Magnetic Surgical Instruments for Robotic Abdominal Surgery.

This review looks at the implementation of magnetic-based approaches in surgical instruments for abdominal surgeries. As abdominal surgical techniques advance toward minimizing surgical trauma, surgical instruments are enhanced to support such an objective through the exploration of magnetic-based systems. With this design approach, surgical devices are given the capabilities to be fully inserted intraabdominally to achieve access to all abdominal quadrants, without the conventional rigid link connection with the external unit. The variety of intraabdominal surgical devices are anchored, guided, and actuated by external units, with power and torque transmitted across the abdominal wall through magnetic linkage. This addresses many constraints encountered by conventional laparoscopic tools, such as loss of triangulation, fulcrum effect, and loss/lack of dexterity for surgical tasks. Design requirements of clinical considerations to aid the successful development of magnetic surgical instruments, are also discussed

Development of A Soft Robotic Approach for An Intra-abdominal Wireless Laparoscopic Camera

In Single-Incision Laparoscopic Surgery (SILS), the Magnetic Anchoring and Guidance System (MAGS) arises as a promising technique to provide larger workspaces and field of vision for the laparoscopes, relief space for other instruments, and require fewer incisions. Inspired by MAGS, many concept designs related to fully insertable magnetically driven laparoscopes are developed and tested on the transabdominal operation. However, ignoring the tissue interaction and insertion procedure, most of the designs adopt rigid structures, which not only damage the patients\u27 tissue with excess stress concentration and sliding motion but also require complicated operation for the insertion. Meanwhile, lacking state tracking of the insertable camera including pose and contact force, the camera systems operate in open-loop control. This provides mediocre locomotion precision and limited robustness to uncertainties in the environment. This dissertation proposes, develops, and validates a soft robotic approach for an intra-abdominal wireless laparoscopic camera. Contributions presented in this work include (1) feasibility of a soft intra-abdominal laparoscopic camera with friendly tissue interaction and convenient insertion, (2) six degrees of freedom (DOF) real-time localization, (3) Closed-loop control for a robotic-assisted laparoscopic system and (4) untethering solution for wireless communication and high-quality video transmission. Embedding magnet pairs into the camera and external actuator, the camera can be steered and anchored along the abdominal wall through transabdominal magnetic coupling. To avoid the tissue rapture by the sliding motion and dry friction, a wheel structure is applied to achieve rolling motion. Borrowing the ideas from soft robotic research, the main body of the camera implements silicone material, which grants it the bendability to passively attach along the curved abdominal wall and the deformability for easier insertion. The six-DOF pose is estimated in real-time with internal multi-sensor fusion and Newton-Raphson iteration. Combining the pose tracking and force-torque sensor measurement, an interaction model between the deformable camera and tissue is established to evaluate the interaction force over the tissue surface. Moreover, the proposed laparoscopic system is integrated with a multi-DOF manipulator into a robotic-assisted surgical system, where a closed-loop control is realized based on a feedback controller and online optimization. Finally, the wireless control and video streaming are accomplished with Bluetooth Low Energy (BLE) and Analog Video (AV) transmission. Experimental assessments have been implemented to evaluate the performance of the laparoscopic system

Electropermanent magnetic anchoring for surgery and endoscopy

The use of magnets for anchoring of instrumentation in minimally invasive surgery and endoscopy has become of increased interest in recent years. Permanent magnets have significant advantages over electromagnets for these applications; larger anchoring and retraction force for comparable size and volume without the need for any external power supply. However, permanent magnets represent a potential hazard in the operating field where inadvertent attraction to surgical instrumentation is often undesirable. The current work proposes an interesting hybrid approach which marries the high forces of permanent magnets with the control of electromagnetic technology including the ability to turn the magnet OFF when necessary. This is achieved through the use of an electropermanent magnet, which is designed for surgical retraction across the abdominal and gastric walls. Our electropermanent magnet, which is hand-held and does not require continuous power, is designed with a center lumen which may be used for trocar or needle insertion. The device in this application has been demonstrated successfully in the porcine model where coupling between an intraluminal ring magnet and our electropermanent magnet facilitated guided insertion of an 18 Fr Tuohy needle for guidewire placement. Subsequent investigations have demonstrated the ability to control the coupling distance of the system alleviating shortcomings with current methods of magnetic coupling due to variation in transabdominal wall thicknesses. With further refinement, the magnet may find application in the anchoring of endoscopic and surgical instrumentation for minimally invasive interventions in the gastrointestinal tract

