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Abstract
Abstract
Because of the increasing use of laparoscopic surgeries, robotic technologies have been developed to overcome the challenges these surgeries impose on surgeons. This paper presents an overview of the current state of surgical robots used in laparoscopic surgeries. Four main categories were discussed: handheld laparoscopic devices, laparoscope positioning robots, master–slave teleoperated systems with dedicated consoles, and robotic training systems. A generalized control block diagram is developed to demonstrate the general control scheme for each category of surgical robots. In order to review these robotic technologies, related published works were investigated and discussed. Detailed discussions and comparison tables are presented to compare their effectiveness in laparoscopic surgeries. Each of these technologies has proved to be beneficial in laparoscopic surgeries.
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2
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Zhang W, Li H, Cui L, Li H, Zhang X, Fang S, Zhang Q. Research progress and development trend of surgical robot and surgical instrument arm. Int J Med Robot 2021; 17:e2309. [PMID: 34270175 DOI: 10.1002/rcs.2309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND In recent years, surgical robots have become an indispensable part of the medical field. Surgical robots are increasingly being used in the areas of gynaecological surgery, urological surgery, orthopaedic surgery, general surgery and so forth. In this paper, the development of surgical robots in different operations is reviewed and analysed. In the type of master-slave surgical robotic system, the robotic surgical instrument arms were located in the execution terminal of a surgical robot system, as one of the core components, and directly contact with the patient during the operation, which plays an important role in the efficiency and safety of the operation. In clinical, the arm function and design in different systems varies. Furtherly, the current research progress of robotic surgical instrument arms used in different operations is analysed and summarised. Finally, the challenge and trend are concluded. METHODS According to the classification of surgical types, the development of surgical robots for laparoscopic surgery, neurosurgery, orthopaedics and microsurgery are analysed and summarised. Then, focusing on the research of robotic surgical instrument arms, according to structure type, the research and application of straight-rod surgical instrument arm, joint surgical instrument arm and continuous surgical instrument arm are analysed respectively. RESULTS According to the discussion and summary of the characteristics of the existing surgical robots and instrument arms, it is concluded that they still have a lot of room for development in the future. Therefore, the development trends of the surgical robot and instrument arm are discussed and analysed in the five aspects of structural materials, modularisation, telemedicine, intelligence and human-machine collaboration. CONCLUSION Surgical robots have shown the development trend of miniaturisation, intelligence, autonomy and dexterity. Thereby, in the field of science and technology, the research on the next generation of minimally invasive surgical robots will usher in a peak period of development.
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Affiliation(s)
- Wu Zhang
- School of Mechanical and Electrical Engineering, Beijing Information Science and Technology University, Beijing, China
| | - Haiyuan Li
- School of Automation, Beijing University of Posts and Telecommunications, Beijing, China
| | - Linlin Cui
- School of Automation, Beijing University of Posts and Telecommunications, Beijing, China
| | - Haiyang Li
- School of Mechanical and Electrical Engineering, Beijing Information Science and Technology University, Beijing, China
| | - Xiangyan Zhang
- School of Mechanical and Electrical Engineering, Beijing Information Science and Technology University, Beijing, China
| | - Shanxiang Fang
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, Beijing, China
| | - Qinjian Zhang
- School of Mechanical and Electrical Engineering, Beijing Information Science and Technology University, Beijing, China
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3
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Wang Y, Cao Q, Zhu X, Wang P. A cable-driven distal end-effector mechanism for single-port robotic surgery. Int J Comput Assist Radiol Surg 2021; 16:301-309. [PMID: 33389605 DOI: 10.1007/s11548-020-02290-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The development of surgery is to be minimally invasive and collaborative with robot systems, which has caught increasing attention in recent years. However, the narrow access routes and confined working spaces in vivo usually make distal end-effectors of surgical systems not easy to operate. To overcome this problem, a novel cable-driven distal end-effector mechanism designed for single-port robotic surgery was proposed. METHODS A cable-driven joint structure and the corresponding methods of threading cables were proposed which can maintain the length and even the tension force of cables constant during operation. Based on the proposed joint structure, the cable-driven distal end-effector mechanism consists of a parallelogram mechanism and a snake mechanism. The parallelogram mechanism is used to enlarge its reachable workspace through establishing the triangulation of operation. The snake mechanism is used to achieve the expected pose through providing sufficient bending degrees of freedom. All of the degrees of freedom can be decoupled at the expense of a slightly more tedious process of threading cables. RESULTS The primary prototype and its miniature assembled and threaded manually performed as expected regardless of bend, translation and their combination. But the inadequate tension force of cables and assembly errors affect the load capacity and accuracy, which need to be improved by automatic assembly. CONCLUSION A cable-driven distal end-effector mechanism composed of a parallelogram mechanism, and a snake mechanism used for single-port robotic surgery was proposed. The mechanism adopts a novel cable-driven joint structure and corresponding methods of threading cables to keep the length and even the tension force of cables constant during surgery.
