486 IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS, VOL. 5, NO.

3, AUGUST 2023

Safe Manipulation in Robotic Surgery Using

Compliant Constant-Force Mechanism
Yilun Sun , Member, IEEE, and Tim C. Lueth, Senior Member, IEEE

Abstract—Safe manipulation of soft tissue in robotic-assisted

minimally invasive surgery (RMIS) is a challenging task for sur-
geons. The conventional solution is to introduce tactile sensors
to measure the tool-tissue interaction force, and then transmit
the signal back to the surgeon to enable manual force con-
trol. However, since the RMIS-forceps is very small, even the
hand tremor of the surgeon could lead to unstable force applied
to the tissue. To cope with this problem, we present a compli-
ant constant-force mechanism (CFM) in this article to achieve
stable force regulation of RMIS forceps. The proposed CFM
is comprised of a pair of symmetrical compliant slider-crank
mechanisms, whose mechanical behavior can be described by
a pseudo-rigid-body (PRB) model. Cross-spring-based compliant
joints are also introduced to improve the model accuracy, while
the magnitude of the generated constant force can be adjusted
by using detachable slider-crank mechanisms with different force
configurations. In this work, the proposed CFM is selective-laser-
sintered with polyamide (PA2200) and is actuated by a linear
motor. Experiments were also conducted and successfully val-
Fig. 1. Overview of the actuation system of the RMIS-forceps with the
idated the constant-force performance of the proposed CFM.
proposed compliant constant-force mechanism. The force-displacement (F-x)
Furthermore, a grasping test of artificial artery was also per- curve represents the desired constant-force performance.
formed, which demonstrated the application of the developed
CFM system in RMIS.
Index Terms—Constant-force mechanism, tool-tissue
interaction, safe manipulation, compliant mechanism,
robotic-assisted minimally invasive surgery. to measure the instrument force and incorporate haptic feed-
back into RMIS [3], [4]. A commonly used approach is the
vision-based force-sensing method, in which the tool-tissue
I. I NTRODUCTION interaction force is estimated based on the tissue deforma-
VER the last decades, the introduction of robotic- tion information captured from endoscopes [5], [6]. Other
O assisted minimally invasive surgery (RMIS) has greatly
improved surgical efficiency, as it reduces the complexity of
researchers have also integrated different kinds of force sen-
sors into surgical robotic systems to enable direct measurement
traditional open surgery [1] and shortens the patient recov- of instrument forces. In [7], [8], [9], strain-gauge-based force
ery time [2]. In RMIS, surgeons usually use a leader console sensors were mounted on compliant surgical forceps to achieve
to maneuver miniaturized forceps, which is attached to a fol- multi-axis force-sensing. By using optical-based sensors, such
lower driver via a long cable or shaft for manipulating target as the Fiber Bragg Grating (FBG), a micro force-sensing for-
tissues (see Fig. 1). Since the soft tissues and organs inside the ceps and two palpation devices were developed in [10], [11]
human body are very vulnerable, they can be easily damaged and [12], respectively. In addition, some studies also used
if the RMIS-forceps is actuated with excessive force. To cope capacitive-based [13] and barometric-pressure-based [14] sen-
with this issue, many research studies have been conducted sors to enable high-precision force measurement of surgical
forceps. After the instrument force is measured, the force
Manuscript received 15 September 2022; revised 5 December 2022 and 11 information is transmitted to the surgeon via a haptic interface
January 2023; accepted 15 January 2023. Date of publication 18 January 2023; so that the surgeon can manually adjust the force applied to the
date of current version 9 August 2023. This article was recommended for
publication by Associate Editor P. Fiorini and Editor P. Dario upon evaluation tissue. However, it is still challenging to accurately adjust the
of the reviewers’ comments. This work was supported by the Teaching funding force of the RMIS forceps because the size of the forceps is
of TUM School of Engineering and Design, Technical University of Munich, usually very small, which leads to the need for a high-quality
Germany. (Corresponding author: Yilun Sun.)
The authors are with the Institute of Micro Technology and Medical motor to drive it precisely. In addition, the tremor of the sur-
Device Technology, Technical University of Munich, 85748 Munich, Germany geon’s hand can also affect the stability of the force applied
(e-mail: yilun.sun@tum.de; tim.lueth@tum.de). to the tissue. Therefore, it is necessary to develop advanced
This article has supplementary downloadable material available at
https://doi.org/10.1109/TMRB.2023.3237924, provided by the authors. methods for accurately and stably applying instrument forces
Digital Object Identifier 10.1109/TMRB.2023.3237924 to soft tissues.
2576-3202 
c 2023 IEEE. Personal use is permitted, but republication/redistribution requires IEEE permission.
See https://www.ieee.org/publications/rights/index.html for more information.
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SUN AND LUETH: SAFE MANIPULATION IN ROBOTIC SURGERY USING CFM 487

