AbstractRobotic laparoscopic surgery is evolving to include in vivo robotic assistants. The impetus for the development of this technology is to provide surgeons with additional viewpoints and unconstrained manipulators that improve safety and reduce patient trauma. A family of these robots have been developed to provide vision and task assistance. Fixed-base and mobile robots have been designed and tested in animal models with much success. A cholecystectomy, prostatectomy, and nephrectomy have all been performed with the assistance of these robots. These early successful tests show how in vivo laparoscopic robotics may be part of the next advancement in surgical technology

Dumpert, Jason

Farritor, Shane M.

Oleynikov, Dmitry

Platt, Stephen R.

Rentschler, Mark E.

Robotic laparoscopic surgery is evolving to include in vivo robotic assistants. The impetus for the development of this technology is to provide surgeons with additional viewpoints and unconstrained manipulators that improve safety and reduce patient trauma. A family of these robots have been developed to provide vision and task assistance. Fixed-base and mobile robots have been designed and tested in animal models with much success. A cholecystectomy, prostatectomy, and nephrectomy have all been performed with the assistance of these robots. These early successful tests show how in vivo laparoscopic robotics may be part of the next advancement in surgical technology

DigitalCommons@University of Nebraska

University of Nebraska - LincolnDigitalCommons@University of Nebraska - LincolnMechanical & Materials Engineering FacultyPublicationsMechanical & Materials Engineering, Departmentof2006In vivo laparoscopic roboticsMark E. RentschlerUniversity of Nebraska Medical Center, mrentsch@bigred.unl.eduStephen R. PlattUniversity of Nebraska-Lincoln, splatt2@unl.eduJason DumpertUniversity of Nebraska-Lincoln, jdumpert2@unl.eduShane M. FarritorUniversity of Nebraska-Lincoln, sfarritor@unl.eduDmitry OleynikovUniversity of Nebraska Medical Center, doleynik@unmc.eduFollow this and additional works at: http://digitalcommons.unl.edu/mechengfacpubPart of the Mechanics of Materials Commons, Nanoscience and Nanotechnology Commons,Other Engineering Science and Materials Commons, and the Other Mechanical EngineeringCommonsThis Article is brought to you for free and open access by the Mechanical & Materials Engineering, Department of at DigitalCommons@University ofNebraska - Lincoln. It has been accepted for inclusion in Mechanical & Materials Engineering Faculty Publications by an authorized administrator ofDigitalCommons@University of Nebraska - Lincoln.Rentschler, Mark E.; Platt, Stephen R.; Dumpert, Jason; Farritor, Shane M.; and Oleynikov, Dmitry, "In vivo laparoscopic robotics"(2006). Mechanical & Materials Engineering Faculty Publications. 263.http://digitalcommons.unl.edu/mechengfacpub/263In vivo laparoscopic roboticsMark E. Rentschler a,*, Stephen R. Platt a, Jason Dumpert a,Shane M. Farritor a, Dmitry Oleynikov ba Department of Mechanical Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, USAb Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3280, USAKEYWORDSIn vivo;Laparoscopic;Robotics;Mobile;Fixed-baseAbstract Robotic laparoscopic surgery is evolving to include in vivo robotic assis-tants. The impetus for the development of this technology is to provide surgeonswith additional viewpoints and unconstrained manipulators that improve safetyand reduce patient trauma. A family of these robots have been developed to pro-vide vision and task assistance. Fixed-base and mobile robots have been designedand tested in animal models with much success. A cholecystectomy, prostatectomy,and nephrectomy have all been performed with the assistance of these robots.These early successful tests show how in vivo laparoscopic robotics may be partof the next advancement in surgical technology.ª 2006 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.IntroductionThe use of robotics is currently recognized asa major driving force for advancing minimallyinvasive surgery.1e3 However, current surgical ro-bots, such as the da Vinci system made by IntuitiveSurgical, have several significant limitations. Al-though one recent report concluded that roboticsurgery can enhance dexterity compared to tradi-tional laparoscopy,4 most studies suggest thatcurrent robotic systems offer little or no improve-ment over standard laparoscopic instruments inthe performance of basic skills.5e7 Current systemsare also not available in most hospitals and remainconstrained by limited sensory and mobility capa-bilities, and high cost.Currently available surgical robotic systems areimplemented from outside the body and willtherefore always be constrained to some degreeby the limitations of working through small in-cisions. Some work has been done to developmedical robots in which all (or most) of the deviceenters the body. The simplest such mechanismshave been maneuverable endoscopes for colono-scopy8,9 and laparoscopy.10 These devices haveactuators that can turn the endoscope tip after it* Corresponding author. University of Nebraska Medical Cen-ter, Computer Assisted Medicine and Surgery, 984075 NebraskaMedical Center, Omaha, NE 68198-4075, USA. Tel.: þ1 402 5597184; fax: þ1 402 559 4427.E-mail address: mrentsch@bigred.unl.edu (M.E. Rentschler).1743-9191/$ - see front matter ª 2006 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.doi:10.1016/j.ijsu.2006.03.004International Journal of Surgery (2006) 4, 167e171www.int-journal-surgery.comenters the body. However, support equipment suchas power and control (and sometimes the actua-tors) remain outside the body.More advanced in vivo robots have been de-veloped to explore hollow cavities such as thecolon or esophagus with locomotion systems basedon ‘inch-worm’ motion that use a series of grippersand extensors,11,12 rolling tracks,13 or rollingstents.14 These devices all use external power inthe form of electricity and/or vacuum sources forlocomotion.Another approach is a completely un-tetheredpill that is swallowed and passively passed throughthe entire gastrointestinal (GI) tract. One suchcommercially available device, called M2A fromGiven Imaging Ltd,15,16 returns multiple (thousands)images as it naturally moves through the GI tract.However, because the device is entirely passive, itcannot be directed to image a particular locationand the exact locations of the images are notknown. Combined with the very large volume of im-ages, the use of this device for diagnosis is difficult.In order to improve visualization and taskassistance in vivo robots are being tested in theabdominal