Needle Steering for Robot-Assisted Insertion into Soft Tissue:A Survey

Needle insertion is a common surgical procedure used in diagnosis and treatment.The needle steering technologies make continuous developments in theoretical and practical aspects along with the in-depth research on needle insertion.It is necessary to summarize and analyze the existing results to promote the future development of theories and applications of needle insertion.Thus,a survey of the state of the art of research is presented on algorithms of needle steering techniques,the surgical robots and devices.Based on the analysis of the needle insertion procedure,the concept of needle steering is defined as a kinematics problem,which is to place the needle at the target and avoid the obstacles.The needle steering techniques,including the artificial potential field method and the nonholonomic model,are introduced to control the needles for improving the accuracy.Based on the quasi-static thinking,the virtual spring model and the cantilever-beam model are developed to calculate the amount of needle deflection and generate the needle path.The phantoms instead of the real tissue are used to verify the models mentioned in most of the experimentations.For the desired needle trajectories,the image-guided robotic devices and some novel needles are presented to achieve the needle steering.Finally,the challenges are provided involving the controllability of the long flexible needle and the properties of soft tissue.The results and investigations can be used for further study on the precision and accuracy of needle insertion.

Force modeling for needle insertion into soft tissue based on mechanical properties and geometric parameters

The force model during needle insertion into soft tissue is important for accurate percutaneous intervention.In this paper,a force model for needle insertion into a tissue- equivalent material is presented and a series of experiments are conducted to acquire data from needle soft- tissue interaction process.In order to build a more accurate insertion force model,the interaction force between a surgical needle and soft tissue is divided into three parts:stiffness force,friction force,and cutting force.The stiffness force is modeled on the basis of contact mechanics model.The friction force model is presented using a modified Winkler' s foundation model.The cutting force is viewed as a constant depending on a given tissue.The proposed models in the paper are established on the basis of the mechanical properties and geometric parameters of the needle and soft tissue.The experimental results illustrate that the force models are capable of predicting the needle-tissue interaction force.The force models of needle insertion can provide real-time haptic feedback for robot-assisted procedures,thereby improving the accuracy and safety of surgery.

Soft Tissue Deformation Modeling in the Procedure of Needle Insertion:A Kriging‑Based Method

The simulation and planning system(SPS)requires accurate and real-time feedback regarding the deformation of soft tissues during the needle insertion procedure.Traditional mechanical-based models such as the finite element method(FEM)are widely used to compute the deformations of soft tissue.However,it is difficult for the FEM or other methods to find a balance between an acceptable image fidelity and real-time deformation feedback due to their complex material properties,geometries and interaction mechanisms.In this paper,a Kriging-based method is applied to model the soft tissue deformation to strike a balance between the accuracy and efficiency of deformation feedback.Four combinations of regression and correlation functions are compared regarding their ability to predict the maximum deformations of ten characteristic markers at a fixed insertion depth.The results suggest that a first order regression function with Gaussian correlation functions can best fit the results of the ground truth.The functional response of the Kriging-based method is utilized to model the dynamic deformations of markers at a series of needle insertion depths.The feasibility of the method is verified by investigating the adaptation to step variations.Compared with the ground truth of the finite element(FE)results,the maximum residual is less than 0.92 mm in the Y direction and 0.31 mm in the X direction.The results suggest that the Kriging metamodel provides real-time deformation feedback for a target and an obstacle to a SPS.

An effective algorithm for needle tip displacement compensation in robot-assisted percutaneous surgery

This paper presents an automatic compensation algorithm for needle tip displacement in order to keep the needle tip always fixed at the skin entry point in the process of needle orientation in robot-assisted percutaneous surgery. The algorithm, based on a two-degree-of-freedom （2-DOF） robot wrist （not the mechanically constrained remote center of motion （RCM） mechanism） and a 3-DOF robot ann, firstly calculates the needle tip displacement caused by rotational motion of robot wrist in the arm coordinate frame using the robotic forward kinematics, and then inversely compensates for the needle tip displace- ment by real-time Cartesian motion of robot arm. The algorithm achieves the function of the RCM and eliminates many mechanical and virtual constraints caused by the RCM mechanism. Experimental result demonstrates that the needle tip displacement is within 1 inm in the process of needle orientation.