In recent years, constant-force mechanism (CFM) has

become a popular mechanical solution to achieve stable force
regulation for different applications [15]. This is because the
CFM can produce an almost constant output force over a cer-
tain range of input displacements. The conventional CFM are
usually based on rigid links and linear springs. For instance,
Nathan developed a CFM for gravity balancing applications
by using hinged levers and linear springs [16]. Another CFM
based on spring-slider systems was proposed by Nahar and
Sugar in [17] for micro and macro manipulation applications.
Other researchers in [18] also tried to combine curved surfaces
and linear springs to create CFMs. However, the friction force
and wear in the rotation links could reduce the accuracy of Fig. 2. PRB model of the compliant slider-crank mechanism.
rigid-link-based CFMs. To cope with these problems, compli-
ant CFMs with monolithic structure were employed in many
studies. In [19], Chen and Lan developed a 3D-printed compli- performance and outlines the future work. The entire work
ant CFM with adjustable output force by combining a bistable is concluded in Section V.
mechanism and a pre-loaded linear spring. Another compliant
CFM was created in [20] by using initially angled parallel- II. D ESIGN OF THE C OMPLIANT CFM
guiding mechanisms. By incorporating CFMs into gripping A. Mechanical Model of the CFM
jaws, several compliant grippers with constant output force As is shown in Fig. 1, the proposed CFM is composed of
were proposed in [21], [22], [23]. two symmetrical structures, both of which are based on a com-
In the current state of the art, some researchers have also pliant slider-crank mechanism. Using the PRB method [26],
tried to integrate CFMs into RMIS to achieve stable and safe the compliant slider-crank mechanism can be simplified to the
tool-tissue interaction. In [24], Lan and Wang developed a mechanical model as in Fig. 2, which consists of a rigid crank,
compliant constant-torque mechanism (CTM) using a pulley a frictionless slider, a rigid connecting rod and three torsional
with equally spaced flexible beams. The developed CTM was springs. In Fig. 2, L1 and L2 denote the lengths of the crank
attached to the RMIS-forceps through a cable to generate con- and the connecting rod, while θ1 and θ2 represent their tilt
stant force. However, since the cable force applied to the CTM angles. F is a horizontal force applied to the slider for actuat-
is not in equilibrium for the pulley center, the deformation of ing the mechanism, while the torques T1 , T2 and T3 generated
the flexible beams in the pulley was unequal, which resulted in by the three torsional springs can be expressed as:
inaccurate output forces. Although the authors in [25] avoided  
the pulley problem by directly incorporating rigid-link-based T1 = K1 · θ1 − θ1,0 (1)
 
CTM into the forceps tip, the friction force in the rotation T2 = K2 · θ2 − θ2,0 (2)
 