cavity during laparoscopic procedures.The robots have been designed to be either mobileor have a fixed-base. They can now provide visionassistance through onboard cameras and taskassistance with simple manipulators. The goal ofthis robot development is to place the robotcompletely within the abdominal cavity so thatthe entry incision does not constrain the motion ofthe robot. With such technology, the laparoscopeport can be eliminated from many procedures asvisual feedback will come from the in vivo robotsthat will be inserted through one of the tool ports.Current efforts are also focusing on task assis-tance. The eventual outcome will be a family ofthese robots that can be placed in vivo to assistsurgeons, which will improve patient safety andsurgical flexibility.Robot designsFixed-base robotsTo improve visualization for surgeons an in vivorobotic camera was developed. The first prototypedeveloped was a pan and tilt robot (Fig. 1) thatallowed the camera to pan 360 degrees and tiltforward and back 45 degrees. Two independentpermanent magnet direct current motors wereused to provide the actuation. LEDs were used toprovide illumination. The tripod legs are springloaded so that they can fold down during insertionand retraction. This camera robot was used duringporcine surgery to remove a gall-bladder.17 Theadditional views provided additional frames of ref-erence and perspectives that were not availablewith the laparoscope alone. These additional cam-era angles augmented surgical visualization andimproved orientation which proved useful to thesurgeon while removing the pig’s gall-bladder.This allowed the surgeon to have a better under-standing of depth, improving safety and allowingthe surgeon to plan and execute the proceduremore effectively.One drawback of the original pan and tilt robotdesign was a set focal length of the camera lens.The simple lens package allowed for a small foot-print, but reduced flexibility in focusing at differentdistances inside the abdominal cavity. Therefore,the second generation design included an adjust-able-focus mechanism that physically moved thelens to and away from the imager to vary the focallength. To maintain the same size constraints thepan motor was used for the focusing mechanism.Therefore, this tilting robot could tilt 45 degrees(Fig. 2). This tilting robot has LEDs for illumination.They are positioned at the end of an arm that foldsdown in front of the camera. The ring at the end ofthis arm is used for retraction. The bottom edge ofthe ring is seen in the camera view so that the sur-geon can easily clamp onto it and retract the robot.The tripod legs and this retraction arm are bothspring loaded for insertion and retraction.Figure 1 The pan and tilt camera robot can pan 360degrees and tilt45 degrees. Torsion springs allow thelegs to be abducted after abdominal entry. LEDs provideillumination.168 M.E. Rentschler et al.Mobile robotsWhile the fixed-base robots work well to providethe surgeon with additional visual feedback, mo-bility is important for tissue manipulation. Sucha mobile platform can also provide visual feedbackwhile navigating the abdominal cavity. This type ofcamera robot works well for exploring the abdom-inal cavity. These mobile in vivo robots need totraverse the abdominal organs without causingtissue damage. Mobility is difficult because theenvironment is slick, hilly, and deformable. Mucheffort was placed on developing a wheel designthat provided sufficient traction without causingtissue damage.18 The wheel design was improvedthrough viscoelastic modeling, laboratory experi-mentation, and in vivo testing. The final wheeldesign incorporates a helical corkscrew treadedwheel as shown in Fig. 3.To demonstrate the practical applicability ofthis approach to surgery, the successful wheeldesign was used to create a wheeled robot withan adjustable-focus camera (Fig. 3). This mobilerobot has two wheels each connected to an inde-pendent motor. This allows for forward, reverseand turning capability. The tail prevents counter-rotation while the wheels are actuated. The cam-era lens is located between the wheels as shownin Fig. 3. A third motor is used to adjust the lensposition and focus depth.This mobile robotic camera system was tested invivo in a porcine model, and used to explore theabdominal cavity. It also provided the only visualfeedback used by a surgeon during a cholecystec-tomy.19 By inserting such a mobile camera robotinto the abdominal cavity through one of the stan-dard laparoscopic tool ports, the traditional thirdcamera port could be eliminated. This wouldreduce patient trauma, and has the potentialto improve laparoscopy compared to currentsystems.A mobile camera and biopsy robot has also beendeveloped (Fig. 4). This robot includes the adjust-able-focus camera mechanism, with the ability tobiopsy soft tissue. This robot produces sufficientclamping force to sample tissue, and sufficienttraction force to retract the tissue sample if it isnot completely severed.Animal surgery resultsThe tilting adjustable-focus camera robot wasused recently to successfully remove a canineprostate and kidney. The robot was placed on theFigure 2 The tilting adjustable-focus camera robotcan tilt 45 degrees. Torsion springs allow the legs tobe abducted after abdominal entry. LEDs provideillumination.Figure 3 The mobile adjustable-focus camera robothas two independently driven wheels that allow for for-ward, reverse and turning motion. A small tail preventsthe counter-rotation.Figure 4 The mobile camera and biopsy robot imple-ment the successful helical wheel design. This mobileplatform can both be used for visual feedback and tissuemanipulation.In vivo laparoscopic robotics 169opposite side of the prostate (Fig. 5), away fromthe laparoscope. This provided the surgical teamwith two views of the prostate (Fig. 6), one fromboth sides. This proved extremely useful whilesuturing the urethra after the prostate removal.During several portions of the surgery the viewfrom the robotic camera was used exclusively forvisual feedback.The ability to attain a good laparoscope positionduring urological procedures is often difficult.Using the in vivo camera robots, the view caneasily be changed by remotely controlling therobot. Such a robot could be used extensively byurologists operating in the pelvic cavity. Theserobots could provide additional alternate views forthe surgeon, or could in fact provide the sole visualfeedback.Three trocar ports were used for the cholecys-tectomy performed with the mobile camerarobot. The robot was inserted through one of thetool ports. After insertion, this port was usedfor tool