Active constraints, also known as virtual fixtures, are high-level control algorithms which can be used to assist a human in man-machine collaborative manipulation tasks. The active constraint controller monitors the robotic manipulator with respect to the environment and task, and anisotropically regulates the motion to provide assistance. The type of assistance offered by active constraints can vary, but they are typically used to either guide the user along a task-specific pathway or limit the user to within a “safe” region. There are several diverse methods described within the literature for applying active constraints, and these are surveyed within this paper. The active constraint research is described and compared using a simple generalized framework, which consists of three primary processes: 1) constraint definition, 2) constraint evaluation, and 3) constraint enforcement. All relevant research approaches for each of these processes, found using search terms associated to “virtual fixture,” “active constraint” and “motion constraint,” are presented.

We performed a prospective, randomised controlled trial of unicompartmental knee arthroplasty comparing the performance of the Acrobot system with conventional surgery. A total of 27 patients (28 knees) awaiting unicompartmental knee arthroplasty were randomly allocated to have the operation performed conventionally or with the assistance of the Acrobot. The primary outcome measurement was the angle of tibiofemoral alignment in the coronal plane, measured by CT. Other secondary parameters were evaluated and are reported. All of the Acrobot group had tibiofemoral alignment in the coronal plane within 2° of the planned position, while only 40% of the conventional group achieved this level of accuracy. While the operations took longer, no adverse effects were noted, and there was a trend towards improvement in performance with increasing accuracy based on the Western Ontario and McMaster Universities Osteoarthritis Index and American Knee Society scores at six weeks and three months. The Acrobot device allows the surgeon to reproduce a pre-operative plan more reliably than is possible using conventional techniques which may have clinical advantages.

This paper provides an overview of recent trends and developments in medical robotics for minimally invasive soft tissue surgery, with a view to highlight some of the issues posed and solutions proposed in the literature. The paper includes a thorough review of the literature, which focuses on soft tissue surgical robots developed and published in the last five years (between 2004 and 2008) in indexed journals and conference proceedings. Only surgical systems were considered; imaging and diagnostic devices were excluded from the review. The systems included in this paper are classified according to the following surgical specialties: neurosurgery; eye surgery and ear, nose, and throat (ENT); general, thoracic, and cardiac surgery; gastrointestinal and colorectal surgery; and urologic surgery. The systems are also cross-classified according to their engineering design and robotics technology, which is included in tabular form at the end of the paper. The review concludes with an overview of the field, along with some statistical considerations about the size, geographical spread, and impact of medical robotics for soft tissue surgery today.

Six-axis force/torque sensors are transducers capable of measuring three dimensions of force and three dimensions of torque, and have a wide range of applications in robotic systems. The sensing principle behind the greatest majority of these is based on detecting strains in an elastic structure, and there are multiple modalities for strain measurement, including resistive strain gauge, piezoelectric, capacitive, and optoelectronic techniques. Developed sensors can be evaluated based on a range of parameters, including decoupling error, nonlinearity error, and measurement isotropy, where the primary design challenge is to maximise the allowable sensing range while minimising measurement errors. This literature review describes the state of the art of the field, and includes all relevant research associated with the search term “six-axis force/torque sensor” spanning 2015 - June 2021. The published literature for each sensing technique is summarised and evaluated, and a generalised sensor selection framework is proposed to assist the reader with the selection procedure for a state of the art sensor. In the period considered, there have been no significant improvements with the sensors documented in terms of measurement errors. Researchers have instead focused on features such as fault tolerance, alternative sensing techniques, cost reduction, and miniaturisation. These trends are expected to continue, and moving forward, the most significant challenge in the field is expected to be the lowering of manufacturing costs, as trends indicate measurement performance has reached maturity.

Surgeons need to be able to measure angles and distances in three dimensions in the planning and assessment of knee replacement. Computed tomography (CT) offers the accuracy needed but involves greater radiation exposure to patients than traditional long-leg standing radiographs, which give very little information outside the plane of the image. There is considerable variation in CT radiation doses between research centres, scanning protocols and individual scanners, and ethics committees are rightly demanding more consistency in this area. By refining the CT scanning protocol we have reduced the effective radiation dose received by the patient down to the equivalent of one long-leg standing radiograph. Because of this, it will be more acceptable to obtain the three-dimensional data set produced by CT scanning. Surgeons will be able to document the impact of implant position on outcome with greater precision.

Synthetic phantoms are valuable tools for training, research and development in traditional and computer aided surgery, but complex organs, such as the brain, are difficult to replicate. Here, we present the development of a new composite hydrogel capable of mimicking the mechanical response of brain tissue under loading. Our results demonstrate how the combination of two different hydrogels, whose synergistic interaction results in a highly tunable blend, produces a hybrid material that closely matches the strongly dynamic and non-linear response of brain tissue. The new synthetic material is inexpensive, simple to prepare, and its constitutive components are both widely available and biocompatible. Our investigation of the properties of this engineered tissue, using both small scale testing and life-sized brain phantoms, shows that it is suitable for reproducing the brain shift phenomenon and brain tissue response to indentation and palpation