links of the mechanism can still affect its accuracy. T3 = K3 · θ2 − θ1 − θ2,0 + θ1,0 (3)
In this article, we present a novel design of 3D-printed com-
pliant CFM for stable force regulation of RMIS-forceps. The where K1 , K2 and K3 are the rotation stiffnesses of the three
proposed CFM is located in the forceps driver and is actuated torsional springs, while θ1,0 and θ2,0 correspond to the tilt
by a linear motor to produce constant force (see Fig. 1). This angles of L1 and L2 under undeformed springs.
work has the following contributions: Here, the sliding displacement of the slider is represented
1) Conceptual design of the CFM based on a pair of by the distance x between the springs K1 and K2 . Hence, the
symmetrical slider-crank mechanisms and cross-spring- geometrical constraints of the mechanism can be formulated
as:
based compliant joints. 
2) Development of a synthesis method based on pseudo- L1 · sin θ1 − L2 · sin θ2 = 0
(4)
rigid-body (PRB) model and optimization to determine L1 · cos θ1 − L2 · cos θ2 = x
the parameters of the CFM. In order to obtain the force-displacement relationship of
3) Adjusting the magnitude of the generated constant force the compliant slider-crank mechanism, the principle of virtual
by using detachable slider-crank mechanisms with dif- work is used. In our case, when the mechanism is in static
ferent force configurations. equilibrium, the virtual work δW done by the force (F) and
4) Experimental validation of the constant-force the torques (T1 , T2 and T3 ) can be written as:
performance of the proposed CFM using a
δW = F · δx − T1 · δθ1 − T2 · δθ2 − T3 · (δθ2 − δθ1 )
selective-laser-sintered (SLS) prototype.  
∂θ1 ∂θ2
The remainder of this article is organized as follows: = F − (T1 − T3 ) · − (T2 + T3 ) · · δx (5)
Section II first describes the PRBM-based design method- ∂x ∂x
ology, and then presents the realized compliant CFM. where δx is the virtual displacement, while δθ1 and δθ2 are
Experiments are carried out in Section III to test the the virtual rotations. Since δW = 0, F can be expressed as:
constant-force performance of the prototyped CFM. Section IV ∂θ1 ∂θ2
discusses the proposed compliant CFM in terms of its F = (T1 − T3 ) · + (T2 + T3 ) · (6)
∂x ∂x
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488 IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS, VOL. 5, NO. 3, AUGUST 2023

∂θ1
By taking the derivative of (4) with respect to x, ∂x and
∂θ2
∂x can be calculated as:

∂θ1 cos θ2
∂x = L1 ·sin (θ2 −θ1 ) = x·tan θ2
1
∂θ2 cos θ1 (7)
∂x = L2 ·sin (θ2 −θ1 ) = x·tan θ1
1

Substituting (1), (2), (3) and (7) into (6) yields:

   
(K1 + K3 ) · θ1 − θ1,0 − K3 · θ2 − θ2,0
F=
 x · tan θ2   
(K2 + K3 ) · θ2 − θ2,0 − K3 · θ1 − θ1,0
+ (8)
x · tan θ1
On the other hand, according to (4), θ1 and θ2 can also be
written as:
⎧
⎪
⎪ L12 + x2 − L22
⎪
⎪ θ = arccos
⎪
⎪
1
2 · L1 · x
⎪
⎪
⎨ L12 − x2 − L22 Fig. 3. Basic structure of a cross-spring-based compliant joint.
θ2 = arccos (9)
⎪ 2 · L2 · x
⎪
⎪ x0 ·sin θ2,0
⎪
⎪ L = sin θ −θ
⎪ 1
⎪ ( 2,0 1,0 )
⎪
⎩ L2 = x0 ·sin θ1,0
sin(θ2,0 −θ1,0 )

where x0 is the magnitude of x under undeformed springs.

Since the proposed CFM is comprised of two mirrored com-
pliant slider-crank mechanisms, its total output force Ftot can
be formulated by combining (8) and (9) as:
 
Ftot = 2 · F = f x, x0 , θ1,0 , θ2,0 , K1 , K2 , K3 (10)
where f is a function of x, x0 , θ1,0 , θ2,0 , K1 , K2 and K3 . Fig. 4. FEM-simulated stress distribution of two cross-spring-based compli-
From this point of view, the force-displacement (Ftot -x) curve ant joints with the same rotation stiffness but different geometrical parameters:
of the proposed mechanism depends on the choice of the six (a) wa = 6mm, ta = 0.5mm, ha = 3mm, αa = π/4, (b) wb = 3mm,
tb = 0.63mm, hb = 3mm, αb = π/4.
parameters x0 , θ1,0 , θ2,0 , K1 , K2 and K3 .

