J. Bloemberg
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1
Positioning a thin needle into a solid substrate near a target region is difficult because the needle can easily bend and buckle. Nevertheless, in nature, female parasitic wasps can do this by using buckling prevention and steering mechanisms. This study presents a self-propelled needle that incorporates wasp-inspired steering mechanisms, specifically, the use of pretension and asymmetry within the needle segments. The needle with an outer diameter of 0.89 millimeters comprises seven parallel needle segments, with the central needle segment being either straight for a forward trajectory or prebent for steering purposes. By retracting and rotating the prebent central needle segment, the needle is capable of omnidirectional steering. The performance of the needle in tissue-mimicking phantoms was evaluated in terms of its propulsion efficiency and steering performance. The propulsion efficiency, affected by slippage of the needle segments with respect to the tissue-mimicking phantoms, was, on average, 63% ± 4% for forward motion and 55% ± 7% for steering motion. Moreover, the needle successfully steered with a mean deflection-to-insertion ratio of 0.41 ± 0.11 (i.e., radius-of-curvature of 44 mm). The proposed bioinspired needle design is a relevant step toward developing steerable needles for percutaneous interventions.
...
Positioning a thin needle into a solid substrate near a target region is difficult because the needle can easily bend and buckle. Nevertheless, in nature, female parasitic wasps can do this by using buckling prevention and steering mechanisms. This study presents a self-propelled needle that incorporates wasp-inspired steering mechanisms, specifically, the use of pretension and asymmetry within the needle segments. The needle with an outer diameter of 0.89 millimeters comprises seven parallel needle segments, with the central needle segment being either straight for a forward trajectory or prebent for steering purposes. By retracting and rotating the prebent central needle segment, the needle is capable of omnidirectional steering. The performance of the needle in tissue-mimicking phantoms was evaluated in terms of its propulsion efficiency and steering performance. The propulsion efficiency, affected by slippage of the needle segments with respect to the tissue-mimicking phantoms, was, on average, 63% ± 4% for forward motion and 55% ± 7% for steering motion. Moreover, the needle successfully steered with a mean deflection-to-insertion ratio of 0.41 ± 0.11 (i.e., radius-of-curvature of 44 mm). The proposed bioinspired needle design is a relevant step toward developing steerable needles for percutaneous interventions.
Percutaneous pancreatic core biopsy is conclusive but challenging due to large-diameter needles, while smaller-diameter needles used in aspiration methods suffer from buckling and clogging. Inspired by the ovipositor of parasitic wasps, which resists buckling through self-propulsion and prevents clogging via friction-based transport, research has led to the integration of these functionalities into multi-segment needle designs or tissue transport system designs. This study aimed to combine these wasp-inspired functionalities into a single biopsy needle by changing the interconnection of the needle segments. The resulting biopsy needle features six parallel needle segments interconnected by a ring passing through slots along the length of the needle segments, enabling a wasp-inspired reciprocating motion. Actuation employs a cam and follower mechanism for controlled translation of the segments. The needle prototype, constructed from nitinol rods and stainless steel rings, measures 3 mm in outer diameter and 1 mm in inner diameter. Testing in gelatin phantoms demonstrated efficient gelatin core transport (up to 69.9% ± 9.1% transport efficiency) and self-propulsion (0.842 ± 0.042 slip ratio). Future iterations should aim to reduce the outer diameter while maintaining tissue yield. The design offers a promising new avenue for wasp-inspired medical tools, potentially enhancing early pancreatic cancer detection, thus reducing healthcare costs and patient complications.
...
Percutaneous pancreatic core biopsy is conclusive but challenging due to large-diameter needles, while smaller-diameter needles used in aspiration methods suffer from buckling and clogging. Inspired by the ovipositor of parasitic wasps, which resists buckling through self-propulsion and prevents clogging via friction-based transport, research has led to the integration of these functionalities into multi-segment needle designs or tissue transport system designs. This study aimed to combine these wasp-inspired functionalities into a single biopsy needle by changing the interconnection of the needle segments. The resulting biopsy needle features six parallel needle segments interconnected by a ring passing through slots along the length of the needle segments, enabling a wasp-inspired reciprocating motion. Actuation employs a cam and follower mechanism for controlled translation of the segments. The needle prototype, constructed from nitinol rods and stainless steel rings, measures 3 mm in outer diameter and 1 mm in inner diameter. Testing in gelatin phantoms demonstrated efficient gelatin core transport (up to 69.9% ± 9.1% transport efficiency) and self-propulsion (0.842 ± 0.042 slip ratio). Future iterations should aim to reduce the outer diameter while maintaining tissue yield. The design offers a promising new avenue for wasp-inspired medical tools, potentially enhancing early pancreatic cancer detection, thus reducing healthcare costs and patient complications.
In percutaneous interventions, long and thin needles are used to reach deep target locations within the body. However, inserting a long and thin needle into the tissue can cause needle buckling, resulting in poor control of the needle’s trajectory and reduced targeting accuracy. In nature, the female parasitic wasp prevents the buckling of her long and slender ovipositor through a self-propelled motion. This study presents a stationary actuation system that can advance a wasp-inspired self-propelled needle consisting of seven 0.3-mm stainless steel rods with a theoretically unlimited insertion length. Based on the pencil lead advance mechanism in mechanical pencils that advances the pencil lead at a fixed increment when the pencil button is pushed, our actuation system advances the seven needle segments that comprise our needle by locking, advancing, releasing, and retracting the advance mechanisms. Experimental evaluation demonstrated that the actuation system successfully executes these actions, enabling step-by-step propulsion of the needle segments in gelatin-based tissue-mimicking phantoms. Moreover, the needle achieved mean motion efficiencies of 98 ± 2%, 68 ± 5%, and 57 ± 7% in air, 5-wt% gelatin, and 10-wt% gelatin, respectively, over 15 actuation cycles. This actuation system prototype, which is based on a mechanical pencil, is a step forward in developing self-propelled needles for targeting deep tissue structures.
