The Future of NOTES Instrumentation: Flexible Robotics and In Vivo Minirobots
ABSTRACT Natural orifice translumenal endoscopic surgery (NOTES) bridges the gap between standard endoluminal and extraluminal surgery and, as such, presents unique instrumentation challenges, including lack of stable platforms, loss of spatial orientation, and limited instrument tip maneuverability. The proper instrumentation remains to be established, and the incorporation of robotic technology will be essential moving forward. Flexible robotics has been applied to ureteroscopy and holds promise for NOTES. Miniature in vivo robots will potentially play a role. The current status and future implications of these technologies are reviewed.
Conference Paper: Mechanical design of wireless in vivo robot unit for surgical vision[Show abstract] [Hide abstract]
ABSTRACT: Compared to the traditional open surgery, minimally invasive abdominal surgery results in improved results. In order to further reduce the number of incisions, some people put forward laparoendoscopic single-site surgery (LESS) which can get better results. But it also has several disadvantages, such as the tools' interference with each other, the restriction of tools' motion space due to incision. The tools which are able to work in the abdominal cavity entirely can overcome the disadvantages mentioned above, they are ideal for the LESS. We are working on a kind of in vivo robot unit which works entirely in the abdominal cavity. It has the function of lighting and visual feedback. For the purpose of providing better surgical field, the robot unit can tilt to a certain angle and clean the lens automatically. This paper focuses on introducing the design procedure of key transmission parts, self-cleaning executive mechanism and shells.2014 IEEE International Conference on Mechatronics and Automation (ICMA); 08/2014
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ABSTRACT: Natural orifice transluminal endoscopic surgery (NOTES) involves accessing the abdominal cavity via one of the body natural orifices for enabling minimally invasive surgical procedures. However, the constraints imposed by the access modality and the limited available technology make NOTES very challenging for surgeons. Tools redesign and introduction of novel surgical instruments are imperative in order to make NOTES operative in a real surgical scenario, reproducible and reliable. Robotic technology has major potential to overcome current limitations. The robotic platform described here consists of a magnetic anchoring frame equipped with dedicated docking/undocking mechanisms to house up to three modular robots for surgical interventions. The magnetic anchoring frame guarantees the required stability for surgical tasks execution, whilst dedicated modular robots provide the platform with adequate vision, stability and manipulation capabilities. Platform potentialities were demonstrated in a porcine model. Assessment was organized into two consecutive experimental steps, with a hybrid testing modality. First, platform deployment, anchoring and assembly through transoral-transgastric access were demonstrated in order to assess protocol feasibility and guarantee the safe achievement of the following experimental session. Second, transabdominal deployment, anchoring, assembly and robotic module actuation were carried out. This study has demonstrated the feasibility of inserting an endoluminal robotic platform composed of an anchoring frame and modular robotic units into a porcine model through a natural orifice. Once inserted into the peritoneal cavity, the platform provides proper visualization from multiple orientations. For the first time, a platform with interchangeable modules has been deployed and its components have been connected, demonstrating in vivo the feasibility of intra-abdominal assembly. Furthermore, increased dexterity employing different robotic units will enhance future system capabilities.
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ABSTRACT: Stone disease remains a prevalent problem and an important aspect in the urologist’s practice. Flexible ureterorenoscopy (F-URS) is gaining popularity and accessibility over the last two decades for the treatment of ureteral and renal stones. The smaller diameter, durability and maneuverability of the ureteroscope continues to evolve and contribute to the increased effectiveness of this treatment. Studies demonstrating the feasibility and safety of F-URS even in stones larger than 2 cm illustrate the versatility of this technique and the importance of being comfortable with all the equipment available in order to perform a successful surgery. F-URS is presently a treatment option for stones of all sizes and locations in the ureter. In this chapter, we review the instrumentation available, the methods to navigate the ureter and potential complications of F-URS. The specifics regarding ureteral stents, guidewires, baskets, laser lithotripsy and other devices are discussed in other chapters. As proximal ureteral stones can sometimes be relocated or moved into the renal pelvis via retropulsion, we will also touch upon the use of flexible ureteroscopy in the treatment of renal stones in this chapter as wellUreteral Stone Management A Practical Approach, Edited by Sutchin R. Patel, Stephen Y. Nakada, 01/2015: pages 107-126; Springer International Publishing., ISBN: 978-3-319-08792-4