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Affiliation(s)
- Yizhao Wang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Qixin Cao
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.,Institute of Medical Robotics, Shanghai Jiao Tong University, shanghai, 200240, China
| | - Xiaoxiao Zhu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Pengfei Wang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
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4
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Abstract
Just as laparoscopic surgery provided a giant leap in safety and recovery for patients over open surgery methods, robotic-assisted surgery (RAS) is doing the same to laparoscopic surgery. The first laparoscopic-RAS systems to be commercialized were the Intuitive Surgical, Inc. (Sunnyvale, CA, USA) da Vinci and the Computer Motion Zeus. These systems were similar in many aspects, which led to a patent dispute between the two companies. Before the dispute was settled in court, Intuitive Surgical bought Computer Motion, and thus owned critical patents for laparoscopic-RAS. Recently, the patents held by Intuitive Surgical have begun to expire, leading to many new laparoscopic-RAS systems being developed and entering the market. In this study, we review the newly commercialized and prototype laparoscopic-RAS systems. We compare the features of the imaging and display technology, surgeons console and patient cart of the reviewed RAS systems. We also briefly discuss the future directions of laparoscopic-RAS surgery. With new laparoscopic-RAS systems now commercially available we should see RAS being adopted more widely in surgical interventions and costs of procedures using RAS to decrease in the near future.
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Feng H, Lu Y, Chen D, Ma T, Fu Y. Development on a magnetic anchoring robot system based on visual servo control for laparoendoscopic single-site surgery. Int J Med Robot 2018; 14:e1904. [PMID: 29974669 DOI: 10.1002/rcs.1904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 12/26/2017] [Accepted: 01/23/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Surgical robot systems have been used in laparoendoscopic single-site surgery (LESS) to improve patient outcomes. A magnetic anchoring surgical robot system for LESS can effectively extend the operation space. METHODS A robot system based on visual servo control for LESS is proposed. It includes a magnetic anchoring robot and a control subsystem, in which an uncalibrated visual servo control method obtains an accurate positioning capability of the robot for LESS. RESULTS The results of the simulation and the tissue experiment show that the robot system can successfully accomplish the expected control functionalities for LESS. The average positioning error of the proposed system is 1.622 mm. CONCLUSION The magnetic anchoring robot system is able to implement the autonomous positioning of its end-effector through the proposed control approach according to experimental results.
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Affiliation(s)
- Haibo Feng
- Harbin Institute of Technology, Harbin, Heilongjiang Province, China
| | - Yu Lu
- Faw-volkswagen Automative Co., Changchun, China
| | - Dong Chen
- Harbin Institute of Technology, Harbin, Heilongjiang Province, China
| | - Tengfei Ma
- Harbin Institute of Technology, Harbin, Heilongjiang Province, China
| | - Yili Fu
- Harbin Institute of Technology, Harbin, Heilongjiang Province, China
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6
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Abstract
Minimally invasive surgery is slowly taking over as the preferred operative approach for colorectal diseases. However, many of the procedures remain technically difficult. This article will give an overview of the state of minimally invasive surgery and the many advances that have been made over the last two decades. Specifically, we discuss the introduction of the robotic platform and some of its benefits and limitations. We also describe some newer techniques related to robotics.
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Affiliation(s)
- Matthew Whealon
- Department of Surgery, University of California, Irvine, Orange, California
| | - Alessio Vinci
- Department of Surgery, University of California, Irvine, Orange, California
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, Orange, California
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7
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Avgousti S, Christoforou EG, Panayides AS, Voskarides S, Novales C, Nouaille L, Pattichis CS, Vieyres P. Medical telerobotic systems: current status and future trends. Biomed Eng Online 2016; 15:96. [PMID: 27520552 PMCID: PMC4983067 DOI: 10.1186/s12938-016-0217-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/02/2016] [Indexed: 01/27/2023] Open
Abstract
Teleoperated medical robotic systems allow procedures such as surgeries, treatments, and diagnoses to be conducted across short or long distances while utilizing wired and/or wireless communication networks. This study presents a systematic review of the relevant literature between the years 2004 and 2015, focusing on medical teleoperated robotic systems which have witnessed tremendous growth over the examined period. A thorough insight of telerobotics systems discussing design concepts, enabling technologies (namely robotic manipulation, telecommunications, and vision systems), and potential applications in clinical practice is provided, while existing limitations and future trends are also highlighted. A representative paradigm of the short-distance case is the da Vinci Surgical System which is described in order to highlight relevant issues. The long-distance telerobotics concept is exemplified through a case study on diagnostic ultrasound scanning. Moreover, the present review provides a classification into short- and long-distance telerobotic systems, depending on the distance from which they are operated. Telerobotic systems are further categorized with respect to their application field. For the reviewed systems are also examined their engineering characteristics and the employed robotics technology. The current status of the field, its significance, the potential, as well as the challenges that lie ahead are thoroughly discussed.
