Miniature in vivo robotics and novel robotic surgical platforms.
ABSTRACT 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.
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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.06/2010; 2(6):217-23. DOI:10.4240/wjgs.v2.i6.217
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ABSTRACT: Minimally invasive surgery (MIS) reduces trauma and improves patient recovery. Traditional laparoscopic procedures are performed using multiple long, thin tools that are inserted through small incisions in the abdominal wall. The advantages of these procedures are often restricted to less complicated procedures owing to imaging and tissue manipulation limitations. These limitations can be overcome using advanced surgical systems, such as da Vinci (R), that provide the surgeon with enhanced visualization and improved tool dexterity. However, the da Vinci system is expensive and occupies significant space in the operating room. The compact bevel-geared robot for advanced surgery, CoBRASurge, is a compact robotic system that addresses the space and expense limitations of large external robotic systems. This system provides a stable platform for laparoscopic tool manoeuvring, while also allowing the surgical team improved access to the patient. New methods for performing MIS, including single incision and natural orifice access, are also being developed to further minimize invasiveness through reducing or eliminating external incisions. However, the instruments for these procedures are further limited by accessing the peritoneal cavity through a single insertion point. Dexterous miniature robots that are completely inserted into the peritoneal cavity are being developed that mitigate these limitations to provide improved triangulation.ARCHIVE Proceedings of the Institution of Mechanical Engineers Part C Journal of Mechanical Engineering Science 1989-1996 (vols 203-210) 07/2010; 224:1487-1494. DOI:10.1243/09544062JMES1877 · 0.59 Impact Factor
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ABSTRACT: To analyse the evidence supporting current and future application of robotic technology in natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). Early clinical experience with the application of currently available da Vinci robotic system to LESS has been encouraging, as some of the constraints encountered during conventional LESS can be overcome. Robotic devices that are currently being developed for NOTES and LESS focus on improving either tissue manipulation capabilities for externally actuated robotic and flexible endoscopy systems or visualization for robots that are inserted completely into the peritoneal cavity. Robotic technology is rapidly evolving and is expected to drive several aspects of minimally invasive surgery forward in the near future with the ultimate goal of minimizing complications and improving outcomes.Current opinion in urology 10/2010; 21(1):71-7. DOI:10.1097/MOU.0b013e32833fd602 · 2.12 Impact Factor