Nathan A. Wood

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.

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.

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.

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

BackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionThis 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.

Dexterous miniature in vivo robot for NOTES

The complete elimination of external incisions through natural orifice access to the peritoneal cavity is potentially the next step in reducing the invasiveness of surgery. Natural Orifice Translumenal Endoscopic Surgery (NOTES) provides distinct patient advantages, but is surgically challenging. For the NOTES approach to be applied routinely, devices need to be developed that provide the surgeon with a stable multi-tasking platform for tissue manipulation and visualization. Much research towards device development for NOTES is based on the flexible endoscopy platform. However, these tools remain constrained by the entry incision and are further limited by challenges in tool triangulation, and multi-tasking capabilities. An alternative approach is the use of miniature in vivo robots that can be fully introduced into the peritoneal cavity through a natural orifice. A robotic platform for NOTES is being developed that attempts to emulate laparoscopic capabilities and control. This paper presents the prototype design of this platform and in vivo feasibility studies in non-survivable animal model procedures.

Dexterous Miniature In Vivo Surgical Robot for Long Duration Space Flight

Long duration human space exploration will require the capabilities to perform surgery in emergency situations. Robotic and telerobotic surgical capabilities may be of significant use in improving medical care in remote and harsh environments, such as space, where minimally invasive surgery (MIS) can significantly reduce surgical risk. Surgical robots developed for MIS, while successful in the operating room, remain large, expensive, and require significant support personnel making them ineffectual in space exploration. In vivo surgical robots that function entirely inside the patient, have been shown to be effective as assistants in MIS, but were previously unable to perform surgical interventions. This paper presents a dexterous in vivo surgical robot that possesses the potential to perform teleoperated minimally invasive procedures. This potential is well suited for space exploration as the in vivo approach limits the size of the robot as compared to existing surgical robotic technology.

Towards Autonomous Robot-Assisted Natural Orifice Translumenal Endoscopic Surgery

Natural Orifice Translumenal Endoscopic Surgery (NOTES) promises to reduce the invasiveness of surgical procedures by accessing the peritoneal cavity through a natural orifice. Current tools for performing NOTES are based on the flexible endoscopy platform, and are significantly limited in imaging and manipulation by the size and geometry of the natural lumen. For NOTES to revolutionize minimally invasive surgery, new approaches are necessary that enable the surgeon to perform procedures with vision and dexterity equivalent to laparoscopic procedures. An image-guided, two-armed, dexterous miniature NOTES robot has been developed that can be placed into the peritoneal cavity through a transgastric incision. Using this robot, the surgeon has effectively demonstrated tissue dissection in non-survivable animal model procedures. A next step in the development of miniature in vivo robots is the automation of routinely performed, low level surgical tasks. This paper details work towards autonomous tissue dissection using the NOTES robot. As a first step, visual tracking and robot control methods are being developed.Copyright