...
In percutaneous interventions, long and thin needles are used to reach deep target locations within the body. However, inserting a long and thin needle into the tissue can cause needle buckling, resulting in poor control of the needle’s trajectory and reduced targeting accuracy. In nature, the female parasitic wasp prevents the buckling of her long and slender ovipositor through a self-propelled motion. This study presents a stationary actuation system that can advance a wasp-inspired self-propelled needle consisting of seven 0.3-mm stainless steel rods with a theoretically unlimited insertion length. Based on the pencil lead advance mechanism in mechanical pencils that advances the pencil lead at a fixed increment when the pencil button is pushed, our actuation system advances the seven needle segments that comprise our needle by locking, advancing, releasing, and retracting the advance mechanisms. Experimental evaluation demonstrated that the actuation system successfully executes these actions, enabling step-by-step propulsion of the needle segments in gelatin-based tissue-mimicking phantoms. Moreover, the needle achieved mean motion efficiencies of 98 ± 2%, 68 ± 5%, and 57 ± 7% in air, 5-wt% gelatin, and 10-wt% gelatin, respectively, over 15 actuation cycles. This actuation system prototype, which is based on a mechanical pencil, is a step forward in developing self-propelled needles for targeting deep tissue structures.
Ovipositing the Prostate
Wasp-Inspired Needles for Prostate Laser Ablation
Prostate cancer is one of the most common types of cancer in men, especially as they get older. The primary treatments involve radical prostatectomy or radiotherapy, which target the entire prostate gland but often lead to side effects that impair urinary, sexual, or bowel function. The good news is that prostate cancer usually grows slowly and is often detected at an early stage, opening the door for more localized treatments with fewer side effects, such as TransPerineal Laser Ablation (TPLA). TPLA is based on light-tissue interaction. The tissue absorbs the light and converts it into heat, which induces irreversible thermal damage to the tissue, resulting in local cell death. The light is delivered via a laser fiber inside a needle positioned near the tumor under ultrasound guidance. In the future, Magnetic Resonance Imaging (MRI) is expected to replace ultrasound as the preferred imaging guidance option.
For TPLA, control of the needle path is of utmost importance to accurately reach the target region. Commonly used needles are rigid and bound to straight trajectories, which might lead to restricted access because of Pubic Arch Interference (PAI) or targeting errors because of needle deflection caused by needle-tissue interaction. Therefore, using current needles makes it hard to control the needle trajectory and reach the target region.
In nature, needle-like structures exist that allow for trajectory control. Specifically, certain species of parasitic wasps possess a slender and steerable needle-like structure called the ovipositor, of which they can control the trajectory. These wasps not only advance their ovipositors through often stiff substrates without suffering damage by using a so-called self-propelled motion, but they can also steer their ovipositors in order to reach their desired targets. Wasp-inspired mechanisms might address current challenges in TPLA needles. Therefore, the main purpose of this thesis is to present and evaluate innovative wasp-inspired needle designs developed to enhance needle trajectory control for TPLA treatment.
In Part 1, Chapter 2 reviews challenges in needle positioning for therapeutic prostate cancer interventions, including (1) access restrictions to the prostate gland caused by the pubic arch, known as PAI, and (2) needle positioning errors. Current clinical guidelines addressing PAI and needle positioning errors are ambiguous, and clinical compliance varies, complicating the assessment of acceptable levels of PAI and needle positioning errors.
Chapter 3 reviews the state-of-the-art in bioinspired medical needles, categorizing the strategies for needle-tissue interaction (i.e., reduce or enlarge grip) and propulsion (i.e., external or internal strategies) of the needle.
To identify future directions of the technologies applied by instruments for localized cancer treatment, Chapter 4 reviews the patent literature on minimally- and non-invasive focal therapy instruments to treat localized cancer, categorizing the patented instruments based on their treatment target, treatment purpose, and treatment means.
Part 2 presents two designs of wasp-inspired needles. Parasitic wasps can self-propel their ovipositors and transport eggs through them. Chapter 5 combines these mechanisms into a 3-mm outer diameter needle comprising six parallel nitinol rods interconnected by an internal ring. The prototype demonstrated self-propulsion through and transport of tissue-mimicking phantoms.
In addition to self-propulsion and transport, the parasitic wasp can curve and steer its ovipositor to reach the desired target location. Chapter 6 presents the design of a steerable self-propelled 0.89-mm outer diameter needle containing a central needle segment with a bevel-shaped prebent tip. The prototype was able to self-propel and steer in tissue-mimicking phantoms without buckling.
Part 3 explores novel actuation mechanisms for wasp-inspired needles, enabling MRI guidance. Chapter 7 presents a manual MRI-compatible actuation system for a 0.84-mm outer diameter self-propelled needle. The manual actuation system was inspired by the click pen and solely consists of MR-safe 3D-printed parts. The evaluation showed that the needle was visible in MR images and self-propelled through ex vivo human prostate tissue. Chapter 8 enhances this system by integrating a steering mechanism into the actuation system and accommodating an optical fiber for TPLA procedures, enabling discrete bevel-shaped tip steering in tissue-mimicking phantoms.
Chapter 9 investigates MRI-compatible pneumatic actuation for wasp-inspired needles, which alleviates the need for urologists to operate the needle manually within the confined space of the MRI bore. The prototype demonstrated that it was able to actuate the self-propelled needle in ex vivo porcine liver tissue under MRI guidance.
