Robotic surgical systems, such as the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California), have revolutionized laparoscopic surgery but are limited by large size, increased costs, and limitations in imaging. Miniature in vivo robots are being developed that are inserted entirely into the peritoneal cavity for laparoscopic and natural orifice transluminal endoscopic surgical (NOTES) procedures. In the future, miniature camera robots and microrobots should be able to provide a mobile viewing platform. This article discusses the current state of miniature robotics and novel robotic surgical platforms and the development of future robotic technology for general surgery and urology.
"Name Length [mm] Diameter [mm] Reference Miniature robot 180 (extended) ˜17 Lehman et al. (2011) Lehman et al. (2009) Tiwari et al. (2010) Lightning robot 110 12 Shah et al. (2009) Mobile endoluminal robot 75 12 Rentschler et al. (2007) Lehman et al. (2006) operation area where the planned surgical tasks have to be performed and a certain number of DoFs can be transmitted through the abdomen without any mechanical connections. Despite the overall system potentialities, MAGS have a lack of a stable magnetic anchoring force when the abdominal wall thickness is over 2.5 cm (Best et al., 2010); in addition, undesired interactions appear when multiple instruments are used, thus requiring a " safety distance " to be maintained between the respective external frames. "
[Show abstract][Hide abstract] ABSTRACT: Natural orifice transluminal endoscopic surgery (NOTES) is one of the modern surgical techniques that led to the miniaturization of surgical tools and brings the concept of inserting many robotic units into the peritoneal cavity for executing “scarless” surgical tasks. However, the development of transabdominal anchoring systems that guarantee stability is recognized as a challenging issue in the design of miniature intra-abdominal robotic devices. A dedicated platform, exploiting magnetic coupling for anchoring, has been designed by respecting anatomical constraints, maximizing the volume to increase the number of embedded magnets, and consequently incrementing operating distance. The device is equipped with a SMA (shape memory alloy) mechanism that allows configuration change from an extended cylindrical (compliant for deployment) to a compact triangular (rigid for providing stability) design. The feasibility and the potential of the proposed platform have been demonstrated both in in vitro and in in vivo conditions on a human phantom and a porcine model, respectively.
The International Journal of Robotics Research 03/2013; 32(3):360-370. DOI:10.1177/0278364912469672 · 2.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Natural orifice translumenal endoscopic surgery (NOTES) is the integration of laparoscopic minimally invasive surgery techniques with endoscopic technology. Despite the advances in NOTES technology, the approach presents several unique instrumentation and technique-specific challenges. Current flexible endoscopy platforms for NOTES have several drawbacks including limited stability, triangulation and dexterity, and lack of adequate visualization, suggesting the need for new and improved instrumentation for this approach. Much of the current focus is on the development of flexible endoscopy platforms that incorporate robotic technology. An alternative approach to access the abdominal viscera for either a laparoscopic or NOTES procedure is the use of small robotic devices that can be implanted in an intracorporeal manner. Multiple, independent, miniature robots can be simultaneously inserted into the abdominal cavity to provide a robotic platform for NOTES surgery. The capabilities of the robots include imaging, retraction, tissue and organ manipulation, and precise maneuverability in the abdominal cavity. Such a platform affords several advantages including enhanced visualization, better surgical dexterity and improved triangulation for NOTES. This review discusses the current status and future perspectives of this novel miniature robotics platform for the NOTES approach. Although these technologies are still in pre-clinical development, a miniature robotics platform provides a unique method for addressing the limitations of minimally invasive surgery, and NOTES in particular.
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