Smart Camera Robotic Assistant for Laparoscopic Surgery

The cognitive architecture also includes learning mechanisms to adapt the behavior of the robot to the different ways of working of surgeons, and to improve the robot behavior through experience, in a similar way as a human assistant would do. The theoretical concepts of this dissertation have been validated both through in-vitro experimentation in the labs of medical robotics of the University of Malaga and through in-vivo experimentation with pigs in the IACE Center (Instituto Andaluz de Cirugía Experimental), performed by expert surgeons.In the last decades, laparoscopic surgery has become a daily practice in operating rooms worldwide, which evolution is tending towards less invasive techniques. In this scenario, robotics has found a wide field of application, from slave robotic systems that replicate the movements of the surgeon to autonomous robots able to assist the surgeon in certain maneuvers or to perform autonomous surgical tasks. However, these systems require the direct supervision of the surgeon, and its capacity of making decisions and adapting to dynamic environments is very limited. This PhD dissertation presents the design and implementation of a smart camera robotic assistant to collaborate with the surgeon in a real surgical environment. First, it presents the design of a novel camera robotic assistant able to augment the capacities of current vision systems. This robotic assistant is based on an intra-abdominal camera robot, which is completely inserted into the patient’s abdomen and it can be freely moved along the abdominal cavity by means of magnetic interaction with an external magnet. To provide the camera with the autonomy of motion, the external magnet is coupled to the end effector of a robotic arm, which controls the shift of the camera robot along the abdominal wall. This way, the robotic assistant proposed in this dissertation has six degrees of freedom, which allow providing a wider field of view compared to the traditional vision systems, and also to have different perspectives of the operating area. On the other hand, the intelligence of the system is based on a cognitive architecture specially designed for autonomous collaboration with the surgeon in real surgical environments. The proposed architecture simulates the behavior of a human assistant, with a natural and intuitive human-robot interface for the communication between the robot and the surgeon

sCAM: An Untethered Insertable Laparoscopic Surgical Camera Robot

Fully insertable robotic imaging devices represent a promising future of minimally invasive laparoscopic vision. Emerging research efforts in this field have resulted in several proof-of-concept prototypes. One common drawback of these designs derives from their clumsy tethering wires which not only cause operational interference but also reduce camera mobility. Meanwhile, these insertable laparoscopic cameras are manipulated without any pose information or haptic feedback, which results in open loop motion control and raises concerns about surgical safety caused by inappropriate use of force.This dissertation proposes, implements, and validates an untethered insertable laparoscopic surgical camera (sCAM) robot. Contributions presented in this work include: (1) feasibility of an untethered fully insertable laparoscopic surgical camera, (2) camera-tissue interaction characterization and force sensing, (3) pose estimation, visualization, and feedback with sCAM, and (4) robotic-assisted closed-loop laparoscopic camera control. Borrowing the principle of spherical motors, camera anchoring and actuation are achieved through transabdominal magnetic coupling in a stator-rotor manner. To avoid the tethering wires, laparoscopic vision and control communication are realized with dedicated wireless links based on onboard power. A non-invasive indirect approach is proposed to provide real-time camera-tissue interaction force measurement, which, assisted by camera-tissue interaction modeling, predicts stress distribution over the tissue surface. Meanwhile, the camera pose is remotely estimated and visualized using complementary filtering based on onboard motion sensing. Facilitated by the force measurement and pose estimation, robotic-assisted closed-loop control has been realized in a double-loop control scheme with shared autonomy between surgeons and the robotic controller.The sCAM has brought robotic laparoscopic imaging one step further toward less invasiveness and more dexterity. Initial ex vivo test results have verified functions of the implemented sCAM design and the proposed force measurement and pose estimation approaches, demonstrating the technical feasibility of a tetherless insertable laparoscopic camera. Robotic-assisted control has shown its potential to free surgeons from low-level intricate camera manipulation workload and improve precision and intuitiveness in laparoscopic imaging