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Affiliation(s)
- Sotiris Avgousti
- Nursing Department, School of Health and Science, Cyprus University of Technology, 30 Archbishop Kyprianou Street, 3036 Limassol, Cyprus
| | - Eftychios G. Christoforou
- Department of Electrical and Computer Engineering, University of Cyprus, 75 Kalipoleos Street, P.O.BOX 20537, 1678 Nicosia, Cyprus
| | - Andreas S. Panayides
- Department of Electrical and Electronic Engineering, Imperial College, South Kensington Campus, London, SW7 2AZ UK
- Department of Computer Science, University of Cyprus, 75 Kalipoleos Street, P.O.BOX 20537, 1678 Nicosia, Cyprus
| | - Sotos Voskarides
- Department of Electrical Engineering, Computer Engineering and Informatics, Cyprus University of Technology, 30 Archbishop Kyprianou Street, 3036 Lemesos, Cyprus
| | - Cyril Novales
- Laboratoire PRISME-Universite d’Orleans, 63 Avenue de Lattre de Tassigny, 18020 Bourges, France
| | - Laurence Nouaille
- Laboratoire PRISME-Universite d’Orleans, 63 Avenue de Lattre de Tassigny, 18020 Bourges, France
| | - Constantinos S. Pattichis
- Department of Computer Science, University of Cyprus, 75 Kalipoleos Street, P.O.BOX 20537, 1678 Nicosia, Cyprus
| | - Pierre Vieyres
- Laboratoire PRISME-Universite d’Orleans, 63 Avenue de Lattre de Tassigny, 18020 Bourges, France
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9
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Abstract
In the past 10 years, laparoscopy has been challenged by robotic surgery; nevertheless, laparoscopic techniques are subject to continuous change. Ultrahigh definition is the next development in video technology, it delivers fourfold more detail than full high definition resulting in improved fine detail, increased texture, and an almost photographic emulsion of smoothness of the image. New 4K ultrahigh-definition technology might remove the current need for the use of polarized glasses. New devices for laparoscopy include advanced sealing devices, instruments with six degrees of freedom, ergonomic platforms with armrests and a chest support, and camera holders. A manually manipulated robot-like device is still at the experimental stage. Robot-assisted surgery has substantially revolutionized laparoscopy, increasing its distribution; however, robot-assisted surgery is associated with considerable costs. All technical improvements of laparoscopic surgery are extremely valuable to further simplify the use of classical laparoscopy.
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10
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Inaki N, Tsuji T, Doden K, Sakimura Y, Tawara H, Matsui R, Yamamoto D, Kitamura H, Bando H, Yamada T. Reduced port laparoscopic gastrectomy for gastric cancer. Transl Gastroenterol Hepatol 2016; 1:38. [PMID: 28138605 DOI: 10.21037/tgh.2016.04.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/11/2016] [Indexed: 12/20/2022] Open
Abstract
The use of reduced port laparoscopic surgery (RPS) has become increasingly popular. The concept of RPS includes all procedures derived from various efforts minimizing the invasiveness of surgery, with single-incision laparoscopic surgery (SILS) being the ultimate reduced port technique. Reduced-port laparoscopic gastrectomy (RPLG) for gastric cancer has not yet been fully established and still has issues such as feasibility, oncological validity, training, and education. The short-term results of reported studies are acceptable. However, long-term results that verify positive results or radical cure even in cases of cancer have not yet been published. Patients for whom RPLG is indicated should be selected carefully. Prospective multicenter studies should be conducted to establish RPS as a truly evidence-based practice that addresses not only cosmesis but also the appropriate balance between minimal invasiveness and radical cure.