In addition to MRI compatibility, TPLA requires decoupling the needle from the actuation system, which is explored in Part 4. Chapter 10 presents a user-friendly design, allowing the actuation system to be stationary as it drives the needle forward in a self-propelled sequence. In this design, the low-friction ball spline facilitates needle propulsion into tissue while preventing buckling, which was exemplified in experiments in tissue-mimicking phantoms.
Chapter 11 explores a modular actuation system that enables a theoretically infinite needle length inspired by mechanical pencils. By clamping, advancing, and releasing the needle segments sequentially, the needle achieved self-propulsion through tissue-mimicking phantoms and fruits with differing stiffnesses and inhomogeneous anatomies.
This thesis shows the value of translating biological into engineering mechanisms to tackle design challenges in medical instruments. The needle and actuation system designs presented in this thesis contribute to a new generation of needles that enhance needle trajectory control for TPLA treatment. The proposed wasp-inspired needle designs and actuation systems pave the way for improving percutaneous interventions, particularly TPLA for prostate cancer treatment. ...
For TPLA, control of the needle path is of utmost importance to accurately reach the target region. Commonly used needles are rigid and bound to straight trajectories, which might lead to restricted access because of Pubic Arch Interference (PAI) or targeting errors because of needle deflection caused by needle-tissue interaction. Therefore, using current needles makes it hard to control the needle trajectory and reach the target region.
In nature, needle-like structures exist that allow for trajectory control. Specifically, certain species of parasitic wasps possess a slender and steerable needle-like structure called the ovipositor, of which they can control the trajectory. These wasps not only advance their ovipositors through often stiff substrates without suffering damage by using a so-called self-propelled motion, but they can also steer their ovipositors in order to reach their desired targets. Wasp-inspired mechanisms might address current challenges in TPLA needles. Therefore, the main purpose of this thesis is to present and evaluate innovative wasp-inspired needle designs developed to enhance needle trajectory control for TPLA treatment.
In Part 1, Chapter 2 reviews challenges in needle positioning for therapeutic prostate cancer interventions, including (1) access restrictions to the prostate gland caused by the pubic arch, known as PAI, and (2) needle positioning errors. Current clinical guidelines addressing PAI and needle positioning errors are ambiguous, and clinical compliance varies, complicating the assessment of acceptable levels of PAI and needle positioning errors.
Chapter 3 reviews the state-of-the-art in bioinspired medical needles, categorizing the strategies for needle-tissue interaction (i.e., reduce or enlarge grip) and propulsion (i.e., external or internal strategies) of the needle.
To identify future directions of the technologies applied by instruments for localized cancer treatment, Chapter 4 reviews the patent literature on minimally- and non-invasive focal therapy instruments to treat localized cancer, categorizing the patented instruments based on their treatment target, treatment purpose, and treatment means.
Part 2 presents two designs of wasp-inspired needles. Parasitic wasps can self-propel their ovipositors and transport eggs through them. Chapter 5 combines these mechanisms into a 3-mm outer diameter needle comprising six parallel nitinol rods interconnected by an internal ring. The prototype demonstrated self-propulsion through and transport of tissue-mimicking phantoms.
In addition to self-propulsion and transport, the parasitic wasp can curve and steer its ovipositor to reach the desired target location. Chapter 6 presents the design of a steerable self-propelled 0.89-mm outer diameter needle containing a central needle segment with a bevel-shaped prebent tip. The prototype was able to self-propel and steer in tissue-mimicking phantoms without buckling.
Part 3 explores novel actuation mechanisms for wasp-inspired needles, enabling MRI guidance. Chapter 7 presents a manual MRI-compatible actuation system for a 0.84-mm outer diameter self-propelled needle. The manual actuation system was inspired by the click pen and solely consists of MR-safe 3D-printed parts. The evaluation showed that the needle was visible in MR images and self-propelled through ex vivo human prostate tissue. Chapter 8 enhances this system by integrating a steering mechanism into the actuation system and accommodating an optical fiber for TPLA procedures, enabling discrete bevel-shaped tip steering in tissue-mimicking phantoms.
Chapter 9 investigates MRI-compatible pneumatic actuation for wasp-inspired needles, which alleviates the need for urologists to operate the needle manually within the confined space of the MRI bore. The prototype demonstrated that it was able to actuate the self-propelled needle in ex vivo porcine liver tissue under MRI guidance.
In addition to MRI compatibility, TPLA requires decoupling the needle from the actuation system, which is explored in Part 4. Chapter 10 presents a user-friendly design, allowing the actuation system to be stationary as it drives the needle forward in a self-propelled sequence. In this design, the low-friction ball spline facilitates needle propulsion into tissue while preventing buckling, which was exemplified in experiments in tissue-mimicking phantoms.
Chapter 11 explores a modular actuation system that enables a theoretically infinite needle length inspired by mechanical pencils. By clamping, advancing, and releasing the needle segments sequentially, the needle achieved self-propulsion through tissue-mimicking phantoms and fruits with differing stiffnesses and inhomogeneous anatomies.
This thesis shows the value of translating biological into engineering mechanisms to tackle design challenges in medical instruments. The needle and actuation system designs presented in this thesis contribute to a new generation of needles that enhance needle trajectory control for TPLA treatment. The proposed wasp-inspired needle designs and actuation systems pave the way for improving percutaneous interventions, particularly TPLA for prostate cancer treatment. ...
Prostate cancer is one of the most common types of cancer in men, especially as they get older. The primary treatments involve radical prostatectomy or radiotherapy, which target the entire prostate gland but often lead to side effects that impair urinary, sexual, or bowel function. The good news is that prostate cancer usually grows slowly and is often detected at an early stage, opening the door for more localized treatments with fewer side effects, such as TransPerineal Laser Ablation (TPLA). TPLA is based on light-tissue interaction. The tissue absorbs the light and converts it into heat, which induces irreversible thermal damage to the tissue, resulting in local cell death. The light is delivered via a laser fiber inside a needle positioned near the tumor under ultrasound guidance. In the future, Magnetic Resonance Imaging (MRI) is expected to replace ultrasound as the preferred imaging guidance option.
