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Automated Robotic Needle Puncture for Percutaneous Dilatational Tracheostomy

Yuan Tang, Bruno V. Adorno, Brendan A. McGrath, Andrew Weightman

TL;DR

The small deviations from the nominal puncture in a simulated experimental setup and formal guarantees of collision-free insertions suggest the feasibility of the robotic PDT puncture.

Abstract

Percutaneous dilatational tracheostomy (PDT) is frequently performed on patients in intensive care units for prolonged mechanical ventilation. The needle puncture, as the most critical step of PDT, could lead to adverse consequences such as major bleeding and posterior tracheal wall perforation if performed inaccurately. Current practices of PDT puncture are all performed manually with no navigation assistance, which leads to large position and angular errors (5 mm and 30 degree). To improve the accuracy and reduce the difficulty of the PDT procedure, we propose a system that automates the needle insertion using a velocity-controlled robotic manipulator. Guided using pose data from two electromagnetic sensors, one at the needle tip and the other inside the trachea, the robotic system uses an adaptive constrained controller to adapt the uncertain kinematic parameters online and avoid collisions with the patient's body and tissues near the target. Simulations were performed to validate the controller's implementation, and then four hundred PDT punctures were performed on a mannequin to evaluate the position and angular accuracy. The absolute median puncture position error was 1.7 mm (IQR: 1.9 mm) and midline deviation was 4.13 degree (IQR: 4.55 degree), measured by the sensor inside the trachea. The small deviations from the nominal puncture in a simulated experimental setup and formal guarantees of collision-free insertions suggest the feasibility of the robotic PDT puncture.

Automated Robotic Needle Puncture for Percutaneous Dilatational Tracheostomy

TL;DR

The small deviations from the nominal puncture in a simulated experimental setup and formal guarantees of collision-free insertions suggest the feasibility of the robotic PDT puncture.

Abstract

Percutaneous dilatational tracheostomy (PDT) is frequently performed on patients in intensive care units for prolonged mechanical ventilation. The needle puncture, as the most critical step of PDT, could lead to adverse consequences such as major bleeding and posterior tracheal wall perforation if performed inaccurately. Current practices of PDT puncture are all performed manually with no navigation assistance, which leads to large position and angular errors (5 mm and 30 degree). To improve the accuracy and reduce the difficulty of the PDT procedure, we propose a system that automates the needle insertion using a velocity-controlled robotic manipulator. Guided using pose data from two electromagnetic sensors, one at the needle tip and the other inside the trachea, the robotic system uses an adaptive constrained controller to adapt the uncertain kinematic parameters online and avoid collisions with the patient's body and tissues near the target. Simulations were performed to validate the controller's implementation, and then four hundred PDT punctures were performed on a mannequin to evaluate the position and angular accuracy. The absolute median puncture position error was 1.7 mm (IQR: 1.9 mm) and midline deviation was 4.13 degree (IQR: 4.55 degree), measured by the sensor inside the trachea. The small deviations from the nominal puncture in a simulated experimental setup and formal guarantees of collision-free insertions suggest the feasibility of the robotic PDT puncture.
Paper Structure (15 sections, 8 equations, 10 figures, 2 tables)

This paper contains 15 sections, 8 equations, 10 figures, 2 tables.

Table of Contents

  1. Introduction
  2. Sensor-guided adaptive constrained control for needle insertion
  3. VFI-based constrained control law
  4. Nominal constrained control law
  5. Adaptive control law
  6. Constraints
  7. The robotic puncture procedure
  8. Validation in simulation
  9. Methodology of simulation
  10. Results and discussion of simulation
  11. Experimental validation
  12. Methodology of experiments
  13. Results
  14. Discussion
  15. Conclusions

Figures (10)

  • Figure 1: Bronchoscopic view of an extremely lateral PDT puncture ruda2012. Lateral punctures could lead to complications such as tracheostomy tube misplacements and posterior tracheal wall damage.
  • Figure 2: System hardware for automated needle puncture: a robot manipulator, an electromagnetic transmitter, and two sensors (one at the needle tip for navigating the robot, one inserted through the bronchoscope channel and reaching its tip for measuring the desired target puncture position and direction).
  • Figure 3: Simulation setup for robotic PDT needle puncture. The initial estimated needle tip position might be very inaccurate due to high uncertainty in the robot base displacement and needle attachment.
  • Figure 4: Simulation results of the needle puncture. (A) The nominal quintic trajectory (black curve) prescribes a smooth approach closely executed in the closed-loop system; (B) at the start of the robot motion, the error is larger than the threshold, but it is quickly reduced to satisfy the constraints. (C) The small violations ($<0.01^{\circ}$) are due to noisy measurements.
  • Figure 5: Simulation results of the adaptation law.
  • ...and 5 more figures