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Affiliation(s)
- Noriyuki Inaki
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Toshikatsu Tsuji
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kenta Doden
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Yusuke Sakimura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroki Tawara
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Ryota Matsui
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Daisuke Yamamoto
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Tetsuji Yamada
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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11
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Morelli L, Guadagni S, Di Franco G, Palmeri M, Di Candio G, Mosca F. Da Vinci single site© surgical platform in clinical practice: a systematic review. Int J Med Robot 2015; 12:724-734. [PMID: 26525827 DOI: 10.1002/rcs.1713] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/18/2015] [Accepted: 10/05/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Da Vinci single-site© surgical platform (DVSSP) is a set of single-site instruments and accessories specifically dedicated to robot-assisted single-site surgery. METHODS The PubMed database from inception to June 2015 was searched for English literature on the clinical use of DVSSP in general surgery, urology and gynecology. RESULTS Twenty-nine articles involving the clinical application of DVSSP were identified; 15 articles on general surgery (561 procedures), four articles on urology (48 procedures) and 10 articles on gynecology (212 procedures). All studies have proven the safety and feasibility of the use of DVSSP. The principal reported advantage is the restoration of intra-abdominal triangulation, while the main reported limitation is the lack of the endowrist. CONCLUSIONS Da Vinci systems have proven to be valuable assets in single-site surgery, owing to the combination of robot use with the dedicated single-incision platform. However, case-control or prospective trials are warranted to draw more definitive conc lusions. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Luca Morelli
- General Surgery Department of Oncology, Transplantation and New Technologies, University of Pisa, Pisa, Italy.,EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Simone Guadagni
- General Surgery Department of Oncology, Transplantation and New Technologies, University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- General Surgery Department of Oncology, Transplantation and New Technologies, University of Pisa, Pisa, Italy
| | - Matteo Palmeri
- General Surgery Department of Oncology, Transplantation and New Technologies, University of Pisa, Pisa, Italy
| | - Giulio Di Candio
- General Surgery Department of Oncology, Transplantation and New Technologies, University of Pisa, Pisa, Italy
| | - Franco Mosca
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
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12
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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.
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13
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Inaki N. Reduced port laparoscopic gastrectomy: a review, techniques, and perspective. Asian J Endosc Surg 2015; 8:1-10. [PMID: 25496345 DOI: 10.1111/ases.12163] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/20/2014] [Accepted: 11/09/2014] [Indexed: 12/17/2022]
Abstract
Reduced port laparoscopic surgery has been used increasingly. It is a concept that has grown out of the various efforts aimed at minimally invasive surgery, with SILS being the ultimate reduced port technique. Reduced port laparoscopic surgery has been used to perform sleeve gastrectomy in bariatric surgery and excision of benign gastric submucosal tumor, applications that generally do not require lymph node dissection or complicated reconstruction. It can be done safely, result in a permanent cure, and offer good cosmetic outcomes. Reduced port laparoscopic surgery for gastric cancer has a short history, and its usefulness has not yet been fully established. This review describes the present situation and challenges faced as well as standardized procedures and the future prospects of reduced port laparoscopic gastrectomy for gastric cancer, which my team performs almost daily. These aspects of reduced port laparoscopic surgery are presented in light of the literature.
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Affiliation(s)
- Noriyuki Inaki
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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14
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In silico investigation of a surgical interface for remote control of modular miniature robots in minimally invasive surgery. Minim Invasive Surg 2014; 2014:307641. [PMID: 25295187 PMCID: PMC4175786 DOI: 10.1155/2014/307641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/03/2014] [Indexed: 11/20/2022] Open
Abstract
Aim. Modular mini-robots can be used in novel minimally invasive surgery techniques like natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single site (LESS) surgery. The control of these miniature assistants is complicated. The aim of this study is the in silico investigation of a remote controlling interface for modular miniature robots which can be used in minimally invasive surgery. Methods. The conceptual controlling system was developed, programmed, and simulated using professional robotics simulation software. Three different modes of control were programmed. The remote controlling surgical interface was virtually designed as a high scale representation of the respective modular mini-robot, therefore a modular controlling system itself. Results. With the proposed modular controlling system the user could easily identify the conformation of the modular mini-robot and adequately modify it as needed. The arrangement of each module was always known. The in silico investigation gave useful information regarding the controlling mode, the adequate speed of rearrangements, and the number of modules needed for efficient working tasks. Conclusions. The proposed conceptual model may promote the research and development of more sophisticated modular controlling systems. Modular surgical interfaces may improve the handling and the dexterity of modular miniature robots during minimally invasive procedures.
