Miniature surgical robot for laparoendoscopic single-incision colectomy.

BACKGROUND: This study aimed to demonstrate the effectiveness of using a multifunctional miniature in vivo robotic platform to perform a single-incision colectomy. Standard laparoscopic techniques require multiple ports. A miniature robotic platform to be inserted completely into the peritoneal cavity through a single incision has been designed and built. The robot can be quickly repositioned, thus enabling multiquadrant access to the abdominal cavity. METHODS: The miniature in vivo robotic platform used in this study consists of a multifunctional robot and a remote surgeon interface. The robot is composed of two arms with shoulder and elbow joints. Each forearm is equipped with specialized interchangeable end effectors (i.e., graspers and monopolar electrocautery). RESULTS: Five robotic colectomies were performed in a porcine model. For each procedure, the robot was completely inserted into the peritoneal cavity, and the surgeon manipulated the user interface to control the robot to perform the colectomy. The robot mobilized the colon from its lateral retroperitoneal attachments and assisted in the placement of a standard stapler to transect the sigmoid colon. This objective was completed for all five colectomies without any complications. CONCLUSIONS: The adoption of both laparoscopic and single-incision colectomies currently is constrained by the inadequacies of existing instruments. The described multifunctional robot provides a platform that overcomes existing limitations by operating completely within one incision in the peritoneal cavity and by improving visualization and dexterity. By repositioning the small robot to the area of the colon to be mobilized, the ability of the surgeon to perform complex surgical tasks is improved. Furthermore, the success of the robot in performing a completely in vivo colectomy suggests the feasibility of using this robotic platform to perform other complex surgeries through a single incision.

Miniature in vivo cameras for use in single-incision robotic surgery - biomed 2011.

Single-incision surgery provides numerous benefits over traditional open and laparoscopic surgery techniques including reduced pain, shortened recovery times, and minimal tissue scarring. The use of miniature in vivo robots inserted through a single incision offers additional advantages over conventional laparoscopy in improved maneuverability and dexterity. One consequence of performing surgical procedures through a small single incision is the loss of direct visualization through a large open incision or visualization via laparoscopic cameras inserted through additional ports. For this reason, a miniature in vivo actuated camera was designed to pass through a single incision and attach to a miniature in vivo robot, providing live video feedback at the control of the surgeon. The device was tested in a lab setting and porcine model surgery and demonstrated successful movement, control, and high-quality visualization, indicating the device’s functionality and feasibility for use in single-incision robotic surgery.

Laparoendoscopic single-site surgery using a multi-functional miniature in vivo robot.

BACKGROUND: Existing methods used to perform laparoendoscopic single-site surgery (LESS) require multiple laparoscopic tools that are inserted into the peritoneal cavity through a single, specialized port. These methods are inherently limited in visualization and dextrous capabilities by working through a single access point. A miniature in vivo robotic platform that is completely inserted into the peritoneal cavity through a single incision can address these limitations, providing more intuitive manipulation capabilities and improved visualization. METHODS: The miniature in vivo robotic platform for LESS consists of a multi-functional robot and a remote surgeon interface. The robot has two arms and specialized end effectors that can be interchanged to provide monopolar cautery, tissue manipulation, and intracorporeal suturing capabilities. RESULTS: This robot has been demonstrated in multiple non-survival procedures in a porcine model, including four cholecystectomies. CONCLUSION: This study demonstrates the effectiveness of using a multi-functional miniature in vivo robot platform to perform LESS.

Dexterous miniature robot for advanced minimally invasive surgery.

This study demonstrates the feasibility of using a miniature robot to perform complex, single-incision, minimal access surgery. Instrument positioning and lack of triangulation complicate single-incision laparoscopic surgery, and open surgical procedures are highly invasive. Using minimally invasive techniques with miniature robotic platforms potentially offers significant clinical benefits. A miniature robot platform has been designed to perform advanced laparoscopic surgery with speed, dexterity, and tissue-handling capabilities comparable to standard laparoscopic instruments working through trocars. The robotic platform includes a dexterous in vivo robot and a remote surgeon interface console. For this study, a standard laparoscope was mounted to the robot to provide vision and lighting capabilities. In addition, multiple robots could be inserted through a single incision rather than the traditional use of four or five different ports. These additional robots could provide capabilities such as tissue retraction and supplementary visualization or lighting. The efficacy of this robot has been demonstrated in a nonsurvival cholecystectomy in a porcine model. The procedure was performed through a single large transabdominal incision, with supplementary retraction being provided by standard laparoscopic tools. This study demonstrates the feasibility of using a dexterous robot platform for performing single-incision, advanced laparoscopic surgery.