Comparison of Gluteal Muscle Intramuscular Injection Sites of Japanese Healthy Subjects: Considerations for Optimal Insertion of Injection Needle Length

Long Acting Injectable (LAI) medications for patients with schizophrenia is commonly administered to relieve their symptoms. Through shared decision-making and clinical evidence-based, psychiatrists should systematically offer LAIs to all patients requiring long-term antipsychotic treatment as a first-line treatment. Gluteal intramuscular (IM) injection requires accurate insertion of needles into the specific muscle area, often the outer upper quadrant of the buttocks, in order to achieve the required blood concentration. The purposes of this study were to compare the “Distance from the Epidermis to the Under-Fascia (DEUF)” and “Distance from the Epidermis to the Iliac Bone (DEB)” of the buttocks IM injection sites at the dorsogluteal and ventrogluteal sites among healthy Japanese volunteer subjects, and to identify the optimal insertion injection needle length. The DEUF and DEB at the gluteal regions were measured by ultrasonography. Welch’s one-way analysis of variance was used to compare the DEUF and the DEB at the gluteal IM injection regions. There was no statistically significant difference observed between the right and left mean values of DEUF for Hochstetter and Clark’s point at the ventrogluteal sites, and the Four and Three-way split or Double Cross point at the dorsogluteal sites. However in the DEB, the Hochstetter’s point (P < 0.01) at ventrogluteal site on the right side, and Clark’s point (P < 0.05) were significantly shorter than the Double Cross point at dorsogluteal sites (F = 4.38). The left buttocks Hochstetter’s point was significantly shorter than the Double Cross point (F = 4.38, P < 0.01). These results, however, did not establish a statistically significant difference in the DEUF among injection sites. It was considered that the difference in the DEB depended on muscle volume and thickness in the gluteal injection sites.

Fuzzy control method to minimize the needle deflection during needle insertion therapy

A fuzzy control algorithm is adopted to help the needle hit the target more accurately. The experimental setup for the needle insertion is built up to validate the algorithm. How the forces dur- ing the insertion make the needle deflect away from the planned path is given, and the normal meth- od correcting the deflection is obtained accordingly. Because the normal method cannot perform well for correction, a fuzzy controller is established. The input module, output module, fuzzification module, defuzzification module and inference engine for the controller are given respectively accord- ing to the fuzzy theory. Our experimental results show that the fuzzy controlling system presenting in the paper can better eliminate the deflection.

Method with repeated extraction-insertion cycles to im prove the needle insertion accuracy

In order to improve the effectiveness of percutaneous diagnosis and therapies, the needle insertion into the deforming soft and inhomogenous tissue should be accurate. In this study a needle with 6 degrees of freedom force/torque sensor is used to find the relationship between the pathway＇s length and the force. Our experiments show that the method with repeated extraction-insertion cy- cles can make the needle approach the target as much as possible. Meanwhile a method to obtain the appropriaterepeated extraction-insertion cycles is given to drive the needle to execute the repeat- ed cycles efficiently. Experiments and discussions were conducted to preliminarily validate the meth- od.

Sensitivity of Influential Factors on Needle Insertion Experiments:A Quantitative Analysis on Phantom Deformations and Needle Deflections

High repeatability of needle insertion experiments is essential to the needle-phantom interaction model validation.However,the influential factors governing the accuracy of the phantom and needle deformations have not been systematically studied.In this paper,the impact of influential factors,including phantom characteristic represented by the ratio of DMSO and thawing time(TT),needle properties represented by needle external diameter(NED)and operating factors such as needle insertion velocity(IV),insertion positions(IP)and repeated insertion times(RITs)are analyzed by orthogonal experiment design.The range calculation shows the most sensitive parameters to phantom deformations are RITs,IV and DMSO while the most sensitive parameters to needle deflection are DMSO,TT and NED.By variance analysis,the significant factors on maximum tissue deformation(MTD)are IV,followed by RITs,DMSO and IP.And NED and TT have nearly no significant impact on MTD.The significant sequence on maximum needle deflection(MND)is as follows:DMSO,TT and NED.Results show that,among all impacting factors,phantom deformation is susceptible to both material properties and operative factors while the needle deflection is more susceptible to material properties of the phantom,which can help researchers in related fields to conduct experiments in a more precise manner and better understand the needle-phantom interaction mechanism.

