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

Ergonomics in Laparoscopic Surgery

Despite the many advantages for patients, laparoscopic surgery entails certain ergonomic inconveniences for surgeons, which may result in decreasing the surgeons’ performance and musculoskeletal disorders. In this chapter, the current status of ergonomics in laparoscopy, laparoendoscopic single‐site surgery (LESS), and robot‐assisted surgery will be reviewed. Ergonomic guidelines for laparoscopic surgical practice and methods for ergonomic assessment in surgery will be described. Results will be based on the scientific literature and our experience. Results showed that the surgeon\u27s posture during laparoscopic surgery is mainly affected by the static body postures, the height of the operating table, the design of the surgical instruments, the position of the main screen, and the use of foot pedals. Ergonomics during the laparoscopic surgical practice is related to the level of experience. Better ergonomic conditions entail an improvement in task performance. Laparoscopic instruments with axial handle lead to a more ergonomic posture for the wrist compared to a ring handle. LESS is physically more demanding than conventional and hybrid approaches, requiring greater level of muscular activity in the back and arm muscles, but better wrist position compared with traditional laparoscopy. Physical and cognitive ergonomics with robotic assistance were significantly less challenging when compared to conventional laparoscopic surgery

A Novel Minimally Invasive Tumour Localization Device

Lung cancer is one of the leading causes of death, by cancer. The usual treatment is surgical resection of tumours. However, patients who are weak or have poor pulmonary function are deemed unfit for surgery. For these patients, a minimally-invasive approach is desired. A major problem associated with minimally-invasive approaches is tumour localization in real time and accurate measurement of tool--tissue forces. This thesis describes the design, analysis, manufacturing and validation of a minimally-invasive instrument for tumour localization, named Palpatron. The instrument has an end effector that is able to support two previously designed jaws, one containing an ultrasound sensor and the other a tactile sensor. The jaws can move with two degrees of freedom to palpate tissue and rotate about the central axis of the instrument. The Palpatron has uncoupled jaw motion that allows for optimal alignment of sensors to improve data acquisition. The instrument can be easily assembled and disassembled allowing it to be cleaned and sterilized. The mechanism is articulated using push rods, each actuated by a motor. A semi-automatic control system was created for palpation. It is composed of a microcontroller that controls four motors via serial communication. In addition, the Palpatron has the ability to prevent tissue damage by measuring tool--tissue forces. Finite element analysis was used to guide material selection for designed components. Grade 5 titanium was selected for end effector links to provide a factor of safety of 1.2 against yielding under a 10 N point load at the tip of a jaw. The design was fabricated and validated by conducting experiments to test articulation and load carrying capacity. An 8-N force was applied to the instrument, which was successfully supported. The semi-automatic control system was used to perform basic maneuvering tasks to verify jaw motion capabilities. With positive testing results, the Palpatron forms the next step towards a comprehensive robotic-assisted palpation technology

Modeling, Analysis, Force Sensing and Control of Continuum Robots for Minimally Invasive Surgery

This dissertation describes design, modeling and application of continuum robotics for surgical applications, specifically parallel continuum robots (PCRs) and concentric tube manipulators (CTMs). The introduction of robotics into surgical applications has allowed for a greater degree of precision, less invasive access to more remote surgical sites, and user-intuitive interfaces with enhanced vision systems. The most recent developments have been in the space of continuum robots, whose exible structure create an inherent safety factor when in contact with fragile tissues. The design challenges that exist involve balancing size and strength of the manipulators, controlling the manipulators over long transmission pathways, and incorporating force sensing and feedback from the manipulators to the user. Contributions presented in this work include: (1) prototyping, design, force sensing, and force control investigations of PCRs, and (2) prototyping of a concentric tube manipulator for use in a standard colonoscope. A general kinetostatic model is presented for PCRs along with identification of multiple physical constraints encountered in design and construction. Design considerations and manipulator capabilities are examined in the form of matrix metrics and ellipsoid representations. Finally, force sensing and control are explored and experimental results are provided showing the accuracy of force estimates based on actuation force measurements and control capabilities. An overview of the design requirements, manipulator construction, analysis and experimental results are provided for a CTM used as a tool manipulator in a traditional colonoscope. Currently, tools used in colonoscopic procedures are straight and exit the front of the scope with 1 DOF of operation (jaws of a grasper, tightening of a loop, etc.). This research shows that with a CTM deployed, the dexterity of these tools can be increased dramatically, increasing accuracy of tool operation, ease of use and safety of the overall procedure. The prototype investigated in this work allows for multiple tools to be used during a single procedure. Experimental results show the feasibility and advantages of the newly-designed manipulators

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

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

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

Handheld Devices for Laparoscopic Surgery

Despite the well-known benefits of minimally invasive surgery (MIS) to the patients, this surgical technique implies some technical challenges for surgeons. These technical limitations are increased with the introduction of laparoendoscopic single-site (LESS) surgery. In order to overcome some of these technical difficulties, new handheld devices have been developed, providing improved functionalities along with precision-driven and articulating instrument tips. In this chapter, we will review the current status of handheld devices for laparoscopy and LESS surgery. Devices that provide additional and innovative functionalities in comparison with conventional surgical instruments will be considered. Results will be based on studies published in the scientific literature and our experience. These surgical devices will be organized into two main groups, mechanical devices and robotic-driven devices. In general, these instruments intend to simulate the dexterity of movements of a human wrist. Mechanical devices are cheaper and easier to develop, so most of the available handheld instruments fall into this category. The majority of the robotic-driven devices are needle holders with an articulating tip, controlled by an interface implemented on the instrument handle. In general, these handheld devices claim to offer an enhancement of dexterity, precision, and ergonomics