insertion. The second port was alsoused for tool insertion, while the third port wasused only for the laparoscope. The laparoscopeprovided lighting for the robot’s camera, but thesurgeon did not use visual feedback from thelaparoscope during the procedure (Fig. 7).A cholecystectomy was performed with thismobile camera robot providing the only visualfeedback available to the surgeon (Fig. 8) (i.e.the video from the laparoscope was not viewedby the surgeon). The ability of the robot to tiltthe adjustable-focus camera 15 degrees withoutchanging the position of the wheels proved ex-tremely useful while retracting the liver. The ad-justable-focus capability of the camera systemallowed the surgeon to have a better understandingFigure 5 The tilting camera robot observing theprostatectomy. The video feedback from the tiltingrobot was used exclusively during portions of thesurgery.Figure 6 A view from the tilting robot while suturingafter the prostate removal.Figure 7 The view from the laparoscope during chole-cystectomy with the mobile camera robot.Figure 8 The view from the mobile camera robot dur-ing the cholecystectomy.170 M.E. Rentschler et al.of depth. The mobile robot also proved very usefulfor abdominal exploration and observation of trocarand tool insertion.This cholecystectomy demonstrated the effec-tiveness of a two port procedure with visualfeedback only from the mobile camera robot.This shows that the designated laparoscope portmay be eliminated and only two ports may berequired for most procedures. The ports could beinitially used for robot insertion and then for tools.If the laparoscope view was ever needed forassistance with robot placement it could be in-serted through one of the tool ports until the robotwas correctly positioned.DiscussionThese tests have demonstrated that it is possibleto perform a common laparoscopic procedureusing an in vivo camera system as the sole sourceof visual feedback. This has the potential toreduce patient trauma by eliminating the needfor a camera port and instead inserting in vivocamera robots through one of the tool ports. Whilethe initial prototype was slightly larger thana traditional trocar, future robots will be smallerin size, have no tethers, and will incorporateadditional sensors.Miniature in vivo robots will be far more agileinside the abdominal cavity than the currentgeneration of large and expensive external tele-manipulators. Current laparoscopic robots arebulky, unwieldy and cannot be easily transported.Because of their cost, they are typically designedfor multiple surgical procedures with interchange-able instrument arms. Future miniature robotsmay be designed for each specific task. Becausethey are small, multiple robots can be employedsimultaneously. Although in the future it might bepossible for such robots to perform the entireprocedure, current technology is more appropriatefor the robots to be used as assistants duringsurgery, aiding in visualization and micromani-pulation. Equipped with additional sensors theywill also be able to explore and provide tissuediagnosis.The long-term goal of this work is to createa team of in vivo robots that could serve as surgicalassistants and/or replace traditional laparoscopictools. The successful animal trials show the greatpromise for in vivo robotics, and the projectedoutcomes have the potential to make importantadvancements in minimally invasive surgery.References1. Satava RM. Surgical robotics: the early chronicles. Surgicallaparoscopy. Endoscopy & Percutaneous Techniques 2002;12:6e16.2. Ballantyne GH. Robotic surgery, telerobotic surgery, tele-presence, and telementoring. Surgical Endoscopy 2002;16:1389e402.3. Schurr MO, Buess G, Neisius B, Voges U. Robotics and tele-manipulation technologies for endoscopic surgery. SurgicalEndoscopy 2000;14:375e81.4. Moorthy K, Munz Y, Dosis A, Hernandez J, Martin S, Bello F,et al. Dexterity enhancement with robotic surgery. SurgicalEndoscopy 2004;18:790e5.5. Dakin GF, Gagner M. Comparison of laparoscopic skills per-formance between standard instruments and two surgicalrobotic systems. Surgical Endoscopy 2003;17:574e9.6. Nio D, Bemelman WA, den Boer KT, Dunker MS, Gouma DJ,van Gulik TM. Efficiency of manual vs. robotical (Zeus) assis-ted laparoscopic surgery in the performance of standard-ized tasks. Surgical Endoscopy 2002;16:412e5.7. MelvinWS,NeedlemanBJ,KrauseKR, SchneiderC, EllisonEC.Computer-enhanced vs. standard laparoscopic antirefluxsurgery. Journal of Gastrointestinal Surgery 2002;6:11e6.8. Fukuda T, Guo S, Kosuge K, Arai F, Negoro M, Nakabayashi K.Micro active catheter system with multi degrees of free-dom. In: Proceedings of the IEEE international conferenceon robotics and automation; 1994.9. Suzumori K, Iikura S, Tanaka H. Development of flexiblemicroactuator and its applications to robotics mechanisms.In: Proceedings of the IEEE international conference onrobotics and automation; 1991.10. Olympus, http://www.letsgodigital.org/en/news/articles/story_2150.html, 2004.11. Phee L, Accoto D, Menciassi A, Stefanini C, Carrozza M,Dario P. Analysis and development of locomotion devicesfor the gastrointestinal tract. IEEE Transactions on Biomed-ical Engineering 2002;49(6).12. Grundfest SW, Burdick JW, Slatkin AB. The development ofa robotic endoscope. In: Proceedings of the IEEE internationalconference on robotics and automation; 1995. p. 162e71.13. Flynn A, Udayakumar K, Barret D, McLurkin J, Franck D,Shectman A. Tomorrow’s surgery: micromotors and microro-bots for minimally invasive procedures. Journal of MinimallyInvasive Therapy and Allied Technologies 1998;4:343e52.14. Breedveld P, Danielle E, Van Gorp M. Locomotion throughthe intestine by means of rolling stents. In: Proceedings ofthe ASME Design Engineering Technical Conferences; 2004.15. Glukhovsky A, Jacob H. The development and application ofwireless capsuleendoscopy. International JournalofMedicalRobotics and Computer Assisted Surgery 2004;1:114e23.16. Meron G. The development of the swallowable videocapsule. Gastrointestinal Endoscopy 2000;6:817e9.17. Oleynikov D, Rentschler M, Hadzialic A, Dumpert J, Platt SR,Farritor S. Miniature robots can assist in laparoscopic chole-cystectomy. Surgical Endoscopy 2005;19:473e6.18. Rentschler ME, Dumpert J, Platt SR, Iagnemma K,Oleynikov D, Farritor SM. Modeling, analysis, and experi-mental study of in vivo wheeled robotic mobility. IEEETransactions on Robotics 2006;22(2):308e21.19. Rentschler M, Dumpert J, Platt SR, Farritor S, Oleynikov D.Mobile in vivo robots provide sole visual feedback forabdominal exploration and cholecystectomy. SurgicalEndoscopy 2006;20(1):135e8.In vivo laparoscopic robotics 171