B. Cross-Spring-Based Compliant Joint

In order to improve the model accuracy, the flexible joints
used in the real mechanism, represented by the torsional
springs in the PRB model, should have the property of
maintaining a rotation center with little position shift during
large-angle rotations. In this work, cross-spring-based compli-
ant joints [27], [28], [29] are employed in the construction to
fulfill this requirement.
As is shown in Fig. 3, the cross-spring-based compliant
joint is comprised of three cross-axis flexible beams with
widths of w/4, w/2 and w/4. With the cross-axis structure,
the rotation stability of the compliant joint in z-axis can be
greatly improved. In the figure, t and α indicate the thickness
and tilt angle of a beam, while the length of the compliant
joint in y-axis is denoted as h. According to [28], [30], the
rotation stiffness K of the cross-spring-based compliant joint
in Fig. 3 can be formulated as:
E · sin α
· w · t3
K= (11)
12 · h
where E is the elastic modulus of the material used to fabricate
the compliant joint.
Another advantage of the cross-spring-based compliant joint
is that it has an even stress distribution for large-angle rota-
tions, which can effectively prevent the problem of mechanical
fatigue or fracture. As is shown in Fig. 4(a) and Fig. 4(b),
two simulations based on finite element method (FEM) [31]
were conducted to evaluate the mechanical performance of the
cross-spring-based compliant joints with different geometrical
parameters. From Fig. 4, it can be seen that, with the same
torque Mz , the stresses generated on the flexible beams of
the two compliant joints are evenly distributed. On the other
hand, Fig. 4 also shows that, although the two compliant joints
have the same rotation stiffness, the case (a) with a larger
value of w and a smaller value of t produces a lower stress
level. Therefore, in order to prevent plastic deformation of
the compliant joint, we set t as a constant parameter with
small value (0.5 mm) and choose w as the design variable
of K.
C. Optimization of the Design Parameters
In this section, we present an optimization-based method to
synthesize the parameters of the proposed CFM so that it can
produce a specific constant force.
Firstly, a vector p of four design variables is defined for the
optimization problem:
T
p = θ1,0 θ2,0 w1 w2 (12)

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SUN AND LUETH: SAFE MANIPULATION IN ROBOTIC SURGERY USING CFM 489

TABLE I
N ON -D ESIGN PARAMETERS OF THE CFM

Algorithm 1: Algorithm of the Function g for Calculating

Ferr
Input: p, Fconst
Output: Ferr
1 Initialization: Ninc ← 100, ηconst ← 0.85, sum ← 0;
2 x ← linspace(x0 , xmax , Ninc );
3 K1 ← k0 · p[3];
4 K2 ← k0 · p[4];
5 K3 ← k0 · p[4]; Fig. 5. Workflow of the optimization process of p.
6 Nini ← Ninc · (1 − ηconst ) + 1;
7 for i = Nini : Ninc do
8 Ftot ← f (x[i], x0 , p[1], p[2], K1 , K2 , K3 ); of the proposed CFM is always monotonically increasing in
9 sum ← sum + (Ftot − Fconst )2 ; its starting phase (see Fig. 1), we have introduced a factor
 ηconst = 0.85 in Algorithm 1 to define an effective constant-
sum force interval, which means that only the latter 85% of the
10 Ferr ← ;
Ninc · ηconst sliding interval is considered in the calculation of Ferr . In addi-
tion, several linear boundary conditions of p are also included
in the design problem of (14) to ensure that the realized CFM
has a reasonable and manufacturable geometry.
where w1 and w2 are design variables of the torsional springs Finally, we have implemented the entire optimization
(compliant joints) K1 , K2 and K3 : problem in the environment of MATLAB 2021a and used
⎧
⎪ 3 ·sin α
⎨ K1 = E·t12·h · w1 = k0 · w1 a gradient-based solver (function fmincon) to calculate the
E·t3 ·sin α optimal p. The basic principle of the solution process is illus-
⎪ K2 = · w2 = k0 · w2 (13)
⎩ K = K 12·h trated by the workflow in Fig. 5. Herein, the initial value of
3 2
p is defined by:
Here, the compliant joints K2 and K3 have the same geometry, T
3 ·sin α
and k0 is used to represent the term E·t12·h . p0 = π/6 π/4 10 10 (15)
Then, we set the other non-design parameters of the The optimization process converges when the relative change
proposed CFM as constants during the optimization pro- in all elements of p are less than 10−6 in a step.
cess (see Table I). Herein, PA2200 is the printing mate- In order to select reasonable constant-force values (Fconst )
rial for selective-laser-sintering (Formiga P100, EOS GmbH, for the proposed CFM, we have conducted the optimization
Germany), while xmax is used to define the maximum distance for 11 times, using Fconst = 2, 3, . . . , 12N respectively. The
of x that can effectively generate constant-force. optimization results are presented in Fig. 6 and Fig. 7. It
After that, an optimization problem can be formulated as can be seen that, p[1] and p[2] decrease continuously as
follows: Fconst increases, while the difference between the two variables
⎫
min : Ferr = g(p, Fconst ) ⎪
⎪ remains almost constant. This phenomenon can be explained
p ⎪
⎪ by the property of the slider-crank mechanism, because as θ1,0
subject to : 0 ≤ p[1] ≤ π/2 ⎪
⎪
⎪
⎬ and θ2,0 decrease, T1 and T2 generated by the compliant joints
: π/8 ≤ p[2] ≤ π/2 (14) generally become larger [according to (1) and (2)], which leads
: 6mm ≤ p[3] ≤ 15mm ⎪ ⎪
⎪
: 6mm ≤ p[4] ≤ 15mm ⎪ ⎪ to a increase in the output force. As for p[3] and p[4], we
⎪
⎪ can see that p[3] is always equal to the lower bound (6mm)
: p[1] ≤ p[2] ⎭
when Fconst < 9N, while p[4] increases monotonically with
where Ferr indicates the force error between the target Fconst . The increase of p[4] stops when Fconst > 9N because
constant-force Fconst and the generated output force Ftot of its upper bound (15mm) is reached. In this case, p[3] starts
the proposed mechanism. Algorithm 1 shows the pseudocode to increase with Fconst until it also reaches the upper bound.
of the function g(p, Fconst ), where the sliding interval of the On the other hand, from the Fconst -Ferr curve in Fig. 7 we
CFM is divided into 100 increments (Ninc ) and the root mean can see that, the force error of the synthesized CFM becomes
square value is used for calculating Ferr . Since the F-x curve larger as Fconst increases. In particular, the growth rate of Ferr

