Andy Prima Kencana

Master and slave transluminal endoscopic robot (MASTER) for natural Orifice Transluminal Endoscopic Surgery (NOTES)

Although the flexible endoscopy has been widely used in the medical field for many years, there is still great potential in improving the endoscopists capability to perform therapeutic tasks. Tentatively, tools for the flexible endoscope have poor maneuverability and limited Degree Of Freedom (DOF). In this paper, we propose a surgical robotic system MASTER (Master And Slave Transluminal Endoscopic Robot). MASTER is a dexterous and flexible master-slave device which can be used in tandem with a conventional flexible endoscope. Using this robotic system, ESD (Endoscopic Submucosal Dissection) and NOTES (Natural Orifice Transluminal Endoscopic Surgery) have been conducted on in vivo and ex vivo animal trials with promising results.

Endoscopic submucosal dissection of gastric lesions by using a Master and Slave Transluminal Endoscopic Robot (MASTER)

BACKGROUND Performing endoscopic submucosal dissection (ESD) by using standard endoscopy platforms is technically challenging because of the equipments lack of dexterity. OBJECTIVE To explore the feasibility of using the Master and Slave Transluminal Endoscopic Robot (MASTER), a novel robotics-enhanced endosurgical system, to perform ESD. DESIGN ESD was performed on simulated gastric lesions in 5 Erlangen porcine stomach models (ex vivo) and 5 live pigs (in vivo). Performance of ESD by using the MASTER was compared with that using the insulation-tipped (IT) diathermic knife. SETTING SMART Laboratory, Advance Surgical Training Centre, National University Hospital, Singapore. SUBJECTS Five Erlangen porcine stomach models and 5 pigs, 5 to 7 months old, each weighing about 35 kg. INTERVENTIONS ESD. MAIN OUTCOME MEASUREMENTS Lesion resection time, grasper and hook efficacy grade, completeness of resection, and presence of procedure-related perforation. RESULTS In the Erlangen stomach models, 15 simulated lesions from the cardia, antrum, and body were removed en bloc (mean dimension, 37.4 x 26.5 mm) by electrocautery excision using the MASTER. The mean ESD time was 23.9 minutes (range 7-48 minutes). There was no difference in the dissection times of lesions at different locations (P = .449). In the live pigs, the MASTER took a mean of 16.2 minutes (range 3-29 minutes) to complete the ESD of 5 gastric lesions, whereas the IT diathermic knife took 18.6 minutes (range 9-34 minutes). There was no significant difference in the times taken (P = .708). All lesions were excised en bloc; the mean dimensions of lesions resected by the MASTER and the IT diathermic knife were 37.2 x 30.1 mm and 32.78 x 25.6 mm, respectively. The MASTER exhibited good grasping and cutting efficiency throughout. Surgical maneuvers were achieved with ease and precision. There was no incidence of excessive bleeding or stomach wall perforation. LIMITATIONS Exploratory study with limited sample size. CONCLUSIONS Performing ESD by using the MASTER is feasible.

Natural orifice transgastric endoscopic wedge hepatic resection in an experimental model using an intuitively controlled master and slave transluminal endoscopic robot (MASTER)

BackgroundThe lack of triangulation of standard endoscopic devices limits the degree of freedom for surgical maneuvers during natural orifice transluminal endoscopic surgery (NOTES). This study explored the feasibility of adapting an intuitively controlled master and slave transluminal endoscopic robot (MASTER) the authors developed to facilitate wedge hepatic resection in NOTES.MethodsThe MASTER consists of a master controller, a telesurgical workstation, and a slave manipulator that holds two end-effectors: a grasper, and a monopolar electrocautery hook. The master controller is attached to the wrist and fingers of the operator and connected to the manipulator by electrical and wire cables. Movements of the operator are detected and converted into control signals driving the slave manipulator via a tendon-sheath power transmission mechanism allowing nine degrees of freedom. Using this system, wedge hepatic resection was performed through the transgastric route on two female pigs under general anesthesia. Entry into the peritoneal cavity was via a 10-mm incision made on the anterior wall of the stomach by the electrocautery hook. Wedge hepatic resection was performed using the robotic grasper and hook. Hemostasis was achieved with the electrocautery hook. After the procedure, the resected liver tissue was retrieved through the mouth using the grasper.ResultsUsing the MASTER, transgastric wedge hepatic resection was successfully performed on two pigs with no laparoscopic assistance. The entire procedure took 9.4 min (range, 8.5–10.2 min), with 7.1 min (range, 6–8.2 min) spent on excision of the liver tissue. The robotics-controlled device was able to grasp, retract, and excise the liver specimen successfully in the desired plane.ConclusionThis study demonstrated for the first time that the MASTER could effectively mitigate the technical constraints normally encountered in NOTES procedures. With it, the triangulation of surgical tools and the manipulation of tissue became easy, and wedge hepatic resection could be accomplished successfully without the need for assistance using laparoscopic instruments.

Design of a master and slave transluminal endoscopic robot for natural orifice transluminal endoscopic surgery

Abstract Natural orifice transluminal endoscopic surgery (NOTES) is an endoscopic surgical intervention technique for treatment within the intraperitoneal cavity, which utilizes natural orifices (i.e. mouth, vagina, anus, etc.) as the entry point. In line with minimally invasive surgery (MIS), NOTES aims to perform surgical procedures without skin incisions, thus eliminating unsightly scars. In this article, a master—slave robotic system is proposed to enable the endoscopist to perform demanding NOTES procedures, which are currently performed by surgeons in an opened or keyhole surgery setting. The robotic system consists of a master console and slave manipulators driven by tendon—sheath actuation. Force prediction at the slave end is also introduced in this article to provide force feedback to the surgeon. Using the developed robotic system, liver wedge resection has been conducted in animal trials with promising results.

