This paper presents the design and fabrication of Single-Port lapaRoscopy bImaNual roboT (SPRINT), a novel teleoperated robotic system for minimally invasive surgery. SPRINT, specifically designed for single-port laparoscopy, is a high-dexterity miniature robot, able to reproduce the movement of the hands of the surgeon, who controls the system through a master interface. It comprises two arms with six degrees of freedom (DOFs) that can be individually inserted and removed in a 30-mm-diameter umbilical access port. The system is designed to leave a central lumen free during operations, thus allowing the insertion of other laparoscopic tools. The four distal DOFs of each arm are actuated by on-board brushless dc motors, while the two proximal DOFs of the shoulder are actuated by external motors. The constraints generated by maximum size and power requirements led to the design of compact mechanisms for the actuation of the joints. The wrist is actuated by three motors hosted in the forearm, with a peculiar differential mechanism that allows us to have intersecting roll-pitch-roll axes. Preliminary tests and validations were performed ex vivo by surgeons on a first prototype of the system.

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Design of a Novel Bimanual Robotic System for Single-Port Laparoscopy

Background
The da Vinci robotic surgical telemanipulator has been utilized in several surgical specialties for varied procedures, and the users' experiences have been widely published. To date, no detailed system technical analyses have been performed.

Methods
A detailed review was performed of all publications and patents about the technical aspects of the da Vinci robotic system.

Results
Published technical literature on the da Vinci system highlight strengths and weaknesses of the robot design. While the system facilitates complex surgical operations and has a low malfunction rate, the lack of haptic (especially tactile) feedback and collisions between the robotic arms remain the major limitations of the system. Accurate, preplanned positioning of access ports is essential.

Conclusion
Knowledge of the technical aspects of the da Vinci robot is important for optimal use. We confirmed the excellent system functionality and ease of use for surgeons without an engineering background. Research and development of the surgical robot has been predominant in the literature. Future trends address robot miniaturization and intelligent control design. Copyright © 2012 John Wiley & Sons, Ltd.

Technical review of the da Vinci surgical telemanipulator.

Single-port laparoscopy (SPL) has attracted continuous attention in the past decade due to the potential of generating better surgical outcomes than the traditional multiport laparoscopy. In order to ease the challenging surgical manipulation tasks using manual tools in SPL, several robotic systems were constructed to provide surgeons an intuitive way to operate. With possible improvements identified, the SJTU unfoldable robotic system (SURS) for SPL is developed for improved system specifications. The SURS can be deployed into abdomen through a $\phi$ 12-mm port in its folded configuration and can then be unfolded for dual-arm surgical interventions with onboard 3-D visual guidance. A few key design concepts which lead to the specification improvements are elaborated. The design descriptions, kinematics modeling, actuation compensations, and experimental characterizations are detailed to demonstrate the potentials of the SURS.

Development of the SJTU Unfoldable Robotic System (SURS) for Single Port Laparoscopy

The first wireless camera pills created a revolutionary new perspective for engineers and physicians, demonstrating for the first time the feasibility of achieving medical objectives deep w...

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Swallowable medical devices for diagnosis and surgery: The state of the art:

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. 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. 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. 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.

Natural orifice cholecystectomy using a miniature robot

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.

Surgery with cooperative robots

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.

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

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.

Abigail Q. Visty

Papers

Natural orifice cholecystectomy using a miniature robot

Surgery with cooperative robots

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

In vivo robotics for natural orifice transgastric peritoneoscopy.