English

In vivo laparoscopic robotics

Elsevier - Publisher Connector 

International Journal of Surgery (2006) 4, 167e171
www.int-journal-surgery.comIn vivo laparoscopic robotics
Mark E. Rentschler a,*, Stephen R. Platt a, Jason Dumpert a,
Shane M. Farritor a, Dmitry Oleynikov b
a Department of Mechanical Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
b Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3280, USA
KEYWORDS
In vivo;
Laparoscopic;
Robotics;
Mobile;
Fixed-base
Abstract Robotic laparoscopic surgery is evolving to include in vivo robotic assis-
tants. The impetus for the development of this technology is to provide surgeons
with additional viewpoints and unconstrained manipulators that improve safety
and reduce patient trauma. A family of these robots have been developed to pro-
vide vision and task assistance. Fixed-base and mobile robots have been designed
and tested in animal models with much success. A cholecystectomy, prostatectomy,
and nephrectomy have all been performed with the assistance of these robots.
These early successful tests show how in vivo laparoscopic robotics may be part
of the next advancement in surgical technology.
ª 2006 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.Introduction
The use of robotics is currently recognized as
a major driving force for advancing minimally
invasive surgery.1e3 However, current surgical ro-
bots, such as the da Vinci system made by Intuitive
Surgical, have several significant limitations. Al-
though one recent report concluded that robotic
surgery can enhance dexterity compared to tradi-
tional laparoscopy,4 most studies suggest that
* Corresponding author. University of Nebraska Medical Cen-
ter, Computer Assisted Medicine and Surgery, 984075 Nebraska
Medical Center, Omaha, NE 68198-4075, USA. Tel.: þ1 402 559
7184; fax: þ1 402 559 4427.
E-mail address:mrentsch@bigred.unl.edu (M.E. Rentschler).1743-9191/$ - see front matter ª 2006 Surgical Associates Ltd. Pu
doi:10.1016/j.ijsu.2006.03.004current robotic systems offer little or no improve-
ment over standard laparoscopic instruments in
the performance of basic skills.5e7 Current systems
are also not available in most hospitals and remain
constrained by limited sensory and mobility capa-
bilities, and high cost.
Currently available surgical robotic systems are
implemented from outside the body and will
therefore always be constrained to some degree
by the limitations of working through small in-
cisions. Some work has been done to develop
medical robots in which all (or most) of the device
enters the body. The simplest such mechanisms
have been maneuverable endoscopes for colono-
scopy8,9 and laparoscopy.10 These devices have
actuators that can turn the endoscope tip after itblished by Elsevier Ltd. All rights reserved.
168 M.E. Rentschler et al.enters the body. However, support equipment such
as power and control (and sometimes the actua-
tors) remain outside the body.
More advanced in vivo robots have been de-
veloped to explore hollow cavities such as the
colon or esophagus with locomotion systems based
on ‘inch-worm’ motion that use a series of grippers
and extensors,11,12 rolling tracks,13 or rolling
stents.14 These devices all use external power in
the form of electricity and/or vacuum sources for
locomotion.
Another approach is a completely un-tethered
pill that is swallowed and passively passed through
the entire gastrointestinal (GI) tract. One such
commercially available device, called M2A from
Given Imaging Ltd,15,16 returnsmultiple (thousands)
images as it naturally moves through the GI tract.
However, because the device is entirely passive, it
cannot be directed to image a particular location
and the exact locations of the images are not
known. Combined with the very large volume of im-
ages, the use of this device for diagnosis is difficult.
In order to improve visualization and task
assistance in vivo robots are being tested in the
abdominal cavity during laparoscopic procedures.
The robots have been designed to be either mobile
or have a fixed-base. They can now provide vision
assistance through onboard cameras and task
assistance with simple manipulators. The goal of
this robot development is to place the robot
completely within the abdominal cavity so that
the entry incision does not constrain the motion of
the robot. With such technology, the laparoscope
port can be eliminated from many procedures as
visual feedback will come from the in vivo robots
that will be inserted through one of the tool ports.
Current efforts are also focusing on task assis-
tance. The eventual outcome will be a family of
these robots that can be placed in vivo to assist
surgeons, which will improve patient safety and
surgical flexibility.
Robot designs
Fixed-base robots
To improve visualization for surgeons an in vivo
robotic camera was developed. The first prototype
developed was a pan and tilt robot (Fig. 1) that
allowed the camera to pan 360 degrees and tilt
forward and back 45 degrees. Two independent
permanent magnet direct current motors were
used to provide the actuation. LEDs were used to
provide illumination. The tripod legs are spring
loaded so that they can fold down during insertionand retraction. This camera robot was used during
porcine surgery to remove a gall-bladder.17 The
additional views provided additional frames of ref-
erence and perspectives that were not available
with the laparoscope alone. These additional cam-
era angles augmented surgical visualization and
improved orientation which proved useful to the
surgeon while removing the pig’s gall-bladder.
This allowed the surgeon to have a better under-
standing of depth, improving safety and allowing
the surgeon to plan and execute the procedure
more effectively.
One drawback of the original pan and tilt robot
design was a set focal length of the camera lens.
The simple lens package allowed for a small foot-
print, but reduced flexibility in focusing at different
distances inside the abdominal cavity. Therefore,
the second generation design included an adjust-
able-focus mechanism that physically moved the
lens to and away from the imager to vary the focal
length. To maintain the same size constraints the
pan motor was used for the focusing mechanism.
Therefore, this tilting robot could tilt 45 degrees
(Fig. 2). This tilting robot has LEDs for illumination.
They are positioned at the end of an arm that folds
down in front of the camera. The ring at the end of
this arm is used for retraction. The bottom edge of
the ring is seen in the camera view so that the sur-
geon can easily clamp onto it and retract the robot.
The tripod legs and this retraction arm are both
spring loaded for insertion and retraction.
Figure 1 The pan and tilt camera robot can pan 360
degrees and tilt45 degrees. Torsion springs allow the
legs to be abducted after abdominal entry. LEDs provide
illumination.
In vivo laparoscopic robotics 169Mobile robots
While the fixed-base robots work well to provide
the surgeon with additional visual feedback, mo-
bility is important for tissue manipulation. Such
a mobile platform can also provide visual feedback
while navigating the abdominal cavity. This type of
camera robot works well for exploring the abdom-
inal cavity. These mobile in vivo robots need to
traverse the abdominal organs without causing
tissue damage. Mobility is difficult because the
environment is slick, hilly, and deformable. Much
effort was placed on developing a wheel design
that provided sufficient traction without causing
tissue damage.18 The wheel design was improved
through viscoelastic modeling, laboratory experi-
mentation, and in vivo testing. The final wheel
design incorporates a helical corkscrew treaded
wheel as shown in Fig. 3.
To demonstrate the practical applicability of
this approach to surgery, the successful wheel
design was used to create a wheeled robot with
an adjustable-focus camera (Fig. 3). This mobile
robot has two wheels each connected to an inde-
pendent motor. This allows for forward, reverse
and turning capability. The tail prevents counter-
rotation while the wheels are actuated. The cam-
era lens is located between the wheels as shown
in Fig. 3. A third motor is used to adjust the lens
position and focus depth.
This mobile robotic camera system was tested in
vivo in a porcine model, and used to explore the
abdominal cavity. It also provided the only visual
Figure 2 The tilting adjustable-focus camera robot
can tilt 45 degrees. Torsion springs allow the legs to
be abducted after abdominal entry. LEDs provide
illumination.feedback used by a surgeon during a cholecystec-
tomy.19 By inserting such a mobile camera robot
into the abdominal cavity through one of the stan-
dard laparoscopic tool ports, the traditional third
