METHODS, SYSTEMS, AND DEVICES FOR SURGICAL ACCESS AND PROCEDURES

The embodiments disclosed herein relate to various medical device components, including components that can be incorporated into robotic and/or in vivo medical devices. Certain embodiments include various actuation system embodiments, including fluid actuation systems, drive train actuation systems, and motorless actuation systems. Additional embodiments include a reversibly lockable tube that can provide access for a medical device to a patient\u27s cavity and further provides a reversible rigidity or stability during operation of the device. Further embodiments include various operational components for medical devices, including medical device arm mechanisms that have both axial and rotational movement while maintaining a relatively compact structure. medical device winch components, medical device biopsy/stapler/clamp mechanisms, and medical device adjustable focus mechanisms

Modular instrument for a haptically-enabled robotic surgical system (HeroSurg)

To restore the sense of touch in robotic surgical systems, a modular force feedback-enabled laparoscopic instrument is developed and employed in a robotic-assisted minimally invasive surgical system (HeroSurg). Strain gauge technology is incorporated into the instrument to measure tip/tissue lateral interaction forces. The modularity feature of the proposed instrument makes it interchangeable between various tip types of different functionalities, e.g., cutter, grasper, and dissector, without losing force sensing capability. Series of experiments are conducted and results are reported to evaluate force sensing capability of the instrument. The results reveal mean errors of 1.32 g and 1.98° in the measurements of tip/tissue load magnitude and direction across all experiments, respectively

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

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

Force measurement capability for robotic assisted minimally invasive surgery systems

An automated laparoscopic instrument capable of non-invasive measurement of tip/tissue interaction forces for direct application in robotic assisted minimally invasive surgery systems_ is introduced in this paper. It has the capability to measure normal grasping forces as well as lateral interaction forces without any sensor mounted on the tip jaws. Further to non-invasive actuation of the tip, the proposed instrument is also able to change the grasping direction during surgical operation. Modular design of the instrument allows conversion between surgical modalities (e.g., grasping, cutting, and dissecting). The main focus of this paper is on evaluation of the grasping force capability of the proposed instrument. The mathematical formulation of fenestrated insert is presented and its non-linear behaviour is studied. In order to measure the stiffness of soft tissues, a device was developed that is also described in this paper. Tissue characterisation experiments were conducted and results are presented and analysed here. The experimental results verify the capability of the proposed instrument in accurately measuring grasping forces and in characterising artificial tissue samples of varying stiffness.<br /

Snake-Like Robots for Minimally Invasive, Single Port, and Intraluminal Surgeries

The surgical paradigm of Minimally Invasive Surgery (MIS) has been a key driver to the adoption of robotic surgical assistance. Progress in the last three decades has led to a gradual transition from manual laparoscopic surgery with rigid instruments to robot-assisted surgery. In the last decade, the increasing demand for new surgical paradigms to enable access into the anatomy without skin incision (intraluminal surgery) or with a single skin incision (Single Port Access surgery - SPA) has led researchers to investigate snake-like flexible surgical devices. In this chapter, we first present an overview of the background, motivation, and taxonomy of MIS and its newer derivatives. Challenges of MIS and its newer derivatives (SPA and intraluminal surgery) are outlined along with the architectures of new snake-like robots meeting these challenges. We also examine the commercial and research surgical platforms developed over the years, to address the specific functional requirements and constraints imposed by operations in confined spaces. The chapter concludes with an evaluation of open problems in surgical robotics for intraluminal and SPA, and a look at future trends in surgical robot design that could potentially address these unmet needs.Comment: 41 pages, 18 figures. Preprint of article published in the Encyclopedia of Medical Robotics 2018, World Scientific Publishing Company www.worldscientific.com/doi/abs/10.1142/9789813232266_000

Soft Robot-Assisted Minimally Invasive Surgery and Interventions: Advances and Outlook

Since the emergence of soft robotics around two decades ago, research interest in the field has escalated at a pace. It is fuelled by the industry's appreciation of the wide range of soft materials available that can be used to create highly dexterous robots with adaptability characteristics far beyond that which can be achieved with rigid component devices. The ability, inherent in soft robots, to compliantly adapt to the environment, has significantly sparked interest from the surgical robotics community. This article provides an in-depth overview of recent progress and outlines the remaining challenges in the development of soft robotics for minimally invasive surgery

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

Designing a robotic port system for laparo-endoscopic single-site surgery

Current research and development in the field of surgical interventions aim to reduce the invasiveness by using few incisions or natural orifices in the body to access the surgical site. Considering surgeries in the abdominal cavity, the Laparo-Endoscopic Single-site Surgery (LESS) can be performed through a single incision in the navel, reducing blood loss, post-operative trauma, and improving the cosmetic outcome. However, LESS results in less intuitive instrument control, impaired ergonomic, loss of depth and haptic perception, and restriction of instrument positioning by a single incision. Robot-assisted surgery addresses these shortcomings, by introducing highly articulated, flexible robotic instruments, ergonomic control consoles with 3D visualization, and intuitive instrument control algorithms. The flexible robotic instruments are usually introduced into the abdomen via a rigid straight port, such that the positioning of the tools and therefore the accessibility of anatomical structures is still constrained by the incision location. To address this limitation, articulated ports for LESS are proposed by recent research works. However, they focus on only a few aspects, which are relevant to the surgery, such that a design considering all requirements for LESS has not been proposed yet. This partially originates in the lack of anatomical data of specific applications. Further, no general design guidelines exist and only a few evaluation metrics are proposed. To target these challenges, this thesis focuses on the design of an articulated robotic port for LESS partial nephrectomy. A novel approach is introduced, acquiring the available abdominal workspace, integrated into the surgical workflow. Based on several generated patient datasets and developed metrics, design parameter optimization is conducted. Analyzing the surgical procedure, a comprehensive requirement list is established and applied to design a robotic system, proposing a tendon-driven continuum robot as the articulated port structure. Especially, the aspects of stiffening and sterile design are addressed. In various experimental evaluations, the reachability, the stiffness, and the overall design are evaluated. The findings identify layer jamming as the superior stiffening method. Further, the articulated port is proven to enhance the accessibility of anatomical structures and offer a patient and incision location independent design