Intelligent vision guide for automatic grommet tube insertion on human Tympanic Membrane

Otitis Media with Effusion (OME), a worldwide common ear disease, occurs in adults and children when the middle ear is infected. The current treatment is to surgically insert a grommet tube onto the Tympanic Membrane (TM) to bypass the Eustachian tube in raining fluid. A robotic device allowing fast and automatic grommet tube insertion has been designed in an earlier work. However, the part of the membrane where the malleus bone is attached to the inner surface is to be avoided so as not to touch or hit the bone during the insertion process. To solve this problem, an endoscope is used to provide the vision guide for the device. Thus, to locate a suitable target spot for tube insertion and plan the working channel trajectory by tracking the malleus from the endoscopic views form crucial steps for a safe and effective OME surgery. This paper mainly focuses on an incorporative optical flow based gradient vector flow active contours algorithm to achieve an online tracking of malleus to guide the working channel to conduct the surgery appropriately and automatically. Preclinical tests are carried out to verify the feasibility and efficacy of the proposed approach.