For TPLA, control of the needle path is of utmost importance to accurately reach the target region. Commonly used needles are rigid and bound to straight trajectories, which might lead to restricted access because of Pubic Arch Interference (PAI) or targeting errors because of needle deflection caused by needle-tissue interaction. Therefore, using current needles makes it hard to control the needle trajectory and reach the target region.
In nature, needle-like structures exist that allow for trajectory control. Specifically, certain species of parasitic wasps possess a slender and steerable needle-like structure called the ovipositor, of which they can control the trajectory. These wasps not only advance their ovipositors through often stiff substrates without suffering damage by using a so-called self-propelled motion, but they can also steer their ovipositors in order to reach their desired targets. Wasp-inspired mechanisms might address current challenges in TPLA needles. Therefore, the main purpose of this thesis is to present and evaluate innovative wasp-inspired needle designs developed to enhance needle trajectory control for TPLA treatment.
In Part 1, Chapter 2 reviews challenges in needle positioning for therapeutic prostate cancer interventions, including (1) access restrictions to the prostate gland caused by the pubic arch, known as PAI, and (2) needle positioning errors. Current clinical guidelines addressing PAI and needle positioning errors are ambiguous, and clinical compliance varies, complicating the assessment of acceptable levels of PAI and needle positioning errors.
Chapter 3 reviews the state-of-the-art in bioinspired medical needles, categorizing the strategies for needle-tissue interaction (i.e., reduce or enlarge grip) and propulsion (i.e., external or internal strategies) of the needle.
To identify future directions of the technologies applied by instruments for localized cancer treatment, Chapter 4 reviews the patent literature on minimally- and non-invasive focal therapy instruments to treat localized cancer, categorizing the patented instruments based on their treatment target, treatment purpose, and treatment means.
Part 2 presents two designs of wasp-inspired needles. Parasitic wasps can self-propel their ovipositors and transport eggs through them. Chapter 5 combines these mechanisms into a 3-mm outer diameter needle comprising six parallel nitinol rods interconnected by an internal ring. The prototype demonstrated self-propulsion through and transport of tissue-mimicking phantoms.
In addition to self-propulsion and transport, the parasitic wasp can curve and steer its ovipositor to reach the desired target location. Chapter 6 presents the design of a steerable self-propelled 0.89-mm outer diameter needle containing a central needle segment with a bevel-shaped prebent tip. The prototype was able to self-propel and steer in tissue-mimicking phantoms without buckling.
Part 3 explores novel actuation mechanisms for wasp-inspired needles, enabling MRI guidance. Chapter 7 presents a manual MRI-compatible actuation system for a 0.84-mm outer diameter self-propelled needle. The manual actuation system was inspired by the click pen and solely consists of MR-safe 3D-printed parts. The evaluation showed that the needle was visible in MR images and self-propelled through ex vivo human prostate tissue. Chapter 8 enhances this system by integrating a steering mechanism into the actuation system and accommodating an optical fiber for TPLA procedures, enabling discrete bevel-shaped tip steering in tissue-mimicking phantoms.
Chapter 9 investigates MRI-compatible pneumatic actuation for wasp-inspired needles, which alleviates the need for urologists to operate the needle manually within the confined space of the MRI bore. The prototype demonstrated that it was able to actuate the self-propelled needle in ex vivo porcine liver tissue under MRI guidance.
In addition to MRI compatibility, TPLA requires decoupling the needle from the actuation system, which is explored in Part 4. Chapter 10 presents a user-friendly design, allowing the actuation system to be stationary as it drives the needle forward in a self-propelled sequence. In this design, the low-friction ball spline facilitates needle propulsion into tissue while preventing buckling, which was exemplified in experiments in tissue-mimicking phantoms.
Chapter 11 explores a modular actuation system that enables a theoretically infinite needle length inspired by mechanical pencils. By clamping, advancing, and releasing the needle segments sequentially, the needle achieved self-propulsion through tissue-mimicking phantoms and fruits with differing stiffnesses and inhomogeneous anatomies.
This thesis shows the value of translating biological into engineering mechanisms to tackle design challenges in medical instruments. The needle and actuation system designs presented in this thesis contribute to a new generation of needles that enhance needle trajectory control for TPLA treatment. The proposed wasp-inspired needle designs and actuation systems pave the way for improving percutaneous interventions, particularly TPLA for prostate cancer treatment.
For TPLA, control of the needle path is of utmost importance to accurately reach the target region. Commonly used needles are rigid and bound to straight trajectories, which might lead to restricted access because of Pubic Arch Interference (PAI) or targeting errors because of needle deflection caused by needle-tissue interaction. Therefore, using current needles makes it hard to control the needle trajectory and reach the target region.
In nature, needle-like structures exist that allow for trajectory control. Specifically, certain species of parasitic wasps possess a slender and steerable needle-like structure called the ovipositor, of which they can control the trajectory. These wasps not only advance their ovipositors through often stiff substrates without suffering damage by using a so-called self-propelled motion, but they can also steer their ovipositors in order to reach their desired targets. Wasp-inspired mechanisms might address current challenges in TPLA needles. Therefore, the main purpose of this thesis is to present and evaluate innovative wasp-inspired needle designs developed to enhance needle trajectory control for TPLA treatment.
In Part 1, Chapter 2 reviews challenges in needle positioning for therapeutic prostate cancer interventions, including (1) access restrictions to the prostate gland caused by the pubic arch, known as PAI, and (2) needle positioning errors. Current clinical guidelines addressing PAI and needle positioning errors are ambiguous, and clinical compliance varies, complicating the assessment of acceptable levels of PAI and needle positioning errors.
