Single-Site Colectomy With Miniature \u3ci\u3eIn Vivo\u3c/i\u3e Robotic Platform

There has been a continuing push to reduce the invasiveness of surgery by accessing the abdominal cavity through a single incision, such as with laparoendoscopic single-site (LESS) surgery. Although LESS procedures offer significant benefits, added complexities still inhibit the procedures. Robotic surgery is proving to be an excellent option to overcome these limitations. This paper presents the experimental results of the single-incision in vivo surgical robot (SISR), a multifunctional, dexterous, twoarmed robot capable of performing surgical tasks while overcoming the issues associated with manual LESS operations. In vivo surgical procedures have been used to demonstrate the efficacy of using a robotic platform over traditional laparoscopic tools. The most recent experimental test resulted in the first successful in vivo robotic LESS colectomy utilizing a robot completely contained within the abdominal cavity. In this test, SISR showed significant benefits including access to all quadrants in the peritoneal cavity and improved dexterity

Robotic technology and endoluminal surgery in digestive surgery

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

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Design of a Flexible Control Platform and Miniature in vivo Robots for Laparo-Endoscopic Single-Site Surgeries

Minimally-invasive laparoscopic procedures have proven efficacy for a wide range of surgical procedures as well as benefits such as reducing scarring, infection, recovery time, and post-operative pain. While the procedures have many advantages, there are significant shortcomings such as limited instrument motion and reduced dexterity. In recent years, robotic surgical technology has overcome some of these limitations and has become an effective tool for many types of surgeries. These robotic platforms typically have an increased workspace, greater dexterity, improved ergonomics, and finer control than traditional laparoscopic methods. This thesis presents the designs of both a four degree-of-freedom (DOF) and 5-DOF miniature in vivo surgical robot as well as a software architecture for development and control of such robots. The proposed surgical platform consists of a two-armed robotic prototype, distributed motor control modules, custom robot control software, and remote surgeon console. A plug-in architecture in the control software provides the user a wide range of user input devices and control algorithms, including a numerical inverse kinematics solver, to allow intuitive control and rapid development of future robot prototypes. A variety of experiments performed by a surgeon at the University of Nebraska Medical Center were used to evaluate the performance of the robotic platform. Adviser: Shane Farrito

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

Design of a Flexible Control Platform and Miniature in vivo Robots for Laparo-Endoscopic Single-Site Surgeries

Minimally-invasive laparoscopic procedures have proven efficacy for a wide range of surgical procedures as well as benefits such as reducing scarring, infection, recovery time, and post-operative pain. While the procedures have many advantages, there are significant shortcomings such as limited instrument motion and reduced dexterity. In recent years, robotic surgical technology has overcome some of these limitations and has become an effective tool for many types of surgeries. These robotic platforms typically have an increased workspace, greater dexterity, improved ergonomics, and finer control than traditional laparoscopic methods. This thesis presents the designs of both a four degree-of-freedom (DOF) and 5-DOF miniature in vivo surgical robot as well as a software architecture for development and control of such robots. The proposed surgical platform consists of a two-armed robotic prototype, distributed motor control modules, custom robot control software, and remote surgeon console. A plug-in architecture in the control software provides the user a wide range of user input devices and control algorithms, including a numerical inverse kinematics solver, to allow intuitive control and rapid development of future robot prototypes. A variety of experiments performed by a surgeon at the University of Nebraska Medical Center were used to evaluate the performance of the robotic platform. Adviser: Shane Farrito

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

The Next-Generation Surgical Robots

The chronicle of surgical robots is short but remarkable. Within 20 years since the regulatory approval of the first surgical robot, more than 3,000 units were installed worldwide, and more than half a million robotic surgical procedures were carried out in the past year alone. The exceptionally high speeds of market penetration and expansion to new surgical areas had raised technical, clinical, and ethical concerns. However, from a technological perspective, surgical robots today are far from perfect, with a list of improvements expected for the next-generation systems. On the other hand, robotic technologies are flourishing at ever-faster paces. Without the inherent conservation and safety requirements in medicine, general robotic research could be substantially more agile and explorative. As a result, various technical innovations in robotics developed in recent years could potentially be grafted into surgical applications and ignite the next major advancement in robotic surgery. In this article, the current generation of surgical robots is reviewed from a technological point of view, including three of possibly the most debated technical topics in surgical robotics: vision, haptics, and accessibility. Further to that, several emerging robotic technologies are highlighted for their potential applications in next-generation robotic surgery

Ring and Peg Simulation for Minimally Invasive Surgical Robot

Surgical procedures utilizing minimally invasive laparoscopic techniques have shown less complications, better cosmetic results, and less time in the hospital than conventional surgery. These advantages are partially offset by inherent difficulties of the procedures which include an inverted control scheme, instrument clashing, and loss of triangulation. Surgical robots have been designed to overcome the limitations, the Da Vinci being the most widely used. A dexterous in vivo, two-armed robot, designed to enter an insufflated abdomen with a limited insertion profile and expand to perform a variety of operations, has been created as a less expensive, versatile alternative to the Da Vinci. Various surgical simulators are currently marketed to help with the rigors of training and testing potential surgeons for the Da Vinci system, and have been proven to be effective at improving surgical skills. Using the existing simulators as a baseline, the goal of this thesis was to design, build, and test a ring and peg simulation that emulates the four degree of freedom minimally invasive surgical robot from UNL. The simulation was created in the virtual reality software platform Vizard using the python programming language. Featuring imported visual models and compound simple shape collision objects, the simulation monitors and generates a metric file that records the user’s time to task completion along with various errors. A preliminary study was done on the simulation that measured seven participant’s performance on the simulation over three consecutive attempts. The study showed that participant’s time to completion and amount of recorded errors decreased across the three trials, indicating improvement in the robot operation with use of the simulation. The validation study provided confidence in continued development and testing of the introductory surgical robot simulation trainer. Adviser: Shane Farrito

Ring and Peg Simulation for Minimally Invasive Surgical Robot

Surgical procedures utilizing minimally invasive laparoscopic techniques have shown less complications, better cosmetic results, and less time in the hospital than conventional surgery. These advantages are partially offset by inherent difficulties of the procedures which include an inverted control scheme, instrument clashing, and loss of triangulation. Surgical robots have been designed to overcome the limitations, the Da Vinci being the most widely used. A dexterous in vivo, two-armed robot, designed to enter an insufflated abdomen with a limited insertion profile and expand to perform a variety of operations, has been created as a less expensive, versatile alternative to the Da Vinci. Various surgical simulators are currently marketed to help with the rigors of training and testing potential surgeons for the Da Vinci system, and have been proven to be effective at improving surgical skills. Using the existing simulators as a baseline, the goal of this thesis was to design, build, and test a ring and peg simulation that emulates the four degree of freedom minimally invasive surgical robot from UNL. The simulation was created in the virtual reality software platform Vizard using the python programming language. Featuring imported visual models and compound simple shape collision objects, the simulation monitors and generates a metric file that records the user’s time to task completion along with various errors. A preliminary study was done on the simulation that measured seven participant’s performance on the simulation over three consecutive attempts. The study showed that participant’s time to completion and amount of recorded errors decreased across the three trials, indicating improvement in the robot operation with use of the simulation. The validation study provided confidence in continued development and testing of the introductory surgical robot simulation trainer. Adviser: Shane Farrito