Optimal needle insertion length for intramuscular injection of risperidone long-acting injectable (RLAI)

Risperidone long-acting injectable (RLAI) is approved for the treatment of schizophrenia in many countries. The suggested site is the gluteal muscle with a needle length of two inches (50 mm) in Japan, which is longer than the ordinarily used needle for intramuscular injections. The aim of this study was to determine the optimal needle insertion length for accurate delivery of RLAI procedure among subjects who have normal body mass index (BMI: 18 to 25) and high BMI (>25). Thirty-seven patients with schizophrenia were administered RLAI intramuscularly into the dorsogluteal muscle. The standard procedure required inserting 80% of the two inch needle. By using data collected by ultrasonography, the findings confirmed that the median needle insertion lengths for subjects with normal and high BMI were 39.0 and 45.5 mm, respectively. To deliver RLAI effectively and safely, the authors strongly recommend that a specialized needle be used that is “marked” at the 40 mm point from the tip of the needle to the base. In this way regardless of subcutaneous fat content, the RLAI can be safely delivered into the muscle without causing untoward or side effects.

Effects of Depth of Needle Insertion with Risperidone Long-Acting Injectable in Persons with Schizophrenia: A Randomized Double-Blind Study

In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is deeper than anticipated, needle penetration may cause damage to nerves, arteries and veins. Few clinical studies were done to evaluate the depth of needle length insertion reaching the intended gluteal muscle. The aim of this study was to evaluate the suitable depth of injecting RLAI. Twenty-six patients with schizophrenia were treated with RLAI, and randomly divided into two groups: 50 mm needle inserted group (Group-D, deep insertion, n = 13) and 20 mm needle insertion group (Group-S, shallow insertion, n = 13). For Group-S, the needle length was marked with a spacer at exactly 20 mm. Injections were performed by the psychiatrist or nurse, alternating between the two gluteal sites by double-cross method every two weeks. Clinical psychotic symptoms and injection site reactions were recorded throughout the study period. Experienced psychologists who were blinded from the needle-length experimental variable evaluated patients’ psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS) every two weeks. The plasma 9-hydroxyrisperidone (9-OH-RIS) concentrations were measured every two weeks;comparison data were determined on the 8th week and the 14th week. No significant difference was observed in 9-OH-RIS concentrations, psychotic symptoms, injection site skin reactions of subjects in both groups. However, in Group-D, injection site adverse reactions were confirmed in two subjects (15%). In Group-S, injection site reactions were confirmed in six subjects (46%). Although effective 9-OH-RIS concentrations were obtained with the insertion using both depth, it was concluded that the 50 mm insertion length was more suitable for dorsogluteal IM injections in adult patients with schizophrenia as demonstrated by the incidence of local adverse skin reactions.

Differential Insertion Depths of Filiform Needle, Concept and Application

In this paper, the background, evolution, basic meaning, clinical application and the detail operating procedures of the differential insertion depth in filiform needle acupuncture were discussed based on the classical expositions of the Yellow Emperor’s Canon of Medicine. It is believed that the differential insertion depth reflects the basic idea of expelling the evil Qi from the body in the application of traditional acupuncture. Since the site of evil invasion has different shades, the position of evil Qi and correct differentiation has become the operation key points of needle insertion. Apart from this, the Yellow Emperor’s Canon of Medicine has further associated the clinical application of filiform needle insertion depth with the seasonal change of Yin and Yang, the body built of the patients, the nature of the diseases, the heat or cold pathogenic factors of the illness, the excess and deficiency of the patient, and the reinforcing and reducing function of acupuncture. These elaborations have greatly enriched the basic content of acupuncture and laid a systematic theoretical foundation of filiform needle operation. The differential insertion depth in acupuncture has its specific meaning, the emphasis of insertion depth of filiform needle with its differentiated clinical implication exemplifies the perceptual thinking features of traditional acupuncture and typical reveals the uniqueness of Chinese civilization.

Important Issues of Needle Insertion into Soft Tissue

Needle insertion procedures have been gaining in popularity with medical communities and patients over the recent years.Currently,their applications span a wide range of diagnostic and therapeutic procedures and there is still a growing tenden?cy toward integrating needle insertion into other procedures and surgeries.Its less invasive nature,which is performed locally on the body,largely explains this growing trend.This results in less intraoperative tissue damage and shorter post-operative recovery time.Many procedures like biopsy,deep brain stimulation,and cancer treatments are done using needles/eatheters.However,despite all the advantages of needle insertion procedures,the inherent complications resulting from them,such as tissue deformation,needle deflection,tissue inhomogeneity,patient variability,and associated uncertainty,can hardly be missed.Therefore,a needle insertion procedure requires that we address promising aspects and associated concerns.Against this backdrop,this paper provides a review of some of the main issues associated with a generic needle insertion procedure.