Chapter 3 reviews the state-of-the-art in bioinspired medical needles, categorizing the strategies for needle-tissue interaction (i.e., reduce or enlarge grip) and propulsion (i.e., external or internal strategies) of the needle.
To identify future directions of the technologies applied by instruments for localized cancer treatment, Chapter 4 reviews the patent literature on minimally- and non-invasive focal therapy instruments to treat localized cancer, categorizing the patented instruments based on their treatment target, treatment purpose, and treatment means.
Part 2 presents two designs of wasp-inspired needles. Parasitic wasps can self-propel their ovipositors and transport eggs through them. Chapter 5 combines these mechanisms into a 3-mm outer diameter needle comprising six parallel nitinol rods interconnected by an internal ring. The prototype demonstrated self-propulsion through and transport of tissue-mimicking phantoms.
In addition to self-propulsion and transport, the parasitic wasp can curve and steer its ovipositor to reach the desired target location. Chapter 6 presents the design of a steerable self-propelled 0.89-mm outer diameter needle containing a central needle segment with a bevel-shaped prebent tip. The prototype was able to self-propel and steer in tissue-mimicking phantoms without buckling.
Part 3 explores novel actuation mechanisms for wasp-inspired needles, enabling MRI guidance. Chapter 7 presents a manual MRI-compatible actuation system for a 0.84-mm outer diameter self-propelled needle. The manual actuation system was inspired by the click pen and solely consists of MR-safe 3D-printed parts. The evaluation showed that the needle was visible in MR images and self-propelled through ex vivo human prostate tissue. Chapter 8 enhances this system by integrating a steering mechanism into the actuation system and accommodating an optical fiber for TPLA procedures, enabling discrete bevel-shaped tip steering in tissue-mimicking phantoms.
Chapter 9 investigates MRI-compatible pneumatic actuation for wasp-inspired needles, which alleviates the need for urologists to operate the needle manually within the confined space of the MRI bore. The prototype demonstrated that it was able to actuate the self-propelled needle in ex vivo porcine liver tissue under MRI guidance.
In addition to MRI compatibility, TPLA requires decoupling the needle from the actuation system, which is explored in Part 4. Chapter 10 presents a user-friendly design, allowing the actuation system to be stationary as it drives the needle forward in a self-propelled sequence. In this design, the low-friction ball spline facilitates needle propulsion into tissue while preventing buckling, which was exemplified in experiments in tissue-mimicking phantoms.
Chapter 11 explores a modular actuation system that enables a theoretically infinite needle length inspired by mechanical pencils. By clamping, advancing, and releasing the needle segments sequentially, the needle achieved self-propulsion through tissue-mimicking phantoms and fruits with differing stiffnesses and inhomogeneous anatomies.
This thesis shows the value of translating biological into engineering mechanisms to tackle design challenges in medical instruments. The needle and actuation system designs presented in this thesis contribute to a new generation of needles that enhance needle trajectory control for TPLA treatment. The proposed wasp-inspired needle designs and actuation systems pave the way for improving percutaneous interventions, particularly TPLA for prostate cancer treatment.
Therapeutic prostate cancer interventions
A systematic review on pubic arch interference and needle positioning errors
Review
(2024)
-
Jette Bloemberg, Martijn de Vries, Luigi A.M.J.G. van Riel, Theo M. de Reijke, Aimée Sakes, Paul Breedveld, John J. van den Dobbelsteen
Introduction: This study focuses on the quantification of and current guidelines on the hazards related to needle positioning in prostate cancer treatment: (1) access restrictions to the prostate gland by the pubic arch, so-called Pubic Arch Interference (PAI) and (2) needle positioning errors. Next, we propose solution strategies to mitigate these hazards. Methods: The literature search was executed in the Embase, Medline ALL, Web of Science Core Collection*, and Cochrane Central Register of Controlled Trials databases. Results: The literature search resulted in 50 included articles. PAI was reported in patients with various prostate volumes. The level of reported PAI varied between 0 and 22.3 mm, depending on the patient’s position and the measuring method. Low-Dose-Rate Brachytherapy induced the largest reported misplacement errors, especially in the cranio-caudal direction (up to 10 mm) and the largest displacement errors were reported for High-Dose-Rate Brachytherapy in the cranio-caudal direction (up to 47 mm), generally increasing over time. Conclusions: Current clinical guidelines related to prostate volume, needle positioning accuracy, and maximum allowable PAI are ambiguous, and compliance in the clinical setting differs between institutions. Solutions, such as steerable needles, assist in mitigating the hazards and potentially allow the physician to proceed with the procedure. This systematic review was performed in accordance with the PRISMA guidelines. The review was registered at Protocols.io (DOI: dx.doi.org/10.17504/protocols.io.6qpvr89eplmk/v1).
...
Introduction: This study focuses on the quantification of and current guidelines on the hazards related to needle positioning in prostate cancer treatment: (1) access restrictions to the prostate gland by the pubic arch, so-called Pubic Arch Interference (PAI) and (2) needle positioning errors. Next, we propose solution strategies to mitigate these hazards. Methods: The literature search was executed in the Embase, Medline ALL, Web of Science Core Collection*, and Cochrane Central Register of Controlled Trials databases. Results: The literature search resulted in 50 included articles. PAI was reported in patients with various prostate volumes. The level of reported PAI varied between 0 and 22.3 mm, depending on the patient’s position and the measuring method. Low-Dose-Rate Brachytherapy induced the largest reported misplacement errors, especially in the cranio-caudal direction (up to 10 mm) and the largest displacement errors were reported for High-Dose-Rate Brachytherapy in the cranio-caudal direction (up to 47 mm), generally increasing over time. Conclusions: Current clinical guidelines related to prostate volume, needle positioning accuracy, and maximum allowable PAI are ambiguous, and compliance in the clinical setting differs between institutions. Solutions, such as steerable needles, assist in mitigating the hazards and potentially allow the physician to proceed with the procedure. This systematic review was performed in accordance with the PRISMA guidelines. The review was registered at Protocols.io (DOI: dx.doi.org/10.17504/protocols.io.6qpvr89eplmk/v1).