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490 IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS, VOL. 5, NO. 3, AUGUST 2023
Fig. 6. Synthesis results of p with respect to different Fconst values:
(a) Optimized p[1] and p[2]. (b) Optimized p[3] and p[4].
Fig. 7. Relationship between Fconst and the minimized Ferr .
Fig. 8. PRB-calculated force-displacement (F-x) curve for CFM that is
designed with Fconst = 6N.
turns much faster when Fconst > 8N. This means that, under
the provided geometrical boundary conditions, there is a limit
to the constant force that can be generated by the synthesized
CFM. Therefore, to ensure the precision of the created CFM,
Fconst is chosen from [2N, 8N] to perform mechanism synthe-
sis. The calculated Ftot -x curve in Fig. 8 (with Fconst = 6N)
is used to demonstrate the constant-force performance of the
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Fig. 9. Components of the realized compliant CFM (with Fconst = 6N).
(a) The detachable compliant slider-crank mechanism. (b) The central-line
slider set.
synthesized CFM. It can be seen that, for x ∈ [12mm, 25mm],
the output force Ftot can be successfully maintained at 6N.
D. Realized CFM System
In order to make the proposed CFM applicable to surgical
manipulation applications with different tissue stiffnesses, we
have created a modular and detachable design of the symmet-
rical slider-crank mechanisms. Herein, a central-line slider set
is introduced on the symmetry axis to connect the shaft of the
surgical tool and the actuating motor, while the two slider-
crank mechanisms are mounted on the central-line slider set
by using screws. In this way, the slider-crank mechanism can
be easily replaced for a different force configuration without
disassembling the entire CFM. Accordingly, Fig. 9 shows the
realized surface models of the CFM components, where the
optimized p value for Fconst = 6N, for illustration purpose, is
used for geometry modeling. As is presented in the figure, the
compliant slider-crank mechanism has a monolithic structure,
and the torsional springs K1 , K2 and K3 are constructed using
the cross-spring-based compliant joints. The distance between
the rotation centers of K1 , K2 and K3 is calculated using (9),
while the crank and connecting rod are realized using curved
rods with a square cross section. In this work, the SGCL
language [32], also implemented in MATLAB, was used for
geometry modeling.
Fig. 10 shows the SLS-printed CFM prototype. It can be
seen that, the entire CFM system has a symmetrical lay-
out, which helps to prevent potential jamming and friction
problems. In addition, we have utilized post-processing tech-
niques, such as the chemical vapor smoothing (PostPro3D,
AMT Ltd., U.K.), to further reduce the surface friction of
the 3D-printed parts and also to improve their mechanical
reliability.
SUN AND LUETH: SAFE MANIPULATION IN ROBOTIC SURGERY USING CFM
Fig. 10. SLS-printed prototype of the proposed CFM.
Fig. 11. Experimental setup for testing the constant-force performance of
the proposed CFM system.
III. E XPERIMENTS
A. Experimental Setup
In this section, experiments were carried out to test the
constant-force performance of the realized CFM system. The
experimental setup is presented in Fig. 11, where the linear
motor (DC12V 50mm Mini Electric Linear, HYSMOTOR,
China) was used to drive the compliant CFM in x-axis. A force
gauge (SF-500, Tripod Instrument Manufacturing Company,
Ltd., China) was used to measure the output force Ftot of
the CFM system, while the sliding distance x was measured
by a digital microscope (DigiMicro 2.0 Scale, Toolcraft AG,
Germany). In addition, slider-crank mechanism pairs with dif-
ferent force configurations were also used in the experiment
to adjust the generated constant-force values.
B. Experimental Results
In the experiment, we first measured the Ftot -x curves of
the CFM system with four different Fconst values (2N, 4N,
6N and 8N). The utilized slider-crank mechanism pairs were
constructed with the corresponding parameters from Fig. 6,
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491
Fig. 12. PRB-calculated and experimentally measured force-displacement
(F-x) curves for the opening motion of the CFM systems. The orange, blue,
green and gray curves correspond to the results of the first, second, third and
fourth test case, respectively.
Fig. 13. PRB-calculated and experimentally measured force-displacement
(F-x) curves for the closing motion of the CFM systems. The orange, blue,
green and gray curves correspond to the results of the first, second, third and
fourth test case, respectively.
while the opening and closing motions of the CFM were
both measured. We have repeated each test case for three
times, and the mean value of the measured Ftot is reported
in Fig. 12 and Fig. 13. It can be seen that, in all four cases,
the Ftot -x curves measured in the opening and closing motions
are generally consistent with the trend of the PRB-calculated
results, which has successfully validated the constant-force
performance of the proposed CFM. Nevertheless, a certain
amount of difference between the calculated and measured Fi
can still be observed, when the compliant CFM undergoes a
large deformation. A possible reason for that is the nonlinear
characteristics of the compliant joints at large-angle deflec-
tions, which may introduce errors into their rotation stiffnesses
calculated by (11).
On the other hand, to evaluate the mechanical reliability
of the fabricated CFM, we have also performed repeatability
tests, in which the prototype was open and closed for 200
492 IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS, VOL. 5, NO. 3, AUGUST 2023
Fig. 14. Grasping of a soft artificial artery by using a laparoscopic forceps that is equipped with the proposed CFM.
Fig. 15. (a) Graphical illustration of the mechanism principle of the rigid-
link-based forceps. (b) FEM-calculated force-deformation curve of the soft
tube, which is clamped by the forceps in Section III-C. The deformed cross-
section of the tube with Fc,y = 1N is also presented for illustration purpose.
TABLE II
T HE M AXIMUM Ftot M EASURED IN D IFFERENT L OAD C YCLES
times in each test case. The maximum Ftot measured in the 1st ,
50th , 100th , 150th and 200th load cycle is reported in Table II.
Results show that, thanks to the post-processing techniques,
the measured Ftot in all cases can still remain at least 90 % of
their original values after 200 load cycles.
C. Demonstration of the Application in RMIS
In this section, in order to show the application of the
proposed CFM in RMIS (see Fig. 14), we have attached a
laparoscopic forceps (Karl Storz SE & Co. KG, Germany)
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to the prototyped CFM system and used it to apply a sta-
ble clamping force of Fc = 1N on a 3D-printed soft artery
(Formlabs Inc., USA).
Before the clamping test, we should first select an appro-
priate constant-force value (Fconst ) for the CFM system to
generate Fc = 1N. As is illustrated in Fig. 15(a), the uti-
lized MIS forceps is based on a rigid-link mechanism. Here,
the clamping position L1 is always set to 30mm while the
clamping part of the soft artery can be simplified as a circular
tube with an outer diameter of D0 = 7mm and a thickness of
t0 = 1mm. The forceps opening angle is denoted as φ. With
the calculation result in (16) we can see that, the small ratio of
D0 φ
2·L1 leads to a small value of 2 when the forceps jaw deforms
the elastic tube:
 
