Medical Robotics

This white paper presents a conceptual governance architecture for applying Execution Governance 2.0 and Execution Governance 2.1 to nuclear and critical energy systems, including nuclear monitoring and decision support, grid control, renewable energy optimization, storage systems, and microgrid automation.

The paper argues that as critical energy systems become increasingly digital, automated, and, in some domains, more autonomous, governance should not focus only on model output, access control, cybersecurity, design-time safety, or post-event audit. Instead, high-consequence energy actions require an execution-boundary governance layer that asks whether a specific proposed action may become real now, under current authority, admissibility, continuity, safety, integrity, and auditability conditions.

The paper instantiates key Execution Governance concepts for the energy domain, including structural admissibility, authority anchoring, continuity preservation, continuity verification, valid-looking drift detection, degraded-state governance, emergency governance mode, no-committed-effect outcomes, and auditable governance records.

The paper is a conceptual research contribution. It does not propose to replace nuclear safety standards, reactor protection systems, engineered safety features, licensed operator authority, safety cases, grid reliability frameworks, regulatory approval processes, or site-specific operating procedures. It is not a nuclear safety standard, engineering deployment manual, licensing submission, operating procedure, or technical implementation specification.

A desktop haptic device is used to teleoperate an industrial redundant and compliant robotic arm with a surgical instrument mounted on its end-effector. The master and slave devices are coupled in a bilateral position-position architecture. Force feedback is provided by the master haptic device to the user, from the position of the slave's wrist. A surgical task (palpation) that involves force feedback is presented and tested in a user study with surgeons and non-medical participants. Results show that users easily discern between three different materials during palpation given minimal familiarisation time. Active constraint enforcement is also integrated with the system as a sensitive area around the palpation samples which the slave instrument is prohibited to enter.

Purpose: Recent developments in robotics and artificial intelligence (AI) have led to significant advances in healthcare technologies enhancing robot-assisted minimally invasive surgery (RAMIS) in some surgical specialties. However, current human–robot interfaces lack intuitive teleoperation and cannot mimic surgeon’s hand/finger sensing required for fine motion micro-surgeries. These limitations make teleoperated robotic surgery not less suitable for, e.g. cardiac surgery and it can be difficult to learn for established surgeons. We report a pilot study showing an intuitive way of recording and mapping surgeon’s gross hand motion and the fine synergic motion during cardiac micro-surgery as a way to enhance future intuitive teleoperation. Methods: We set to develop a prototype system able to train a Deep Neural Network (DNN) by mapping wrist, hand and surgical tool real-time data acquisition (RTDA) inputs during mock-up heart micro-surgery procedures. The trained network was used to...

Embodied Artificial Intelligence-the integration of AI with physical robotic systems-is rapidly transitioning from laboratory research to real-world deployment. From humanoid robots in industrial settings to autonomous vehicles and domestic service robots, these systems are increasingly capable of initiating physical actions that directly impact human safety, property, and public space. However, a critical governance gap remains: the implicit conflation of a motion plan's feasibility in principle with the authority to execute that plan as physical action under dynamically changing conditions.

Medical systems-including surgical robots, AI-based diagnostics, implantable devices, infusion pumps, and closed-loop drug delivery platforms-are undergoing a fundamental transition from assistive tools to autonomous, execution-bound actors with direct and often irreversible consequences for patient physiology. This transition exposes a critical governance gap: the implicit conflation of a system's capability to generate a clinical decision with the authority to commit that decision to real-world effect. This white paper proposes a structural architecture for Execution Governance (EG) in medical systems, fully aligned with the EG 2.0 v1.4 and EG 2.1 doctrinal frameworks. It introduces a dedicated governance layer that enforces a non-bypassable boundary between clinical intelligence and physical execution. The architecture operationalizes structural admissibility-defining what may become an executable clinical candidate-and ensures continuity preservation from intent to effect. Critically, it extends EG 2.1's continuity verification to address valid-looking drift (VLD) in clinical contexts, where a system may satisfy all local, real-time safety checks while its trajectory silently diverges from the authoritative, admissible space defined by medical policy, anatomical constraints, or physiological safety envelopes. The framework integrates authority-anchored admissibility definition, constraint invariance during formation, continuity verification, and commit semantics that guarantee no committed effect on the patient or clinical workflow upon governance failure. It provides a conformance framework, a maturity model for adoption, and explicit mechanisms for degraded-state governance and emergency overrides. This paper establishes a vendor-neutral, cross-domain doctrine instantiated for the high-consequence domain of healthcare, aiming to provide a structural foundation for accountable, verifiable, and resilient autonomous medical action.

