An Interventional Surgical Robot Based on Multi-Data Detection

Round 1

Reviewer 1 Report

The motivation for robotics in cardiovascular applications has several other more important reasons, mainly the option to reduce the radiation load for the surgeon (just shortly mentioned in the introduction).

It is the most obvious to put sensors at the tip of a catheter or guide wire, but this comes with huge disadvantages, cables / active components, dedicated and expensive catheters / guidewires, and a huge consumable cost. These disadvantages were not really discussed and the available options to overcome these were not mentioned. There are already several research ideas, e.g. use of audio sensing with proximal sensors, that would overcome and address some of these aforementioned issues.

The procedure description is also quite superficial. Typically no catheter is inserted initially, but a guide wire and that is also the device that should be intelligent. A catheter typically is then pushed over that guide wire. Yes, there are few applications that do not require a guide wire. 

The part explaining the force sensor is excessive and in the opinion of the reviewer not needed in that detail. It should be discussed however why the force is such an important measure (e.g. difference between vessel penetration / puncture and bumping with a catheter / guide wire at a vessel turn or scrubbing along a vessel wall).

The paper presents a very rudimentary prototype additionally employing a theoretical framework on how to apply machine learning: This is very early research and is far away from any application even in ex-vivo experiments. The test phantoms and structures still need to be developed.

AI / machine learning can be combined with everything, but it is difficult to assess the need to do it for this application. Or in other words I am missing the reasons.

It is also not clear (and then it would make sense with respect to my previous sentence) on how intraoperative real-time imaging is combined with the catheter push (just mentioned in figure 1). Is it possible to reduce the radiation exposure to the patient as well? ... or the volume of nephrotoxic contrast media?

The references should be corrected and cleaned up in my opinion.

 

Author Response

Dear Reviewer:

Thank you for your review and criticism of this manuscript.

We did overlook the description of the role of the guide wire in the text and have now added an explanation.

For the force sensor section, we have added a description of the importance of force detection to highlight the purpose and significance of the research.

The real-time image shown in Figure 1 is displayed through a monitor in the main operating room, providing visual feedback to the operator. Our view is that using a multidimensional data fusion sensing system to identify the bending changes of the current catheter head can reduce the number of contrast agent investments made by doctors due to uncertainty, thereby reducing the patient's physical burden.

We sincerely accept your criticism and correction, and wish you all the best.

Author Response File: Author Response.docx

Reviewer 2 Report

Significant progress has been made in the development of interventional surgical robots.In order to control precisely and solve the problem of conventional force sensors in surgical robots can only detect the axial thrust pressure of the catheter,this paper designed a structure with a thin-film force sensing device in the catheter head.It is an interesting work and it would promote the development of Interventional Surgery Robot.There are still some issues that need to be discussed.

1.Some detailed information needs to be added. The thin film sensor metioned in line 197 needs to give the product information.

2.After mounting the brackets to fix the thin film sensor,it has changed the deformation performance of the catheter,How does it affect the surgery?

3.After fix the thin film sensor on the catheter,there is a significant change in size of the catheter, if it can not entering the blood vessels, how to solve this problem? 

4.it is better to figure out the sensor and other parts in figure 5

5.Why cite the reference in line 199?

6.Please specify the material of the vascular model in figure 8,rigid or flexible?

Author Response

Dear Reviewer

Thank you for your criticism of the article. We have the following answers to your question:

1.The detailed model number of the thin film sensor (BFH350-6AA)  mentioned in line 197 has been marked in the text.

2. The bracket we designed consists of two identical structures in the front and back, with no rigid connection in the middle, so there will be no significant obstruction to the bending of the catheter. In the future, we will customize special sized thin film sensors (longer than current sensors) to ensure the flexibility of the catheter.

3.The current bracket size is designed based on existing thin film sensors (BFH350-6AA). If it is necessary to enter narrower blood vessels, we will use customized small-sized thin film sensors, so that the size of the stent will be smaller to adapt to different vascular environments.

4. Modifications have been made in Figure 5.

5. We took inspiration from the citation in line 199 and enhanced the anti-interference ability of thin film sensors to the external environment by building a half bridge connection.

6. The vascular model in Figure 8 is 3D printed with transparent resin and is a rigid model.

Thank you again for reviewing this manuscript, and I wish you all the best.

Author Response File: Author Response.docx

Reviewer 3 Report

Please find the attachment for the comments.

Comments for author File: Comments.pdf

Author Response

Dear Reviewer:

Thank you for your criticism of the article. We will provide the following answers to the three questions you raised:

Due to issues with production time and cost, we are currently using silicone hoses as a substitute for vascular models. Due to its own size issue, we have currently made 11 angle models for experiments. In the future, we will use 3D printed customized vascular models to ensure that the experimental environment is consistent with the human body environment, in order to achieve better testing results.

2. In the future, we will write automatic test scripts, automatically conduct experiments and collect data to ensure that the data set is large enough to ensure that the network does not have overfitting.

3. For the interference of blood flow, we plan to use a water pump to simulate blood flow in the later stage of the experiment, add interference sources to observe the fluctuation of the data, and use appropriate filtering methods for filtering.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Thanks for the revision, but you did not adress several of my initial comments and only did very minor changes / adjustments.

Especially the requested discussion of the reasons and motivations have not been done or improved

My recommendation has therefore not changed.

Author Response

Thank you for your comment. We sincerely accept your criticism and suggestions. We have revised the article on the advantages/disadvantages, and research hotspots of robotic surgery. And strengthened the description of the purpose and motivation of this article.

Author Response File: Author Response.docx