camera port could be eliminated. This would
reduce patient trauma, and has the potential
to improve laparoscopy compared to current
systems.
A mobile camera and biopsy robot has also been
developed (Fig. 4). This robot includes the adjust-
able-focus camera mechanism, with the ability to
biopsy soft tissue. This robot produces sufficient
clamping force to sample tissue, and sufficient
traction force to retract the tissue sample if it is
not completely severed.
Animal surgery results
The tilting adjustable-focus camera robot was
used recently to successfully remove a canine
prostate and kidney. The robot was placed on the
Figure 3 The mobile adjustable-focus camera robot
has two independently driven wheels that allow for for-
ward, reverse and turning motion. A small tail prevents
the counter-rotation.
Figure 4 The mobile camera and biopsy robot imple-
ment the successful helical wheel design. This mobile
platform can both be used for visual feedback and tissue
manipulation.
170 M.E. Rentschler et al.opposite side of the prostate (Fig. 5), away from
the laparoscope. This provided the surgical team
with two views of the prostate (Fig. 6), one from
both sides. This proved extremely useful while
suturing the urethra after the prostate removal.
During several portions of the surgery the view
from the robotic camera was used exclusively for
visual feedback.
The ability to attain a good laparoscope position
during urological procedures is often difficult.
Using the in vivo camera robots, the view can
easily be changed by remotely controlling the
robot. Such a robot could be used extensively by
urologists operating in the pelvic cavity. These
robots could provide additional alternate views for
the surgeon, or could in fact provide the sole visual
feedback.
Figure 5 The tilting camera robot observing the
prostatectomy. The video feedback from the tilting
robot was used exclusively during portions of the
surgery.
Figure 6 A view from the tilting robot while suturing
after the prostate removal.Three trocar ports were used for the cholecys-
tectomy performed with the mobile camera
robot. The robot was inserted through one of the
tool ports. After insertion, this port was used
for tool insertion. The second port was also
used for tool insertion, while the third port was
used only for the laparoscope. The laparoscope
provided lighting for the robot’s camera, but the
surgeon did not use visual feedback from the
laparoscope during the procedure (Fig. 7).
A cholecystectomy was performed with this
mobile camera robot providing the only visual
feedback available to the surgeon (Fig. 8) (i.e.
the video from the laparoscope was not viewed
by the surgeon). The ability of the robot to tilt
the adjustable-focus camera 15 degrees without
changing the position of the wheels proved ex-
tremely useful while retracting the liver. The ad-
justable-focus capability of the camera system
allowed the surgeon to have a better understanding
Figure 7 The view from the laparoscope during chole-
cystectomy with the mobile camera robot.
Figure 8 The view from the mobile camera robot dur-
ing the cholecystectomy.
In vivo laparoscopic robotics 171of depth. The mobile robot also proved very useful
for abdominal exploration and observation of trocar
and tool insertion.
This cholecystectomy demonstrated the effec-
tiveness of a two port procedure with visual
feedback only from the mobile camera robot.
This shows that the designated laparoscope port
may be eliminated and only two ports may be
required for most procedures. The ports could be
initially used for robot insertion and then for tools.
If the laparoscope view was ever needed for
assistance with robot placement it could be in-
serted through one of the tool ports until the robot
was correctly positioned.
Discussion
These tests have demonstrated that it is possible
to perform a common laparoscopic procedure
using an in vivo camera system as the sole source
of visual feedback. This has the potential to
reduce patient trauma by eliminating the need
for a camera port and instead inserting in vivo
camera robots through one of the tool ports. While
the initial prototype was slightly larger than
a traditional trocar, future robots will be smaller
in size, have no tethers, and will incorporate
additional sensors.
Miniature in vivo robots will be far more agile
inside the abdominal cavity than the current
generation of large and expensive external tele-
manipulators. Current laparoscopic robots are
bulky, unwieldy and cannot be easily transported.
Because of their cost, they are typically designed
for multiple surgical procedures with interchange-
able instrument arms. Future miniature robots
may be designed for each specific task. Because
they are small, multiple robots can be employed
simultaneously. Although in the future it might be
possible for such robots to perform the entire
procedure, current technology is more appropriate
for the robots to be used as assistants during
surgery, aiding in visualization and micromani-
pulation. Equipped with additional sensors they
will also be able to explore and provide tissue
diagnosis.
The long-term goal of this work is to create
a team of in vivo robots that could serve as surgical
assistants and/or replace traditional laparoscopic
tools. The successful animal trials show the great
promise for in vivo robotics, and the projected
outcomes have the potential to make important
advancements in minimally invasive surgery.References
1. Satava RM. Surgical robotics: the early chronicles. Surgical
laparoscopy. Endoscopy & Percutaneous Techniques 2002;
12:6e16.
2. Ballantyne GH. Robotic surgery, telerobotic surgery, tele-
presence, and telementoring. Surgical Endoscopy 2002;16:
1389e402.
3. Schurr MO, Buess G, Neisius B, Voges U. Robotics and tele-
manipulation technologies for endoscopic surgery. Surgical
Endoscopy 2000;14:375e81.
4. Moorthy K, Munz Y, Dosis A, Hernandez J, Martin S, Bello F,
et al. Dexterity enhancement with robotic surgery. Surgical
Endoscopy 2004;18:790e5.
5. Dakin GF, Gagner M. Comparison of laparoscopic skills per-
formance between standard instruments and two surgical
robotic systems. Surgical Endoscopy 2003;17:574e9.
6. Nio D, Bemelman WA, den Boer KT, Dunker MS, Gouma DJ,
van Gulik TM. Efficiency of manual vs. robotical (Zeus) assis-
ted laparoscopic surgery in the performance of standard-
ized tasks. Surgical Endoscopy 2002;16:412e5.
7. MelvinWS,NeedlemanBJ,KrauseKR, SchneiderC, EllisonEC.
Computer-enhanced vs. standard laparoscopic antireflux
surgery. Journal of Gastrointestinal Surgery 2002;6:11e6.
8. Fukuda T, Guo S, Kosuge K, Arai F, Negoro M, Nakabayashi K.
Micro active catheter system with multi degrees of free-
dom. In: Proceedings of the IEEE international conference
on robotics and automation; 1994.
9. Suzumori K, Iikura S, Tanaka H. Development of flexible
microactuator and its applications to robotics mechanisms.
In: Proceedings of the IEEE international conference on
robotics and automation; 1991.
10. Olympus, http://www.letsgodigital.org/en/news/articles/
story_2150.html, 2004.
11. Phee L, Accoto D, Menciassi A, Stefanini C, Carrozza M,
Dario P. Analysis and development of locomotion devices
for the gastrointestinal tract. IEEE Transactions on Biomed-
ical Engineering 2002;49(6).
12. Grundfest SW, Burdick JW, Slatkin AB. The development of
a robotic endoscope. In: Proceedings of the IEEE international
conference on robotics and automation; 1995. p. 162e71.
13. Flynn A, Udayakumar K, Barret D, McLurkin J, Franck D,
Shectman A. Tomorrow’s surgery: micromotors and microro-
bots for minimally invasive procedures. Journal of Minimally
Invasive Therapy and Allied Technologies 1998;4:343e52.
14. Breedveld P, Danielle E, Van Gorp M. Locomotion through
the intestine by means of rolling stents. In: Proceedings of
the ASME Design Engineering Technical Conferences; 2004.
15. Glukhovsky A, Jacob H. The development and application of
wireless capsuleendoscopy. International JournalofMedical
Robotics and Computer Assisted Surgery 2004;1:114e23.
16. Meron G. The development of the swallowable video
capsule. Gastrointestinal Endoscopy 2000;6:817e9.
17. Oleynikov D, Rentschler M, Hadzialic A, Dumpert J, Platt SR,
Farritor S. Miniature robots can assist in laparoscopic chole-
cystectomy. Surgical Endoscopy 2005;19:473e6.
18. Rentschler ME, Dumpert J, Platt SR, Iagnemma K,
Oleynikov D, Farritor SM. Modeling, analysis, and experi-
mental study of in vivo wheeled robotic mobility. IEEE
Transactions on Robotics 2006;22(2):308e21.
19. Rentschler M, Dumpert J, Platt SR, Farritor S, Oleynikov D.
Mobile in vivo robots provide sole visual feedback for
abdominal exploration and cholecystectomy. Surgical
Endoscopy 2006;20(1):135e8.


