7 research outputs found

    Robotics for Natural Orifice Transluminal Endoscopic Surgery: A Review

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    Natural Orifice Transluminal Endoscopic Surgery (NOTES) involves accessing the abdominal cavity via one of the bodies’ natural orifices, for example, mouth, anus, or vagina. This new surgical procedure is very appealing from patients’ perspectives because it eliminates completely abdominal wall aggression and promises to reduce postoperative pain, in addition to all other advantages brought by laparoscopic surgery. However, the constraints imposed by both the mode of access and the limited technology currently available make NOTES very challenging for the surgeons. Redesign of the instruments is imperative in order to make this emerging operative access safe and reproducible. In this paper, we survey on the state-of-the-art devices used in NOTES and introduce both the flexible instruments based on improvement of current endoscopic platforms and the revolutionary concept of robotic platforms based on the convergence of communication and micromechatronics technologies. The advantages and limitations of each category are addressed. Potential solutions are proposed to improve the existing designs and develop robust and stable robotic platforms for NOTES

    Robotic technology and endoluminal surgery in digestive surgery

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    BACKGROUND. Colorectal cancer (CRC) is the third most common cancer in males and second in females, and the fourth most common cause of cancer death worldwide. The implementation of screening programs has allowed to the identification of an increasing number of early-stage neoplastic lesions. Presently, superficial colorectal neoplasms (including precancerous lesions and early cancer) can be resected in the colon by Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD), while in the rectum by Transanal Endoscopic Microsurgery (TEM). They are the preferred choices inside of the minimally invasive panorama regarding the CRC treatment. TEM technique offers more advantages than EMR and ESD, but it can’t overcome the recto-sigmoid junction. Many authors, research institutes and biomedical industries have proposed different solutions for microsurgery dissection of early lesions in the colon, but all these proposals have in common the development of platforms expressly designed for this use, with significant purchasing and management costs. The aim of our research project is to develop a robotic platform that allows to treat lesions throughout the colon limiting the costs of management and purchasing. This new robotic platform, developed in collaboration with Scuola Superiore Sant’Anna in Pisa, is called RED (Robot for Endoscopic Dissection). At the tip of a standard endoscope a hood (RED) is placed. RED is equipped by two extractable teleoperated robotic arms (i.e., diathermic hook and gripper); their motion is provided by onboard miniaturized commercial motors and a dedicated external platform. The endoscopist holds the endoscope near the lesion, while the operator drives the robotic arms through a remote control. MATERIALS AND METHODS. Several preliminary studies have been conducted in the following order. A first test was conducted for identification of force value for lifting and pulling maneuvers using a modified TEM instrument. A CAD study was conducted to determine the maximum size that the hood must have in order to overcome the critical angle represented by the splenic flexure. Several tests were conducted to determine the degrees of freedom of each robotic arm, starting with the CAD drawing to make subsequently the mock-ups of each configuration. Finally, a 3D mock-up was produced that was assembled on an endoscope to perform the in vitro test to evaluate the workspace and field of view using a pelvic trainer for TEM. RESULTS. The first test shown that the minimum force that the gripper will have to develop with the push-pull is 1.5N. The CAD study shown that the maximum dimensions the hood must have to overcome splenic flexure are: maximum diameter 28mm, maximum length 57mm. After several configurations was been tested, the final prototype features are: gripper arm with pitch sliding and open/close of the tip and diathermic hook arm with pitch, roll and sliding. There will be 6 such distributed motors: 3 external motors for the gripper arm that will operate through cables contained in a sheath adherent to colonscope and 3 embedded motors for diathermic hook arm (one integrated on the hood for the sliding degree of motion and the other two inside of the arm). The in-vitro test has been carried out to evaluate the workspace and they proved that the operating field vision is not obstructed by the hood and the working range is sufficiently wide to perform a dissection. CONCLUSION. Tests conducted up to this point have allowed us to identify the overall layout of the RED: dimensions, degrees of freedom, number and distribution of motors needed for the operation of robotic arms; moreover, it is proved that the device, once assembled, maintained the visual and operational field characteristics necessary to perform an accurate dissection. The next step will be to realize a RED steel final prototype and in-vivo tests will be carry out to replicate an endoscopic dissection into the colon

