Person: Kesner, Samuel
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Kesner
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Samuel
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Kesner, Samuel
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Publication Robotic Catheters for Beating Heart Surgery(2012-12-12) Kesner, Samuel; Howe, Robert D.; Wood, Robert; Slocum, Alexander; Dupont, PierreCompliant and flexible cardiac catheters provide direct access to the inside of the heart via the vascular system without requiring clinicians to stop the heart or open the chest. However, the fast motion of the intracardiac structures makes it difficult to modify and repair the cardiac tissue in a controlled and safe manner. In addition, rigid robotic tools for beating heart surgery require the chest to be opened and the heart exposed, making the procedures highly invasive. The novel robotic catheter system presented here enables minimally invasive repair on the fast-moving structures inside the heart, like the mitral valve annulus, without the invasiveness or risks of stopped heart procedures. In this thesis, I investigate the development of 3D ultrasound-guided robotic catheters for beating heart surgery. First, the force and stiffness values of tissue structures in the left atrium are measured to develop design requirements for the system. This research shows that a catheter will experience contractile forces of 0.5 – 1.0 N and a mean tissue structure stiffness of approximately 0.1 N/mm while interacting with the mitral valve annulus. Next, this thesis presents the catheter system design, including force sensing, tissue resection, and ablation end effectors. In order to operate inside the beating heart, position and force control systems were developed to compensate for the catheter performance limitations of friction and deadzone backlash and evaluated with ex vivo and in vivo experiments. Through the addition of friction and deadzone compensation terms, the system is able to achieve position tracking with less than 1 mm RMS error and force tracking with 0.08 N RMS error under ultrasound image guidance. Finally, this thesis examines how the robotic catheter system enhances beating heart clinical procedures. Specifically, this system improves resection quality while reducing the forces experienced by the tissue by almost 80% and improves ablation performance by reducing contact resistance variations by 97% while applying a constant force on the moving tissue.Publication Assured Safety Drill With Bi-Stable Bit Retraction Mechanism(ASME, 2013-08-04) Loschak, Paul; Xiao, Kechao; Pei, Hao; Kesner, Samuel; Thomas, Ajith; Walsh, ConorA handheld, portable cranial drilling tool for safely creating holes in the skull without damaging brain tissue is presented. Such a device is essential for neurosurgeons and mid-level practitioners treating patients with traumatic brain injury. A typical procedure creates a small hole for inserting sensors to monitor intra-cranial pressure measurements and/or removing excess fluid. Drilling holes in emergency settings with existing tools is difficult and dangerous due to the risk of a drill bit unintentionally plunging into brain tissue. Cranial perforators, which counter-bore holes and automatically stop upon skull penetration, do exist but are limited to large diameter hole size and an operating room environment. The tool presented here is compatible with a large range of bit diameters and provides safe, reliable access. This is accomplished through a dynamic bi-stable linkage that supports drilling when force is applied against the skull but retracts upon penetration when the reaction force is diminished. Retraction is achieved when centrifugal forces from rotating masses overpower the axial forces, thus changing the state of the bi-stable mechanism. Initial testing on ex-vivo animal structures has demonstrated that the device can withdraw the drill bit in sufficient time to eliminate the risk of soft tissue damage. Ease of use and portability of the device will enable its use in unregulated environments such as hospital emergency rooms and emergency disaster relief areas.Publication Robotic catheter cardiac ablation combining ultrasound guidance and force control(SAGE Publications, 2014) Kesner, Samuel; Howe, RobertCardiac catheters allow physicians to access the inside of the heart and perform therapeutic interventions without stopping the heart or opening the chest. However, conventional manual and actuated cardiac catheters are currently unable to precisely track and manipulate the intracardiac tissue structures because of the fast tissue motion and potential for applying damaging forces. This paper addresses these challenges by proposing and implementing a robotic catheter system that uses 3D ultrasound image guidance and force control to enable constant contact with a moving target surface in order to perform interventional procedures, such as intracardiac tissue ablation. The robotic catheter system, consisting of a