In vivo laparoscopic robotics 

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Mechanical & Materials Engineering Faculty
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Mechanical & Materials Engineering, Department
of
2006
In vivo laparoscopic robotics
Mark E. Rentschler
University of Nebraska Medical Center, mrentsch@bigred.unl.edu
Stephen R. Platt
University of Nebraska-Lincoln, splatt2@unl.edu
Jason Dumpert
University of Nebraska-Lincoln, jdumpert2@unl.edu
Shane M. Farritor
University of Nebraska-Lincoln, sfarritor@unl.edu
Dmitry Oleynikov
University of Nebraska Medical Center, doleynik@unmc.edu
Follow this and additional works at: http://digitalcommons.unl.edu/mechengfacpub
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DigitalCommons@University of Nebraska - Lincoln.
Rentschler, Mark E.; Platt, Stephen R.; Dumpert, Jason; Farritor, Shane M.; and Oleynikov, Dmitry, "In vivo laparoscopic robotics"
(2006). Mechanical & Materials Engineering Faculty Publications. 263.
http://digitalcommons.unl.edu/mechengfacpub/263
In vivo laparoscopic robotics
Mark E. Rentschler a,*, Stephen R. Platt a, Jason Dumpert a,
Shane M. Farritor a, Dmitry Oleynikov b
a Department of Mechanical Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
b Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3280, USA
KEYWORDS
In vivo;
Laparoscopic;
Robotics;
Mobile;
Fixed-base
Abstract Robotic laparoscopic surgery is evolving to include in vivo robotic assis-
tants. The impetus for the development of this technology is to provide surgeons
with additional viewpoints and unconstrained manipulators that improve safety
and reduce patient trauma. A family of these robots have been developed to pro-
vide vision and task assistance. Fixed-base and mobile robots have been designed
and tested in animal models with much success. A cholecystectomy, prostatectomy,
and nephrectomy have all been performed with the assistance of these robots.
These early successful tests show how in vivo laparoscopic robotics may be part
of the next advancement in surgical technology.
ª 2006 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Introduction
The use of robotics is currently recognized as
a major driving force for advancing minimally
invasive surgery.1e3 However, current surgical ro-
bots, such as the da Vinci system made by Intuitive
Surgical, have several significant limitations. Al-
though one recent report concluded that robotic
surgery can enhance dexterity compared to tradi-
tional laparoscopy,4 most studies suggest that
current robotic systems offer little or no improve-
ment over standard laparoscopic instruments in
the performance of basic skills.5e7 Current systems
are also not available in most hospitals and remain
constrained by limited sensory and mobility capa-
bilities, and high cost.
Currently available surgical robotic systems are
implemented from outside the body and will
therefore always be constrained to some degree
by the limitations of working through small in-
cisions. Some work has been done to develop
medical robots in which all (or most) of the device
enters the body. The simplest such mechanisms
have been maneuverable endoscopes for colono-
scopy8,9 and laparoscopy.10 These devices have
actuators that can turn the endoscope tip after it
* Corresponding author. University of Nebraska Medical Cen-
ter, Computer Assisted Medicine and Surgery, 984075 Nebraska
Medical Center, Omaha, NE 68198-4075, USA. Tel.: þ1 402 559
7184; fax: þ1 402 559 4427.
E-mail address:mrentsch@bigred.unl.edu (M.E. Rentschler).
1743-9191/$ - see front matter ª 2006 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijsu.2006.03.004
International Journal of Surgery (2006) 4, 167e171
www.int-journal-surgery.com
enters the body. However, support equipment such
as power and control (and sometimes the actua-
tors) remain outside the body.
More advanced in vivo robots have been de-
veloped to explore hollow cavities such as the
colon or esophagus with locomotion systems based
on ‘inch-worm’ motion that use a series of grippers
and extensors,11,12 rolling tracks,13 or rolling
stents.14 These devices all use external power in
the form of electricity and/or vacuum sources for
locomotion.
Another approach is a completely un-tethered
pill that is swallowed and passively passed through
the entire gastrointestinal (GI) tract. One such
commercially available device, called M2A from
Given Imaging Ltd,15,16 returnsmultiple (thousands)
images as it naturally moves through the GI tract.
However, because the device is entirely passive, it
cannot be directed to image a particular location
and the exact locations of the images are not
known. Combined with the very large volume of im-
ages, the use of this device for diagnosis is difficult.
In order to improve visualization and task
assistance in vivo robots are being tested in the
abdominal cavity during laparoscopic procedures.
The robots have been designed to be either mobile
or have a fixed-base. They can now provide vision
assistance through onboard cameras and task
assistance with simple manipulators. The goal of
this robot development is to place the robot
completely within the abdominal cavity so that
the entry incision does not constrain the motion of
the robot. With such technology, the laparoscope
port can be eliminated from many procedures as
visual feedback will come from the in vivo robots
that will be inserted through one of the tool ports.
Current efforts are also focusing on task assis-
tance. The eventual outcome will be a family of
these robots that can be placed in vivo to assist
surgeons, which will improve patient safety and
surgical flexibility.
Robot designs
Fixed-base robots
To improve visualization for surgeons an in vivo
robotic camera was developed. The first prototype
developed was a pan and tilt robot (Fig. 1) that
allowed the camera to pan 360 degrees and tilt
forward and back 45 degrees. Two independent
permanent magnet direct current motors were
used to provide the actuation. LEDs were used to
provide illumination. The tripod legs are spring
loaded so that they can fold down during insertion
and retraction. This camera robot was used during