In percutaneous interventions, needles are used to reach target locations inside the body. However, when the needle is pushed through the tissue, forces arise at the needle tip and along the needle body, making the needle prone to buckling. Recently, needles that prevent buckling inspired by the ovipositor of female parasitic wasps have been developed. Building on these needle designs, this study proposes a manual actuation unit that allows the operator to drive the wasp-inspired needle through stationary tissue. The needle consists of six 0.3-mm spring steel wires, of which one is advanced while the others are retracted. The advancing needle segment has to overcome a cutting and friction force while the retracting ones experience a friction force in the opposite direction. The actuation unit moves the needle segments in the required sequence using a low-friction ball spline mechanism. The moving components of the needle have low inertia, and its connection to the actuation unit using a ball spline introduces a small friction force, generating a small push force on the needle that facilitates the needle’s propulsion into tissue while preventing needle buckling. Experimental testing evaluated the needle’s ability to move through stationary 15-wt% gelatin tissue phantoms for different actuation velocities. It was found that the needle moved through the tissue phantoms with mean slip ratios of 0.35, 0.31, and 0.29 for actuation velocities of π, 2π, and 3π rad/s, respectively. Furthermore, evaluation in 15-wt%, 10-wt%, and 5-wt% gelatin tissue phantoms showed that decreasing the gelatin concentration decreased the mean slip ratios from 0.35 to 0.19 and 0.18, respectively. The needle actuation system design is a step forward in developing a wasp-inspired needle for percutaneous procedures that prevents buckling.
...
In percutaneous interventions, needles are used to reach target locations inside the body. However, when the needle is pushed through the tissue, forces arise at the needle tip and along the needle body, making the needle prone to buckling. Recently, needles that prevent buckling inspired by the ovipositor of female parasitic wasps have been developed. Building on these needle designs, this study proposes a manual actuation unit that allows the operator to drive the wasp-inspired needle through stationary tissue. The needle consists of six 0.3-mm spring steel wires, of which one is advanced while the others are retracted. The advancing needle segment has to overcome a cutting and friction force while the retracting ones experience a friction force in the opposite direction. The actuation unit moves the needle segments in the required sequence using a low-friction ball spline mechanism. The moving components of the needle have low inertia, and its connection to the actuation unit using a ball spline introduces a small friction force, generating a small push force on the needle that facilitates the needle’s propulsion into tissue while preventing needle buckling. Experimental testing evaluated the needle’s ability to move through stationary 15-wt% gelatin tissue phantoms for different actuation velocities. It was found that the needle moved through the tissue phantoms with mean slip ratios of 0.35, 0.31, and 0.29 for actuation velocities of π, 2π, and 3π rad/s, respectively. Furthermore, evaluation in 15-wt%, 10-wt%, and 5-wt% gelatin tissue phantoms showed that decreasing the gelatin concentration decreased the mean slip ratios from 0.35 to 0.19 and 0.18, respectively. The needle actuation system design is a step forward in developing a wasp-inspired needle for percutaneous procedures that prevents buckling.
Transperineal laser ablation is a minimally invasive thermo-ablative treatment for prostate cancer that requires the insertion of a needle for accurate optical fiber positioning. Needle insertion in soft tissues may cause tissue motion and deformation, resulting in tissue damage and needle positioning errors. In this study, we present a wasp-inspired self-propelled needle that uses pneumatic actuation to move forward with zero external push force, thus avoiding large tissue motion and deformation. The needle consists of six parallel 0.25-mm diameter Nitinol rods driven by a pneumatic actuation system. The pneumatic actuation system consists of Magnetic Resonance (MR) safe 3D-printed parts and off-the-shelf plastic screws. A self-propelled motion is achieved by advancing the needle segments one by one, followed by retracting them simultaneously. The advancing needle segment has to overcome a cutting and friction force, while the stationary needle segments experience a friction force in the opposite direction. The needle self-propels through the tissue when the friction force of the five stationary needle segments overcomes the sum of the friction and cutting forces of the advancing needle segment. We evaluated the prototype’s performance in 10-wt% gelatin phantoms and ex vivo porcine liver tissue inside a preclinical Magnetic Resonance Imaging (MRI) scanner in terms of the slip ratio of the needle with respect to the phantom or liver tissue. Our results demonstrated that the needle was able to self-propel through the phantom and liver tissue with slip ratios of 0.912–0.955 and 0.88, respectively. The prototype is a promising step toward the development of self-propelled needles for MRI-guided transperineal laser ablation as a method to treat prostate cancer.
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Transperineal laser ablation is a minimally invasive thermo-ablative treatment for prostate cancer that requires the insertion of a needle for accurate optical fiber positioning. Needle insertion in soft tissues may cause tissue motion and deformation, resulting in tissue damage and needle positioning errors. In this study, we present a wasp-inspired self-propelled needle that uses pneumatic actuation to move forward with zero external push force, thus avoiding large tissue motion and deformation. The needle consists of six parallel 0.25-mm diameter Nitinol rods driven by a pneumatic actuation system. The pneumatic actuation system consists of Magnetic Resonance (MR) safe 3D-printed parts and off-the-shelf plastic screws. A self-propelled motion is achieved by advancing the needle segments one by one, followed by retracting them simultaneously. The advancing needle segment has to overcome a cutting and friction force, while the stationary needle segments experience a friction force in the opposite direction. The needle self-propels through the tissue when the friction force of the five stationary needle segments overcomes the sum of the friction and cutting forces of the advancing needle segment. We evaluated the prototype’s performance in 10-wt% gelatin phantoms and ex vivo porcine liver tissue inside a preclinical Magnetic Resonance Imaging (MRI) scanner in terms of the slip ratio of the needle with respect to the phantom or liver tissue. Our results demonstrated that the needle was able to self-propel through the phantom and liver tissue with slip ratios of 0.912–0.955 and 0.88, respectively. The prototype is a promising step toward the development of self-propelled needles for MRI-guided transperineal laser ablation as a method to treat prostate cancer.
