Design control of precision surgical device for otitis media with effusion

DESIGN AND CONTROL OF PRECISION SURGICAL DEVICE FOR OTITIS MEDIA WITH EFFUSION LIANG WENYU NATIONAL UNIVERSITY OF SINGAPORE 2014 DESIGN AND CONTROL OF PRECISION SURGICAL DEVICE FOR OTITIS MEDIA WITH EFFUSION LIANG WENYU (B. Eng., China Agricultural University, CAU) (M. Eng., China Agricultural University, CAU) A THESIS SUBMITTED FOR THE DEGREE OF DOCTOR OF PHILOSOPHY DEPARTMENT OF ELECTRICAL AND COMPUTER ENGINEERING NATIONAL UNIVERSITY OF SINGAPORE 2014 Declaration I hereby declare that this thesis is my original work and it has been written by me in its entirety. I have duly acknowledged all the sources of information which have been used in the thesis. This thesis has also not been submitted for any degree in any university previously. LIANG Wenyu 30 July 2014 Acknowledgments This thesis is an important milestone in my life. I would like to express my most sincere appreciation to all who had helped me during my PhD candidature in National University of Singapore (NUS). First and foremost, I would like to express my deepest gratitude to my supervisor, Prof. Tan Kok Kiong, for his enlightenment, inspiration, patient guidance, helpful advice and enthusiastic encouragement. He not only provided me with the unique opportunities to build the surgical device and the precision systems, but also gave me invaluable guidance and support which greatly helped me throughout my study and research as well as brightened my research paths. I would also like to thank Dr. Huang Sunan, who gave me constructive suggestions and warm encouragement, and discussed with me on the precision motion control systems. He has been being supportive since I began my study in NUS. Moreover, I would like to extend my thanks to the technicians and the support staffs in Department of Electrical and Computer Engineering (ECE) and Mechatronics and Automation (M&A) Lab for their support and help in offering me the required resources for my study and research. Special thanks to Mr. Tan Chee Siong, the lab officer of M&A Lab, who provided the high-class laboratory environment. My grateful thanks are also extended to Prof. Lim Hsueh Yee from Department of Otolaryngology in NUS for her useful and valuable recommendations I ACKNOWLEDGMENTS on my research project and the design of the surgical device, to Dr. Chen Silu from Singapore Institute of Manufacturing Technology (SIMTech) who gave me insightful comments and suggestions on my research, and to Prof. Zhou Huixing from China Agricultural University for his advice on the mechanical design of the Spherical Air Bearing Positioning System. Furthermore, I am thankful to Department of ECE for providing me with the scholarship to undertake my PhD research, and SIMTech for providing me with the financial support for numerous research activities. In the last four years, I have had the pleasure of working with a number of talented graduate students and researchers in Singapore. Thank all of them for their friendship and help. My thanks must go to Dr. Yuan Jian, Dr. Liu Lei, Dr. Tang Kok Zuea, Dr. Andi Sudjana Putra, Mr. Gao Wenchao and Ms. Er Poi Voon for their feedbacks. Many thanks also go to the project team of “Office-based Ventilation Tube Applicator for Patients with Otitis Media with Effusion”. Finally, I would like to thank the one I love and my family for their endless love and unconditional support. II Contents Acknowledgments I Summary VII List of Tables XI List of Figures XII Introduction 1.1 Otitis Media with Effusion . . . . . . . . . . . . . . . . . . . . . . 1.2 Existing Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2.1 Laser-assisted Myringotomy Approach . . . . . . . . . . . 1.2.2 Approaches for Myringotomy with Grommet Insertion . . 1.3 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.4 Organization of the Thesis . . . . . . . . . . . . . . . . . . . . . . 10 Mechatronic Design of an Office-based Surgical Device for Myringotomy with Grommet Insertion 12 2.1 Background and Challenges . . . . . . . . . . . . . . . . . . . . . 12 2.1.1 Space and Accessibility . . . . . . . . . . . . . . . . . . . 12 2.1.2 Operation Time . . . . . . . . . . . . . . . . . . . . . . . 14 2.1.3 Precision and Repeatability . . . . . . . . . . . . . . . . . 15 2.1.4 Diversity . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Mechanical System . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.2.1 16 2.2 Mechanical Structure . . . . . . . . . . . . . . . . . . . . III CONTENTS 2.2.2 2.3 2.4 2.5 2.6 Mechanical Design . . . . . . . . . . . . . . . . . . . . . . 19 Sensing System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.3.1 Built-in Endoscope Camera Subsystem . . . . . . . . . . . 26 2.3.2 Force Sensing Subsystem . . . . . . . . . . . . . . . . . . 28 Motion Control System . . . . . . . . . . . . . . . . . . . . . . . 37 2.4.1 Motion Sequences for Incision . . . . . . . . . . . . . . . . 37 2.4.2 Motion Sequences for Insertion . . . . . . . . . . . . . . . 39 2.4.3 Motion Controller for USM stage . . . . . . . . . . . . . . 41 2.4.4 Working Process . . . . . . . . . . . . . . . . . . . . . . . 41 Prototype and Experiments . . . . . . . . . . . . . . . . . . . . . 43 2.5.1 Prototype . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 2.5.2 Experiments and Results . . . . . . . . . . . . . . . . . . 46 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Precision Control of a Piezoelectric Ultrasonic Motor 55 3.1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 3.2 Problem Statements and Specifications . . . . . . . . . . . . . . . 59 3.2.1 Clinical Requirements . . . . . . . . . . . . . . . . . . . . 59 3.2.2 Technical Specifications . . . . . . . . . . . . . . . . . . . 60 System Identification . . . . . . . . . . . . . . . . . . . . . . . . . 60 3.3.1 System Description of USM . . . . . . . . . . . . . . . . . 61 3.3.2 System Modeling of USM . . . . . . . . . . . . . . . . . . 62 3.3.3 Parameter Estimation . . . . . . . . . . . . . . . . . . . . 63 3.3.4 Model Validation . . . . . . . . . . . . . . . . . . . . . . . 66 Control Scheme . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 3.3 3.4 IV CHAPTER 5. DEVELOPMENT OF A SPHERICAL AIR BEARING POSITIONING SYSTEM observed from the figures that the tracking error is significantly improved by the proposed control. 5.5 Conclusions In this chapter, a Spherical Air Bearing Positioning System (SABS) is developed. This system combines voice coil actuators with pneumatic bearing in order to achieve higher accuracy and better performance than the traditional multi-DOF system. The mechanical structure is carefully designed. The design and the construction of the control system for the SABS is presented, which involves system modeling, parameter identification, eliminating noise and controller design. The model of the SABS is identified based on the adaptive control concepts first. Then a noise filter is designed to remove the measurement white noise on the basis of the model. Finally, an observer-based PID controller is applied to the SABS and implemented on a dSPACE 1104 control card. The experimental results indicate that the observer-based PID controller is effective in controlling the SABS. Comparing it with the traditional PID controller, it is clear that the observer-based PID controller achieves higher precision and better tracking performance of about 10 times than the traditional one. 140 Chapter Conclusions In this chapter, the summary of contributions for this thesis is drawn at first, followed by the suggestions for future work. 6.1 Summary of Contributions The primary objective of this study was to develop an all-in-one office-based precision surgical device for the treatment of a common ear disease: Otitis Media with Effusion (OME). The mechatronic system of the device, including mechanical system, sensing system and control system, has been developed to address the problems associated with conventional surgery and reported devices for similar purposes. Based on the experimental results, it was found that the prototype was able to carry out the myringotomy with grommet insertion in a single procedure automatically with a high success rate over 90% as well as a short surgical time less than 3s initially and then being reduced to less than 1s after program optimization. Significantly, the surgical time is much shorter than the conventional surgery which normally takes about 15 minutes. This is attributed to the sensing and motion systems which provide precise actions for each procedure. Moreover, this surgical device was operated without the need of surgeon during the exper141 CHAPTER 6. CONCLUSIONS iments. This implies that the surgery is much simplified and the workload is reduced by using this surgical device. An important contribution of this