φ D0 ◦ φ
≤ arctan = 6.6 =⇒ 0.99 ≤ cos < 1 (16)
2 2 · L1 2
Therefore, in this work, Fc can be treated as a y-axis force with
Fc,y = Fc cos ( φ2 ) ≈ Fc to calculate the tube deformation. As a
result, the relationship between Fconst and Fc can be obtained
as (17) by using the principle of virtual work:
Fc Fc Fc,y xs
= ≈ = (17)
Fconst Fs Fs yc
where xs and yc are the incremental x-axis displacement
of the shaft and the incremental y-axis displacement of the
clamping point, respectively. Fs is the shaft force. Since the
value of yxcs depends on L1 , φ and the forceps geome-
try [24], [33], we can see that φ plays an important role in
selecting Fconst .
To determine the value of φ for Fc,y ≈ Fc = 1N, we
have performed FE-analysis on the elastic tube by applying
a pair of symmetrical forces (Fc,y ) on it [see Fig. 15(b)].
Simulation results show that, before the elastic tube is fully
∗ = 5.3N, D∗ = 2mm), D decreases monotoni-
squeezed (Fc,y y y
cally as Fc,y increases. In particular, Dy reaches 5.2 mm when
Fc,y = 1N. With the value of Dy , φ can be approximated by:
Dy
φ ≈ 2 · arcsin = 10◦ (18)
2 · L1
and the value of yxcs is thus obtained as 0.167 according
to [24], [33]. Therefore, we selected Fconst = Fc · yxcs = 6N
for the CFM.
In the clamping test, we first used the linear motor to pull the
shaft to close the forceps jaws. When the sliding displacement
x of the CFM reached xmax = 25mm, we switched the motion
SUN AND LUETH: SAFE MANIPULATION IN ROBOTIC SURGERY USING CFM 493