Five-plane lancet needle design for soft PVC phantom tissue cutting

Lancet needle, having three planes at the tip to generate a sharp lancet point, is the most common needle tip geometry and used for medical procedures. This research presents two five-plane lancet needle designs, the five-plane lancet needle with two back bevels （FLN-B） and five-plane lancet needle with two front bevels （FLN-F）, to study the effects of two additional bevel planes on the reduction of soft tissue cutting force. Mathematical models to calculate the inclination angle and rake angle along the cutting edges of FLN-B and FLN-F are developed. By using the grinding process, the prototype FLN-B and FLN-F needles are fabricated. And their inclination and rake angles along the cutting edges are investigated and compared to that of regular lancet needle. Needles insertion tests were conducted on soft PVC phantom which mimics the soft tissue. The initial peak insertion force and steady-state cutting force during needle insertion were identified, and the effect of cutting edge on needle soft tissue cutting force was studied. Compared to lancet needle, FLN-B and FLN-F both have higher inclination and rake angles at the tip cutting edge, could reduce the initial peak needle insertion force and tissue cutting forces, and thus can efficiently cut the soft tissue for medical applications.

分期取穴针刺法结合表面肌电生物反馈对脑卒中后吞咽障碍患者吞咽功能的影响

目的探讨分期取穴针刺法结合表面肌电生物反馈(sEMGBF)对脑卒中后吞咽障碍患者吞咽功能的影响。方法选择郑州市第十五人民医院在2021年1月至2023年1月收治的80例脑卒中后吞咽障碍患者作为研究对象,将其随机划分为观察组和对照组,各40名。对照组给予sEMGBF法治疗,观察组在对照组基础上给予分期取穴针刺法治疗。比较两组洼田饮水试验(WST)、表面肌电图(sEMG)检测结果、吞咽疗效、吞咽功能、生活质量。结果治疗后,两组患者WST分级均明显改善,且观察组优于对照组,差异有统计学意义(P<0.05);与治疗前比较,两组患者sEMG平均波幅升高,且观察组高于对照组,差异有统计学意义;两组患者吞咽时限降低,且观察组低于对照组,差异有统计学意义(P<0.05);观察组疗后有效率显著高于对照组,差异有统计学意义(P<0.05);与治疗前比较,两组患者SSA评分均降低,且观察组降低幅度更大,差异有统计学意义(P<0.05);两组患者较治疗前SWAL-QOL评分均升高,且观察组上升幅度更大,差异有统计学意义(P<0.05)。结论对脑卒中后吞咽障碍患者给予分期取穴针刺法结合表面肌电生物反馈治疗,可明显改善患者吞咽功能,提高生活质量,获得良好恢复效果,值得应用。

1000 CASES OF MUMPS TREATED WITH EAR NEEDLING ON PINGJIAN POINT (MA-T2)

Since 1968,we have treated over 1000 casesof infantile mumps with ear needling on Pingjianpoint(MA-T2)with satisfactory result.The re-port is as follows.

A study to investigate needle insertion at Shenshu(BL23) to puncture psoas major muscle

OBJECTIVE： It is unknown whether the psoas major muscle, thought to be a key muscle for treatment of lower back pain, can be punctured at Shenshu（BL23）.METHODS： Twelve dissected specimens were used for studying the needling pathway of BL23 by perpendicularly inserting the depth-measuring blade of a vernier caliper at BL23. Dimensions of psoas muscle were measured. Correlation studies were conducted. In addition, our samples were grouped by gender and underlying medical conditions for analysis.RESULTS： Half（50%） of the needle insertions successfully punctured psoas muscle. The mean depth of needle insertion to puncture psoas muscle（D_（min）） in the group with short-term underlying medical conditions was 38.0 mm（interquartile range 29.0–51.8 mm）, approximately 6 mm deeper than 32.0（29.3–42.5） mm in the group with long-term health problems（P = 0.041）. The cross-sectional area（CSA） of psoas muscle in the former group was on average approximately 1.5 times that of the latter group（P = 0.04）. When the data were analysed by gender, the thickness of psoas muscle in the male group was 19.0（6.5–24.0） mm compared to 19.5（5.8–34.8） mm in the female group（P = 0.02）. The age in the female group（P = 0.04） and the body length of the total group（P = 0.04） negatively correlated to D_（min）.CONCLUSION： Needle insertion at BL23 might be able to puncture psoas muscle. Differences in the CSA of psoas muscle and D_（min） were observed in groups with short-term and long-term underlying medical conditions.