Bioinspired medical needles
A review of the scientific literature
Needles are commonly used in medical procedures. However, current needle designs have some disadvantages. Therefore, a new generation of hypodermic needles and microneedle patches drawing inspiration from mechanisms found in nature (i.e. bioinspiration) is being developed. In this systematic review, 80 articles were retrieved from Scopus, Web of Science, and PubMed and classified based on the strategies for needle-tissue interaction and propulsion of the needle. The needle-tissue interaction was modified to reduce grip for smooth needle insertion or enlarge grip to resist needle retraction. The reduction of grip can be achieved passively through form modification and actively through translation and rotation of the needle. To enlarge grip, interlocking with the tissue, sucking the tissue, and adhering to the tissue were identified as strategies. Needle propelling was modified to ensure stable needle insertion, either through external (i.e. applied to the prepuncturing movement of the needle) or internal (i.e. applied to the postpuncturing movement of the needle) strategies. External strategies include free-hand and guided needle insertion, while friction manipulation of the tissue was found to be an internal strategy. Most needles appear to be using friction reduction strategies and are inserted using a free-hand technique. Furthermore, most needle designs were inspired by insects, specifically parasitoid wasps, honeybees, and mosquitoes. The presented overview and description of the different bioinspired interaction and propulsion strategies provide insight into the current state of bioinspired needles and offer opportunities for medical instrument designers to create a new generation of bioinspired needles.
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Needles are commonly used in medical procedures. However, current needle designs have some disadvantages. Therefore, a new generation of hypodermic needles and microneedle patches drawing inspiration from mechanisms found in nature (i.e. bioinspiration) is being developed. In this systematic review, 80 articles were retrieved from Scopus, Web of Science, and PubMed and classified based on the strategies for needle-tissue interaction and propulsion of the needle. The needle-tissue interaction was modified to reduce grip for smooth needle insertion or enlarge grip to resist needle retraction. The reduction of grip can be achieved passively through form modification and actively through translation and rotation of the needle. To enlarge grip, interlocking with the tissue, sucking the tissue, and adhering to the tissue were identified as strategies. Needle propelling was modified to ensure stable needle insertion, either through external (i.e. applied to the prepuncturing movement of the needle) or internal (i.e. applied to the postpuncturing movement of the needle) strategies. External strategies include free-hand and guided needle insertion, while friction manipulation of the tissue was found to be an internal strategy. Most needles appear to be using friction reduction strategies and are inserted using a free-hand technique. Furthermore, most needle designs were inspired by insects, specifically parasitoid wasps, honeybees, and mosquitoes. The presented overview and description of the different bioinspired interaction and propulsion strategies provide insight into the current state of bioinspired needles and offer opportunities for medical instrument designers to create a new generation of bioinspired needles.
Prostate cancer diagnosis and focal laser ablation treatment both require the insertion of a needle for biopsy and optical fibre positioning. Needle insertion in soft tissues may cause tissue motion and deformation, which can, in turn, result in tissue damage and needle positioning errors. In this study, we present a prototype system making use of a wasp-inspired (bioinspired) self-propelled needle, which is able to move forward with zero external push force, thereby avoiding large tissue motion and deformation. Additionally, the actuation system solely consists of 3D printed parts and is therefore safe to use inside a magnetic resonance imaging (MRI) system. The needle consists of six parallel 0.25-mm diameter Nitinol rods driven by the actuation system. In the prototype, the self-propelled motion is achieved by advancing one needle segment while retracting the others. The advancing needle segment has to overcome a cutting and friction force while the retracting needle segments experience a friction force in the opposite direction. The needle self-propels through the tissue when the friction force of the five retracting needle segments overcomes the sum of the friction and cutting forces of the advancing needle segment. We tested the performance of the prototype in ex vivo human prostate tissue inside a preclinical MRI system in terms of the slip ratio of the needle with respect to the prostate tissue. The results showed that the needle was visible in MR images and that the needle was able to self-propel through the tissue with a slip ratio in the range of 0.78–0.95. The prototype is a step toward self-propelled needles for MRI-guided transperineal laser ablation as a method to treat prostate cancer.
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Prostate cancer diagnosis and focal laser ablation treatment both require the insertion of a needle for biopsy and optical fibre positioning. Needle insertion in soft tissues may cause tissue motion and deformation, which can, in turn, result in tissue damage and needle positioning errors. In this study, we present a prototype system making use of a wasp-inspired (bioinspired) self-propelled needle, which is able to move forward with zero external push force, thereby avoiding large tissue motion and deformation. Additionally, the actuation system solely consists of 3D printed parts and is therefore safe to use inside a magnetic resonance imaging (MRI) system. The needle consists of six parallel 0.25-mm diameter Nitinol rods driven by the actuation system. In the prototype, the self-propelled motion is achieved by advancing one needle segment while retracting the others. The advancing needle segment has to overcome a cutting and friction force while the retracting needle segments experience a friction force in the opposite direction. The needle self-propels through the tissue when the friction force of the five retracting needle segments overcomes the sum of the friction and cutting forces of the advancing needle segment. We tested the performance of the prototype in ex vivo human prostate tissue inside a preclinical MRI system in terms of the slip ratio of the needle with respect to the prostate tissue. The results showed that the needle was visible in MR images and that the needle was able to self-propel through the tissue with a slip ratio in the range of 0.78–0.95. The prototype is a step toward self-propelled needles for MRI-guided transperineal laser ablation as a method to treat prostate cancer.