catheter module, ablation and force sensing end effector, drive system, and image-guidance and control system, was commanded to apply a constant force against a moving target using a position-modulated force control method. The control system uses a combination of position tracking, force feedback, and friction and backlash compensation to achieve accurate and safe catheter–tissue interactions. The catheter was able to maintain a 1 N force on a moving motion simulator target under ultrasound guidance with 0.08 N RMS error. In a simulated ablation experiment, the robotic catheter was also able to apply a consistent force on the target while maintaining ablation electrode contact with 97% less RMS contact resistance variation than a passive mechanical equivalent. In addition, the use of force control improved catheter motion tracking by approximately 20%. These results demonstrate that 3D ultrasound guidance and force tracking allow the robotic system to maintain improved contact with a moving tissue structure, thus allowing for more accurate and repeatable cardiac procedures.Publication Position Control of Motion Compensation Cardiac Catheters(Institute of Electrical & Electronics Engineers (IEEE), 2011) Kesner, Samuel; Howe, RobertRobotic catheters have the potential to revolutionize cardiac surgery by enabling minimally invasive structural repairs within the beating heart. This paper presents an actuated catheter system that compensates for the fast motion of cardiac tissue using 3-D ultrasound image guidance. We describe the design and operation of the mechanical drive system and catheter module and analyze the catheter performance limitations of friction and backlash in detail. To mitigate these limitations, we propose and evaluate mechanical and control-system compensation methods, which include inverse and model-based backlash compensation, to improve the system performance. Finally, in vivo results are presented, which demonstrate that the catheter can track the cardiac tissue motion with less than 1-mm rms error. The ultimate goal of this research is to create a fast and dexterous robotic catheter system that can perform surgery on the delicate structures inside of the beating heart.Publication Design of a Motion Compensated Tissue Resection Catheter for Beating Heart Cardiac Surgery(ASME International, 2011) Kesner, Samuel; Howe, RobertCardiac catheters allow clinicians to minimally invasively interact with the beating heart without stopping the heart or opening the chest. However, the fast motion of the intracardiac structures makes it difficult to modify and repair the tissue in a controlled and safe manner. To enable surgical procedures on the inside of the beating heart, we have developed an ultrasound-guided catheter system that virtually freezes the heart by compensating for the fast cardiac motions. The device presented in this paper is a resection tool that allows the catheter system to cut moving tissue, a key surgical task required for many intracardiac procedures including valve and leaflet repair. The motion tracking system is demonstrated in vivo and the tissue resection tool is evaluated by resecting tissue mounted on a cardiac motion simulator. The motion compensated catheter is shown to greatly improve the resection cut quality on the moving tissue target while reducing the forces experienced by the tissue by almost 80%Publication Ultrasound Servoing of Catheters for Beating Heart Valve Repair(Springer Verlag, 2010) Kesner, Samuel; Yuen, Shelten G.; Howe, RobertRobotic cardiac catheters have the potential to revolutionize heart surgery by extending minimally invasive techniques to complex surgical repairs inside the heart. However, catheter technologies are currently unable to track fast tissue motion, which is required to perform delicate procedures inside a beating heart. This paper presents an actuated catheter tool that compensates for the motion of heart structures like the mitral valve apparatus by servoing a catheter guidewire inside a flexible sheath. We examine design and operation parameters and establish that friction and backlash limit the tracking performance of the catheter system. Based on the results of these experiments, we implement compensation methods to improve trajectory tracking. The catheter system is then integrated with an ultrasound-based visual servoing system to enable fast tissue tracking. In vivo tests show RMS tracking errors of 0.77 mm for following the porcine mitral valve annulus trajectory. The results demonstrate that an ultrasound-guided robotic catheter system can accurately track the fast motion of the mitral valve.Publication Force control of flexible catheter robots for beating heart surgery(Institute of Electrical and Electronics Engineers, 2011) Kesner, Samuel; Howe, RobertRecent developments in cardiac catheter technology promise to allow physicians to perform most cardiac interventions without stopping the heart or opening the chest. However, current cardiac devices, including newly developed