Fig. 16. The deployment process of the CFM prototype at different time points and the corresponding deformation states of the artificial artery: (A1) t = 0s,
(A2) t = 2s, (A3) t = 3s, (A4) t = 4s, (A5) t = 9s.

Fig. 17. The actuation displacement of the linear motor in the comparison group and the corresponding deformation states of the artificial artery: (B1) t = 0s,
(B2) t = 2s, (B3) t = 3s, (B4) t = 4s, (B5) t = 9s.

direction of the motor to reopen the jaws. The entire grasping
process took 9s and Fig. 16 presents the state of the deformed
artery and the deployed CFM at several time points. It can
be seen that, from state (A1) to (A2), the CFM was slightly
deformed and mainly underwent a translational motion. This
is because the forceps jaws encountered little resistance at this
stage so that only a small force was transmitted to the CFM.
In state (A3), the compliant CFM began to be deployed since
the forceps gradually pressed the artery. From state (A3) to
(A4), although the deformation of the compliant CFM in the
x-axis became larger, it can be noticed that the soft artery
was not further squeezed (Dy = 5.2mm > D∗y ), which means
that the clamping force Fc was constant at this stage. After
that, the linear motor changed its motion direction to reopen
the forceps jaws, and the soft artery recovered to its original
shape at the end of the clamping test [state (A5)].
As a comparison group, we have also performed a clamp-
ing test without the proposed CFM. In this case, the shaft
was directly connected to the linear motor, while the maxi-
mum displacement of the motor was set to 2.8mm to achieve
fully closure of the forceps jaws. The entire grasping process
also took 9s and Fig. 17 presents the state of the deformed
artery and the actuation displacement at several time points.
It can be seen that, after the initial contact in state (B2), the
forceps jaws kept compressing the soft artery until it was com-
pletely squeezed [Dy = 2mm = D∗y in state (B4)]. This is
because, without the CFM, the clamping force Fc increases
continuously with the actuation displacement. On the other
hand, it can also be noticed that, the forceps squeezed the soft
artery completely [from state (B2) to (B4)] with only 0.6 mm
of actuation displacement, which indicates the difficulty of
achieving accurate force regulation in RMIS by only adjusting
the actuation displacement. Therefore, through the compara-
tive clamping tests, the feasibility of the proposed CFM for
achieving safe manipulation in the RMIS has been successfully
verified.

