1
|
Progress in Control-Actuation Robotic System for Gastrointestinal NOTES Development. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7047481. [PMID: 36349314 PMCID: PMC9637469 DOI: 10.1155/2022/7047481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022]
Abstract
Purpose Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive surgical procedure that reduces patient trauma, infection probability, and rehabilitation time. This paper reviews the progress made in the control-actuation robotic systems for gastrointestinal NOTES development. Material and Methods. A survey on both existing and state-of-the-art control-actuation robotic systems for gastrointestinal NOTES was conducted in December 2021. Results Nine control-actuation robotic systems for gastrointestinal NOTES were identified. The structures and specifications of these robotic systems were reported. The technical parameters were also discussed. Special attention was directed to systems using a control-actuation structure and tendon-driven mechanism. The control-actuation robotic systems typically deploy a control-actuation structure and tendon-driven mechanism. Control-actuation robotic systems for gastrointestinal NOTES show great ability to improve operational accuracy and flexibility and flatten the learning curve of procedures. These characteristics suggest that the use of control-actuation robotic systems is worth exploring in future development.
Collapse
|
2
|
Cui Y, Thompson CC, Chiu PWY, Gross SA. Robotics in therapeutic endoscopy (with video). Gastrointest Endosc 2022; 96:402-410. [PMID: 35667390 DOI: 10.1016/j.gie.2022.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 02/08/2023]
Abstract
Since its inception, endoscopy has evolved from a solely diagnostic procedure to an expanding therapeutic field within gastroenterology. The incorporation of robotics in gastroenterology initially addressed shortcomings of flexible endoscopes in natural orifice transluminal endoscopy. Developing therapeutic endoscopic robotic platforms now offer operators improved ergonomics, visualization, dexterity, precision, and control and the possibility of increasing proficiency and standardization of complex endoscopic procedures including endoscopic submucosal dissection, endoscopic full-thickness resection, and endoscopic suturing. The following review discusses the history, potential applications, and tools currently available and in development for robotics in therapeutic endoscopy.
Collapse
Affiliation(s)
- YongYan Cui
- Department of Gastroenterology, New York University Medical Center, New York, New York, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Wai Yan Chiu
- Department of Surgery, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Seth A Gross
- Department of Gastroenterology, New York University Medical Center, New York, New York, USA
| |
Collapse
|
3
|
Design and Performance Investigation of a Robot-Assisted Flexible Ureteroscopy System. Appl Bionics Biomech 2021; 2021:6911202. [PMID: 34840603 PMCID: PMC8616660 DOI: 10.1155/2021/6911202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/27/2021] [Indexed: 12/21/2022] Open
Abstract
Flexible ureteroscopy (FURS) has been developed and has become a preferred routine procedure for both diagnosis and treatment of kidney stones and other renal diseases inside the urinary tract. The traditional manual FURS procedure is highly skill-demanding and easily brings about physical fatigue and burnout for surgeons. The improper operational ergonomics and fragile instruments also hinder its further development and patient safety enhancement. A robotic system is presented in this paper to assist the FURS procedure. The system with a master-slave configuration is designed based on the requirement analysis in manual operation. A joint-to-joint mapping strategy and several control strategies are built to realize intuitive and safe operations. Both phantom and animal experiments validate that the robot has significant advantages over manual operations, including the easy-to-use manner, reduced intraoperative time, and improved surgical ergonomics. The proposed robotic system can solve the major drawbacks of manual FURS. The test results demonstrate that the robot has great potential for clinical applications.
Collapse
|
4
|
Kaan HL, Ho KY. Robot-Assisted Endoscopic Resection: Current Status and Future Directions. Gut Liver 2021; 14:150-152. [PMID: 31158954 PMCID: PMC7096234 DOI: 10.5009/gnl19047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/06/2019] [Indexed: 12/20/2022] Open
Abstract
Therapeutic endoscopic resection has gained favor for its ability to achieve high en bloc and histologically complete resection rates via a minimally invasive approach. The main technical difficulties faced by interventionists are first the lack of traction causing suboptimal visualization of the dissection field and second, the lack of triangulation using existing therapeutic apparatuses. These challenges can be overcome with the use of robots and the multiple degrees of freedom afforded by the robotic wrists. Nevertheless, complications such as bleeding and perforation can occur. It is hence beneficial for the robotic device to be equipped with additional abilities such as suturing. Once the robotic prototypes have been fully optimized and marketed, a structured program should be instituted to ensure proper and adequate training of the end-users. The future of robotics should then explore the possibility of developing a soft robot or a robot with more natural human-like movements. A robot with a force feedback mechanism would be superior and improve safety. Eventually, a supervised autonomous robot may perform interventions with greater precision and accuracy than an expert procedurist. This review describes the benefits of robot-assisted endoscopic resections, recent developments aimed at managing iatrogenic complications and future directions for robotic endoscopy.
Collapse
Affiliation(s)
- Hung Leng Kaan
- Department of General Surgery, National University Hospital, Singapore
| | - Khek Yu Ho
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
5
|
Nakadate R, Iwasa T, Onogi S, Arata J, Oguri S, Okamoto Y, Akahoshi T, Eto M, Hashizume M. Surgical Robot for Intraluminal Access: An Ex Vivo Feasibility Study. CYBORG AND BIONIC SYSTEMS 2020; 2020:8378025. [PMID: 37063410 PMCID: PMC10097415 DOI: 10.34133/2020/8378025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022] Open
Abstract
Early-stage gastrointestinal cancer is often treated by endoscopic submucosal dissection (ESD) using a flexible endoscope. Compared with conventional percutaneous surgery, ESD is much less invasive and provides a high quality of life for the patient because it does not require a skin incision, and the organ is preserved. However, the operator must be highly skilled because ESD requires using a flexible endoscope with energy devices, which have limited degrees of freedom. To facilitate easier manipulation of these flexible devices, we developed a surgical robot comprising a flexible endoscope and two articulating instruments. The robotic system is based on a conventional flexible endoscope, and an extrapolated motor unit moves the endoscope in all its degrees of freedom. The instruments are thin enough to allow insertion of two instruments into the endoscope channel, and each instrument has a bending section that allows for up–down, right–left, and forward–backward motion. In this study, we performed an ex vivo feasibility evaluation using the proposed robotic system for ESD in a porcine stomach. The procedure was successfully performed by five novice operators without complications. Our findings demonstrated the feasibility of the proposed robotic system and, furthermore, suggest that even operators with limited experience can use this system to perform ESD.