Instrumented spinal fusion surgery is increasingly performed in the treatment of degenerative disorders, Spondylolisthesis, deformity, trauma and tumors affecting the spine (Davis, 1994;. In-vitro and In-vivo studies using the free hand or fluoroscopically assisted techniques documented breaching of the pedicle in 3-55% (

The introduction of telemanipulator systems into cardiac surgery enables the heart surgeon to perform sophisticated mini-invasive and endoscopic procedures with high precision under stereoscopic view. At present, the commercially available robotic surgical systems do not dispose of force feedback for the operating surgeon. The lack of haptic (force or tactile) feedback causes damage of tissue and bending or breaking of suture material. For further improvement of telemanipulated systems, we implemented haptic into a realistic experimental platform to evaluate force-feedback for robotic heart surgery.

A popular method for an easy and also flexible programming of robots is learning by demonstration. An intelligent controller learns a task from several examples carried out by an experienced user. Afterwards, the task can be adapted to new, formerly unknown environments. One particular challenge arising with this technique is generalization of demonstrations in order to get a generic description of the task. In this paper a new methodology for solving this problem is proposed. The main part of the algorithm exploits principles known from fluid dynamics.

Smart laparoscope device was developed and integrated into the ROBIN HEART surgery robot system. Miniaturised silicon based force sensors were developed and integrated into laparoscope tweezers for the special applications. Different sensors were applied to detect tactile information at the tip of the laparoscope and to measure the clamping force between the tweezers. Preliminary tests were accomplished to evaluate the force and tactile signals of the integrated sensors during interventions. Tactile measurements were implemented on artificial and real animal tissues to prove the applicability of the device for biomechanical screening during Minimal Invasive Surgery.

Nano robotics is an emerging, advanced and multidisciplinary field that calls for scientific and technical expertise of medical, pharmaceutical, bio-medical, engineering as well as other applied and basic scientists. Nano robots differ from macro-world robots specifically in their Nano-sized constructs. Due to their small size and wide functional properties, nano robots have created exceptional prospects in medical, biomedical and pharmaceutical applications. Although, no technology is available to construct artificial nano robots, it is now possible to create nano robots by using biological means. Nanorobots, nano machines, and other nano systems are objects with overall dimensions at or below the micro meter range and are made of assemblies of nanoscale components with individual dimensions ranging approximately between 1 to 100 nm. Smaller the size, larger is the specific surface area and energy efficiency. This is the prime concept behind all micro or nanotechnology devices. Even though the nano robots have not yet been deployed in any commercial application with currently available science and technology, the ongoing intensity of research and development work tends to a brighter future where we expect number of miracles with such tiny nano machines. In this context a productive discussion has been carried out concerned with the future application as well as past-present research scenario of nano robotics.

In the last decade, the advancement of endoscopic and minimally invasive surgery has had a significant impact on patients and surgeons in various surgical fields. But in heart surgery the design of telemanipulators did not leverage endoscopic procedures. The focus is on building an experimental system for endoscopic and minimally invasive heart surgery which provides force feedback. In addition automating endoscopic surgical skills like knottying are implemented.

We present an open robot platform for minimally invasive surgery capable of very sensitive force feedback, which has been developed in very close cooperation with surgeons from cardiac surgery. Forces are measured at the surgical instruments and fed back into the surgeon's hands using multi-dimensional haptic styluses. Integration of force feedback with stereo vision, as offered by the system, will improve accuracy, drastically reduce the time needed for operations and tissue trauma, along with a reduction of stress on the surgeon. This could lead to a wider acceptance of robotic surgery by both, patients and surgeons. The system's software interface and mechanical set-up descriptions are freely available to enable other research groups to participate in the development.

The evaluation of the haptic feature for surgical tasks especially including the value of surgical experience for telemanipulation is presented. In an experimental telemanipulating surgical platform the amount of force in the dominant and non-dominant hand and its dependency on the surgical experience was examined.