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494
IV. D ISCUSSION
The work presented in this article aims at developing a
purely mechanical approach to improve the stability of the
surgical instrument forces applied to soft tissues. Based on
a pair of symmetrical compliant slider-crank mechanism, the
developed CFM effectively simplifies the force regulation pro-
cess in RMIS because it can keep the output force constant
over a certain range of input displacements. Compared to
the rotational-structure-based compliant CFM in [24], whose
deformation is asymmetrical due to unbalanced forces, the
CFM realized in this paper is based on linear motion and
hence, has a more balanced deformation. On the other hand,
different from the adaptive forceps and gripper in our previous
work [34], [35], [36], the proposed solution also allows to
adjust the magnitude of the instrument force to cope with
soft tissues of different stiffnesses. In addition, since the
cross-spring-based compliant joints have stable rotation cen-
ters, the accuracy of the PRB model used in this work has
been improved, which outperforms the work presented in [20].
Furthermore, thanks to its modular design, the proposed CFM
is disposable and can be easily attached to different kinds of
commercial RMIS instruments for safe manipulation, which
has also promoted its application.
Nevertheless, this work can still be improved in several
aspects. For instance, we can incorporate a nonlinear model
of the compliant joint into the PRB model of (10) in the
future to take into account its nonlinear properties. On the
other hand, due to the limitations of the mechanical properties
of the PA2200 material, some mechanical instabilities can still
be observed in the repeatability test, and the miniaturization of
the proposed CFM prototype is also very difficult. Therefore,
in future work, we plan to use other advanced metal materi-
als (e.g., titan and nitinol) and manufacturing methods (e.g.,
selective laser melting and electrical discharge machining) to
fabricate the proposed CFM and deeply explore its application
in micro surgery. In addition, we also plan to introduce a rota-
tion mechanism in the CFM to realize the rotation movement
of the connected forceps.
V. C ONCLUSION
In this article, we developed a novel compliant constant-
force mechanism (CFM) with adjustable output force for safe
manipulation of soft tissues in RMIS. The PRB-based mechan-
ical model and the optimization-based synthesis method were
presented to illustrate the design principle of the proposed
CFM. The constant-force performance of the SLS-printed
CFM was successfully validated by a series of experiments.
In addition, a grasping test of soft artificial artery was also
performed, which demonstrated the application the proposed
CFM in RMIS.
ACKNOWLEDGMENT
The authors would like to thank all reviewers and editors
for their constructive criticism of the manuscript. The authors
would like to thank Chujun Zong for her helpful discussions
in writing this article.
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IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS, VOL. 5, NO. 3, AUGUST 2023
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495
Yilun Sun (Member, IEEE) received the B.Sc.
degree in mechanical engineering and automation
from Shanghai Jiao Tong University, Shanghai,
China, in 2013, and the M.Sc. and Dr.-Ing. degrees
in mechanical engineering from the Technical
University of Munich (TUM), Munich, Germany, in
2017 and 2021, respectively.
He is currently a Postdoctoral Research Scientist
with the Institute of Micro Technology and Medical
Device Technology, TUM. His research interests
include bio-robotics, soft robotic manipulators, med-
ical robotics, structural-optimization-based automatic design, and 3D-printing
technologies.
Dr. Sun received the grade summa cum laude for his Doctoral thesis. He
was also the Finalist of the Best Student Paper Award at the 2019 IEEE
International Conference on Cyborg and Bionic Systems.
Tim C. Lueth (Senior Member, IEEE) received the
Dipl.-Ing. degree in electrical engineering from the
Darmstadt University of Technology, Darmstadt,
Germany, in 1989, and the Ph.D. degree in robotics
and the Habilitation degree in computer science
from the University of Karlsruhe, Karlsruhe,
Germany, in 1993 and 1997, respectively.
From 1994 to 1995, he was a Visiting Researcher
with MITI-AIST Electrotechnical Laboratory,
Tsukuba, Japan. In 1997, he became an Associate
Professor with Humboldt University, Berlin,
Germany, and the Director of the Department of Mechatronic Medical
Devices, Humboldt-University and Fraunhofer Society in 2001. In 2005,
he became a Full Professor and the Director of the Department of Micro
Technology and Medical Device Technology, Department of Mechanical
Engineering, Technical University of Munich, Munich, Germany. His current
research interests include mechatronic medical devices, surgical navigation
systems for dental, ENT, CMF, neuro, and soft tissue surgery, navigated
control applications, RFID, and rapid prototyping technologies.
Prof. Lueth received several national and international awards for his
research on medical devices. He became an Elected Member of “acatech,”
from the German National Academy for Science and Technology in 2010.
He is also an Active Member of the IEEE R&A Society and the IEEE
Engineering in Medicine and Biology Society.