study is that it may provide a better solution to carry out the surgical treatment for the patients with OME automatically in very short time, avoiding the need of the costly expertise and equipment. In order to achieve high precision and fast response motions for the surgical procedures, the model of the ultrasonic piezomotor (USM) stage has been investigated and built, and then a composite precision motion controller based on the model has been designed and implemented in this study. The experimental results showed that the LQR-assisted PID tuning method achieved a high level of performance. Comparing with the conventional relay-tuned PID controller [56], the LQR-assisted PID controller achieves significantly smaller overshoot, faster response, higher precision, better tracking performance, lower energy consumption and smaller control input. One possible explanation is that the selection of the weighting matrix in LQR-assisted PID tuning method relates to the performance requirements. Different performance requirements can be achieved by changing the weighting matrix. According to the weighting matrix, the optimal controller gains can be obtained. Furthermore, it was also found that the errors were much reduced by applying the friction compensation and adaptive control law with the proposed PID controller. These results suggest that the nonlinear compensation is effective in enhancing the performance significantly. The significance of the proposed composite controller is that it may provide a new control scheme to achieve high performance and precise motions by the USM stage which induces nonlinear dynamics mainly caused by the friction. These precise motions are important and helpful in improving the success rate for grommet insertion. 142 CHAPTER 6. CONCLUSIONS In order to enhance the repeatability and the success rate of the surgical device, a stabilization system for the surgical device based on force feedback with vision-based motion compensation has been developed in this study. It was found from the results that the relative motion and the contact force between the grommet and the membrane can be maintained precisely at a desired level after touching. Thus, the grommet insertion could be done more precisely while the proposed controller was applied after the grommet on the device touched the membrane. It was also found that the device with the proposed controller had good ability to nullify the effects of unforeseen disturbances. This is due to the ability of the force controller that assists the device in closely tracking the membrane position. This study is the first to implement the stabilization system for such kind of surgical devices (specifically for ear surgery) using force feedback approach. The proposed approach provides a novel method to stabilize the device as well as to enhance the anti-disturbance capacity of the device. In order to further guarantee the stabilization between the surgical device and the tympanic membrane, another stabilization system based on a novel 2DOF spherical air bearing positioning system (SABS) which combines a directdrive electromagnetic motor with pneumatic bearing has been developed and proposed for stabilizing the patient’s head rotation in this study. The experiment results showed that the SABS could provide highly precise angular motions. The design controller could achieve much higher precision and much better tracking performance than a traditional PID controller. Due to the advantages of high precision, high repeatability and fast response that the SABS offers, it provides a feasible approach in head stabilization and other applications which require spherical motion. 143 CHAPTER 6. CONCLUSIONS 6.2 Suggestions for Future Work The proposed surgical device offers a good, precise and robust solution for the surgical treatment of OME. However, there are some limitations in this study and thus further research is required in order to overcome these limitations. • The surgical device developed in this study may not be able to perform the surgery on the ears with abnormal structures, i.e., tortuous or extremely narrow ear canals. This is because the design of the tool set is rigid and straight. To address this problem, the design of the flexible tool set which can be bent controllably should be considered in future. • The nonlinear term of the USM stage’s model may not be perfectly accurate since the