Collapse
Affiliation(s)
- Ryu Nakadate
- Center for Advanced Medical Innovation, Kyushu University, Japan
| | - Tsutomu Iwasa
- Kitakyushu Municipal Medical Center, Kyushu University, Japan
| | - Shinya Onogi
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Japan
| | - Jumpei Arata
- Department of Mechanical Engineering, Kyushu University, Japan
| | - Susumu Oguri
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | | | - Tomohiko Akahoshi
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | - Masatoshi Eto
- Center for Advanced Medical Innovation, Kyushu University, Japan
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
- Department of Urology, Kyushu University, Japan
| | | |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Advanced endoscopy procedures are technically challenging and require extensive training. Recent technological advances made in computer science and robotics have the potential to enhance the performance of complex intraluminal and transluminal interventions and potentially optimize precision and safety. This review covers the different technologies used for robot-assisted interventions in the gastrointestinal tract, organized according to their clinical availability, and focusing on flexible endoscopy-based systems. RECENT FINDINGS In the curvilinear gastrointestinal anatomy, robotic technology can enhance flexible endoscopes to augment effectiveness, safety, and therapeutic capabilities, particularly for complex intraluminal and transluminal interventions. Increased visual angles, increased degrees of freedom of instrumentation, optimized navigation, and locomotion, which may lead to a reduced physician learning curve and workload, are promising achievements with the promise to ultimately replace conventional endoscopy techniques for screening and therapeutic endoscopy. SUMMARY The majority of these devices are not commercially available yet. The best clinical applications are also currently being researched. Nonetheless, robotic assistance may encourage surgeons to use flexible endoscopes to administer surgical therapies and increase interest among gastroenterologists in advanced therapies. Robotics may be a means to overcome the technical obstacles of incisionless natural orifice procedures and favor an increased adoption of complex endoscopic procedures such as third-space therapies.
Collapse
|
7
|
Kim BG, Choi HS, Park SH, Hong JH, Lee JM, Kim SH, Chun HJ, Hong D, Keum B. A Pilot Study of Endoscopic Submucosal Dissection Using an Endoscopic Assistive Robot in a Porcine Stomach Model. Gut Liver 2020; 13:402-408. [PMID: 30600676 PMCID: PMC6622573 DOI: 10.5009/gnl18370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/01/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022] Open
Abstract
Background/Aims Endoscopic assistive devices have been developed to reduce the complexity and improve the safety of surgeries involving the use of endoscopes. We developed an assistive robotic arm for endoscopic submucosal dissection (ESD) and evaluated its efficiency and safety in this in vitro pilot study. Methods ESD was performed using an auxiliary transluminal endoscopic robot. An in vitro test bed replicating the intra-abdominal environment and pig stomachs were used for the experiment. Participants were divided into skilled operators and unskilled operators. Each group performed ESD 10 times by using both conventional and robot-assisted methods. The perforation incidence, operation time, and resected mucous membrane size were measured. Results For the conventional method, significant differences were noted between skilled and unskilled operators regarding operation time (11.3 minutes vs 26.7 minutes) and perforation incidence (0/10 vs 6/10). Unskilled operators showed a large decrease in the perforation incidence with the robot-assisted method (conventional method vs robot-assisted method, 6/10 vs 1/10). However, the operation time did not differ between the conventional and robot-assisted methods. On the other hand, skilled operators did not show differences in the operation time and perforation incidence between the conventional and robot-assisted methods. Among both skilled and unskilled operators, the operation time decreased with the robot-assisted method as the experiment proceeded. Conclusions The surgical safety of unskilled operators greatly improved with robotic assistance. Thus, our assistive robotic arm was beneficial for ESD. Our findings suggest that endoscopic assistive robots have positive effects on surgical safety.
Collapse
Affiliation(s)
- Byung Gon Kim
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Sei Hoon Park
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Jun Ho Hong
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Jung Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Seung Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Daehie Hong
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Sivananthan A, Glover B, Ayaru L, Patel K, Darzi A, Patel N. The evolution of lower gastrointestinal endoscopy: where are we now? Ther Adv Gastrointest Endosc 2020; 13:2631774520979591. [PMID: 33426522 PMCID: PMC7754801 DOI: 10.1177/2631774520979591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022] Open
Abstract
Lower gastrointestinal endoscopy has evolved over time, fulfilling a widening diagnostic and therapeutic remit. As our understanding of colorectal cancer and its prevention has improved, endoscopy has progressed with improved diagnostic technologies and advancing endoscopic therapies. Despite this, the fundamental design of the endoscope has remained similar since its inception. This review presents the important role lower gastrointestinal endoscopy serves in the prevention of colorectal cancer and the desirable characteristics of the endoscope that would enhance this. A brief history of the endoscope is presented. Current and future robotic endoscopic platforms, which may fulfil these desirable characteristics, are discussed. The incorporation of new technologies from allied scientific disciplines will help the endoscope fulfil its maximum potential in preventing the increasing global burden of colorectal cancer. There are a number of endoscopic platforms under development, which show significant promise.
Collapse
Affiliation(s)
| | | | | | - Kinesh Patel
- Chelsea and Westminster NHS Healthcare Trust, UK
| | | | | |
Collapse
|
9
|
Development of a Novel Gastrointestinal Endoscopic Robot Enabling Complete Remote Control of All Operations: Endoscopic Therapeutic Robot System (ETRS). Gastroenterol Res Pract 2019; 2019:6909547. [PMID: 31781197 PMCID: PMC6875422 DOI: 10.1155/2019/6909547] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/03/2019] [Accepted: 09/07/2019] [Indexed: 02/07/2023] Open
Abstract
Background and Objective The master and slave transluminal endoscopic robot and other flexible endoscopy platforms are designed primarily for the remote control of forceps, with manipulation of the endoscope itself still dependent on conventional techniques. We have developed an endoscopic therapeutic robot system (ETRS) that provides complete remote control of all forceps and endoscope operations. Method We carried out endoscopic submucosal dissection (ESD) in porcine stomachs using the ETRS. All procedures were completed with the endoscopist seated at the console the entire time. Results Total en bloc resection was achieved in all 7 cases with no complications. The mean total procedure time was 36.14 ± 14.98 min, the mean size of the resected specimen was 3.39 ± 0.66 cm × 3.03 ± 0.63 cm, and the mean dissection time was 14.91 ± 8.61 min. Conclusion We successfully used the ETRS to perform completely remote-controlled ESD in porcine stomachs.
Collapse
|
10
|
Abstract
Traditionally, suturing is performed in open surgery using a needle holder and forceps. The aim is to achieve accurate approximation of both edges of the wound and to tie a secure knot. With the development of laparoscopic surgery, traditional suturing methods have been adapted to meet the constraints of rigid laparoscopic instruments with limited degrees of freedom. The subsequent introduction of three-dimensional robotic suturing has since made intracorporeal suturing easier to learn, primarily because of its intuitiveness and the additional degree of freedom of the robotic wrists. With the increasing popularity of therapeutic endoscopic procedures for early gastrointestinal cancers, devices allowing for endoscopic suturing have since been developed. Nevertheless, these devices remain challenging to use as they require double-channel endoscopes and do not have the extra degree of freedom of robotic wrists. The introduction of robotics to the field of endoscopic suturing has proven to be promising. This review describes the development and adaptation of basic suturing techniques to various platforms, such as laparoscopic, robotic and endoscopic.
