1
|
Takazawa S, Ishimaru T, Fujii M, Harada K, Deie K, Fujishiro J, Sugita N, Mitsuishi M, Iwanaka T. A multi-degree-of-freedom needle driver with a short tip and small shaft for pediatric laparoscopic surgery: in vivo assessment of multi-directional suturing on the vertical plane of the liver in rabbits. Surg Endosc 2015; 30:3646-53. [PMID: 26511118 DOI: 10.1007/s00464-015-4616-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Laparoscopic Kasai portoenterostomy has been performed in infants with biliary atresia at several institutions, but laparoscopic anastomosis requiring multi-directional suturing on a vertical plane of the liver remains a challenge. To assist multi-directional suturing, we developed a multi-degree-of-freedom (DOF) needle driver whose tip length was 15 mm and shaft diameter was 3.5 mm. The tip of the multi-DOF needle driver has three DOFs for grasp, flection and rotation. The aim of this study was to evaluate the performance of the multi-DOF needle driver in two kinds of in vivo experiments. METHODS Surgeons were asked to perform four-directional laparoscopic suturing on a vertical plane of the liver in six rabbits using the multi-DOF needle driver or a conventional needle driver. The needle grasping time, the needle handling time, the number of needle insertions, the number of liver lacerations, the suturing width and depth, and the area of necrotic tissues were analyzed and compared. Additionally, one surgeon was asked to perform laparoscopic hepato-jejunostomy in four rabbits to assess the feasibility of Kasai portoenterostomy using the multi-DOF needle driver. RESULTS The suturing depth using the multi-DOF needle driver was significantly larger than that using the conventional needle driver in both the right and downward suturing directions. No statistically significant differences were found in other metrics. Liver lacerations were observed only when suturing was performed using the conventional needle driver. The experimental laparoscopic hepato-jejunostomy using the multi-DOF needle driver was successful. CONCLUSIONS Using the multi-DOF needle driver, uniform multi-directional suturing on a vertical plane of the liver could be performed. The short distal tip of the multi-DOF needle driver demonstrated its advantages in multi-directional suturing in a small body cavity. The multi-DOF needle driver may be able to be used to perform complex tasks in laparoscopic Kasai portoenterostomy.
Collapse
Affiliation(s)
- Shinya Takazawa
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tetsuya Ishimaru
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Masahiro Fujii
- Department of Mechanical Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Kanako Harada
- Department of Mechanical Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Kyoichi Deie
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Naohiko Sugita
- Department of Mechanical Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Mamoru Mitsuishi
- Department of Mechanical Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Saitama Children's Medical Center, 2100 Magome, Iwatsuki-ku, Saitama, Saitama, 339-8551, Japan
| |
Collapse
|
2
|
Okubo T, Harada K, Fujii M, Tanaka S, Ishimaru T, Iwanaka T, Nakatomi H, Sora S, Morita A, Sugita N, Mitsuishi M. Hand-held multi-DOF robotic forceps for neurosurgery designed for dexterous manipulation in deep and narrow space. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:6868-71. [PMID: 25571574 DOI: 10.1109/embc.2014.6945206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neurosurgical procedures require precise and dexterous manipulation of a surgical suture in narrow and deep spaces in the brain. This is necessary for surgical tasks such as the anastomosis of microscopic blood vessels and dura mater suturing. A hand-held multi-degree of freedom (DOF) robotic forceps was developed to aid the performance of such difficult tasks. The diameter of the developed robotic forceps is 3.5 mm, and its tip has three DOFs, namely, bending, rotation, and grip. Experimental results showed that the robotic forceps had an average needle insertion force of 1.7 N. Therefore, an increase in the needle insertion force is necessary for practical application of the developed device.
Collapse
|
3
|
Pelizzo G, Nakib G, Romano P, Avolio L, Mencherini S, Zambaiti E, Raffaele A, Stoll T, Mineo N, Calcaterra V. Five millimetre-instruments in paediatric robotic surgery: Advantages and shortcomings. MINIM INVASIV THER 2014; 24:148-53. [DOI: 10.3109/13645706.2014.975135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
4
|
Assessment of suturing in the vertical plane shows the efficacy of the multi-degree-of-freedom needle driver for neonatal laparoscopy. Pediatr Surg Int 2013; 29:1177-82. [PMID: 23975019 DOI: 10.1007/s00383-013-3380-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE We have developed a thin needle driver with multiple degrees-of-freedom (DOFs) for neonatal laparoscopic surgery. The tip of this needle driver has three DOFs for grasp, deflection and rotation. Our aim was to evaluate the performance of the multi-DOF needle driver in vertical plane suturing. METHODS Six pediatric surgeons performed four directional suturing tasks in the vertical plane using the multi-DOF needle driver and a conventional one. Assessed parameters were the accuracy of insertion and exit, the depth of suture, the inclination angle of the needle and the force applied on the model. RESULTS In left and right direction sutures, the inclination angle of the needle with the multi-DOF needle driver was significantly smaller than that with the conventional one (p = 0.014, 0.042, respectively). In left and right direction sutures, the force for pulling the model with the multi-DOF needle driver was smaller than that with the conventional one (p = 0.036, 0.010, respectively). CONCLUSION This study showed that multi-directional suturing on a vertical plane using the multi-DOF needle driver had better needle trajectories and was less invasive as compared to a conventional needle driver.
Collapse
|
5
|
Ishimaru T, Takazawa S, Uchida H, Kawashima H, Fujii M, Harada K, Sugita N, Mitsuishi M, Iwanaka T. Development of a needle driver with multiple degrees of freedom for neonatal laparoscopic surgery. J Laparoendosc Adv Surg Tech A 2013; 23:644-8. [PMID: 23755855 DOI: 10.1089/lap.2013.0130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The aims of this study were to develop a thin needle driver with multiple degrees of freedom and to evaluate its efficacy in multidirectional suturing compared with a conventional needle driver. MATERIALS AND METHODS The tip (15 mm) of the novel user-friendly needle driver (3.5 mm in diameter) has three degrees of freedom for grasping, rotation, and deflection. Six pediatric surgeons performed two kinds of suturing tasks in a dry box: three stitches in continuous suturing that were perpendicular or parallel to the insertion direction of the instrument, first using the novel instrument, then using a conventional instrument, and finally using the novel instrument again. The accuracy of insertion and exit compared with the target points and the procedure time were measured. RESULTS In the conventional and novel procedures the mean gaps from the insertion point to the target in perpendicular suturing were 0.8 mm and 0.7 mm, respectively; in parallel suturing they were 0.8 mm and 0.6 mm, respectively. The mean gaps from the exit point to the target in perpendicular suturing were 0.6 mm and 0.6 mm for conventional and novel procedures, respectively; in parallel suturing they were 0.6 mm and 0.8 mm, respectively. The procedure time for perpendicular suturing was 33 seconds and 64 seconds for conventional and novel procedures, respectively (P=.02); for parallel suturing it was 114 seconds and 91 seconds, respectively. CONCLUSIONS Our novel needle driver maintained accuracy of suturing; parallel suturing with the novel driver may be easier than with the conventional one.
Collapse
Affiliation(s)
- Tetsuya Ishimaru
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|