hysteretic phenomenon of the piezoelectric martial was not considered during the system modeling. Thus, another possible avenue of future work is to investigate the nonlinear dynamics of the USM stage and identify the nonlinear term by combining the friction model and the Preisach hysteresis model [35]. Following that, a better nonlinear compensator or controller could be designed based on the more accurate nonlinear model. • The force controller for the stabilization system is not achieving the same performance on all tympanic membranes since the controller parameters are fixed while the characteristics of different tympanic membranes are not exactly the same. In future, the adaptive control algorithm could be considered since it can adjust the controller parameters by itself to achieve the desired performance in response to the different or varying conditions. 144 CHAPTER 6. CONCLUSIONS • The 2-DOF SABS is not yet fully integrated into the surgical device. One future work is to complete the integration between both system. 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Lee, “Empirical Formulation of Torque Output for Spherical Actuators with Low-cost Rotor Poles,” 2009 IEEE/ASME International Conference on Advanced Intelligent Mechatronics, Singapore, pp1625-1630, 2009 [86] C. K. Lim, I. M. Chen, L. Yan, G. Yang, K. M. Lee, “Electromechanical Modeling of a Permanent-Magnet Spherical Actuator Based on MagneticDipole-Moment Principle,” IEEE Transactions on Industrial Electronics, vol. 56, no. 5, pp. 1640-1647, May 2009 [87] Z. Zhou, K. M. Lee, “Real-time Motion Control of a Multi-degree-of-freedom Variable Reluctance Spherical Motor,” 1996 IEEE International Conference on Robotics and Automation, vol. 3, pp. 2859-2864, 1996 [88] K. S. Chen, D. L. Trumper, S. T. Smith,“Design and control for an electromagnetically driven X − Y − θ stage,” Precision Engineering, vol. 26, no. 4, pp. 355-369, Oct. 2002 [89] M. Hu, S. F. Ling, H. Du, J. K. Teo, “Design of a novel ultrasonic spherical motor,” 2000 IEEE Ultrasonics Symposium. Proceedings. An International Symposium, pp. 667-670, Oct. 2000 [90] D. H. Yeom, N. J. Park, S. Y. Jung, “Digital controller of novel voice coil motor actuator for optical image stabilizer,” 2007 International Conference on Control, Automation and Systems, Seoul, Korea, pp2201-2206, 2007 152 Author’s Publications Journal Papers [1] K. K. Tan, W. Liang, S. Huang, L. P. Pham, H. Y. Lim, and C. W. Gan, “Design of a Surgical Device for Office-Based Myringotomy and Grommet Insertion for Patients With Otitis Media With Effusion,” Journal of Medical Devices, vol. 8, no. 3, pp. 031001-1-12, Sep. 2014 (published) [2] W. Gao, K. K. Tan, W. Liang, C. W. Gan, and H. Y. Lim, “Intelligent Vision Guide for Automatic Ventilation Grommet Insertion on Tympanic Membrane,” International Journal of Medical Robotics and Computer Assisted Surgery (accepted) [3] P. V. Er, R. Cao, W. Liang, R. Yang, C. S. Teo, and K. K. Tan, “Selective Approach Towards Robust Control and Accommodation of Disturbances,” International Journal of Mechatronics and Automation, vol. 4, no. 3, pp. 161-172, Aug. 2014 (published) [4] W. Liang, K. K. Tan, S. Huang, L. P. Pham, H. Y. Lim, and C. W. Gan, “Control of a 2-DOF Ultrasonic Piezomotor Stage for Grommet Insertion,” Mechatronics, vol. 23, no. 18, pp. 1005-1013, Dec. 2013 (published) [5] K. K. Tan, S. Huang, M. Nguyen, W. Liang, and S. Ng, “An Innovative Design for In-vitro Fertilization Oocyte Retrieval Systems,” IEEE Transactions on Industrial Informatics, vol.9, no.4, pp.1892-1899, Nov. 2013 (published) [6] K. K. Tan, S. Huang, W. Liang, A. A. Mamun, E. K. Koh, and H. Zhou, “Development of a Spherical Air Bearing Positioning System,” IEEE Transactions on Industrial Electronics, vol.59, no.9, pp.3501-3509, Sep. 2012 (published) [7] K. K. Tan, W. Liang, S. Huang, L. P. Pham, S. Chen, C. W. Gan, and H. Y. Lim, “Precision Control of Piezoelectric Ultrasonic Motor for Myringotomy with Tube Insertion” (submitted) [8] W. Liang, K. K. Tan, “Force Feedback Control assisted Tympanostomy Tube Insertion” (submitted) [9] W. Gao, W. Liang, and K. K. Tan, “Intelligent Device with Multiple Sensing Channels for Automated Ventilation Tube Insertion on Tympanic Membrane” (submitted) [10] M. Nguyen, W. Liang, C. S. Teo, K. K. Tan, “Piecewise Affine Modeling and Compensation in Motion of Linear Ultrasonic Actuators” (submitted) [11] S. Chen, N. Kamaldin, T. J. Teo, W. Liang, G. Yang, and