porcine surgery to remove a gall-bladder.17 The
additional views provided additional frames of ref-
erence and perspectives that were not available
with the laparoscope alone. These additional cam-
era angles augmented surgical visualization and
improved orientation which proved useful to the
surgeon while removing the pig’s gall-bladder.
This allowed the surgeon to have a better under-
standing of depth, improving safety and allowing
the surgeon to plan and execute the procedure
more effectively.
One drawback of the original pan and tilt robot
design was a set focal length of the camera lens.
The simple lens package allowed for a small foot-
print, but reduced flexibility in focusing at different
distances inside the abdominal cavity. Therefore,
the second generation design included an adjust-
able-focus mechanism that physically moved the
lens to and away from the imager to vary the focal
length. To maintain the same size constraints the
pan motor was used for the focusing mechanism.
Therefore, this tilting robot could tilt 45 degrees
(Fig. 2). This tilting robot has LEDs for illumination.
They are positioned at the end of an arm that folds
down in front of the camera. The ring at the end of
this arm is used for retraction. The bottom edge of
the ring is seen in the camera view so that the sur-
geon can easily clamp onto it and retract the robot.
The tripod legs and this retraction arm are both
spring loaded for insertion and retraction.
Figure 1 The pan and tilt camera robot can pan 360
degrees and tilt45 degrees. Torsion springs allow the
legs to be abducted after abdominal entry. LEDs provide
illumination.
168 M.E. Rentschler et al.
Mobile robots
While the fixed-base robots work well to provide
the surgeon with additional visual feedback, mo-
bility is important for tissue manipulation. Such
a mobile platform can also provide visual feedback
while navigating the abdominal cavity. This type of
camera robot works well for exploring the abdom-
inal cavity. These mobile in vivo robots need to
traverse the abdominal organs without causing
tissue damage. Mobility is difficult because the
environment is slick, hilly, and deformable. Much
effort was placed on developing a wheel design
that provided sufficient traction without causing
tissue damage.18 The wheel design was improved
through viscoelastic modeling, laboratory experi-
mentation, and in vivo testing. The final wheel
design incorporates a helical corkscrew treaded
wheel as shown in Fig. 3.
To demonstrate the practical applicability of
this approach to surgery, the successful wheel
design was used to create a wheeled robot with
an adjustable-focus camera (Fig. 3). This mobile
robot has two wheels each connected to an inde-
pendent motor. This allows for forward, reverse
and turning capability. The tail prevents counter-
rotation while the wheels are actuated. The cam-
era lens is located between the wheels as shown
in Fig. 3. A third motor is used to adjust the lens
position and focus depth.
This mobile robotic camera system was tested in
vivo in a porcine model, and used to explore the
abdominal cavity. It also provided the only visual
feedback used by a surgeon during a cholecystec-
tomy.19 By inserting such a mobile camera robot
into the abdominal cavity through one of the stan-
dard laparoscopic tool ports, the traditional third
camera port could be eliminated. This would
reduce patient trauma, and has the potential
to improve laparoscopy compared to current
systems.
A mobile camera and biopsy robot has also been
developed (Fig. 4). This robot includes the adjust-
able-focus camera mechanism, with the ability to
biopsy soft tissue. This robot produces sufficient
clamping force to sample tissue, and sufficient
traction force to retract the tissue sample if it is
not completely severed.
Animal surgery results
The tilting adjustable-focus camera robot was
used recently to successfully remove a canine
prostate and kidney. The robot was placed on the
Figure 2 The tilting adjustable-focus camera robot
can tilt 45 degrees. Torsion springs allow the legs to
be abducted after abdominal entry. LEDs provide
illumination.
Figure 3 The mobile adjustable-focus camera robot
has two independently driven wheels that allow for for-
ward, reverse and turning motion. A small tail prevents
the counter-rotation.
Figure 4 The mobile camera and biopsy robot imple-
ment the successful helical wheel design. This mobile
platform can both be used for visual feedback and tissue
manipulation.
In vivo laparoscopic robotics 169
opposite side of the prostate (Fig. 5), away from
the laparoscope. This provided the surgical team
with two views of the prostate (Fig. 6), one from
both sides. This proved extremely useful while
suturing the urethra after the prostate removal.
During several portions of the surgery the view
from the robotic camera was used exclusively for
visual feedback.
The ability to attain a good laparoscope position
during urological procedures is often difficult.
Using the in vivo camera robots, the view can
easily be changed by remotely controlling the
robot. Such a robot could be used extensively by
urologists operating in the pelvic cavity. These
robots could provide additional alternate views for
the surgeon, or could in fact provide the sole visual
feedback.
Three trocar ports were used for the cholecys-
tectomy performed with the mobile camera
robot. The robot was inserted through one of the
tool ports. After insertion, this port was used
for tool insertion. The second port was also
used for tool insertion, while the third port was
used only for the laparoscope. The laparoscope
provided lighting for the robot’s camera, but the
surgeon did not use visual feedback from the
laparoscope during the procedure (Fig. 7).
A cholecystectomy was performed with this
mobile camera robot providing the only visual
feedback available to the surgeon (Fig. 8) (i.e.
the video from the laparoscope was not viewed
by the surgeon). The ability of the robot to tilt
the adjustable-focus camera 15 degrees without
changing the position of the wheels proved ex-
tremely useful while retracting the liver. The ad-
justable-focus capability of the camera system
