Jason Dumpert

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 camera robots provide sole visual feedback for abdominal exploration and cholecystectomy

Abstract The use of small incisions in laparoscopy reduces patient trauma, but also limits the surgeon’s ability to view and touch the surgical environment directly. These limitations generally restrict the application of laparoscopy to procedures less complex than those performed during open surgery. Although current robot-assisted laparoscopy improves the surgeon’s ability to manipulate and visualize the target organs, the instruments and cameras remain fundamentally constrained by the entry incisions. This limits tool tip orientation and optimal camera placement. The current work focuses on developing a new miniature mobile in vivo adjustable-focus camera robot to provide sole visual feedback to surgeons during laparoscopic surgery. A miniature mobile camera robot was inserted through a trocar into the insufflated abdominal cavity of an anesthetized pig. The mobile robot allowed the surgeon to explore the abdominal cavity remotely and view trocar and tool insertion and placement without entry incision constraints. The surgeon then performed a cholecystectomy using the robot camera alone for visual feedback. This successful trial has demonstrated that miniature in vivo mobile robots can provide surgeons with sufficient visual feedback to perform common procedures while reducing patient trauma.

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.

Miniature robots can assist in laparoscopic cholecystectomy.

Laparoscopy reduces patient trauma but eliminates the surgeon’s ability to directly view and touch the surgical environment. Although current robot-assisted laparoscopy improves the surgeon’s ability to manipulate and visualize the target organs, the instruments and cameras remain constrained by the entry incision. This limits tool tip orientation and optimal camera placement. This article focuses on developing miniature in vivo robots to assist surgeons during laparoscopic surgery by providing an enhanced field of view from multiple angles and dexterous manipulators not constrained by the abdominal wall fulcrum effect. Miniature camera robots were inserted through a small incision into the insufflated abdominal cavity of an anesthetized pig. Trocar insertion and other laparoscopic tool placements were then viewed with these robotic cameras. The miniature robots provided additional camera angles that improved surgical visualization during a cholecystectomy. These successful prototype trials have demonstrated that miniature in vivo robots can provide surgeons with additional visual information that can increase procedural safety.

An in vivo Mobile Robot for Surgical Vision and Task Assistance

Current laparoscopic surgical robots are expensive, bulky, and fundamentally constrained by the small entry incisions. A potential new approach to minimally invasive surgery is to place the robot c ...

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.

Miniature in vivo Robots for Remote and Harsh Environments

Long-term human space exploration will require contingencies for emergency medical procedures including some capability to perform surgery. The ability to perform minimally invasive surgery (MIS) would be an important capability. The use of small incisions reduces surgical risk, but also eliminates the ability of the surgeon to view and touch the surgical environment directly. Robotic surgery, or telerobotic surgery, may provide emergency surgical care in remote or harsh environments such as space flight, or extremely forward environments such as battlefields. However, because current surgical robots are large and require extensive support personnel, their implementation has remained limited in forward environments, and they would be difficult, or impossible, to use in space flight or on battlefields. This paper presents experimental analysis of miniature fixed-base and mobile in vivo robots to support MIS surgery in remote and harsh environments. The objective is to develop wireless imaging and task-assisting robots that can be placed inside the abdominal cavity during surgery. Such robots will provide surgical task assistance and enable an on-site or remote surgeon to view the surgical environment from multiple angles. This approach is applicable to long-duration space flight, battlefield situations, and for traditional medical centers and other remote surgical locations.

Mobile in vivo biopsy robot

A mobile in vivo camera robot was developed to provide the ability for a single port biopsy procedure. Such a robot can be inserted into the abdominal cavity through a standard trocar. The surgeon controls the robot using visual feedback from the on-board camera. Measurements were made to identify the forces required to successfully biopsy in vivo tissue, including clamping and tearing forces. The robot design was developed around these parameters and the need to traverse the abdominal environment using specially designed wheels. This mobility allows the biopsy robot to move to the area of interest to sample specific tissues. The lead-screw linkage system that actuated the graspers allows for large force production through careful mechanical design. In vivo testing of this system in a porcine (pig) model has been successful. The robot is capable of traversing the entire in vivo abdominal environment and has successfully been used to biopsy hepatic tissue. In addition, experimental analysis of the biopsy mechanism shows good results towards more elaborate tissue manipulation in the future

Theoretical and experimental analysis of in vivo wheeled mobility

Laparoscopy is abdominal surgery performed with long tools inserted through small incisions. The use of small incisions reduces patient trauma, but also eliminates the surgeon’s ability to directly view and touch the surgical environment. These limitations generally restrict the application of laparoscopy to less complex procedures. Large robots external to the patient have been used to aid in the manipulation of the tools and improve dexterity. This paper presents a theoretical and experimental analysis of miniature in vivo robots. The objective is to develop a wireless mobile imaging robot that can be placed inside the abdominal cavity during surgery. Such robots will allow the surgeon to view the surgical environment from multi-angles. The motion of these in vivo robots will not be constrained by the insertion incisions.Copyright

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.