K. K. Tan, “Modeling and Robust Tracking Control of a Limited Angle Torque Motor with Cylindrical Halbach” (submitted) 153 AUTHOR’S PUBLICATIONS [12] N. Kamaldin, W. Liang, K. K. Tan, C. W. Gan, and H. Y. Lim, “Capacitive Based Contact Sensing for Office-based Ventilation Tube Applicator for Otitis Media with Effusion Treatment” (submitted) Conference Papers [1] W. Gao, W. Liang, and K. K. Tan, “Automated Tube Insertion on Tympanic Membrane based on Vision-Servo and Tactile Sensing,” 2014 The 40th Annual Conference of the IEEE Industrial Electronics Society, IECON 2014, pp. 2706-2711, Oct. 2014 (published) [2] S. Chen, T. J. Teo, N. Kamaldin, W. Liang, K. K. Tan, and G. Yang, “Identification and Robust Tracking Control of a Single-phase Rotary Motor with Halbach Permanent Magnet Array Design,” 2014 International Conference on Mechatronics and Automation, ICMA 2014, pp. 497-502, Aug. 2014 (published) [3] W. Liang, W. Gao, S. Chen, and K. K. Tan, ”Stabilization for an Ear Surgical Device using Force Feedback and Vision-based Motion Compensation,” 2014 IEEE/ASME International Conference on Advanced Intelligent Mechatronics, AIM 2014, pp. 943-948, Jul. 2014 (published) [4] N. Kamaldin, S. Chen, T. J. Teo, W. Liang, K. K. Tan, and G. Yang, Modeling and Robust Output feedback Tracking Control of a Single-phase Rotary Motor with Cylindrical Halbach Array,” 2014 IEEE/ASME International Conference on Advanced Intelligent Mechatronics, AIM 2014, pp. 800-805, Jul. 2014 (published) [5] W. Gao, K. K. Tan, W. Liang, C. W. Gan, and H. Y. Lim, “Intelligent Vision Guide for Automatic Grommet Tube Insertion on Human Eardrum,” 2014 International Symposium on Industrial Electronics, ISIE 2014, Jun. 2014 (published) [6] W. Gao, K. K. Tan, and W. Liang, “Stereo Vision Based Intelligent System for Middle Ear Treatment,” 2013 IEEE International Conference, IEEEROBIO 2013, pp. 1426-1431, Dec. 2013 (published) [7] K. K. Tan, W. Liang, T. H. Lee, C. H. Choy, and Z. Shen “Design and Development of a Feedback Mechanism and Approach for Patient-Instrument Stabilization during Office-based Medical Procedures,” 2013 Seventh International Conference on Sensing Technology, ICST2013, pp. 520-525, Dec. 2013 (published) [8] W. Liang, S. Huang, Silu Chen, and K. K. Tan, “Precision Motion Control of a Linear Piezoelectric Ultrasonic Motor Stage”, 2013 IEEE/ASME International Conference on Advanced Intelligent Mechatronics, AIM 2013, pp. 164-169, Jul. 2013 (published) [9] K. K. Tan, W. Liang, S. Huang, L. P. Pham, H. Y. Lim, and Chee Wee Gan, “Development of a Medical Device for the Surgery of Myringotomy and Grommet Insertion,” 2013 IEEE/ASME International Conference on Advanced Intelligent Mechatronics, AIM 2013, pp.1448-1453, Jul. 2013 (published) 154 AUTHOR’S PUBLICATIONS [10] K. K. Tan, Minh H-T Nguyen, W. Liang, Chek Sing Teo, “Robust Precision Positioning Control on Linear Ultrasonic Motor,” 2013 IEEE/ASME International Conference on Advanced Intelligent Mechatronics, AIM 2013, pp.1448-1453, Jul. 2013 (published) [11] K. K. Tan, W. Liang, S. Huang, L. P. Pham, H. Y. Lim, and Chee Wee Gan, “Surgical Device for Office-based Treatment of Otitis Media with Effusion,” 2013 Conference on Advance in Biotechnology, Biotech 2013, pp. 77-85, Mar. 2013 (published) [12] E. L. Tan, Angel T.-H. Lin, R. Lim, M. Hamidullah, M. Y. Cheng, C. He, and W. Sun, K. K. Tan, W. Liang, and L. P. Pham, “Silicon Nanowires (SiNWs) based Force Sensor for Membrane Contact Measurement”, 2013 Conference on Advance in Biotechnology, Biotech 2013, pp. 46-48, Mar. 2013 (published) [13] K. K. Tan, S. Huang, W. Liang, S. Yu, “Development for precise positioning of air bearing stages,” 2012 International Conference on Mechatronics and Automation, ICMA 2012, pp.1943-1948, Aug. 2012 (published) [14] L. Liu, K. K. Tan, W. Liang, S. Huang, and T. H. Lee, “Flexible Spacecraft Jitter And Its Suppression By Stewart Platform,” 23rd Canadian Congress of Applied Mechanics 2011, CANCAM 2011, pp. 57-60, Jun, 2011 (published) Patent [1] K. K. Tan, W. Liang, S. Huang, L. P. Pham, H. Y. Lim, and C. W. Gan, “Apparatus for Office-based Grommet Tube Insertion”, Technology Disclosure filed with A*STAR Exploits, filed in Jun. 2012 (filed) 155 [...]