Camera trocar lifting in office gasless laparoscopic sterilization under local anesthesia

We evaluated 35 cases of a mechanical approach to abdominal wall lifting, used in office-based gasless laparoscopic sterilization under local anesthesia. Lifting of the abdominal wall, using the camera trocar as an anchoring device and complemented by suprapubic lifting by means of a towel clamp, led to passive intra-abdominal air filling, giving sufficient space to identify, anesthetize, coagulate and cut the Fallopian tubes. Only mild sedation was necessary. All women walked to and from the operating room. All had successful tubal ligation. The overall satisfaction rate was 97%. The mechanical lifting moment was not painful. With the exception of one woman with failed tubal anesthesia, all women had a low mean pain score of 2.6 (VAS 0–10). No complications occurred except one wound infection. The costs were < ¼ of those of traditional laparoscopic sterilization and office hysteroscopic sterilization. This approach is effective for office-based laparoscopic sterilization. Room air, two strings and a needle replace active gas insufflation and narcosis

Development of An In Vivo Robotic Camera for Dexterous Manipulation and Clear Imaging

Minimally invasive surgeriy (MIS) techniques are becoming more popular as replacements for traditional open surgeries. These methods benefit patients with lowering blood loss and post-operative pain, reducing recovery period and hospital stay time, decreasing surgical area scarring and cosmetic issues, and lessening the treatment costs, hence greater patient satisfaction would be earned. Manipulating surgical instruments from outside of abdomen and performing surgery needs precise hand-eye coordination which is provided by insertable cameras. The traditional MIS insertable cameras suffer from port complexity and reduced manipulation dexterity, which leads to defection in Hand-eye coordination and surgical flow. Fully insertable robotic camera systems emerged as a promising solution in MIS. Implementing robotic camera systems faces multiple challenges in fixation, manipulation, orientation control, tool-tissue interaction, in vivo illumination and clear imaging.In this dissertation a novel actuation and control mechanism is developed and validated for an insertable laparoscopic camera. This design uses permanent magnets and coils as force/torque generators in an external control unit to manipulate an in vivo camera capsule. The motorless design of this capsule reduces the, wight, size and power consumption of the driven unit. In order to guarantee the smooth motion of the camera inside the abdominal cavity, an interaction force control method was proposed and validated.Optimizing the system\u27s design, through minimizing the control unit size and power consumption and extending maneuverability of insertable camera, was achieved by a novel transformable design, which uses a single permanent magnet in the control unit. The camera robot uses a permanent magnet as fixation and translation unit, and two embedded motor for tilt motion actuation, as well as illumination actuation. Transformable design provides superior imaging quality through an optimized illumination unit and a cleaning module. The illumination module uses freeform optical lenses to control light beams from the LEDs to achieve optimized illumination over surgical zone. The cleaning module prevents lens contamination through a pump actuated debris prevention system, while mechanically wipes the lens in case of contamination. The performance of transformable design and its modules have been assessed experimentally

Magnetically Activated Stereoscopic Vision System for Laparoendoscopic Single-Site Surgery

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In-vivo pan/tilt endoscope with integrated light source

Endoscopic imaging is still dominated by the paradigm of pushing long sticks into small openings. This approach has a number of limitations for minimal access surgery, such as narrow angle imaging, limited workspace, counter-intuitive motions and additional incisions for the endoscpic instruments. Our intent is to go beyond this paradigm, and remotize sensors and effectors directly into the body cavity. To this end, we have developed a prototype of a novel insertable pan/tilt endoscopic camera with an integrated light source. The package has a size of 110 mm in length and 10 mm in diameter and can be inserted into the abdomen through a standard trocar and then anchored onto the abdominal wall, leaving the incision port open for access. The camera package contains three parts: an imaging module, an illumination module, and a pan/tilt motion platform. The imaging module includes a lens and CCD imaging sensor. The illumination module attaches to the imaging module and has an array of LED light sources. The pan/tilt platform provides the imaging module with pan of 120 degrees and tilt motion of 90 degrees using small servo motors. A fixing mechanism is designed to hold the device in the cavity. A standard joy stick can be used to control the motion of the camera in a natural way. The design allows for multiple camera packages to be inserted through a single incision as well