基于Langer线的穿刺体位对肿瘤化疗患者输液港难免性医用黏胶相关皮肤损伤的预防效果研究

目的探究基于Langer线的无损伤针穿刺体位对肿瘤化疗患者输液港难免性黏胶相关皮肤损伤的预防效果。方法通过平行胸部Langer线对床头抬高60~90°和平卧位穿刺进行皮肤软组织力学、表皮屏障功能理论分析,然后选取2019年5月至2020年5月南京医科大学第一附属医院肿瘤科79例植入胸壁输液港、既往应用Ⅳ3000及液体敷料皮肤保护性屏障仍出现输液港黏胶相关性皮肤损伤的患者为研究对象。采用前瞻性自身前后对照,干预前采用平卧位穿刺,干预后床头抬高60~90°穿刺,比较两种穿刺体位对输液港黏胶相关性皮肤损伤预防效果和带针期间舒适度的影响。结果干预后患者输液港黏胶相关性皮肤相关性损伤总发生率较干预前显著降低(P<0.001),机械性损伤发生率、接触性皮炎发生率较干预前显著降低(均P<0.05),输液港带针期间舒适度较干预前明显提高(P<0.001),且不增加患者穿刺时的疼痛感(P=0.692)。结论床头抬高60~90°穿刺可降低肿瘤化疗患者输液港难免性黏胶相关皮肤损伤,提高患者带针期间的舒适度。

基于立体结构与刺法的腧穴观探析

腧穴是一个三维立体的结构,临床应用时往往需要针具以一定的角度刺入腧穴一定的深度,而刺激到不同层次的组织结构,从而发挥不同的临床效应。文章通过经典文献回顾、不同深浅/角度针刺的穴效关系临床研究和不同刺法的穴效关系机制研究等方面,探讨腧穴的不同组织结构对腧穴效应的影响。并提出理解腧穴主治时,需基于腧穴的立体结构与刺法,具体表述其同一腧穴不同刺法刺激到不同的组织结构可治疗的具体病症,以期进一步加深对腧穴的认识。

单边双针双线摆动缝合轨迹设计及实验验证

针对单边双针双线缝合头插刺机构无法缝制3 mm以上厚度预制体的问题,提出一种不对称的8字形运动轨迹并对插刺机构的运动轨迹进行了设计。首先,基于单边双针双线缝合工艺对插刺机构运动学进行分析,确定摆动插刺机构各构件的尺寸;其次,在ADAMS中构建机构模型并进行轨迹分析;最后,通过实验样机进行缝合实验。实验结果表明,设计的缝合机构可将实际缝合厚度不足3 mm提高到8 mm,并在缝合过程中形成稳定线环,验证了不对称8字形缝合工艺及摆动插刺机构的可靠性。

安全型无损伤针二步结构式垂直固定法在输液港插针中的应用

目的:探讨安全型无损伤针二步结构式垂直固定法在输液港插针中的应用效果。方法:采用便利抽样法,选取南京市某三级甲等医院130例应用输液港的病人,按入院时间进行分组,2021年1月—3月入院的65例应用输液港病人作为对照组,采用常规固定方式进行插针;2021年4月—5月入院的65例应用输液港病人作为试验组,采用安全型无损伤针二步结构式垂直固定法进行插针。比较两组病人一次插针成功率、垂直插针率、穿刺时疼痛评分和插针用时等。结果:试验组一次插针成功率(96.92%)高于对照组(76.92%);试验组垂直插针率(95.38%)高于对照组(66.15%),差异均有统计学意义(P<0.05)。试验组疼痛评分[(1.26±0.44)分]低于对照组[(1.58±0.68)分],差异有统计学意义(P<0.05)。两组插针用时比较,差异无统计学意义(P>0.05)。结论:安全型无损伤针二步结构式垂直固定法能提高输液港一次插针成功率及垂直插针率,降低病人疼痛程度。