The overall project objectives are to produce new knowledge in the area of codim k bifurcations for continuous and discrete (smooth and non-smooth) dynamical systems and provide training in this area of research to early stage researchers. More exactly, we plan firstly to study degenerate two-dimensional Bautin bifurcation for the case when the second Lyapunov coefficient equals zero. Secondly, we aim to study degenerate four-dimensional Hopf-Hopf bifurcations. The degeneracy arises in this case when one or more of the nine generic conditions needed in obtaining a normal form fail to be satisfied. The third and fourth objectives are to study other codim k bifurcations in smooth and non-smooth dynamical systems arising from other bifurcations which bear or not a known name in the literature. In particular, we will focus on discontinuous piecewise differential systems, respectively, continuous and discrete non-smooth dynamical systems resulting from modelling oscillators with impacts. A number of about 40 researchers (30 ERs and 10 ESRs) will contribute to achieving the project objectives by a networking approach based on about 225 months of secondments. Two types of secondments are planned, one for research and another for training. The training is of type training-through-research. During the research secondments, the project ERs will perform research for achieving the planned project tasks and will support ESRs on their training. The training secondments are dedicated to ESRs. Apart from the planned training, the ESRs will participate also to the project research. They will receive specific research tasks from their local managers to contribute to the project research objectives.

Retina indications are the leading cause of visual impairment in industrialized countries and posing a big unmet socio-economic challenge. Performing surgical actions directly at the retina - one of the most delicate and sensitive areas of the human body - with ultra-thin microsurgical instruments and with a limited view makes retina surgery a very challenging discipline with surgeons working at the limit of what is possible, requiring years of training and experience to reach proficiency. The GEYEDANCE project is directly addressing this need by translating methods from Artificial Intelligence to the area of surgical robotics, together to be used for an advanced user support for reducing the mental and physical load of the surgeon. Work in the project is building on two existing main blocks - the CE certified robot platform PSS from project partner Preceyes, and a prototype for a Common-Path OCT system with extended measurement depth from partner ACMIT. For the AI-components to be developed, two European leading groups in this domain - ALTAIR/University of Verona and ARTORG/University of Bern - are part of the consortium. Seamless involvement of key stakeholders during the complete development phase is indispensable for a meaningful outcome, and thus a prominent board of world-wide leading eye surgeons, led by partner University of Ferrara, will provide user insight and evaluate the resulting advanced robotic solution. Development and validation of the GEYEDANCE system is strongly supported by industrial partners Carl Zeiss AG and Carl Zeiss Meditec AG. In-line with the concept of the Innovation Actions instrument, the project aims to generate tangible and close-to-certification" technology reaching a TRL of 7 (or even higher), being evaluated in the framework of a first clinical trial. All together, the planned AI-based guidance system GEYEDANCE will help the consortium to further consolidate their leading position worldwide, will help retinal surgeons to optimize their task, and finally will help the patient by contributing to a better surgical outcome.

Currently during a laparoscopic operation, several units of medical personnel are requested to stay in the operating room for supporting the main surgeon teleoperating the surgical robot. In particular one assistant is always present for taking care of simple surgical procedures (e.g. aspiration of dead tissue after a cut in laparoscopy, moving organs or tissue to make room for cutting or suturing) that the leading surgeon cannot perform with the laparoscopic tools s/he is teleoperating. It is common that an expert surgeon has to play the role of an assistant during an operation led by another surgeon. Furthermore, the assistant is performing critical tasks only for the 30% of the time of the operation and s/he has to stand, waiting, most of the time. Considering the hourly cost of a surgeon, the current practice is very inefficient from an economic point of view but also from a social point of view, leading to unnecessary long waiting lists. The goal of the project is to develop a surgical robotic platform that allows to decrease the number of surgeons necessary for one operation, increasing the social and economic efficiency of a hospital and guaranteeing the same level of safety for the patients. We will focus on laparoscopic surgery, where the surgeon is teleoperating a surgical robot for executing some procedure (e.g. nephrectomy, prostatectomy). The goal of the project is to develop a surgical robotic platform that allows only one surgeon to execute R-MIS operations. SARAS will develop: 1. two assistive robotic arms designed to implement the tasks currently done by the assistant surgeon by holding off-the shelf laparoscopic instruments, 2. a cooperative and cognitive supervisor system able to infer the actual state of the procedure by analysing the information coming from the sensing system and to act accordingly with the surgeon’s needs. Having these technologies available we are in a position to develop a solo surgery system.

The ROBIOPSY project aims at evolving the robotic device for prostate cancer (PC) biopsy demonstrated during the ERC-PoC PROST into a product prototype that will be ready for clinical trials. The focus of the project will be two-fold: the engineerization of the PROST prototype, and the accurate analysis of the business case of prostate cancer diagnosis and its potential extension to focal therapy. We will correct the shortcomings of the pre-clinical tests, meet the strict medical certification regulations, and address the Health Economics implications of our solution. ROBIOPSY will achieve better performance than current competitors because it solves the two main causes of PC diagnostic error: uncertain target identification, and inaccurate needle positioning, as demonstrated in the pre-clinical tests. A novel image fusion method will permit to significantly reduce the target uncertainty, while the robotic device will zero the positioning error.The ROBIOPSY prototype will consist of a single cart holding the robotic needle positioner, and housing all the electronic components. The electronics will be divided into two subsystems: interface and data processing, and safety critical controls. This will reduce the operational risks and will simplify the medical certification. A multi-centric study is ongoing to collect biopsy images to train the Machine Learning algorithms for prostate segmentation and lesion identification. In parallel to the technical development, we will analyze in depth the business case of prostate biopsy in selected European Countries, we will analyze the time/cost reduction due to the new device and will establish the economic foundation of focal therapy, to be ready for the expected evolution of PC treatments.

Annually, cardiovascular disease (CVD) causes over 4m deaths in Europe and 17.3m deaths globally, and is expected to grow to over 23.6m by 2030. It accounts for 40% of deaths in the EU and costs the EU economy almost €196bn each year. 2D ultrasound scans are currently the primary choice for vascular diagnostics. Due to low sensitivity, a limited field of action and the lack of volume information, patients are often referred for CTa, MRa and catheter angiography for the detailed imaging required for diagnosis and treatment planning. Referrals delay treatment, exposes the patient to risks associated with radiation and contrast mediums and increases costs. This presents a need to improve the speed and safety of the diagnosis of vascular conditions for rapid treatment, as well as to improve workflow efficiency and reduce costs. The project consortium will further develop the piur tUS system, a 3D freehand tomographic US system capable of rapid, safe and accurate reconstructive 3D quantifiable vascular imaging. It will provide a low cost and reproducible imaging solution that will reduce the need for referrals and be an effective preventative screening tool for CVD. We aim to complete and publish the results from 4 CVD clinical studies to generate the clinical evidence required for CE marking and clinical validation for market uptake. The 4 clinical applications studied will provide a solution for conditions most frequently referred for detailed 3D imaging to maximise the cost-benefit to clinics of purchasing the piur tUS system. The project consortium combines piur imaging’s expertise in medical device development and commercialisation with 3D imaging specialist ImFusion GmbH and medical device product development and manufacturing experts ACMIT. The clinical input for the product development and the clinical studies will be provided by our consortium partners, Independent Vascular Services Ltd and the Institute for Cardiovascular Science: University of Manchester