    Anthropomorphic surgical system for soft tissue robot-assisted surgery

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    Over the past century, abdominal surgery has seen a rapid transition from open procedures to less invasive methods such as laparoscopy and robot-assisted minimally invasive surgery (R-A MIS). These procedures have significantly decreased blood loss, postoperative morbidity and length of hospital stay in comparison with open surgery. R-A MIS has offered refined accuracy and more ergonomic instruments for surgeons, further minimising trauma to the patient.This thesis aims to investigate, design and prototype a novel system for R-A MIS that will provide more natural and intuitive manipulation of soft tissues and, at the same time, increase the surgeon's dexterity. The thesis reviews related work on surgical systems and discusses the requirements for designing surgical instrumentation. From the background research conducted in this thesis, it is clear that training surgeons in MIS procedures is becoming increasingly long and arduous. Furthermore, most available systems adopt a design similar to conventional laparoscopic instruments or focus on different techniques with debatable benefits. The system proposed in this thesis not only aims to reduce the training time for surgeons but also to improve the ergonomics of the procedure.In order to achieve this, a survey was conducted among surgeons, regarding their opinions on surgical training, surgical systems, how satisfied they are with them and how easy they are to use. A concept for MIS robotic instrumentation was then developed and a series of focus group meetings with surgeons were run to discuss it. The proposed system, named microAngelo, is an anthropomorphic master-slave system that comprises a three-digit miniature hand that can be controlled using the master, a three-digit sensory exoskeleton. While multi-fingered robotic hands have been developed for decades, none have been used for surgical operations. As the system has a human centred design, its relation to the human hand is discussed. Prototypes of both the master and the slave have been developed and their design and mechanisms is demonstrated. The accuracy and repeatability of the master as well as the accuracy and force capabilities of the slave are tested and discussed

    Surgical Applications of Compliant Mechanisms:A Review

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    Current surgical devices are mostly rigid and are made of stiff materials, even though their predominant use is on soft and wet tissues. With the emergence of compliant mechanisms (CMs), surgical tools can be designed to be flexible and made using soft materials. CMs offer many advantages such as monolithic fabrication, high precision, no wear, no friction, and no need for lubrication. It is therefore beneficial to consolidate the developments in this field and point to challenges ahead. With this objective, in this article, we review the application of CMs to surgical interventions. The scope of the review covers five aspects that are important in the development of surgical devices: (i) conceptual design and synthesis, (ii) analysis, (iii) materials, (iv) maim facturing, and (v) actuation. Furthermore, the surgical applications of CMs are assessed by classification into five major groups, namely, (i) grasping and cutting, (ii) reachability and steerability, (iii) transmission, (iv) sensing, and (v) implants and deployable devices. The scope and prospects of surgical devices using CMs are also discussed

    Cable-driven parallel robot for transoral laser phonosurgery

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    Transoral laser phonosurgery (TLP) is a common surgical procedure in otolaryngology. Currently, two techniques are commonly used: free beam and fibre delivery. For free beam delivery, in combination with laser scanning techniques, accurate laser pattern scanning can be achieved. However, a line-of-sight to the target is required. A suspension laryngoscope is adopted to create a straight working channel for the scanning laser beam, which could introduce lesions to the patient, and the manipulability and ergonomics are poor. For the fibre delivery approach, a flexible fibre is used to transmit the laser beam, and the distal tip of the laser fibre can be manipulated by a flexible robotic tool. The issues related to the limitation of the line-of-sight can be avoided. However, the laser scanning function is currently lost in this approach, and the performance is inferior to that of the laser scanning technique in the free beam approach. A novel cable-driven parallel robot (CDPR), LaryngoTORS, has been developed for TLP. By using a curved laryngeal blade, a straight suspension laryngoscope will not be necessary to use, which is expected to be less traumatic to the patient. Semi-autonomous free path scanning can be executed, and high precision and high repeatability of the free path can be achieved. The performance has been verified in various bench and ex vivo tests. The technical feasibility of the LaryngoTORS robot for TLP was considered and evaluated in this thesis. The LaryngoTORS robot has demonstrated the potential to offer an acceptable and feasible solution to be used in real-world clinical applications of TLP. Furthermore, the LaryngoTORS robot can combine with fibre-based optical biopsy techniques. Experiments of probe-based confocal laser endomicroscopy (pCLE) and hyperspectral fibre-optic sensing were performed. The LaryngoTORS robot demonstrates the potential to be utilised to apply the fibre-based optical biopsy of the larynx.Open Acces

