Compact modular system design for teleoperated laparoendoscopic single site surgery

Abstract

Laparoscopic surgery or minimally invasive surgery (MIS) is a technique in which surgery is performed through small incisions, usually in the abdomen. A laparoscope, which is a long slender tubular endoscope used to view the internal body cavities, is connected to a camera that displays the view on a TV monitor. The laparoscope and thin surgical instruments are inserted through the small incisions. Laparoscopic surgery can be done manually or robot-assisted. Some advantages of laparoscopic surgery are reduced pain and patient trauma, shorter recovery time, and smaller scars. Some disadvantages of laparoscopic surgery are limited visibility and range of motion, the small incisions reduce dexterity, and the indirect interaction with tissue. Robot-assisted minimally invasive surgery has most of the same advantages as manual MIS but is an improvement on some of the shortcomings. In robot-assisted MIS, the robotic manipulator is teleoperated by surgeons from a master control console with joystick type controls. It results in improved accuracy, can eliminate manual tremor, can introduce scaling factors between the hand motions of the surgeon and the robotic instruments, and can provide additional articulated joints at the tips of the instruments. Single-port access (SPA) surgery [1] or laparo-endoscopic single-site surgery (LESS) is a technique developed to perform laparoscopic surgery using a single in-cision. Multiple instruments as well as the laparoscope are inserted through the incision, which is typically in the navel. This has the advantage of minimal and hidden scarring compared to standard laparoscopic surgery. Similar instruments as standard laparoscopic surgery can be used and the lack of triangulation from having a single incision can be overcome by using angled or articulated instruments. Single-site surgery could bene t from the improved ergonomics, accuracy, and dexterity of robotic systems. However, it is di cult to use existing robotic surgery systems for single-port surgery due to interference between the robotic arms used to control the surgical instruments. Having more compact positioning mechanisms would allow at least three instruments to be inserted through a single port. The goal of this research was to develop a compact, simple, modular, teleoperated robotic system prototype for laparo-endoscopic single-site surgery by combining and modifying components of a commercial endoscope robot and a previous University of Hawaii teleoperated system. The commercial endoscope robot being used is the ViKY XL system from EndoControl SA.