Collapse
Affiliation(s)
- Hung Leng Kaan
- Department of General Surgery, National University Hospital, Singapore
| | - Khek Yu Ho
- Department of Medicine, National University Hospital, Singapore,Address for correspondence: Prof. Khek-Yu Ho, Department of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore - 119228, Singapore. E-mail:
| |
Collapse
|
11
|
Kume K, Sakai N, Goto T. Haptic feedback is useful in remote manipulation of flexible endoscopes. Endosc Int Open 2018; 6:E1134-E1139. [PMID: 30211304 PMCID: PMC6133662 DOI: 10.1055/a-0655-7497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/03/2018] [Indexed: 01/01/2023] Open
Abstract
Background and study aims We developed the Endoscopic Operation Robot (EOR) version 3, offering built-in haptic feedback and manipulation of the entire scope with one hand. Manipulation of the flexible endoscope is done entirely remotely. However, inclusion of haptic feedback places a huge burden on the system. Our purpose in this study was to determine whether haptic feedback is needed in remote manipulation of a flexible endoscope. Methods Five endoscopists performed total colonoscopy using a colonoscopy training model. A trial was conducted in which the endoscope was inserted up to the cecum five times with haptic feedback and five times without haptic feedback. Insertion time, maximum and mean haptic force, and incidence of sigmoid colon overstretching were compared between groups. Results Insertion time was significantly shorter with haptic feedback than without, and overstretching of the sigmoid colon was less frequent. Insertion could thus be performed without using excessive force. Conclusion Haptic feedback is useful for remote control manipulation of flexible endoscopes.
Collapse
Affiliation(s)
- Keiichiro Kume
- Third Department of Internal Medicine, University of Occupational and Environmental Health, Japan, School of Medicine, Kitakyusyu, Japan,Corresponding author Keiichiro KUME, MD, PhD Third Department of Internal MedicineUniversity of Occupational and Environmental Health, JapanSchool of Medicine1-1 IseigaokaYahatanishi-ku, Kitakyusyu 807-8555Japan+81-93-692-0107
| | - Nobuo Sakai
- Department of Applied Science for Integrated System Engineering, Faculty of Engineering, Kyushu Institute of Technology, Fukuoka, Japan
| | - Takaaki Goto
- Department of Applied Science for Integrated System Engineering, Faculty of Engineering, Kyushu Institute of Technology, Fukuoka, Japan
| |
Collapse
|
12
|
Abstract
Although colonoscopy was originally a diagnostic imaging procedure, it has now expanded to include an increasing range of therapeutic interventions. These procedures require precise maneuvers of instruments, execution of force, efficient transmission of force from the operator to the point of application, and sufficient dexterity in the mobilization of endoscopic surgical instruments. The conventional endoscope is not designed to support technically demanding endoscopic procedures. In case of colonoscopy, the tortuous anatomy of the colon makes inserting, moving, and orientating the endoscope difficult. Exerting excessive pressure can cause looping of the endoscope, pain to the patient, and even perforation of the colon. To mitigate the technical constraints, numerous technically enhanced systems have been developed to enable better control of instruments and precise delivery of force in the execution of surgical tasks such as apposing, grasping, traction, counter-traction, and cutting of tissues. Among the recent developments are highly dexterous robotic master and slave systems, computer-assisted or robotically enhanced conventional endoscopes, and autonomously driven locomotion devices that can effortlessly traverse the colon. Developments in endoscopic instrumentations have overcome technical barriers and opened new horizons for further advancements in therapeutic interventions. This review describes examples of some of these systems in the context of their applications to advanced therapeutic colonoscopy.
Collapse
Affiliation(s)
- Jennie Y Y Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Khek Yu Ho
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
13
|
Tay G, Tan HK, Nguyen TK, Phee SJ, Iyer NG. Use of the EndoMaster robot-assisted surgical system in transoral robotic surgery: A cadaveric study. Int J Med Robot 2018; 14:e1930. [PMID: 29869407 DOI: 10.1002/rcs.1930] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/13/2018] [Accepted: 05/13/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The EndoMaster is a novel robot-assisted surgical system originally designed for endoscopic resection of gastrointestinal polyps and tumours. It incorporates two robotic arms (a grasper and a probe for monopolar diathermy) into the end of a flexible endoscope, creating improved manoeuvrability, with two arms allowing for 9 degrees of movement and triangulation; this enables fine manipulation and dissection of tissues. METHODS The EndoMaster was used in two human cadavers to perform 4 radical tonsillectomies to evaluate its performance in transoral robotic surgery (TORS). RESULTS The EndoMaster allowed for good visualization of the surgical field and its compact form factor allowed for quick docking and avoided the problem of clashing of the working arms. CONCLUSION The EndoMaster system shows promising potential for use in TORS. Further refinements to movements of the effector arms are required.
Collapse
Affiliation(s)
- Gerald Tay
- Singhealth Duke-NUS Head and Neck Centre, Singapore
| | | | | | - Soo Jay Phee
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | | |
Collapse
|
14
|
Feasibility and Technique for Transvaginal Natural Orifice Transluminal Endoscopic Surgery Liver Resection: A Porcine Model. Surg Laparosc Endosc Percutan Tech 2017; 27:e6-e11. [PMID: 28030435 PMCID: PMC5287436 DOI: 10.1097/sle.0000000000000367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Natural orifice transluminal endoscopic surgery (NOTES) is a challenging minimally invasive procedure. Although laparoscopic techniques for liver resection are gaining acceptance worldwide, few studies have investigated NOTES liver resection. We used a porcine model to assess the feasibility and safety of transvaginal NOTES liver resection (TV NOTES LR). MATERIALS AND METHODS Nine female pigs underwent TV NOTES LR. A nonsurvival acute porcine model with general anesthesia was used in all cases. Using hybrid NOTES technique, we placed only 1 umbilical 12-mm umbilical trocar in the abdominal wall, which was used to create pneumoperitoneum. A laparoscope was then advanced to obtain intra-abdominal visualization. A 15-mm vaginal trocar was inserted under direct laparoscopic vision, and a flexible endoscope was introduced through the vaginal trocar. A long, flexible grasper and endocavity retractor were used to stably retract the liver. The liver edge was partially transected using energy devices inserted through the umbilical trocar. To transect the left lateral lobe, a flexible linear stapler was inserted alongside the vaginal trocar. A specimen extraction bag was deployed and extracted transvaginally. Blood loss, bile leakage, operative time, and specimen size were evaluated. Necropsy studies were performed after the procedures. RESULTS Eighteen transvaginal NOTES partial liver resections and 4 transvaginal NOTES left lateral lobectomies were successfully performed on 9 pigs. Mean operative time was 165.8 minutes, and mean estimated blood loss was 76.6 mL. All TV NOTES LRs were performed without complications or deaths. Necropsy showed no bile leakage from remnant liver. CONCLUSIONS Our porcine model suggests that TV NOTES LR is technically feasible and safe and has the potential for clinical use as a minimally invasive alternative to conventional laparoscopic liver resection.
Collapse
|
15
|
Abstract
INTRODUCTION Natural orifices transluminal endoscopic surgery (notes) procedures are limited by a number of factors including closure of the internal entry point, loss of triangulation, and unstable operative platform. Areas covered: In this paper, new technical developments in different aspects of robotic assisted NOTES interventions are reviewed. We further address new research opportunities for more widespread clinical acceptance of robotic assisted NOTES procedures. Expert commentary: The application of robotics in NOTES intervention is still in its infancy. The development of more compact, smart and intuitive robotic NOTES systems holds much promise for the future of NOTES application.