    STUDI PERENCANAAN PERKERASAN LENTUR DENGAN METODE BINA MARGA DAN PERKIRAAN RENCANA ANGGARAN BIAYA NYA PADA PROYEK PEMBANGUNAN JALAN BULUKUMBA – TONDONG PROVINSI SULAWESI SELATAN

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    Pada ruas jalan lintas Bulukumba – Tondong pada tahun 2011 telah dibangun jalan sepanjang 20,7 km dan lebar 11 m dengan menggunakan konstruksi perkerasan lentur, dimana jalan tersebut merupakan jalan nasional yang menghubungkan Kabupaten Bulukumba dengan Kabupaten Sinjai. Banyaknya kendaraan berat yang melintas di sepanjang jalan lintas Bulukumba – Tondong ini diakibatkan oleh para pengguna jalan yang menjadikan jalan ini sebagai salah satu jalan alternatif menuju kota Makassar untuk menghindari kemacetan dan jalan rusak di Kab. Jeneponto. Dimana kondisi fisik atau kontur daerah lumayan berat karna ruas jalan sebagian besar melalui perbukitan dan tebing-tebing. Berdasarkan fungsinya, jalan lintas ini merupakan jalan kolektor dan kelas II. Data yang digunakan dalam studi perencanaan berupa data sekunder. Data volume lalu lintas diperoleh dari Dinas Bina Marga Kab. Bulukumba, data CBR tanah, data geometrik jalan, data cross section dan long section jalan diperoleh dari kantor Kementerian Pekerjaan Umum Kepala Balai Besar Pengelolaan Jalan dan Jembatan Wilayah VI Makassar, Prov. Sulawesi Selatan, sedangkan untuk data harga satuan bahan, upah dan peralatan diperolah dari Dinas Pekerjaan Umum Kab. Bulukumba dan data curah hujan diperoleh dari BPS Prov. Sulawesi Selatan. Metode yang digunakan dalam studi perencanaan ini adalah metode bina marga yang berpatokan pada SKBI tahun 1987. Perencanaan yang dilakukan meliputi perencanaan tebal perkerasan lentur serta perkiraan rencana anggaran biayanya atau estimasi biaya proyek tersebut. Untuk analisa rencana anggaran biayanya berpatokan pada Analisa Harga Satuan Pekerjaan Bidang pekerjaan Umum berdasarkan Permen PUPR Republik Indonesia no 28/PRT/M/2016. Hasil perencanaan perkerasan lentur ini diperoleh 9 segmen jalan dimana setiap segmennya memiliki ketebalan lapisan aspal yang berbeda-beda. Segmen 1 dengan panjang jalan 2070 m memiliki ketebalan laston sebesar 18 cm, segmen 2 dengan panjang 1290 m ketebalan 13 cm, segmen 3 dengan panjang 750 m ketebalan 18 cm, segmen 4 dengan panjang 1050 m ketebalan 12 cm, segmen 5 dengan panjang 2175 m ketebalan 19 cm,segmen 6 dengan panjang 650 m ketebalan 13 cm, segmen 7 dengan panjang 5800 m ketebalan 18 cm, segmen 8 dengan panjang 230 m ketebalan 15 cm dan terakhir segmen 9 dengan panjang jalan 6750 m ketebalan 20 cm. Hasil analisa rencana anggaran biayanya diperoleh sebesar Rp 194.830.399.950,962 yang terbagi dalam 3 divisi pengerjaan dilapangan yaitu pekerjaan pendahuluan, pekerjaan perkerasan dan pekerjaan kelengkapan rambu jalan
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