Introduction
Postoperative ileus (POI) remains a common complication following robotic-assisted radical
prostatectomy (RARP), delaying recovery and increasing healthcare burden. Obesity and impaired
glycemic control are recognized contributors to poor postoperative outcomes. However, their role in
predicting POI, particularly in RARP, remains underexplored.
Method
A retrospective analysis was conducted on 200 patients who underwent RARP between January 2020
and December 2023. Preoperative variables included BMI, HbA1c, clinical T stage, PIRADS score,
prostate volume (MRI), and biopsy Gleason score. Optimal thresholds for BMI and HbA1c were
determined using ROC analysis and Youden’s J statistic. A six-point scoring system was developed
based on categorical cutoffs, with logistic regression and ROC analysis used to evaluate performance.
Results
The overall incidence of POI was 17%. Novel thresholds—BMI ≥31.0 kg/m² and HbA1c ≥8.0%—were
independently associated with higher POI risk. The additive score (range 0–6) showed progressive
increases in POI incidence with higher scores.
Conclusion
The resulting score offers a practical, bedside tool to support early risk stratification and preoperative
counseling. Its simplicity supports clinical integration, and future multicenter validation may enhance
predictive accuracy and expand its utility in enhanced recovery protocols.

Continuum manipulators are a rapidly emerging class of robots. However, due to the complexity of their mathematical models and modeling inaccuracies, the development of effective control systems is a particularly challenging task. This paper presents the first attempt on kinematic control of continuum manipulators using a fuzzymodel-based approach. A fuzzy controller is proposed for autonomous execution of end-effector trajectory tracking tasks for a continuum manipulator. Particularly, membership functions are employed to combine the linearized statespace models, to achieve, overall, a fuzzy model. The fuzzy model can help design the fuzzy controller; in our approach, this process is supported by a thorough stability analysis. This control methodology enables a solution with low computational requirements to this motion control problemthere is no need to continuously update the Jacobian of the continuum manipulator. The superior performance of this controller is validated in MATLAB simulations and compared with those of classical controllers found in the literature. The experiments on a rapid-prototyped continuum manipulator further verify the feasibility and the advantages of this fuzzy controller in the presence of modeling discrepancies and hardware inaccuracies.

Machines built at the molecular level (referred to as "nanomachines") may be utilized to treat the human body of its numerous diseases. Nanorobotics is the science of building machines or robots at or near the scale of a nanometre (10-9 meters). Nanomedicine is the term used to describe this application of nanotechnology to the field of medicine. Futurelooking uses for nanotechnology include minuscule robots that can build other machines, navigate inside the body to distribute drugs, or do microsurgery. Chemists are discovering how to use protein dynamics to power micro and nano size machines using catalytic processes, drawing inspiration from the biological motors of live cells. The toolkit for nanorobots includes items like a cavity for storing medication, probes, blades, and chisels to remove plaque and obstructions, microwave emitters, and ultrasonic signal generators to destroy cancerous cells, two electrodes generating an electric current, heating the cell up until it dies, powerful lasers could burn away harmful material like arterial plaque. A cream incorporating nanorobots that remove the proper amount of dead skin, remove excess oils, add missing oils, apply the right amounts of natural moisturizing ingredients, and even accomplish the elusive objective of "deep pore cleaning" may be utilized to treat skin problems. Other uses include the treatment of gout, kidney stones, gouty arthritis, parasite elimination, cancer treatment, and arteriosclerosis treatment.

This team description paper describes the approaches that will be taken by the UvA@Home team to compete in Standard Platform League with the Softbank Robotics Pepper. The research challenges concern person recognition, object recognition, natural language processing and navigation. Modules implemented so far include face recognition, speech recognition and natural language processing. The remaining challenges will be solved using the previous research and achievements of the UvA teams in the RoboCup.