Collapse
Affiliation(s)
- Siyang Zuo
- a Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education , Tianjin University , Tianjin , China
| | - Shuxin Wang
- a Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education , Tianjin University , Tianjin , China
| |
Collapse
|
16
|
Total mesorectal excision using a soft and flexible robotic arm: a feasibility study in cadaver models. Surg Endosc 2016; 31:264-273. [DOI: 10.1007/s00464-016-4967-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
|
17
|
Roy S, Evans C. Overview of robotic colorectal surgery: Current and future practical developments. World J Gastrointest Surg 2016; 8:143-150. [PMID: 26981188 PMCID: PMC4770168 DOI: 10.4240/wjgs.v8.i2.143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 11/19/2015] [Accepted: 12/11/2015] [Indexed: 02/06/2023] Open
Abstract
Minimal access surgery has revolutionised colorectal surgery by offering reduced morbidity and mortality over open surgery, while maintaining oncological and functional outcomes with the disadvantage of additional practical challenges. Robotic surgery aids the surgeon in overcoming these challenges. Uptake of robotic assistance has been relatively slow, mainly because of the high initial and ongoing costs of equipment but also because of limited evidence of improved patient outcomes. Advances in robotic colorectal surgery will aim to widen the scope of minimal access surgery to allow larger and more complex surgery through smaller access and natural orifices and also to make the technology more economical, allowing wider dispersal and uptake of robotic technology. Advances in robotic endoscopy will yield self-advancing endoscopes and a widening role for capsule endoscopy including the development of motile and steerable capsules able to deliver localised drug therapy and insufflation as well as being recharged from an extracorporeal power source to allow great longevity. Ultimately robotic technology may advance to the point where many conventional surgical interventions are no longer required. With respect to nanotechnology, surgery may eventually become obsolete.
Collapse
|
18
|
Abstract
Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical procedure during which abdominal operations can be performed with an endoscope passed through a natural orifice through an internal incision in the stomach, vagina, bladder or colon. NOTES is still evolving and many barriers stand on its way before it can gain acceptance in modern surgical practice. Effective access to the peritoneal cavity, closure techniques of the natural orifice access sites, development of a multitasking platform to accomplish procedures and support for special orientation are only a handful of its known limitations. Although the endoscope and conventional tools are useful for simple procedures, many important and complicated procedures are currently not possible due to limitation of degree of freedom (DOF) of the end effectors. We have developed a Master and Slave Transluminal Endoscopic Robot (MASTER) with nine degrees of freedom (DOF) in end effectors, which are long and flexible so as to enhance endoscopic procedures and NOTES. Using MASTER we have successfully performed endoscopic sub-mucosal dissections (ESD) to segmental hepatectomies in animal models. Thus, the MASTER robotic system shows great potential to perform new surgical procedures that are otherwise not possible with conventional endoscopic tools.
Collapse
Affiliation(s)
- Davide Lomanto
- Department of Surgery, Minimally Invasive Surgical Centre (MISC), Khoo Teck Puat Advanced Surgery Training Centre (ASTC), National University Hospital , Singapore
| | | | | | | |
Collapse
|
19
|
Hazrah P, Sharma D, Borgharia S, Kumar P, Lal R. Appraisal of Laparoscopic Liver Resection in the Treatment of Liver Metastasis with Special Reference to Outcome in Colorectal Malignancies. Indian J Surg 2015; 76:392-401. [PMID: 26396473 DOI: 10.1007/s12262-013-0944-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/26/2013] [Indexed: 11/30/2022] Open
Abstract
Treatment of metastatic liver disease is at the crossroads of an evolutionary transformation with more and more reports reiterating the benefits of resectional therapy in various cancers. A quest for application of laparoscopic approaches to the management of liver metastasis has arisen due to the projected benefits of less morbidity, early recovery, and equivalent oncological outcome in selected malignancies. However, the diverse and heterogenous data on indications, operative technique, and outcome evaluation make a comparative analysis of these studies difficult. This review is an appraisal of technique and outcome of minimally invasive liver resection as reported in the current literature with special reference to treatment of metastatic colorectal cancers.
Collapse
Affiliation(s)
- Priya Hazrah
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
| | - Deborshi Sharma
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India ; Type V/17, Block III, Lodhi Road Complex, New Delhi, 110003 India
| | - Saurabh Borgharia
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
| | - Pawan Kumar
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
| | - Romesh Lal
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
| |
Collapse
|
20
|
Feussner H, Fiolka A, Schneider A, Cuntz T, Coy J, von Tiesenhausen C, Höller K, Weede O, Konietschke R, Borchard JH, Ellrichmann M, Reiser S, Ortmaier T. The "Iceberg Phenomenon": As Soon as One Technological Problem in NOTES Is Solved, the Next One Appears! Surg Innov 2015; 22:643-50. [PMID: 25733547 DOI: 10.1177/1553350615573578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Though already proclaimed about 7 years ago, natural orifice transluminal endoscopic surgery (NOTES) is still in its early stages. A multidisciplinary working team tried to analyze the technical obstacles and identify potential solutions. METHODS After a comprehensive review of the literature, a group of 3 surgeons, 1 gastroenterologist, 10 engineers, and 1 representative of biomedical industry defined the most important deficiencies within the system and then compiled as well as evaluated innovative technologies that could be used to help overcome these problems. These technologies were classified with regard to the time needed for their implementation and associated hindrances, where priority is based on the level of impact and significance that it would make. RESULTS Both visualization and actuation require significant improvement. Advanced illumination, mist elimination, image stabilization, view extension, 3-dimensional stereoscopy, and augmented reality are feasible options and could optimize visual information. Advanced mechatronic platforms with miniaturized, powerful actuators, and intuitive human-machine interfaces could optimize dexterity, as long as enabling technologies are used. The latter include depth maps in real time, precise navigation, fast pattern recognition, partial autonomy, and cognition systems. CONCLUSION The majority of functional deficiencies that still exist in NOTES platforms could be overcome by a broad range of already existing or emerging enabling technologies. To combine them in an optimal manner, a permanent dialogue between researchers and clinicians is mandatory.
Collapse
Affiliation(s)
| | - Adam Fiolka
- Technical University of Munich, Munich, Germany
| | | | - Timo Cuntz
- Fraunhofer Project Group for Automation in Medicine and Biotechnology (PAMB), Mannheim, Germany
| | | | | | - Kurt Höller
- Friedrich-Alexander University, Erlangen-Nürnberg, Germany
| | - Oliver Weede
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | | | - Mark Ellrichmann
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | |
Collapse
|
21
|
Zygomalas A, Kehagias I, Giokas K, Koutsouris D. Miniature Surgical Robots in the Era of NOTES and LESS. Surg Innov 2015; 22:97-107. [DOI: 10.1177/1553350614532549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Laparoscopy is an established method for the treatment of numerous surgical conditions. Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body as entrances to the abdominal cavity. An alternative concept of minimally invasive approach to the abdominal cavity is to insert all the laparoscopic instruments through ports using a single small incision on the abdominal wall. A suggested name for this technique is laparoendoscopic single-site surgery (LESS). Considering the technical difficulties in NOTES and LESS and the progress in informatics and robotics, the use of robots seems ideal. The aim of this study is to investigate if there is at present, a realistic possibility of using miniature robots in NOTES or LESS in daily clinical practice. An up-to-date review on in vivo surgical miniature robots is made. A Web-based research of the English literature up to March 2013 using PubMed, Scopus, and Google Scholar as search engines was performed. The development of in vivo miniature robots for use in NOTES or LESS is a reality with great advancements, potential advantages, and possible application in minimally invasive surgery in the future. However, true totally NOTES or LESS procedures on humans using miniature robots either solely or as assistance, remain a dream at present.