... Time response of ks with a sine wave reference (20Hz) 79 3.13 Errors associated with different controllers 80 3.14 Energy by using different controller 81 3.15 Errors associated with the composite controller without or with sliding mode control law (with disturbance) 82 3.16 Control performance of one cycle by using the PID controller without and with compensation... controller IX List of Tables 2.1 Conditions for identification of the instances from force output 33 2.2 Cutting time consumed with and without vibration 37 3.1 Tracking Errors associated with different control laws 80 3.2 Maximum control input of different control laws 81 3.3 Tracking Errors by using different control laws 84 4.1 Errors by using different controllers for. .. 102 4.13 Force output of the force control system 103 4.14 Force error of the force control system 103 XIV LIST OF FIGURES 4.15 Position outputs from the linear encoder and the image processing 104 4.16 Error of the vision-based motion measurement 105 4.17 Force outputs of different control methods 106 4.18 Errors of different control methods... motion control system for the device in order to 9 CHAPTER 1 INTRODUCTION achieve high precision, high speed and high performance for the procedures • Propose and design the stabilization system for the device in order to enhance repeatability and success rate The present study may provide a better solution for the surgical treatment of OME without the need of skilled surgeon and complex setup The precision. .. control components fulfill their respective control functions well, and the composite controller is effective towards delivering the level of control performance to meet the objectives for the OME ear procedures Next, due to the office-based design of the surgical device, it is not possible to subject the patient to general anesthesia, i.e., the patient is awake during the surgical treatment with the device. .. limitations of the current art is to develop the precision surgical device for OME In the following sections of this chapter, the detailed background is provided at first, followed by a literature review and a presentation of the objective of this thesis Finally, the organization of this thesis is presented 1.1 Otitis Media with Effusion Generally, the human ear which anatomy is shown in Fig 1.1 consists of three... the control system of the SABS were presented, the model of the SABS was identified based on adaptive control concepts To eliminate the measurement noise, a noise filter was designed on the basis of the model Following that, an observer-based PID controller was designed and implemented The experimental results show that the designed controller achieves higher precision and better tracking performance of. .. instead 1.4 Organization of the Thesis In this thesis, the following chapters are organized as follows The mechatronic system of the proposed precision surgical device are presented in Chapter 2 In Chapter 3, the design details of the precision motion control system for the device is presented Following that, two different stabilization systems for 10 CHAPTER 1 INTRODUCTION the device to enhance repeatability... Finally, conclusions are drawn in Chapter 6 11 Chapter 2 Mechatronic Design of an Office-based Surgical Device for Myringotomy with Grommet Insertion To overcome the limitations of the current existing devices for myringotomy and grommet insertion, a novel surgical device is developed in this chapter to carry out the surgery of myringotomy with grommet insertion in office automatically and quickly 2.1 Background... challenges of such a design are delineated Generally, there are four key challenges to the development of the “all-in-one” autonomous device for office-based myringotomy with grommet insertion, and these challenges shape the selection and design of the constituent components of the overall device, which will be elaborated in this chapter 2.1.1 Space and Accessibility The subject of interest to the design of . DESIGN AND CONTROL OF PRECISION SURGICAL DEVIC E FOR OTITIS MEDIA WITH EFFUSION LIANG WENYU NATIONAL UNIVERSITY OF SINGAPORE 2014 DESIGN AND CONTROL OF PRECISION SURGICAL DEVIC E FOR OTITIS. associated with the composite controller without or with sliding mode control law (with disturbance) . . . . . . . . . . . . 82 3.16 Control perf ormance of one cycle by using the PID controller with- out. the designed controller achieves higher precision and better tracking performance of abou t 10 times compared to that from a traditional PID controller. IX List of Tables 2.1 Conditions for