Stereo image-based arm tracking for in vivo surgical robotics.

Motor-based tracking and image-based tracking are considered for three-dimensional in vivo tracking of the arms of a surgical robot during minimally invasive surgery. Accurate tracking is necessary for tele-medical applications and for the future automation of surgical procedures. An experiment is performed to compare the accuracy of the two methods, and results show that the positioning error of image-based tracking is significantly less than that of motor-based tracking.

Semi-autonomous surgical tasks using a miniature in vivo surgical robot.

Natural Orifice Translumenal Endoscopic Surgery (NOTES) is potentially the next step in minimally invasive surgery. This type of procedure could reduce patient trauma through eliminating external incisions, but poses many surgical challenges that are not sufficiently overcome with current flexible endoscopy tools. A robotic platform that attempts to emulate a laparoscopic interface for performing NOTES procedures is being developed to address these challenges. These robots are capable of entering the peritoneal cavity through the upper gastrointestinal tract, and once inserted are not constrained by incisions, allowing for visualization and manipulations throughout the cavity. In addition to using these miniature in vivo robots for NOTES procedures, these devices can also be used to perform semi-autonomous surgical tasks. Such tasks could be useful in situations where the patient is in a location far from a trained surgeon. A surgeon at a remote location could control the robot even if the communication link between surgeon and patient has low bandwidth or very high latency. This paper details work towards using the miniature robot to perform simple surgical tasks autonomously.

Video. Natural Orifice Translumenal Endoscopic Surgery with a miniature in vivo surgical robot.

BACKGROUND: The application of flexible endoscopy tools for Natural Orifice Translumenal Endoscopic Surgery (NOTES) is constrained due to limitations in dexterity, instrument insertion, navigation, visualization, and retraction. Miniature endolumenal robots can mitigate these constraints by providing a stable platform for visualization and dexterous manipulation. This video demonstrates the feasibility of using an endolumenal miniature robot to improve vision and to apply off-axis forces for task assistance in NOTES procedures. METHODS: A two-armed miniature in vivo robot has been developed for NOTES. The robot is remotely controlled, has on-board cameras for guidance, and grasper and cautery end effectors for manipulation. Two basic configurations of the robot allow for flexibility during insertion and rigidity for visualization and tissue manipulation. Embedded magnets in the body of the robot and in an exterior surgical console are used for attaching the robot to the interior abdominal wall. This enables the surgeon to arbitrarily position the robot throughout a procedure. RESULTS: The visualization and task assistance capabilities of the miniature robot were demonstrated in a nonsurvivable NOTES procedure in a porcine model. An endoscope was used to create a transgastric incision and advance an overtube into the peritoneal cavity. The robot was then inserted through the overtube and into the peritoneal cavity using an endoscope. The surgeon successfully used the robot to explore the peritoneum and perform small-bowel dissection. CONCLUSION: This study has demonstrated the feasibility of inserting an endolumenal robot per os. Once deployed, the robot provided visualization and dexterous capabilities from multiple orientations. Further miniaturization and increased dexterity will enhance future capabilities.

Natural orifice cholecystectomy using a miniature robot.

BACKGROUND: Natural orifice translumenal endoscopic surgery (NOTES) is surgically challenging. Current endoscopic tools provide an insufficient platform for visualization and manipulation of the surgical target. This study demonstrates the feasibility of using a miniature in vivo robot to enhance visualization and provide off-axis dexterous manipulation capabilities for NOTES. METHODS: The authors developed a dexterous, miniature robot with six degrees of freedom capable of applying significant force throughout its workspace. The robot, introduced through the esophagus, completely enters the peritoneal cavity through a transgastric insertion. The robot design consists of a central "body" and two "arms" fitted respectively with cautery and forceps end-effectors. The arms of the robot unfold, allowing the robot to flex freely for entry through the esophagus. Once in the peritoneal cavity, the arms refold, and the robot is attached to the abdominal wall using the interaction of magnets housed in the robot body with magnets in an external magnetic handle. Video feedback from the on-board cameras is provided to the surgeon throughout a procedure. RESULTS: The efficacy of this robot was demonstrated in three nonsurvivable procedures in a porcine model, namely, abdominal exploration, bowel manipulation, and cholecystectomy. After insertion, the robot was attached to the interior abdominal wall. The robot was repositioned throughout the procedure to provide optimal orientations for visualization and tissue manipulation. The surgeon remotely controlled the actuation of the robot using an external console to assist in the procedures. CONCLUSION: This study has shown that a dexterous miniature in vivo robot can apply significant forces in arbitrary directions and improve visualization to overcome many of the limitations of current endoscopic tools for performing NOTES procedures.