Collapse
|
22
|
Ban D, Kudo A, Irie T, Ochiai T, Aihara A, Matsumura S, Tanaka S, Tanabe M. Advances in reduced port laparoscopic liver resection. Asian J Endosc Surg 2015; 8:11-5. [PMID: 25510567 DOI: 10.1111/ases.12164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/08/2014] [Accepted: 11/09/2014] [Indexed: 12/14/2022]
Abstract
Reduced port surgery has been attracting attention in the field of minimally invasive surgery. Although the use of SILS is becoming widespread, technical difficulty has delayed its adoption for laparoscopic liver resection. Recently, advances in laparoscopic liver resection have been made in tandem with advances in surgical skill and devices. The main driver in conventional laparoscopic liver resection's evolution to become less surgically invasive seems to be single-incision laparoscopic liver resection (SILLR). To date, most reports on SILLR have been single case reports or case series. Only a few cohort studies on conventional laparoscopic surgery and SILLR have been conducted. Recent reports have described the use of SILLR for well-localized lesions and solitary tumors located in the anterolateral segments of the liver or left liver lobe, but its application remains limited to partial resection and left lateral sectionectomy. The feasibility and safety of SILLR have been demonstrated, but additional work is needed for standardization of the procedure.
Collapse
Affiliation(s)
- Daisuke Ban
- Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Arkenbout EA, Henselmans PWJ, Jelínek F, Breedveld P. A state of the art review and categorization of multi-branched instruments for NOTES and SILS. Surg Endosc 2014; 29:1281-96. [PMID: 25249149 DOI: 10.1007/s00464-014-3816-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 08/12/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Since the advent of Natural Orifice Translumenal Endoscopic Surgery (NOTES) and single incision laparoscopic surgery (SILS), a variety of multitasking platforms have been under development with the objective to allow for bimanual surgical tasks to be performed. These instruments show large differences in construction, enabled degrees of freedom (DOF), and control aspects. METHODS Through a literature review, the absence of an in-depth analysis and structural comparison of these instruments in the literature is addressed. All the designed and prototyped multitasking platforms are identified and categorized with respect to their actively controlled DOF in their shafts and branches. Additionally, a graphical overview of patents, bench test experiments, and animal and/or human trials performed with each instrument is provided. RESULTS The large range of instruments, various actuation strategies, and different direct and indirect control methods implemented in the instruments show that an optimal instrument configuration has not been found yet. Moreover, several questions remain unanswered with respect to which DOF are essential for bimanual tasks and which control methods are best suited for the control of these DOF. CONCLUSIONS Considering the complexity of the currently prototyped and tested instruments, future NOTES and SILS instrument development will potentially necessitate a reduction of the available DOF to minimize the control complexity, thereby allowing for single surgeon bimanual task execution.
Collapse
Affiliation(s)
- Ewout A Arkenbout
- Bio-Inspired Technology Group, Biomechanical Engineering Dept., Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands,
| | | | | | | |
Collapse
|
24
|
Patel N, Seneci C, Yang GZ, Darzi A, Teare J. Flexible platforms for natural orifice transluminal and endoluminal surgery. Endosc Int Open 2014; 2:E117-23. [PMID: 26135256 PMCID: PMC4423273 DOI: 10.1055/s-0034-1377171] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The flexible endoscope is playing an increasingly pivotal role in minimally invasive transluminal and endoluminal surgery. Whilst the flexible nature of the platform is desirable in order to navigate through the abdominal cavity or through a lumen, there are a number of issues with using the platform for this purpose. The challenges associated with using flexible endoscopes such as a lack of triangulation of instruments and force transmission, which is often inadequate for endoscopic surgery are discussed in this review. As a result of these difficulties, a number of mechanically and robotically driven devices based upon the flexible endoscope are emerging. The design of these devices and potential problems are also reviewed. Finally, future robotic systems which are still in the development and validation stage are briefly discussed. The field of gastroenterology is diverging. The narrowing divide between minimally invasive and endoluminal surgery has led to a surge of innovative and novel devices which may in the future enable precise, seamless and scar less surgery.
Collapse
Affiliation(s)
- Nisha Patel
- St. Mary’s Hospital, Imperial – Gastroenterology, London, United Kingdom,Hamlyn Centre – Robotics and Engineering, London, United Kingdom,Corresponding author Nisha Patel, BSc (Hons), MBBS (Hons), MRCP St. Mary’s Hospital – GastroenterologyPraed St, Paddington, London W2 1NYUnited Kingdom0797167931307971679313
| | - Carlo Seneci
- Hamlyn Centre – Robotics and Engineering, London, United Kingdom
| | - Guang-Zhong Yang
- Hamlyn Centre – Robotics and Engineering, London, United Kingdom
| | - Ara Darzi
- St. Mary’s Hospital, Imperial – Gastroenterology, London, United Kingdom,Hamlyn Centre – Robotics and Engineering, London, United Kingdom
| | - Julian Teare
- St. Mary’s Hospital, Imperial – Gastroenterology, London, United Kingdom,Hamlyn Centre – Robotics and Engineering, London, United Kingdom
| |
Collapse
|
25
|
Abstract
Laparoscopy is an established method for the treatment of numerous surgical conditions. Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body as entrances to the abdominal cavity. An alternative concept of minimally invasive approach to the abdominal cavity is to insert all the laparoscopic instruments through ports using a single small incision on the abdominal wall. A suggested name for this technique is laparoendoscopic single-site surgery (LESS). Considering the technical difficulties in NOTES and LESS and the progress in informatics and robotics, the use of robots seems ideal. The aim of this study is to investigate if there is at present, a realistic possibility of using miniature robots in NOTES or LESS in daily clinical practice. An up-to-date review on in vivo surgical miniature robots is made. A Web-based research of the English literature up to March 2013 using PubMed, Scopus, and Google Scholar as search engines was performed. The development of in vivo miniature robots for use in NOTES or LESS is a reality with great advancements, potential advantages, and possible application in minimally invasive surgery in the future. However, true totally NOTES or LESS procedures on humans using miniature robots either solely or as assistance, remain a dream at present.
