Study of Individual Characteristic Abdominal Wall Thickness Based on Magnetic Anchored Surgical Instruments

Magnetic anchor technique in laparoscopic cholecystectomy: a single-center, prospective, randomized controlled trial

BACKGROUND

There have been no prospective randomized controlled clinical trials evaluating the advantages of the magnetic anchor technique (MAT) used in reduced-port laparoscopic cholecystectomy (LC). The present study evaluated a novel magnetic anchor device designed by the authors.

METHODS

Between April 2019 and June 2020, 60 patients with gallbladder diseases participated in a single-center, prospective, randomized controlled clinical trial. The patients were randomly apportioned to undergo either 2-port LC assisted by the novel MAT (MAT-2P-LC, experimental group) or conventional 3-port LC (3P-LC, control). The groups were compared regarding operative time, postoperative complications, surgical incision pain score (Wong-Baker), and other indicators. The patients were followed for 2 years.

RESULTS

The test and control groups were comparable in age, gender, body mass index, and primary disease. No patient in the MAT-2P-LC group was converted to 3P-LC. No patients were converted to laparotomy. On the first postoperative day, the Wong-Baker pain score of the experimental group (1.60 ± 0.67) was significantly lower than that of the control (2.20 ± 0.76; P = 0.002). The groups were statistically similar regarding intraoperative blood loss; operative time; time to leave bed; hospital stay; postoperative pain scores at 1 and 4 weeks; and complications.

CONCLUSIONS

This rigorous clinical trial shows that the novel MAT used to assist reduced-port LC significantly reduced postoperative pain, but has no obvious advantages in other terms. Clinical Trails.gov. number, ChiCTR1800019464.

s-CAM: An Untethered Insertable Laparoscopic Surgical Camera Robot with Non-Contact Actuation

Fully insertable robotic imaging devices represent a promising future of minimally invasive laparoscopic vision. Emerging research efforts in this field have resulted in several proof-of-concept prototypes. One common drawback of these designs derives from their clumsy tethering wires which not only cause operational interference but also reduce camera mobility. In this paper, a tetherless insertable surgical camera (s-CAM) robot with non-contact transabdominal actuation is presented for single-incision laparoscopic vision. Wireless video transmission and control communication using onboard power help eliminate cumbersome tethering wires. Furthermore, magnetic based camera actuation gets rid of intrinsic physical constraints of mechanical driving mechanisms, thereby improving camera mobility and reducing operational interference. In addition, a custom Bluetooth low energy (BLE) application profile and a real-time operating system (RTOS) based multitask programming framework are also proposed to facilitate embedded software design for insertable medical devices. Initial ex vivo test results of the s-CAM design have demonstrated technical feasibility of a tetherless insertable laparoscopic camera. Effective imaging is confirmed at as low as 500 lx illumination. Wireless laparoscopic vision is accessible within a distance of more than 10 m. Transabdominal BLE communication is stable at over −52 dBm and shows its potential for wireless control of insertable medical devices. RTOS based sfotware event response is bounded within 1 ms while the CPU usage is at 3∼5%. The device is able to work for 50 min with its onboard power. For the mobility, the robot can translate against the interior abdominal wall to reach full abdomen quadrants, tilt between −180∘ and +180∘, and pan in the range of 0∘∼360∘. The s-CAM has brought robotic laparoscopic imaging one step further toward less invasiveness and more dexterity.

Deployable Tubular Mechanisms Integrated with Magnetic Anchoring and Guidance System

Deployable mechanism has received more attention in the medical field due to its simple structure, dexterity, and flexibility. Meanwhile, the advantages of the Magnetic Anchoring and Guidance System (MAGS) are further highlighted by the fact that the operators can remotely control the corresponding active and passive magnetic parts in vivo. Additionally, MAGS allows the untethered manipulation of intracorporeal devices. However, the conventional instruments in MAGS are normally rigid, compact, and less flexible. Therefore, to solve this problem, four novel deployable tubular mechanisms, Design 1 (Omega-shape mechanism), Design 2 (Fulcrum-shape mechanism), Design 3 (Archway-shape mechanism), and Design 4 (Scissor-shape mechanism) in this paper, are proposed integrated with MAGS to realize the laser steering capability. Firstly, this paper introduces the motion mechanism of the four designs and analyzes the motion characterization of each structure through simulation studies. Further, the prototypes of four designs are fabricated using tubular structures with embedded magnets. The actuation success rate, the workspace characterization, the force generation and the load capability of four mechanisms are tested and analyzed based on experiments. Then, the demonstration of direct laser steering via macro setup shows that the four mechanisms can realize the laser steering capability within the error of 0.6 cm. Finally, the feasibility of indirect laser steering via a macro-mini setup is proven. Therefore, such exploration demonstrates that the application of the deployable tubular mechanisms integrated with MAGS towards in vivo treatment is promising.

Physical Bases, Indications, and Results of the Use of Magnets in Digestive Surgery: A Narrative Review

Background: The use of magnetic devices in digestive surgery has been a matter of debate in recent years. The aim of this review was to describe the physical bases, indications, and results of the use of magnets in digestive surgery. Methods: A review of the literature was performed using Scopus, PubMed, ScienceDirect, and SciELO databases considering as inclusion criteria all articles published since 2007 to date, describing the physical basis of magnetic assisted surgery and those that describe the surgical procedure, including case reports, as well as, articles on humans and experimental animals. Results: Sixty-four studies were included, 15 detailing aspects on the physical basis and 49 about indications and results. Magnets are currently used to perform fixed traction, mobilizing structures, and anastomosis in humans and experimental animals. Conclusions: The use of magnets in digestive surgery has shown good results, and no complications arising from their use have been reported. However, more prospective and randomized studies that compare magnetic surgery and conventional techniques are needed.

Development of an in vivo visual robot system with a magnetic anchoring mechanism and a lens cleaning mechanism for laparoendoscopic single-site surgery (LESS)

BACKGROUND

Surgical robot systems which can significantly improve surgical procedures have been widely used in laparoendoscopic single-site surgery (LESS). For a relative complex surgical procedure, the development of an in vivo visual robot system for LESS can effectively improve the visualization for surgical robot systems.

METHODS

In this work, an in vivo visual robot system with a new mechanism for LESS was investigated. A finite element method (FEM) analysis was carried out to ensure the safety of the in vivo visual robot during the movement, which was the most important concern for surgical purposes. A master-slave control strategy was adopted, in which the control model was established by off-line experiments.

RESULTS

The in vivo visual robot system was verified by using a phantom box. The experiment results show that the robot system can successfully realize the expected functionalities and meet the demands of LESS.

CONCLUSION

The experiment results indicate that the in vivo visual robot with high manipulability has great potential in clinical application.