significant improvements in time efficiency, accuracy, and success rate. Needle intervention performance improved by approximately 50% compared to the conventional US-guided workflow. We present the first robotic dual-modality imaging system designed to guide clinical applications. The results show significant performance improvements compared to traditional manual interventions.

Ultrasound (US)-guided needle insertion is widely employed in percutaneous interventions. However, providing feedback on the needle tip position via US image presents challenges due to noise, artifacts, and the thin imaging plane of US, which degrades needle features and leads to intermittent tip visibility. In this paper, a Mamba-based US needle tracker MambaXCTrack utilizing structured state space models cross-correlation (SSMX-Corr) and implicit motion prompt is proposed, which is the first application of Mamba in US needle tracking. The SSMX-Corr enhances cross-correlation by long-range modeling and global searching of distant semantic features between template and search maps, benefiting the tracking under noise and artifacts by implicitly learning potential distant semantic cues. By combining with cross-map interleaved scan (CIS), local pixel-wise interaction with positional inductive bias can also be introduced to SSMX-Corr. The implicit low-level motion descriptor is proposed as a non-visual prompt to enhance tracking robustness, addressing the intermittent tip visibility problem. Extensive experiments on a dataset with motorized needle insertion in both phantom and tissue samples demonstrate that the proposed tracker outperforms other state-of-the-art trackers while ablation studies further highlight the effectiveness of each proposed tracking module.

Robotic platforms provide repeatable and precise tool positioning that significantly enhances retinal microsurgery. Integration of such systems with intraoperative optical coherence tomography (iOCT) enables image-guided robotic interventions, allowing to autonomously perform advanced treatment possibilities, such as injecting therapeutic agents into the subretinal space. Yet, tissue deformations due to tool-tissue interactions are a major challenge in autonomous iOCT-guided robotic subretinal injection, impacting correct needle positioning and, thus, the outcome of the procedure. This paper presents a novel method for autonomous subretinal injection under iOCT guidance that considers tissue deformations during the insertion procedure. This is achieved through real-time segmentation and 3D reconstruction of the surgical scene from densely sampled iOCT B-scans, which we refer to as B5-scans, to monitor the positioning of the instrument regarding a virtual target layer defined at a relative position between the ILM and RPE. Our experiments on ex-vivo porcine eyes demonstrate dynamic adjustment of the insertion depth and overall improved accuracy in needle positioning compared to previous autonomous insertion approaches. Compared to a 35% success rate in subretinal bleb generation with previous approaches, our proposed method reliably and robustly created subretinal blebs in all our experiments.

Autonomous surgical robots have demonstrated significant potential to standardize surgical outcomes, driving innovations that enhance safety and consistency regardless of individual surgeon experience. Deep anterior lamellar keratoplasty (DALK), a partial thickness corneal transplant surgery aimed at replacing the anterior part of cornea above Descemet membrane (DM), would greatly benefit from an autonomous surgical approach as it highly relies on surgeon skill with high perforation rates. In this study, we proposed a novel autonomous surgical robotic system (AUTO-DALK) based on a customized neural network capable of precise needle control and consistent big bubble demarcation on cadaver and live rabbit models. We demonstrate the feasibility of an AI-based image-guided vertical drilling approach for big bubble generation, in contrast to the conventional horizontal needle approach. Our system integrates an optical coherence tomography (OCT) fiber optic distal sensor into the eye-mountable micro robotic system, which automatically segments OCT M-mode depth signals to identify corneal layers using a custom deep learning algorithm. It enables the robot to autonomously guide the needle to targeted tissue layers via a depth-controlled feedback loop. We compared autonomous needle insertion performance and resulting pneumo-dissection using AUTO-DALK against 1) freehand insertion, 2) OCT sensor guided manual insertion, and 3) teleoperated robotic insertion, reporting significant improvements in insertion depth, pneumo-dissection depth, task completion time, and big bubble formation. Ex vivo and in vivo results indicate that the AI-driven, AUTO-DALK system, is a promising solution to standardize pneumo-dissection outcomes for partial thickness keratoplasty.

Cancer cases have been rising globally, resulting in nearly 10 million deaths in 2023. Biopsy, crucial for diagnosis, is often performed under ultrasound (US) guidance, demanding precise hand coordination and cognitive decision-making. Robot-assisted interventions have shown improved accuracy in lesion targeting by addressing challenges such as noisy 2D images and maintaining consistent probe-to-surface contact. Recent research has focused on fully autonomous robotic US systems to enable standardized diagnostic procedures and reproducible US-guided therapy. This study presents a fully autonomous system for US-guided needle placement capable of performing end-to-end clinical workflow. The system autonomously: 1) identifies the liver region on the patient's abdomen surface, 2) plans and executes the US scanning path using impedance control, 3) localizes lesions from the US images in real-time, and 4) targets the identified lesions, all without human intervention. This study evaluates both position and impedance-controlled systems. Validation on agar phantoms demonstrated a targeting error of 5.74 +- 2.70 mm, highlighting its potential for accurately targeting tumors larger than 5 mm. Achieved results show its potential for a fully autonomous system for US-guided biopsies.

In trauma and critical care settings, rapid and precise intravascular access is key to patients' survival. Our research aims at ensuring this access, even when skilled medical personnel are not readily available. Vessel bifurcations are anatomical landmarks that can guide the safe placement of catheters or needles during medical procedures. Although ultrasound is advantageous in navigating anatomical landmarks in emergency scenarios due to its portability and safety, to our knowledge no existing algorithm can autonomously extract vessel bifurcations using ultrasound images. This is primarily due to the limited availability of ground truth data, in particular, data from live subjects, needed for training and validating reliable models. Researchers often resort to using data from anatomical phantoms or simulations. We introduce BIFURC, Bifurcation Identification for Ultrasound-driven Robot Cannulation, a novel algorithm that identifies vessel bifurcations and provides optimal needle insertion sites for an autonomous robotic cannulation system. BIFURC integrates expert knowledge with deep learning techniques to efficiently detect vessel bifurcations within the femoral region and can be trained on a limited amount of in-vivo data. We evaluated our algorithm using a medical phantom as well as real-world experiments involving live pigs. In all cases, BIFURC consistently identified bifurcation points and needle insertion locations in alignment with those identified by expert clinicians.