Research Endo2010

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[[image:note_bulb.png|text-bottom|12px]] This work was supported in part by the National Science Foundation of China Grant #51005146 and in part by the University of Michigan - Shanghai Jiao Tong University Collaborative Research Fund.
[[image:note_bulb.png|text-bottom|12px]] This work was supported in part by the National Science Foundation of China Grant #51005146 and in part by the University of Michigan - Shanghai Jiao Tong University Collaborative Research Fund.
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[[File: Research_Endo2010_0.jpg‎|thumb|300px|A schematic of NOTES]]
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[[File: Research_Endo2010_0.jpg‎|thumb|180px|A schematic of NOTES]]
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[[File: Research_Endo2010_1.jpg‎|thumb|400px|The endoscopic robotic surgical testbed for NOTES: (A) the folded configuration (B) the working configuration]]
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Natural Orifice Translumenal Endoscopic Surgery (NOTES) is a newly developed surgical technique in which skin incisions or scars can be avoided. In NOTES, an endoscope was often inserted through a patient’s natural orifices (e.g. mouth, anus, vulva, urethra, etc.) then through an internal incision (e.g. in the esophagus, stomach, colon, vagina, bladder, etc.) to reach surgical sites for interventions. NOTES has recently attracted lots of attention, promising surgical procedures with fewer complications, better cosmesis, lower pains and faster recovery.
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Natural Orifice Translumenal Endoscopic Surgery (NOTES) is a newly developed surgical technique in which skin incisions or scars can be avoided. In NOTES, an endoscope was often inserted through a patient’s natural orifices (e.g. mouth, anus, vulva, urethra, etc.) then through an internal incision (e.g. in the esophagus, stomach, colon, vagina, bladder, etc.) to reach surgical sites for interventions. NOTES has recently attracted lots of attention, promising surgical procedures with fewer complications, better cosmesis, lower pains and faster recovery
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A robotic system for NOTES should be capable at least of doing the following:
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* The device should be foldable to facilitate its insertion into stomach through pharynx and esophagus. Gastroscopes from Olympus® have outer diameters from 11.3mm (GIF-1TQ160) to 12.6mm (GIF-XTQ160). The presented design shall have a comparable or smaller diameter (currently 12mm).
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* The device can deploy itself into a working configuration for suturing, knot tying, ablation, etc.
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* Additional channels should be available for insufflation, manipulation tools for knot-tying, ablation, etc.
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* The device can be positioned and oriented to achieve suturing and knot tying within the entire stomach. This can be achieved by placing the device at the distal tip of an endoscope.
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* The device has a vision unit with integrated illumination.
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* The device is actuated by its actuation unit located outside patient’s mouth.
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[[File: Research_Endo2010_1.jpg‎|thumb|460px|The endoscopic robotic surgical testbed for NOTES: (A) the folded configuration (B) the working configuration]]
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A robotic system for the Single Port Access (SPA) surgeries should be capable at least doing the following:
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To meet the challenges of NOTES, a continuum endoscopic surgical testbed shown in the figure was firstly developed for establishing benchmark characteristics of surgical robots for NOTES procedures. Design challenge of this testbed is centered at the outer diameter of its endoscope configuration (currently 12mm). A smaller diameter could lead to less invasiveness and less discomfort during the insertion. However, a smaller diameter brings more design challenges. It will be more difficult to integrate enough DoFs to ensure sufficient performance and dexterity. With more DoFs incorporated into a certain diameter, structures might have to be slimmer and fail to manipulate sufficient payload with adequate stiffness.
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* The robot should have a folded configuration so that it can pass through a single small skin incision;
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* The robot should be self deployable into a working configuration;
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* The robot can manipulate target organs and their related tissues (such as gallbladder, hepatic tissues, pancreas, etc.) with enough precision and payload;
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* End effectors of the robot can be independently replaced during operations for different tasks;
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* The translational workspace should be bigger than 50mm×50mm×50mm (size of target organs);
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* The robot should posses a stereo vision unit for depth perception and tool tracking;
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* Illumination should to be integrated into the robot.
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To meet the challenges of SPA surgeries, an Insertable Robotic Effector Platform (IREP) shown in the figure is designed by merging enabling technologies of endoscopic imaging (Hu, Allen et al. 2007; Hogle, Hu et al. 2008; Hu, Allen et al. 2008; Hu, Allen et al. 2008) and distal dexterity enhancement (Kapoor, Simaan et al. 2005; Simaan 2005; Xu and Simaan 2006; Xu and Simaan 2008; Simaan, Xu et al. 2009)
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This testbed consists of one 5-DoF vision unit and two 5-DoF snake-like exchangeable continuum manipulation arms with grippers. The continuum manipulation arm can be replaced by sensor modules (e.g. an ultrasound probe) or energy sources (e.g. a cautery). The endoscopic tstbed can be inserted in its endoscopic configuration then unfold itself into a working configuration to perform NOTES operations. Deployment of this testbed is shown below. At this stage, the testbed is pure mechanical and all the motions were posed manually to verify its motion capabilities.  
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The IREP robot consists of two five-DoF snake-like continuum robots, two two-DoF parallelogram mechanisms, and one three-DoF stereo vision module. It is designed to meet the challenge of enabling abdominal SPA procedures, such as cholecystectomy, appendectomy, liver resection, etc. When it is in its folded configuration, it can be deployed into the abdomen through an Ø15mm skin incision while using its forward-looking stereo vision module to guide surgeons through the insertion phase. The IREP can then unfold itself into a working configuration to perform SPA procedures after being deployed.
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* Each snake-like continuum robot includes four components: i) a gripper, ii) a one-DoF rotational wrist, iii) a four-DoF continuum snake arm and iv) a flexible stem. It acts as a surgical telemanipulation slave for dual arm interventions and delivery of sensors (e.g. ultrasound probe) or energy sources (e.g. cautery). During SPA procedures, each of the arms of the IREP robot can be independently pulled out and replaced with another arm equipped with different surgical end effectors.
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* Each parallelogram mechanism has two degrees of freedom for a translational placement of the snake-like continuum robot. The flexible stem will be independently fed in and out to comply with the parallelogram’s motion.
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* The stereo vision module has a pair of CCD cameras for depth perception as well as surgical tool tracking. It has three degrees of freedom for pan, tilt, and zoom. A light source using optic fiber bundles is also integrated.
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* All these controlled joints will be actuated by NiTi tubes or stainless steel rods in push-pull mode. The actuation unit will remain outside patient’s body.
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[[File: Research_Endo2010_1.jpg‎|thumb|380px|The control system hierarchy for the IREP robot]]
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The control system of the IREP robot uses a host-target environment powered by xPC Target&trade; from The MathWorks, Inc, which provides a rapid prototyping approach for control system setup in an open hardware architecture.
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The planned control hierarchy is presented in the figure to the right. A GUI running on the host PC takes motion inputs from two master manipulators and then sends them down to the target PC via ethernet connection after scaling and mapping. Target PC processes the desired motions of the IREP robot by solving kinematics and redundancy resolution in a 1kHz servo control loop. A third PC running vision processing module will output the stereo display for surgeons and feed tool tracking results to the host PC for motion compensations of the IREP’s dual snake-like arms.
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A simulation of the IREP robot is shown, demonstrating different operation modes during the insertion configuration and the working configuration.
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Revision as of 06:58, 21 February 2013