Collapse
|
26
|
Phee SJ, Sun Z, Wang Z, Wong JYY, Ho KY. The future of transluminal surgery. Expert Rev Med Devices 2014; 8:669-71. [DOI: 10.1586/erd.11.54] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
27
|
Wong JY, Ho KY. Hurdles and highlights in the development of a novel robotic platform for endoscopic surgery. GASTROINTESTINAL INTERVENTION 2013. [DOI: 10.1016/j.gii.2013.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
28
|
Zygomalas A, Giokas K, Koutsouris D. Modular Assembly Micro-Robots for Natural Orifice Transluminal Endoscopic Surgery. ROBOTICS 2013. [DOI: 10.4018/978-1-4666-4607-0.ch078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Surgical operations are progressively being performed using minimally invasive techniques. Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body in order to approach the peritoneal cavity. There are two basic types of robotics for NOTES; the external robots that stay outside the patient but act inside the abdominal cavity, and the internal robots that stay and act in the abdomen. The internal robots could only be mini-robots. The development of modular assembling reconfigurable micro-robots is a revolutionary idea for the NOTES. Modular micro-robots consist of small subunits which could be assembled and construct a functional miniature robot. These surgical micro-robots may increase the possibility for true scarless tele-surgery. Although specific applications of intrabdominal surgical micro-robots are still in an early concept stage, the field is rapidly evolving. In the future, patients may be operated by specialized micro-robotic intrabdominal surgeons.
Collapse
Affiliation(s)
- Apollon Zygomalas
- University of Patras, Greece & University Hospital of Patras, Greece
| | | | | |
Collapse
|
29
|
Feasibility of full-thickness gastric resection using master and slave transluminal endoscopic robot and closure by Overstitch: a preclinical study. Surg Endosc 2013; 28:319-24. [PMID: 23990156 DOI: 10.1007/s00464-013-3149-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/22/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastric submucosal tumors are often treated by laparoscopic wedge resection. This study aimed to examine the feasibility of gastric full-thickness resection through a totally endoscopic approach using the master and slave transluminal endoscopic robot (MASTER), and closure of the luminal defect with an endoscopic suturing device. METHODS The operation was performed in two live porcine models under general anesthesia. First, the anterior wall of the stomach was slung to the abdominal wall using a percutaneous suturing device. An imaginary 5-cm lesion was marked using a needle knife. After the initial mucosal incision was made using an IT knife, the MASTER was introduced through a long overtube. A circumferential mucosal incision was completed with the MASTER to expose the muscularis propria which was grasped and incised to the serosal layer by electrocautery applied through the hook of the MASTER. The full-thickness resection of the gastric wall was completed with retraction using the grasper and dissection using the hook. While the defect was being created, the luminal space was maintained with traction of the percutaneous sutures. The defect was closed with suture plication using an Apollo Overstitch device. RESULTS Two full-thickness gastric resections were performed in two nonsurvival porcine models (body weight = 30 and 35 kg, respectively) using the MASTER. The total procedure time was 56 min for the first model and 70 min for the second model. The luminal view was maintained during the whole procedure, and there was no damage to surrounding organs throughout the whole procedure. The gastric defects were closed successfully using Overstitch, with satisfactory gastric distension and no gas leakage afterward. CONCLUSION The current experiment demonstrated the feasibility and safety of a totally endoscopic approach for the treatment of gastric submucosal tumors: full-thickness resection with the MASTER and successful closure of the defect using Overstitch.
Collapse
|
30
|
Demura Y, Ishikawa N, Hirano Y, Inaki N, Matsunoki A, Watanabe G. Transrectal robotic natural orifice translumenal endoscopic surgery (NOTES) applied to intestinal anastomosis in a porcine intestine model. Surg Endosc 2013; 27:4693-701. [DOI: 10.1007/s00464-013-3117-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 07/17/2013] [Indexed: 12/13/2022]
|
31
|
SUN ZHENGLONG, WANG ZHENG, PHEE SOOJAY. HAPTIC MODELING OF STOMACH FOR REAL-TIME PROPERTY AND FORCE ESTIMATION. J MECH MED BIOL 2013. [DOI: 10.1142/s0219519413500218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Robotic devices are being employed in gastrointestinal endoscopy procedures for diagnostics and surgery. However, force measurement, a very important factor for control and haptic feedback, becomes very challenging due to the strict size limitation of such devices and the flexible nature of the endoscope. This paper focuses on the modeling of the interior stomach wall for tool–tissue interactions from two perspectives: (1) If the interaction force between the robotic tool and the tissue can be measured, we utilize the force information to estimate the mechanical property of the stomach wall in real-time; given the force and position information, we would derive mathematically the only system model that can guarantee identifiability under arbitrary manipulation; (2) in the worst case scenario where force measurement is not available, we propose a viscoelastic model to restore force information solely based on position and motion information available from the robot. Ex-vivo experiments were performed on porcine stomach specimens to demonstrate the performance of the proposed models. Based on these findings, generalization and implementations of the modeling in real-time applications were discussed.
Collapse
Affiliation(s)
- ZHENGLONG SUN
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, 639798, Singapore
| | - ZHENG WANG
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, 639798, Singapore
| | - SOO JAY PHEE
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, 639798, Singapore
| |
Collapse
|
32
|
Petroni G, Niccolini M, Caccavaro S, Quaglia C, Menciassi A, Schostek S, Basili G, Goletti O, Schurr MO, Dario P. A novel robotic system for single-port laparoscopic surgery: preliminary experience. Surg Endosc 2013; 27:1932-7. [DOI: 10.1007/s00464-012-2690-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 10/23/2012] [Indexed: 01/28/2023]
|
33
|
Tortora G, Salerno M, Ranzani T, Tognarelli S, Dario P, Menciassi A. A modular magnetic platform for Natural Orifice Transluminal Endoscopic Surgery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:6265-6268. [PMID: 24111172 DOI: 10.1109/embc.2013.6610985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Modern surgery is currently developing NOTES (Natural Orifice Translumenal Endoscopic Surgery) robotic approaches to enable scarless surgical procedures. Despite of the variegated devices proposed, they still have several limitations. In this work, we propose a surgical platform composed of specialized modules, in order to provide the overall system with adequate stability, dexterity and force generation. The concept behind the platform, the main modules and their performance are described to highlight the system potential to outperform current NOTES procedures.
Collapse
|
34
|
Vitiello V, Lee SL, Cundy TP, Yang GZ. Emerging robotic platforms for minimally invasive surgery. IEEE Rev Biomed Eng 2012; 6:111-26. [PMID: 23288354 DOI: 10.1109/rbme.2012.2236311] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recent technological advances in surgery have resulted in the development of a range of new techniques that have reduced patient trauma, shortened hospitalization, and improved diagnostic accuracy and therapeutic outcome. Despite the many appreciated benefits of minimally invasive surgery (MIS) compared to traditional approaches, there are still significant drawbacks associated with conventional MIS including poor instrument control and ergonomics caused by rigid instrumentation and its associated fulcrum effect. The use of robot assistance has helped to realize the full potential of MIS with improved consistency, safety and accuracy. The development of articulated, precision tools to enhance the surgeon's dexterity has evolved in parallel with advances in imaging and human-robot interaction. This has improved hand-eye coordination and manual precision down to micron scales, with the capability of navigating through complex anatomical pathways. In this review paper, clinical requirements and technical challenges related to the design of robotic platforms for flexible access surgery are discussed. Allied technical approaches and engineering challenges related to instrument design, intraoperative guidance, and intelligent human-robot interaction are reviewed. We also highlight emerging designs and research opportunities in the field by assessing the current limitations and open technical challenges for the wider clinical uptake of robotic platforms in MIS.