TransRectal Ultrasound (TRUS) is used for image guidance during prostate biopsy and for treatment planning of brachytherapy due to low cost and accessibility in operating room. However, tumors have better visibility in Magnetic Resonance (MR) images. The fusion of TRUS and MR images of the prostate can aid with the diagnosis and treatment planning for prostate cancer and with post-brachytheraphy quality assurance. We developed a 3D deformable registration method using the segmentations obtained from TRUS and MR images and a biomechanical model that employs stiffness values derived from elastography. The segmented source volume is meshed and a linear finite element model is created for it. This volume is deformed to the target image volume by applying surface forces computed by assuming a negative relative pressure between the non-overlapping and the overlapping regions of the volumes. This pressure drives the model to increase the volume overlap until the surfaces are aligned. We tested our algorithm on prostate surfaces extracted from postoperative MR and TRUS images for 14 patients and pre-operative MR and TRUS images for 4 patients, using a model with elasticity within the range reported in the literature for the prostate. We used three evaluation metrics for validation: the Dice Similarity Coefficient (DSC) (ideally equal to 1.0), the volume change in source surface during registration, and the Target Registration Error (TRE) defined as the mean distance between landmarks such as urethrae and calcifications. For post-operative images, we obtained a DSC of 0.96±0.02 and a TRE of 1.5±1.4mm. The change in the volume of the source surface was 1.5±1.4%. For pre-operative images, we obtained the DSC of 0.96±0.01 and a TRE of 1.3±0.8mm. The change in the volume of the source surface was -0.9±0.2%. Our results show that this ii method is a promising tool for physically-based deformable surface registration. We also used our technique to register ultrasound strain images to free mount histo-pathology images with the goal of correlating cancer with areas of low strain. This was done using relative stiffness values derived from vibroelastography data. We also performed Computed Tomography (CT) and Ultrasound (US) kidney surface registration using this technique. iii 1

This article is intended as an introduction to and an overview of Pneumatic Artificial Muscles (PAMs). These are pneumatic actuators made mainly of a flexible and inflatable membrane. First, their concept and way of operation are explained. Next, the properties of these actuators are given, the most important of which are the compliant behavior and extremely low weight. A classification and review is following this section. Typical applications are dealt with in the last but one section and, finally, some concluding remarks are made.

A engenharia tecidual é um campo interdisciplinar voltado para desenvolvimento de estruturas biológicas que restaurem, mantenham ou melhorem funções teciduais. Dentre os componentes necessários para isso, há os arcabouços tridimensionais, estruturas criadas para suporte inicial das células e consequente formação de um tecido. Para avaliação do desempenho do arcabouço, é importante analisar características microestruturais como a porosidade, a interconectividade e o tamanho dos poros. Algumas técnicas como a microscopia eletrônica de varredura (MEV), picnometria e porosimetria de mercúrio, já vem sendo usadas para caracterizar os arcabouços. Todavia, alguns estudos mostraram a microtomografia computadorizada como padrão ouro para extrair informações detalhadas sem danificar a amostra em estudo. A Microtomografia Computadorizada de Raios X (microCT) é uma técnica não invasiva e apresenta uma alta resolução, contribuindo para análise e visualização tridimensional interna de vários tipos de amostras. Devido a essas vantagens, diversos pesquisadores vem estudando a microCT como técnica para caracterização de arcabouços para engenharia tecidual, visando obter informações mais apuradas a respeito da porosidade dessas estruturas, que irão influenciar diversos fatores como o desempenho biológico e as propriedades mecânicas das mesmas. O objetivo do trabalho consiste em apresentar a microCT como ferramenta de caracterização de arcabouços para engenharia tecidual e compará-la com outras técnicas utilizadas atualmente. Verificou-se que a microCT vem sendo utilizada na área para análises qualitativas e quantitativas, principalmente por conseguir visualizar poros cegos e área da seção transversal, sem utilizar elementos tóxicos ou sem destruir a amostra. Existem algumas desvantagens, que seriam pouca capacidade de absorção de raios-x em amostras de baixa densidade radiográfica. No entanto, apesar do crescente interesse em utilizar essa técnica, é possível perceber que muitos pesquisadores não a dominam por não ter relatórios com detalhes importantes sobre vários parâmetros da microestrutura e da utilização correta da microCT. Concluiu-se que a caracterização de arcabouços por microtomografia computadorizada é uma área que ainda está em desenvolvimento e com acesso limitado, porém vem ganhando destaque e tende a se tornar mais procurada e usada entre os pesquisadores para aplicação na engenharia tecidual.