An ingestible wireless capsule for treatment of obesity

Intragastric balloon has become a popular method for treatment of obesity due to its less-invasive and non-pharmaceutical procedure. In this method, a gas (or liquid)-filled balloon is inserted into the stomach using endoscopy or surgery. The balloon stays in and partially fills the stomach for a desired period of time to induce the feeling of satiety in the patient. At the end of the treatment period, the balloon is removed from the body using endoscopy or surgery. Although proven effective in treatment of obesity, this method suffers from several drawbacks. Requiring an endoscopic procedure or surgery to insert and exert the balloon from the stomach is the most important disadvantage of this method. These procedures are usually costly and may cause the patient to feel uncomfortable. Here, we propose a non-invasive method to overcome these drawbacks. In this method, an intragastric balloon is introduced into the body using an ingestible capsule. The volume of the capsule can be adjusted wirelessly after being swallowed by the patient. Using this method, a non-invasive and patient-specific treatment is possible.

Wireless capsule endoscopes for enhanced diagnostic inspection of gastrointestinal tract

Wireless capsule endoscopy has become a common procedure for diagnostic inspection of gastrointestinal tract. This method offers a less-invasive alternative to traditional endoscopy and provides the opportunity for exploring inaccessible areas of the small intestine. Current capsule endoscopes, however, move by peristalsis and are not capable of detailed and on-demand inspection of desired locations. Here, we propose and develop two wireless endoscopes with maneuverable vision systems to enhance diagnosis of gastrointestinal disorders. The vision systems in these capsules are equipped with mechanical actuators to adjust the position of the camera. This may help to cover larger areas of the digestive tract and investigate desired locations.

Therapeutic Capsule Endoscopy: Opportunities and Challenges

The increasing demand for non-invasive (or less-invasive) monitoring and treatment of medical conditions has attracted both physicians and engineers to work together and investigate new methodologies. Wireless capsule endoscopy is a successful example of such techniques which has become an accepted routine for diagnostic inspection of the gastrointestinal tract. This method offers a non-invasive alternative to traditional endoscopy and provides the opportunity for exploring distal areas of the small intestine which are otherwise not accessible. Despite these advantages, wireless capsule endoscopy is still limited in functionality compared to traditional endoscopy. Wireless capsule endoscopes with advanced functionalities, such as biopsy or drug delivery, are highly desirable. In this article, the current status of wireless capsule endoscopy is reviewed together with some of its possible therapeutic applications as well as the existing challenges.

Enhancement of spatial orientation and haptic perception for master-slave robotic Natural Orifice Transluminal Endoscopic Surgery (NOTES)

Natural Orifice Transluminal Endoscopic Surgery (NOTES) has advantages in reducing postoperative abdominal wall pain, wound infection, hernia formation and adhesions. However, loss of spatial orientation and lack of haptic feedback during NOTES are two major technical barriers that hinder safe translation into full clinical practice. A complete solution for enhancing the spatial orientation and haptic perceptions for the surgeon during NOTES is needed to improve its safety and efficiency, and at the same time, reduce its complication and complexity. In this paper, we proposed an Interventional Navigation System (INS) and haptic feedback solution for a master-slave robot for NOTES to fulfill the above-mentioned goal.

Modular “Plug-and-Play” capsules for multi-capsule environment in the gastrointestinal tract

The invention of wireless capsule endoscopy has opened new ways of diagnosing and treating diseases in the gastrointestinal tract. Current wireless capsules can perform simple operations such as imaging and data collection (like temperature, pressure, and pH) in the gastrointestinal tract. Researchers are now focusing on adding more sophisticated functions such as drug delivery, surgical clips/tags deployment, and tissue samples collection. The finite on-board power on these capsules is one of the factors that limits the functionalities of these wireless capsules. Thus multiple application-specific capsules would be needed to complete an endoscopic operation. This would give rise to a multi-capsule environment. Having a modular “plug-and-play” capsule design would facilitate doctors in configuring multiple application-specific capsules, e.g. tagging capsule, for use in the gastrointestinal tract. This multi-capsule environment also has the advantage of reducing power consumption through asymmetric multi-hop communication.

Master and Slave Robotic System For Natural Orifice Transluminal Endoscopic Surgery

Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that performs operation to the patient by using an endoscope which passed through the natural orifice in the body then through an incision internally thus avoiding any external incisions or scars. The potential advantages are reduced usage of anesthesia, faster pain and recovery leaving the patient with no visible scars on the body. A major hurdle for NOTES is the difficulty in maneuvering accessories, which can only be moved in one plane in relation to the endoscope. A robotic manipulator was designed for endoscopic use which can simulate the movements of the human upper limbs. The system consists of a master, a telesurgical workstation, and a slave manipulator. Complex and intricate maneuvers such as grasping, retraction and cutting can be effortlessly reproduced. This system has been used in bench and in vivo pig experiments Compared with robotic manipulators for minimally invasive surgery, almost the whole length of the robotic manipulator is flexible and therefore making it capable to follow the endoscope through the natural orifice of the human body.