Collapse
|
35
|
Wang Z, Phee SJ, Wong J, Ho KY. Development of a robotic platform for natural orifice transluminal endoscopic surgery. GASTROINTESTINAL INTERVENTION 2012. [DOI: 10.1016/j.gii.2012.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
36
|
Phee SJ, Reddy N, Chiu PWY, Rebala P, Rao GV, Wang Z, Sun Z, Wong JYY, Ho KY. Robot-assisted endoscopic submucosal dissection is effective in treating patients with early-stage gastric neoplasia. Clin Gastroenterol Hepatol 2012; 10:1117-21. [PMID: 22642951 DOI: 10.1016/j.cgh.2012.05.019] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/04/2012] [Accepted: 05/10/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Endoscopic submucosal dissection (ESD) is a new technique for endoscopic resection of early-stage gastrointestinal cancers. Though ESD achieves high rate of en bloc resection, it is technically difficult to master. The development of a novel robotic endoscopic system that has 2 arms attached to an ordinary endoscope-Master and Slave Transluminal Endoscopic Robot (MASTER)-has improved the performance of complex endoluminal procedures. We evaluated the efficacy of MASTER-assisted ESD in treatment of patients with early-stage gastric neoplasia. METHODS We performed a multicenter prospective study of 5 patients with early-stage gastric neoplasia, limited to the mucosa. After markings and circumferential mucosal incision, all submucosal dissections were performed using the MASTER system. We measured baseline demographics, tumor characteristics, and perioperative and clinical outcomes. RESULTS All patients underwent successful MASTER-assisted ESD. The mean submucosal dissection time was 18.6 minutes (median, 16 minutes; range, 3-50 minutes). No perioperative complications were encountered. Three patients were discharged from the hospital within 12 hours and 2 on the third day after the procedures. Two patients were found to have intramucosal adenocarcinoma, 1 had high-grade dysplasia, 1 had low-grade dysplasia, and 1 had a hyperplastic polyp. The resection margins were clear of tumors in all 5 patients. No complications were observed at the 30-day follow-up examination. Follow-up endoscopic examinations revealed that none of the patients had residual or recurrent tumors. CONCLUSIONS A flexible endoscopy robotic system can be used to perform ESD and effectively treat patients with early gastric neoplasia.
Collapse
Affiliation(s)
- Soo Jay Phee
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Zygomalas A, Giokas K, Koutsouris D. Modular Assembly Micro-Robots for Natural Orifice Transluminal Endoscopic Surgery, the Future of Minimal Invasive Surgery. ACTA ACUST UNITED AC 2012. [DOI: 10.4018/ijrqeh.2012100104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Surgical operations are progressively being performed using minimally invasive techniques. Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body in order to approach the peritoneal cavity. There are two basic types of robotics for NOTES; the external robots that stay outside the patient but act inside the abdominal cavity, and the internal robots that stay and act in the abdomen. The internal robots could only be mini-robots. The development of modular assembling reconfigurable micro-robots is a revolutionary idea for the NOTES. Modular micro-robots consist of small subunits which could be assembled and construct a functional miniature robot. These surgical micro-robots may increase the possibility for true scarless tele-surgery. Although specific applications of intrabdominal surgical micro-robots are still in an early concept stage, the field is rapidly evolving. In the future, patients may be operated by specialized micro-robotic intrabdominal surgeons.
Collapse
Affiliation(s)
- Apollon Zygomalas
- Informatics for Life Sciences, University of Patras & Department of General Surgery, University Hospital of Patras, Patras, Greece
| | - Kostas Giokas
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, Division of Information Transmission Systems and Material Technology, National Technical University of Athens, Athens, Greece
| | - Dimitris Koutsouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, Division of Information Transmission Systems and Material Technology, National Technical University of Athens, Athens, Greece
| |
Collapse
|
38
|
Petroni G, Niccolini M, Menciassi A, Dario P, Cuschieri A. A novel intracorporeal assembling robotic system for single-port laparoscopic surgery. Surg Endosc 2012; 27:665-70. [DOI: 10.1007/s00464-012-2453-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 06/11/2012] [Indexed: 11/28/2022]
|
39
|
A technical review of flexible endoscopic multitasking platforms. Int J Surg 2012; 10:345-54. [PMID: 22641123 DOI: 10.1016/j.ijsu.2012.05.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/04/2012] [Accepted: 05/19/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Further development of advanced therapeutic endoscopic techniques and natural orifice translumenal endoscopic surgery (NOTES) requires a powerful flexible endoscopic multitasking platform. METHODS Medline search was performed to identify literature relating to flexible endoscopic multitasking platform from year 2004-2011 using keywords: Flexible endoscopic multitasking platform, NOTES, Instrumentation, Endoscopic robotic surgery, and specific names of various endoscopic multitasking platforms. Key articles from articles references were reviewed. RESULTS Flexible multitasking platforms can be classified as either mechanical or robotic. Purely mechanical systems include the dual channel endoscope (DCE) (Olympus), R-Scope (Olympus), the EndoSamurai (Olympus), the ANUBIScope (Karl-Storz), Incisionless Operating Platform (IOP) (USGI), and DDES system (Boston Scientific). Robotic systems include the MASTER system (Nanyang University, Singapore) and the Viacath (Hansen Medical). The DCE, the R-Scope, the EndoSamurai and the ANUBIScope have integrated visual function and instrument manipulation function. The IOP and DDES systems rely on the conventional flexible endoscope for visualization, and instrument manipulation is integrated through the use of a flexible, often lockable, multichannel access device. The advantage of the access device concept is that it allows optics and instrument dissociation. Due to the anatomical constrains of the pharynx, systems are designed to have a diameter of less than 20 mm. All systems are controlled by traction cable system actuated either by hand or by robotic machinery. In a flexible system, this method of actuation inevitably leads to significant hysteresis. This problem will be accentuated with a long endoscope such as that required in performing colonic procedures. Systems often require multiple operators. To date, the DCE, the R-Scope, the IOP, and the Viacath system have data published relating to their application in human. CONCLUSION Alternative forms of instrument actuation, camera control and master console ergonomics should be explored to improve instrument precision, sphere of action, size and minimize assistance required.