Microrobot assisted laparoscopic urological surgery in a canine model.

PURPOSE: Robotic technologies have had a significant impact on surgery. We report what is to our knowledge the first use of microrobots to perform laparoscopic urological surgery in a canine model. MATERIALS AND METHODS: Nonsurvival laparoscopic radical prostatectomy and radical nephrectomy were performed using microrobotic camera assistance. Following the administration of general anesthesia miniature camera robots were inserted in the insufflated abdomen via a 15 mm laparoscopic port. These microrobots were mobile, controlled remotely to desired locations and provided views of the abdominal cavity, assisting the laparoscopic procedures. Additional ports and laparoscopic instruments were placed in the abdomen using the views provided by these microrobots. RESULTS: One dog underwent laparoscopic prostatectomy and another underwent laparoscopic nephrectomy. The 2 procedures were completed successfully. Microrobots provided additional views from several angles, aiding in the performance of the procedures. CONCLUSIONS: Miniature camera robots (microrobots) provide a mobile viewing platform. With added functionality these new robots have the potential to further evolve the robotic armamentarium for surgeons.

Towards an in vivo wireless mobile robot for surgical assistance.

The use of miniature in vivo robots that fit entirely inside the peritoneal cavity represents a novel approach to laparoscopic surgery. Previous work has demonstrated that mobile and fixed-base in vivo robots can be used to improve visualization of the surgical field and perform surgical tasks such as collecting biopsy tissue samples. All of these robots used tethers to provide for power and data transmission. This paper describes recent work focused on developing a modular wireless mobile platform that could be used for in vivo robotic sensing and manipulation applications. One vision for these types of self-contained in vivo robotic devices is that they could be easily carried and deployed by non-medical personnel at the site of an injury. Such wireless in vivo robots are much more transportable and lower cost than current robotic surgical assistants, and could ultimately allow a surgeon to become a remote first responder irrespective of the location of the patient.

In vivo robotics for natural orifice transgastric peritoneoscopy.

Natural Orifice Translumenal Endoscopic Surgery (NOTES) is potentially the next paradigm shift in minimally invasive surgery. Currently, NOTES procedures are performed using modified endoscopic tools with significant constraints. New tools are necessary that allow the surgeon to better visualize and dexterously manipulate within the surgical environment. In this study, a two-armed dexterous miniature in vivo robot with stereoscopic vision capabilities has been developed that addresses many of these constraints. The design and kinematic configuration of the robot allows for its complete insertion into the peritoneal cavity, and provides intuitive visualization and sufficient force application for tissue manipulation within the dexterous workspace. The NOTES robot successfully demonstrated various capabilities in a non-survival natural orifice surgical procedure in a porcine model suggesting the feasibility of using miniature in vivo robots for performing natural orifice procedures within the peritoneal cavity.

Surgery with cooperative robots.

Advances in endoscopic techniques for abdominal procedures continue to reduce the invasiveness of surgery. Gaining access to the peritoneal cavity through small incisions prompted the first significant shift in general surgery. The complete elimination of external incisions through natural orifice access is potentially the next step in reducing patient trauma. While minimally invasive techniques offer significant patient advantages, the procedures are surgically challenging. Robotic surgical systems are being developed that address the visualization and manipulation limitations, but many of these systems remain constrained by the entry incisions. Alternatively, miniature in vivo robots are being developed that are completely inserted into the peritoneal cavity for laparoscopic and natural orifice procedures. These robots can provide vision and task assistance without the constraints of the entry incision, and can reduce the number of incisions required for laparoscopic procedures. In this study, a series of minimally invasive animal-model surgeries were performed using multiple miniature in vivo robots in cooperation with existing laparoscopy and endoscopy tools as well as the da Vinci Surgical System. These procedures demonstrate that miniature in vivo robots can address the visualization constraints of minimally invasive surgery by providing video feedback and task assistance from arbitrary orientations within the peritoneal cavity.