In vivo miniature robots for natural orifice surgery: State of the art and future perspectives.

Natural orifice translumenal endoscopic surgery (NOTES) is the integration of laparoscopic minimally invasive surgery techniques with endoscopic technology. Despite the advances in NOTES technology, the approach presents several unique instrumentation and technique-specific challenges. Current flexible endoscopy platforms for NOTES have several drawbacks including limited stability, triangulation and dexterity, and lack of adequate visualization, suggesting the need for new and improved instrumentation for this approach. Much of the current focus is on the development of flexible endoscopy platforms that incorporate robotic technology. An alternative approach to access the abdominal viscera for either a laparoscopic or NOTES procedure is the use of small robotic devices that can be implanted in an intracorporeal manner. Multiple, independent, miniature robots can be simultaneously inserted into the abdominal cavity to provide a robotic platform for NOTES surgery. The capabilities of the robots include imaging, retraction, tissue and organ manipulation, and precise maneuverability in the abdominal cavity. Such a platform affords several advantages including enhanced visualization, better surgical dexterity and improved triangulation for NOTES. This review discusses the current status and future perspectives of this novel miniature robotics platform for the NOTES approach. Although these technologies are still in pre-clinical development, a miniature robotics platform provides a unique method for addressing the limitations of minimally invasive surgery, and NOTES in particular.

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.

The future of NOTES instrumentation: Flexible robotics and in vivo minirobots.

Natural orifice translumenal endoscopic surgery (NOTES) bridges the gap between standard endoluminal and extraluminal surgery and, as such, presents unique instrumentation challenges, including lack of stable platforms, loss of spatial orientation, and limited instrument tip maneuverability. The proper instrumentation remains to be established, and the incorporation of robotic technology will be essential moving forward. Flexible robotics has been applied to ureteroscopy and holds promise for NOTES. Miniature in vivo robots will potentially play a role. The current status and future implications of these technologies are reviewed.

Miniature in vivo robotics and novel robotic surgical platforms.

Robotic surgical systems, such as the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California), have revolutionized laparoscopic surgery but are limited by large size, increased costs, and limitations in imaging. Miniature in vivo robots are being developed that are inserted entirely into the peritoneal cavity for laparoscopic and natural orifice transluminal endoscopic surgical (NOTES) procedures. In the future, miniature camera robots and microrobots should be able to provide a mobile viewing platform. This article discusses the current state of miniature robotics and novel robotic surgical platforms and the development of future robotic technology for general surgery and urology.

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.

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.

The current state of miniature in vivo laparoscopic robotics.

Minimally invasive surgery (MIS) reduces patient trauma and shortens recovery time, but also limits the dexterity of the surgeon because degrees of freedom are lost due to the fulcrum effect of the entry incisions. Visual feedback is also limited by the laparoscope, which typically provides two-dimensional feedback and is constrained by the entry incision. Developments within surgical robotics aim to mitigate these constraints. However, these developments have primarily included large external machines that augment vision and improve dexterity, but are still fundamentally constrained by the use of long tools through small incisions. An alternative concept is the use of miniature in vivo surgical robots that can be placed entirely into the peritoneal cavity through either an abdominal incision, or, after insertion into the stomach through the esophagus, can enter through a gastrotomy. This paper reviews the development of fixed-base camera robots for providing auxiliary views of the surgical field and of mobile robots with a movable platform for vision and task assistance in laparoscopic procedures. Moreover, the progress towards the application of similar robots for natural orifice transluminal endoscopic surgery (NOTES) and forward environments is discussed.

Endoluminal minirobots for transgastric peritoneoscopy.

The performance of surgeries through small incisions or natural orifices minimizes the invasiveness to the patient as compared to open procedures. However, the constraints on visual feedback and dexterity limit the scope of these procedures. Recent robotic technologies attempt to mitigate these constraints for flexible endoscopy and laparoscopy. Much of the current work in flexible endoscopy is in the development of a fully autonomous endoscope capable of providing the surgeon with better control. Advancements in laparoscopic technologies have demonstrated abilities to improve visualization and dexterity through telerobotics and in vivo robotics. The application of new robotic technologies in flexible endoscopy and laparoscopy to natural orifice surgery promises to further benefit the patient by eliminating abdominal incisions, scarring, and the pain associated with these incisions. The safety and feasibility of such robotic technology has been successfully demonstrated for natural orifice transluminal endoscopic surgery (NOTES) in animal models.