An Endoscopic Robotic Surgical System for NOTES

September 2010 to present

Note bulb.png This work was supported in part by the National Science Foundation of China Grant #51005146 and in part by the University of Michigan - Shanghai Jiao Tong University Collaborative Research Fund.

A schematic of NOTES

Natural Orifice Translumenal Endoscopic Surgery (NOTES) is a newly developed surgical technique in which skin incisions or scars can be avoided. In NOTES, an endoscope was often inserted through a patient’s natural orifices (e.g. mouth, anus, vulva, urethra, etc.) then through an internal incision (e.g. in the esophagus, stomach, colon, vagina, bladder, etc.) to reach surgical sites for interventions. NOTES has recently attracted lots of attention, promising surgical procedures with fewer complications, better cosmesis, lower pains and faster recovery.

A robotic system for NOTES should be capable at least of doing the following:

  • The device should be foldable to facilitate its insertion into stomach through pharynx and esophagus. Gastroscopes from Olympus® have outer diameters from 11.3mm (GIF-1TQ160) to 12.6mm (GIF-XTQ160). The presented design shall have a comparable or smaller diameter (currently 12mm).
  • The device can deploy itself into a working configuration for suturing, knot tying, ablation, etc.
  • Additional channels should be available for insufflation, manipulation tools for knot-tying, ablation, etc.
  • The device can be positioned and oriented to achieve suturing and knot tying within the entire stomach. This can be achieved by placing the device at the distal tip of an endoscope.
  • The device has a vision unit with integrated illumination.
  • The device is actuated by its actuation unit located outside patient’s mouth.
The endoscopic robotic surgical testbed for NOTES: (A) the folded configuration (B) the working configuration

To meet the challenges of NOTES, a continuum endoscopic surgical testbed shown in the figure was firstly developed for establishing benchmark characteristics of surgical robots for NOTES procedures. Design challenge of this testbed is centered at the outer diameter of its endoscope configuration (currently 12mm). A smaller diameter could lead to less invasiveness and less discomfort during the insertion. However, a smaller diameter brings more design challenges. It will be more difficult to integrate enough DoFs to ensure sufficient performance and dexterity. With more DoFs incorporated into a certain diameter, structures might have to be slimmer and fail to manipulate sufficient payload with adequate stiffness.

This testbed consists of one 5-DoF vision unit and two 5-DoF snake-like exchangeable continuum manipulation arms with grippers. The continuum manipulation arm can be replaced by sensor modules (e.g. an ultrasound probe) or energy sources (e.g. a cautery). The endoscopic tstbed can be inserted in its endoscopic configuration then unfold itself into a working configuration to perform NOTES operations. Deployment of this testbed is shown below. At this stage, the testbed is pure mechanical and all the motions were posed manually to verify its motion capabilities.

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