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15
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Affiliation(s)
- Abolfazl Pourghodrat
- Department of Mechanical and Materials Engineering, University of Nebraska–Lincoln, Lincoln, NE 68508
| | - Carl A. Nelson
- Department of Mechanical and Materials Engineering, University of Nebraska–Lincoln, Lincoln, NE 68508
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16
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Komninos C, Tuliao P, Rha KH. Current status of robotic laparoendoscopic single-site partial nephrectomy. Int J Urol 2014; 21:954-9. [PMID: 25047133 DOI: 10.1111/iju.12558] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/10/2014] [Indexed: 12/23/2022]
Abstract
Robotic laparoendoscopic single-site partial nephrectomy is increasingly carried out in an attempt to improve the cosmetic outcome of minimally-invasive procedures. However, the actual role of this novel technique remains to be determined. The present article reviews evidence and examines updates of robotic laparoendoscopic single-site partial nephrectomy outcomes reported in more contemporary studies. A comprehensive online systematic search of PubMed, Scopus and Web of Science databases according to Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria recommendations was carried out in January 2014, identifying data from 2008 to 2014 regarding robotic laparoendoscopic single-site partial nephrectomy. The majority of medical evidence to date is based on case reports or retrospective studies. Current studies show that robotic laparoendoscopic single-site partial nephrectomy is a feasible procedure carried out in an acceptable length of operative time, and resulting in a desirable cosmetic outcome and less postoperative pain. However, comparable studies show that robotic laparoendoscopic single-site partial nephrectomy is inferior to the conventional approach, especially with regard to warm ischemia time. Furthermore, the numerous limitations that exist with the utilization of the current commercial single-site devices make robotic laparoendoscopic single-site PN more challenging and more complicated for surgeons compared with conventional procedures. Further significant improvements, along with more studies, are required in order to develop the ideal robotic laparoendoscopic single-site robotic platform and overcome the current limitations. For the time being, robotic laparoendoscopic single-site partial nephrectomy procedures could be applicable in patients with low tumor size and complexity, and should not be routinely applied in all cases.
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Affiliation(s)
- Christos Komninos
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea; Department of Urology, General Hospital of Nikaia "St. Panteleimon", Athens, Greece
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17
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Kobayashi Y, Sekiguchi Y, Noguchi T, Takahashi Y, Liu Q, Oguri S, Toyoda K, Uemura M, Ieiri S, Tomikawa M, Ohdaira T, Hashizume M, Fujie MG. Development of a robotic system with six-degrees-of-freedom robotic tool manipulators for single-port surgery. Int J Med Robot 2014; 11:235-46. [PMID: 24965141 DOI: 10.1002/rcs.1600] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 04/30/2014] [Accepted: 05/09/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Current robotic systems have limitations for single-port surgery (SPS) because the instruments are large, the arms collide and the field of vision requires manual readjustment. We have developed an SPS robotic system that manipulates the vision field. METHODS The master-slave system included a six degrees of freedom (DOFs) tool manipulator, an easy set-up mechanism, a flexible shaft drive with sufficient DOFs and a vertical arrangement for improved vision. The robot manipulates an endoscope within the body. After assembly, the system was tested in vitro and in vivo. RESULTS In vitro testing showed that the tool manipulators resected tissue precisely, with the range of motion required. In vivo testing indicated that an abdominal organ is accurately approached and diseased tissue removed by combined endoscopy and robotics. CONCLUSIONS Our robotics allowed the operator to adjust the vision field intuitively. The tool manipulator approached and resected diseased tissue precisely.
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Affiliation(s)
- Yo Kobayashi
- Faculty of Science and Engineering, Research Institute of Science and Engineering, Waseda University, Japan
| | - Yuta Sekiguchi
- Faculty of Science and Engineering, Research Institute of Science and Engineering, Waseda University, Japan
| | - Takehiko Noguchi
- Faculty of Science and Engineering, Research Institute of Science and Engineering, Waseda University, Japan
| | - Yu Takahashi
- Faculty of Science and Engineering, Research Institute of Science and Engineering, Waseda University, Japan
| | - Quanquan Liu
- Faculty of Science and Engineering, Research Institute of Science and Engineering, Waseda University, Japan
| | - Susumu Oguri
- Faculty of Science and Engineering, Research Institute of Science and Engineering, Waseda University, Japan
| | - Kazutaka Toyoda
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | - Munenori Uemura
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | - Satoshi Ieiri
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | - Morimasa Tomikawa
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | - Takeshi Ohdaira
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | - Makoto Hashizume
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | - Masaktsu G Fujie
- Faculty of Science and Engineering, Research Institute of Science and Engineering, Waseda University, Japan
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18
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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.
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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
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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.
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