allowed the surgeon to have a better understanding
Figure 5 The tilting camera robot observing the
prostatectomy. The video feedback from the tilting
robot was used exclusively during portions of the
surgery.
Figure 6 A view from the tilting robot while suturing
after the prostate removal.
Figure 7 The view from the laparoscope during chole-
cystectomy with the mobile camera robot.
Figure 8 The view from the mobile camera robot dur-
ing the cholecystectomy.
170 M.E. Rentschler et al.
of depth. The mobile robot also proved very useful
for abdominal exploration and observation of trocar
and tool insertion.
This cholecystectomy demonstrated the effec-
tiveness of a two port procedure with visual
feedback only from the mobile camera robot.
This shows that the designated laparoscope port
may be eliminated and only two ports may be
required for most procedures. The ports could be
initially used for robot insertion and then for tools.
If the laparoscope view was ever needed for
assistance with robot placement it could be in-
serted through one of the tool ports until the robot
was correctly positioned.
Discussion
These tests have demonstrated that it is possible
to perform a common laparoscopic procedure
using an in vivo camera system as the sole source
of visual feedback. This has the potential to
reduce patient trauma by eliminating the need
for a camera port and instead inserting in vivo
camera robots through one of the tool ports. While
the initial prototype was slightly larger than
a traditional trocar, future robots will be smaller
in size, have no tethers, and will incorporate
additional sensors.
Miniature in vivo robots will be far more agile
inside the abdominal cavity than the current
generation of large and expensive external tele-
manipulators. Current laparoscopic robots are
bulky, unwieldy and cannot be easily transported.
Because of their cost, they are typically designed
for multiple surgical procedures with interchange-
able instrument arms. Future miniature robots
may be designed for each specific task. Because
they are small, multiple robots can be employed
simultaneously. Although in the future it might be
possible for such robots to perform the entire
procedure, current technology is more appropriate
for the robots to be used as assistants during
surgery, aiding in visualization and micromani-
pulation. Equipped with additional sensors they
will also be able to explore and provide tissue
diagnosis.
The long-term goal of this work is to create
a team of in vivo robots that could serve as surgical
assistants and/or replace traditional laparoscopic
tools. The successful animal trials show the great
promise for in vivo robotics, and the projected
outcomes have the potential to make important
advancements in minimally invasive surgery.
References
1. Satava RM. Surgical robotics: the early chronicles. Surgical
laparoscopy. Endoscopy & Percutaneous Techniques 2002;
12:6e16.
2. Ballantyne GH. Robotic surgery, telerobotic surgery, tele-
presence, and telementoring. Surgical Endoscopy 2002;16:
1389e402.
3. Schurr MO, Buess G, Neisius B, Voges U. Robotics and tele-
manipulation technologies for endoscopic surgery. Surgical
Endoscopy 2000;14:375e81.
4. Moorthy K, Munz Y, Dosis A, Hernandez J, Martin S, Bello F,
et al. Dexterity enhancement with robotic surgery. Surgical
Endoscopy 2004;18:790e5.
5. Dakin GF, Gagner M. Comparison of laparoscopic skills per-
formance between standard instruments and two surgical
robotic systems. Surgical Endoscopy 2003;17:574e9.
6. Nio D, Bemelman WA, den Boer KT, Dunker MS, Gouma DJ,
van Gulik TM. Efficiency of manual vs. robotical (Zeus) assis-
ted laparoscopic surgery in the performance of standard-
ized tasks. Surgical Endoscopy 2002;16:412e5.
7. MelvinWS,NeedlemanBJ,KrauseKR, SchneiderC, EllisonEC.
Computer-enhanced vs. standard laparoscopic antireflux
surgery. Journal of Gastrointestinal Surgery 2002;6:11e6.
8. Fukuda T, Guo S, Kosuge K, Arai F, Negoro M, Nakabayashi K.
Micro active catheter system with multi degrees of free-
dom. In: Proceedings of the IEEE international conference
on robotics and automation; 1994.
9. Suzumori K, Iikura S, Tanaka H. Development of flexible
microactuator and its applications to robotics mechanisms.
In: Proceedings of the IEEE international conference on
robotics and automation; 1991.
10. Olympus, http://www.letsgodigital.org/en/news/articles/
story_2150.html, 2004.
11. Phee L, Accoto D, Menciassi A, Stefanini C, Carrozza M,
Dario P. Analysis and development of locomotion devices
for the gastrointestinal tract. IEEE Transactions on Biomed-
ical Engineering 2002;49(6).
12. Grundfest SW, Burdick JW, Slatkin AB. The development of
a robotic endoscope. In: Proceedings of the IEEE international
conference on robotics and automation; 1995. p. 162e71.
13. Flynn A, Udayakumar K, Barret D, McLurkin J, Franck D,
Shectman A. Tomorrow’s surgery: micromotors and microro-
bots for minimally invasive procedures. Journal of Minimally
Invasive Therapy and Allied Technologies 1998;4:343e52.
14. Breedveld P, Danielle E, Van Gorp M. Locomotion through
the intestine by means of rolling stents. In: Proceedings of
the ASME Design Engineering Technical Conferences; 2004.
15. Glukhovsky A, Jacob H. The development and application of
wireless capsuleendoscopy. International JournalofMedical
Robotics and Computer Assisted Surgery 2004;1:114e23.
16. Meron G. The development of the swallowable video
capsule. Gastrointestinal Endoscopy 2000;6:817e9.
17. Oleynikov D, Rentschler M, Hadzialic A, Dumpert J, Platt SR,
Farritor S. Miniature robots can assist in laparoscopic chole-
cystectomy. Surgical Endoscopy 2005;19:473e6.
18. Rentschler ME, Dumpert J, Platt SR, Iagnemma K,
Oleynikov D, Farritor SM. Modeling, analysis, and experi-
mental study of in vivo wheeled robotic mobility. IEEE
Transactions on Robotics 2006;22(2):308e21.
19. Rentschler M, Dumpert J, Platt SR, Farritor S, Oleynikov D.
Mobile in vivo robots provide sole visual feedback for
abdominal exploration and cholecystectomy. Surgical
Endoscopy 2006;20(1):135e8.
In vivo laparoscopic robotics 171


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