Soon Chiang Low

Robotic system for no-scar gastrointestinal surgery.

Flexible endoscopy allows diagnostic and therapeutic interventions on the gastrointestinal (GI) tract. Simple procedures can be performed endoscopically using currently available tools. More advanced endoscopic surgical interventions are much desired and anticipated, yet they await improvements in instrumentation.

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.

Tendon sheath analysis for estimation of distal end force and elongation for sensorless distal end

Tendon sheath actuation can be found in many applications, particularly in robotic hand and surgical robots. Due to friction between the tendon and sheath, many undesirable characteristic such as backlash, hysteresis and non-linearity are present. It is desirable to know the end effector force and elongation of the tendon to control the system effectively, but it is not always feasible to fix sensors at the end effector. A method to estimate the end effector parameters using only a force and position sensor at the proximal site is given. An analytical study is presented and experiments are reported to support the result, showing a max full scale error of approximately 7%. This result is achieved if the shape of the sheath remains the same and buckling is negligible. The results presented in this study could contribute towards haptic development in robotics surgery.

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.

Master-slave robotic system for therapeutic gastrointestinal endoscopic procedures.

Flexible endoscopy is used to inspect and treat disorders of the gastrointestinal (GI) tract without the need for creating an artificial opening on the patients body. Simple surgical procedures (like polypectomy and biopsy) can be performed by introducing a flexible tool via a working channel to reach the site of interest at the distal end. More technically demanding surgical procedures like hemostasis for arterial bleeding, or suturing to mend a perforation cannot be effectively achieved with flexible endoscopy. The proposed robotic system enables the endoscopist to perform technically demanding therapeutic procedures (currently possible only with open surgery) in conjunction with conventional flexible endoscopes. The robotic system consists of a master console and a slave. The latter is a cable driven flexible robotic manipulator that can be inserted into tool channel of existing endoscopes or attached in tandem to the endoscopes. Together with the real time endoscopic view, the endoscopist would be capable of performing more intricate and difficult surgical procedures

A Testbed for Human-Robot Interactions

This paper describes the design and implementation of a testbed for facilitating the study of human-robot interactions (HRI). HRI has long been a part of robotics research, where humans were typically required to guide the robot task in progress and to ensure safe operation. The current state of human interaction with robots, versus simple “machines” (e.g. in manufacturing automation) is quite different. This called for the need to look into different interaction roles between humans and robots. Robots differ from simple machines in that they are mobile, some may be autonomous and hence not as predictable in their actions. To facilitate the research in this domain, the aim is to develop an easy to use and safe front-end human-robot system for human users to interact with physical mobile robots. This testbed provides different types of system configurations (i.e. one human to one robot, one human to multiple robots, etc.) and interfaces for conducting experiments under different HRI scenarios.Copyright

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.