Natural orifice surgery with an endoluminal mobile robot.

Natural orifice transgastric endoscopic surgery promises to eliminate skin incisions and reduce postoperative pain and discomfort. Such an approach provides a distinct benefit as compared with conventional laparoscopy, in which multiple entry incisions are required for tools and camera. Endoscopy currently is the only method for performing procedures through the gastrointestinal tract. However, this approach is limited by instrumentation and the need to pass the entire scope into the patient. In contrast, an untethered miniature robot inserted through the mouth would be able to enter the abdominal cavity through a gastrotomy for exploration of the entire peritoneal cavity. In this study, the authors developed an endoluminal robot capable of transgastric abdominal exploration under esophagogastroduodenoscopic (EGD) control. Under EGD control, a gastrotomy was created, and the miniature robot was deployed into the abdominal cavity under remote control. Ultimately, future procedures will include a family of robots working together inside the gastric and abdominal cavities after their insertion through the esophagus. Such technology will help to reduce patient trauma while providing surgical flexibility.

Mobile in vivo biopsy and camera robot.

A mobile in vivo biopsy robot has been developed to perform a biopsy from within the abdominal cavity while being remotely controlled. This robot provides a platform for effectively sampling tissue. The robot has been used in vivo in a porcine model to biopsy portions of the liver and mucosa layer of the bowel. After reaching the specified location, the grasper was actuated to biopsy the tissue of interest. The biopsy specimens were gathered from the grasper after robot retraction from the abdominal cavity. This paper outlines the steps towards the successful design of an in vivo biopsy robot. The clamping forces required for successful biopsy are presented and in vivo performance of this robot is addressed.

In vivo laparoscopic robotics.

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

In vivo robotic laparoscopy.

Laparoscopy reduces patient trauma but limits the surgeon's ability to view or touch the surgical environment directly. The surgeon's ability to visualize and manipulate target organs can be improved using currently available external robotic systems. However, tool tip orientation and optimal camera placement remain limited because the robot instruments and cameras are still constrained by the entry incisions. Placing a robot completely within the abdominal cavity would provide an unconstrained platform that could provide an enhanced field of view from arbitrary angles and dexterous manipulators not constrained by the abdominal wall fulcrum effect. Several in vivo robots have been developed and successfully tested in a porcine model. These in vivo robots have been used to observe trocar and tool insertions and placement, and to provide additional camera angles that improved surgical visualization. Equipped with a grasper, such robots will provide task assistance. These in vivo robots will be much less expensive than the current generation of large external robotic surgical systems and will ultimately allow a surgeon to be a remote first responder irrespective of the location of the patient.

Toward in vivo mobility.

Today's laparoscopic tools impose severe ergonomic limitations and are constrained to only four degrees of freedom. These constraints limit the surgeon's ability to orient the tool tips arbitrarily, and can contribute to a variety of complications. Robots external to the patient have been used to aid in the manipulation of the tools and improve dexterity. However, these robots are expensive, bulky, and are used for only select procedures. In vivo robotic assistants have the potential to enhance the capabilities of the surgeon, reduce costs, and reduce patient trauma. The motion of these in vivo robots will not be constrained by the insertion incisions. Such assistants will need to attain optimal viewing angles by traversing the abdominal organs without causing trauma. This paper presents an experimental analysis of miniature in vivo robot wheels.

In vivo robots for laparoscopic surgery.

Laparoscopic techniques have allowed surgeons to perform operations through small incisions. However, the benefits of laparoscopy are still limited to less complex procedures because of losses in imaging and dexterity compared to conventional surgery. This project is developing miniature robots to be placed within the abdominal cavity to assist the surgeon. These remotely controlled in vivo robots provide the surgeon with an enhanced field of view from arbitrary angles as well as provide dexterous manipulators not constrained by small incisions in the abdominal wall.