The Role of Insects in Medical Engineering and Bionics
Towards Entomomedical Engineering
Insects are important agents in ecosystems. Their diverseness and developed coping mechanisms also make them interesting for direct application and as a source of inspiration in medical engineering. We summarized the main contribution of insects in biomedical applications. Medical centers in North America, and Europe use fly larvae for maggot therapy to remove necrotic tissue, decrease infection risk, and improve wound healing. Ant mandibles are used as a suturing technique by African tribes and as sources of inspiration for surgical clamps. Both the mosquito fascicle and the wasp ovipositor are sources of inspiration for the design of medical needles. Herein, a new research field called 'entomomedical engineering,' is proposed. We define entomomedical engineering as the branch of engineering that uses insects either directly or as a source of inspiration to design and develop medical treatments or instruments. In addition, we want to emphasize the importance of preserving insects because of their function in the ecosystem, medicine, and medical engineering.
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Insects are important agents in ecosystems. Their diverseness and developed coping mechanisms also make them interesting for direct application and as a source of inspiration in medical engineering. We summarized the main contribution of insects in biomedical applications. Medical centers in North America, and Europe use fly larvae for maggot therapy to remove necrotic tissue, decrease infection risk, and improve wound healing. Ant mandibles are used as a suturing technique by African tribes and as sources of inspiration for surgical clamps. Both the mosquito fascicle and the wasp ovipositor are sources of inspiration for the design of medical needles. Herein, a new research field called 'entomomedical engineering,' is proposed. We define entomomedical engineering as the branch of engineering that uses insects either directly or as a source of inspiration to design and develop medical treatments or instruments. In addition, we want to emphasize the importance of preserving insects because of their function in the ecosystem, medicine, and medical engineering.
Tissue transport is a challenge during Minimally Invasive Surgery (MIS) with the current suction-based instruments as the increasing length and miniaturisation of the outer diameter requires a higher pressure. Inspired by the wasp ovipositor, a slender and bendable organ through which eggs can be transported, a flexible transport mechanism for tissue was developed that does not require a pressure gradient. The flexible shaft of the mechanism consists of ring magnets and cables that can translate in a similar manner as the valves in the wasp ovipositor. The designed transport mechanism was able to transport 10wt% gelatine tissue phantoms with the shaft in straight and curved positions and in vertical orientation against gravity. The transport rate can be increased by increasing the rotational velocity of the cam. A rotational velocity of 25 RPM resulted in a transport rate of 0.8 mm/s and increasing the rotation velocity of the cam to 80 RPM increased the transport rate to 2.3 mm/s though the stroke efficiency decreased by increasing the rotational velocity of the cam. The transport performance of the flexible transport mechanism is promising. This means of transportation could in the future be an alternative for tissue transport during MIS.
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Tissue transport is a challenge during Minimally Invasive Surgery (MIS) with the current suction-based instruments as the increasing length and miniaturisation of the outer diameter requires a higher pressure. Inspired by the wasp ovipositor, a slender and bendable organ through which eggs can be transported, a flexible transport mechanism for tissue was developed that does not require a pressure gradient. The flexible shaft of the mechanism consists of ring magnets and cables that can translate in a similar manner as the valves in the wasp ovipositor. The designed transport mechanism was able to transport 10wt% gelatine tissue phantoms with the shaft in straight and curved positions and in vertical orientation against gravity. The transport rate can be increased by increasing the rotational velocity of the cam. A rotational velocity of 25 RPM resulted in a transport rate of 0.8 mm/s and increasing the rotation velocity of the cam to 80 RPM increased the transport rate to 2.3 mm/s though the stroke efficiency decreased by increasing the rotational velocity of the cam. The transport performance of the flexible transport mechanism is promising. This means of transportation could in the future be an alternative for tissue transport during MIS.
Focal therapy for localized cancer
A patent review
Introduction: Conventional cancer treatments such as radical surgery and systemic therapy targeting the organ or organ system might have side effects because of damage to the surrounding tissue. For this reason, there is a need for new instruments that focally treat cancer. Areas covered: This review provides a comprehensive overview of the patent literature on minimally and noninvasive focal therapy instruments to treat localized cancer. The medical section of the Google Patents database was scanned, and 128 patents on focal therapy instruments published in the last two decades (2000–2021) were retrieved and classified. The classification is based on the treatment target (cancer cell or network of cancer cells), treatment purpose (destroy the cancerous structure or disable its function), and treatment means (energy, matter, or a combination of both). Expert opinion: We found patents describing instruments for all groups, except for the instruments that destroy a cancer cell network structure by applying matter (e.g. particles) to the network. The description of the different treatment types may serve as a source of inspiration for new focal therapy instruments to treat localized cancer.
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Introduction: Conventional cancer treatments such as radical surgery and systemic therapy targeting the organ or organ system might have side effects because of damage to the surrounding tissue. For this reason, there is a need for new instruments that focally treat cancer. Areas covered: This review provides a comprehensive overview of the patent literature on minimally and noninvasive focal therapy instruments to treat localized cancer. The medical section of the Google Patents database was scanned, and 128 patents on focal therapy instruments published in the last two decades (2000–2021) were retrieved and classified. The classification is based on the treatment target (cancer cell or network of cancer cells), treatment purpose (destroy the cancerous structure or disable its function), and treatment means (energy, matter, or a combination of both). Expert opinion: We found patents describing instruments for all groups, except for the instruments that destroy a cancer cell network structure by applying matter (e.g. particles) to the network. The description of the different treatment types may serve as a source of inspiration for new focal therapy instruments to treat localized cancer.