catheter robots, are unable to accurately track and interact with the fast moving cardiac tissue without applying potentially damaging forces. This paper examines the challenges of implementing force control on a flexible robotic catheter. In particular, catheter friction and backlash must be compensated when controlling tissue interaction forces. Force controller designs are introduced and evaluated experimentally in a number of configurations. The controllers are based on the inner position loop force control approach where the position trajectory is adjusted to achieve a desired force on the target. Friction and backlash compensation improved force tracking up to 86% with residual RMS errors of 0.11 N while following a prerecorded cardiac tissue trajectory with accelerations of up to 3800 mm/s\(^2\). This performance provides sufficient accuracy to enable a wide range of beating heart surgical procedures.Publication Design considerations for an active soft orthotic system for shoulder rehabilitation(IEEE, 2011) Kesner, Samuel; Jentoft, Leif; Hammond, Frank; Howe, Robert; Popovic, MarkoStrokes affect over 750,000 people annually in the United States. This significant and disabling condition can result in paralysis that must be treated by regular sessions with a dedicated physical therapist in order to regain motor function. However, the use of therapists is expensive, in high demand, and requires patient travel to a rehabilitation clinic. We propose an inexpensive and wearable upper body orthotics system that can be used at home to provide the same level of rehabilitation as the current physical therapy standard of care. The system is composed of a soft orthotic device with an integrated cable actuation system that is worn over the upper body, a limb position sensing system, and an actuator package. This paper presents initial design considerations and the evaluation of a proof of concept system for shoulder joint rehabilitation. Through simulations and experimental evaluation, the system is shown to be adjustable, easily wearable, and adaptable to misalignment and anatomical variations. Insights provided by these initial studies will inform the development of a complete upper body orthotic system.Publication Design Principles for Rapid Prototyping Forces Sensors Using 3-D Printing(Institute of Electrical and Electronics Engineers (IEEE), 2011) Kesner, Samuel; Howe, RobertForce sensors provide critical information about robot manipulators, manufacturing processes, and haptic interfaces. Commercial force sensors, however, are generally not adapted to specific system requirements, resulting in sensors with excess size, cost, and fragility. To overcome these issues, 3-D printers can be used to create components for the quick and inexpensive development of force sensors. Limitations of this rapid prototyping technology, however, require specialized design principles. In this paper, we discuss techniques for rapidly developing simple force sensors, including selecting and attaching metal flexures, using inexpensive and simple displacement transducers, and 3-D printing features to aid in assembly. These design methods are illustrated through the design and fabrication of a miniature force sensor for the tip of a robotic catheter system. The resulting force sensor prototype can measure forces with an accuracy of as low as 2% of the 10 N measurement range.Publication Discriminating tissue stiffness with a haptic catheter: Feeling the inside of the beating heart(Institute of Electrical and Electronics Engineers, 2011) Kesner, Samuel; Howe, RobertCatheter devices allow physicians to access the inside of the human body easily and painlessly through natural orifices and vessels. Although catheters allow for the delivery of fluids and drugs, the deployment of devices, and the acquisition of the measurements, they do not allow clinicians to assess the physical properties of tissue inside the body due to the tissue motion and transmission limitations of the catheter devices, including compliance, friction, and backlash. The goal of this research is to increase the tactile information available to physicians during catheter procedures by providing haptic feedback during palpation procedures. To accomplish this goal, we have developed the first motion compensated actuated catheter system that enables haptic perception of fast moving tissue structures. The actuated catheter is instrumented with a distal tip force sensor and a force feedback interface that allows users to adjust the position of the catheter while experiencing the forces on the catheter tip. The efficacy of this device and interface is evaluated through a psychophyisical study comparing how accurately users can differentiate various materials attached to a cardiac motion simulator using the haptic device and a conventional manual catheter. The results demonstrate that haptics improves a user's ability to differentiate material properties and decreases the total number of errors by 50% over the manual catheter system.