Collapse
|
40
|
Simorov A, Otte RS, Kopietz CM, Oleynikov D. Review of surgical robotics user interface: what is the best way to control robotic surgery? Surg Endosc 2012; 26:2117-25. [PMID: 22350236 DOI: 10.1007/s00464-012-2182-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 01/11/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND As surgical robots begin to occupy a larger place in operating rooms around the world, continued innovation is necessary to improve our outcomes. METHODS A comprehensive review of current surgical robotic user interfaces was performed to describe the modern surgical platforms, identify the benefits, and address the issues of feedback and limitations of visualization. RESULTS Most robots currently used in surgery employ a master/slave relationship, with the surgeon seated at a work-console, manipulating the master system and visualizing the operation on a video screen. Although enormous strides have been made to advance current technology to the point of clinical use, limitations still exist. A lack of haptic feedback to the surgeon and the inability of the surgeon to be stationed at the operating table are the most notable examples. The future of robotic surgery sees a marked increase in the visualization technologies used in the operating room, as well as in the robots' abilities to convey haptic feedback to the surgeon. This will allow unparalleled sensation for the surgeon and almost eliminate inadvertent tissue contact and injury. CONCLUSIONS A novel design for a user interface will allow the surgeon to have access to the patient bedside, remaining sterile throughout the procedure, employ a head-mounted three-dimensional visualization system, and allow the most intuitive master manipulation of the slave robot to date.
Collapse
Affiliation(s)
- Anton Simorov
- University of Nebraska Medical Center, Center for Advanced Surgical Technology, 985126 Nebraska Medical Center, Omaha, NE 68198-5126, USA
| | | | | | | |
Collapse
|
41
|
Minimally invasive evaluation and treatment of colorectal liver metastases. Int J Surg Oncol 2012; 2011:686030. [PMID: 22312518 PMCID: PMC3263653 DOI: 10.1155/2011/686030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 05/05/2011] [Indexed: 12/07/2022] Open
Abstract
Minimally invasive techniques used in the evaluation and treatment of colorectal liver metastases (CRLMs) include ultrasonography (US), computed tomography, magnetic resonance imaging, percutaneous and operative ablation therapy, standard laparoscopic techniques, robotic techniques, and experimental techniques of natural orifice endoscopic surgery. Laparoscopic techniques range from simple staging laparoscopy with or without laparoscopic intraoperative US, through intermediate techniques including simple liver resections (LRs), to advanced techniques such as major hepatectomies. Hereins, we review minimally invasive evaluation and treatment of CRLM, focusing on a comparison of open LR (OLR) and minimally invasive LR (MILR). Although there are no randomized trials comparing OLR and MILR, nonrandomized data suggest that MILR compares favorably with OLR regarding morbidity, mortality, LOS, and cost, although significant selection bias exists. The future of MILR will likely include expanding criteria for resectability of CRLM and should include both a patient registry and a formalized process for surgeon training and credentialing.
Collapse
|
42
|
Abstract
Laparoscopic liver resection (LHR) has shown classical advantages of minimally invasive surgery over open counterpart. In spite of introduction in early 1990's only few centres worldwide adapted LHR to routine practice. It was due to considerable technical challenges and uncertainty about oncologic outcomes. Surgical instrumentation and accumulation of surgical experience has largely enabled to solve many technical considerations. Intraoperative navigation options have also been improved. Consequently indications have been drastically expanded nearly reaching criteria equal to open liver resection in expert centres. Recent studies have verified oncologic integrity of LHR. However, mastering of LHR is still a quite demanding task limiting expansion of this patient friendly technique. This emphasizes the necessity of systematic training for laparoscopic liver surgery. This article reviews the state of the art of laparoscopic liver surgery lightening burning issues of research and clinical practice.
Collapse
Affiliation(s)
- B Edwin
- Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | | | | |
Collapse
|
43
|
Sun Z, Ang RY, Lim EW, Wang Z, Ho KY, Phee SJ. Enhancement of a Master-Slave Robotic System for Natural Orifice Transluminal Endoscopic Surgery. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n5p223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: A novel robotic platform for Natural Orifice Transluminal Endoscopic Surgery (NOTES) is presented in this paper. It aims to tackle two crucial technical barriers which hinder its smooth transition from animal studies to clinical trials: providing effective instrumentations to perform complex NOTES procedures and maintaining the spatial orientation for endoscopic navigation. Materials and Methods: The technical barriers are overcome by the design of the robotic system considering size, triangulation, dexterity, maneuverability and complexity. It is also shown that haptic feedback and interventional navigation system could solve the problem of off-axis manipulation of the camera angle and loss of spatial orientation upon entering the peritoneal cavity in transgastric NOTES procedure, respectively. Results: Successful ESD (endoscopic submucosal dissection) and wedge hepatic resection have been performed on live pigs with our Master And Slave Transluminal Endoscopic Robot (MASTER) system, showing its capability to perform advanced endoscopic surgical and NOTES procedures. It is found that the MASTER exhibited good grasping and cutting efficiency. And the lesion resection time could be significantly reduced with more practice between the endoscopist and the robot operator. Conclusion: This study evaluates the feasibility of MASTER system as a platform overcoming the barriers to NOTES. It is also demonstrated that the MASTER could effectively mitigate the technical constraints normally encountered in NOTES procedures.
Key words: Haptic feedback, Instrumentation design, Interventional Navigation System (INS), Tracking
Collapse
Affiliation(s)
| | | | - Ed Wyn Lim
- Nanyang Technological University, Singapore
| | - Zheng Wang
- Nanyang Technological University, Singapore
| | - Khek Yu Ho
- Nanyang Technological University, Singapore
| | | |
Collapse
|
44
|
Shi H, Jiang SJ, Li B, Fu DK, Xin P, Wang YG. Natural orifice transluminal endoscopic wedge hepatic resection with a water-jet hybrid knife in a non-survival porcine model. World J Gastroenterol 2011; 17:926-31. [PMID: 21412502 PMCID: PMC3051143 DOI: 10.3748/wjg.v17.i7.926] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 11/17/2010] [Accepted: 11/24/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the feasibility of a water-jet hybrid knife to facilitate wedge hepatic resection using a natural orifice transluminal endoscopic surgery (NOTES) approach in a non-survival porcine model.
METHODS: The Erbe Jet2 water-jet system allows a needleless, tissue-selective hydro-dissection with a pre-selected pressure. Using this system, wedge hepatic resection was performed through three natural routes (trans-anal, trans-vaginal and trans-umbilical) in three female pigs weighing 35 kg under general anesthesia. Entry into the peritoneal cavity was via a 15-mm incision using a hook knife. The targeted liver segment was marked by an APC probe, followed by wedge hepatic resection performed using a water-jet hybrid knife with the aid of a 4-mm transparent distance soft cap mounted onto the tip of the endoscope for holding up the desired plane. The exposed vascular and ductal structures were clipped with Endoclips. Hemostasis was applied to the bleeding cut edges of the liver parenchyma by electrocautery. After the procedure, the incision site was left open, and the animal was euthanized followed by necropsy.
RESULTS: Using the Erbe Jet2 water-jet system, trans-anal and trans-vaginal wedge hepatic resection was successfully performed in two pigs without laparoscopic assistance. Trans-umbilical attempt failed due to an unstable operating platform. The incision for peritoneal entry took 1 min, and about 2 h was spent on excision of the liver tissue. The intra-operative blood loss ranged from 100 to 250 mL. Microscopically, the hydro-dissections were relatively precise and gentle, preserving most vessels.
CONCLUSION: The Erbe Jet2 water-jet system can safely accomplish non-anatomic wedge hepatic resection in NOTES, which deserves further studies to shorten the dissection time.
Collapse
|