A miniaturized robotic platform for natural orifice transluminal endoscopic surgery: in vivo validation

Permanent magnet array-driven navigation of wireless millirobots inside soft tissues

Creating wireless milliscale robots that navigate inside soft tissues of the human body for medical applications has been a challenge because of the limited onboard propulsion and powering capacity at small scale. Here, we propose around 100 permanent magnet array–based remotely propelled millirobot system that enables a cylindrical magnetic millirobot to navigate in soft tissues via continuous penetration. By creating a strong magnetic force trap with magnetic gradients on the order of 7 T/m inside a soft tissue, the robot is attracted to the center of the array even without active control. By combining the array with a motion stage and a fluoroscopic x-ray imaging system, the magnetic robot followed complex paths in an ex vivo porcine brain with extreme curvatures in sub-millimeter precision. This system enables future wireless medical millirobots that can deliver drugs; perform biopsy, hyperthermia, and cauterization; and stimulate neurons with small incisions in body tissues.

A Soft Retraction System for Surgery Based on Ferromagnetic Materials and Granular Jamming

In recent years, minimally invasive surgery (MIS) has gained wider acceptance among surgeons. MIS requires high skills for the operators, mainly due to its intrinsic technical limitations. Tissue manipulation and retraction remain the most challenging tasks; more specifically liver, stomach, and intestine are the organs mostly involved in retraction tasks for abdominal procedures. The literature reports an increasing interest toward dedicated solutions for abdominal tissue retraction tasks. To overcome the limitations of commercial systems and research prototypes, the aim of this study is the design, the realization, and the validation of a retraction system that is simple, reliable, easy to use, safe, and broadly compatible with MIS. The proposed retractor has two main components: (1) a soft central part with variable stiffness obtained by exploiting the granular jamming phenomenon for assuring, at the same time, safe introduction into the abdominal cavity and stable retraction and (2) two iron cylinders located at the two extremities of the device for anchoring the retractor to the abdominal wall by using the magnetic attraction force between these components and two external permanent magnets. System design has been performed by deeply investigating granular jamming principle and ferromagnetic properties of iron elements. Ex vivo and in vivo assessment has been carried out with the final aim to identify the most appropriate design of each retractor component and to demonstrate the advantages of using a soft system with variable stiffness during a retraction task.

Hybrid Soft-Rigid Actuators for Minimally Invasive Surgery

Fluidic mechanisms have stimulated research and development in minimally invasive surgery instrumentations, because of their good performance in limited size and their force/torque generation with respect to other types of actuation systems. Fluidic solutions can be divided in two major classes: (i) elastic fluidic actuators and (ii) piston-cylinder actuators. Elastic fluidic actuators generate lower forces with smaller displacements; nevertheless, piston-cylinder solutions require seals, which can generate friction and require maintenance costs for a good reliability. The proposed solution is based on a hybrid soft-rigid actuation, which aims to overcome the limitations of both previous solutions while preserving the main advantages of the overall fluidic approach. This approach results in very compact, powerful, and low-cost actuators, which are highly customizable and adaptable to specific constraints, in medical applications but even beyond. This article proposes a novel design of hybrid soft-rigid actuators to be used as basic mechanical joints for enabling pitch and roll degrees of freedom for a miniature robotic arm. Forces up to 1.4 N and up to 2.77 N have been obtained for the above joints, respectively, and even better performance can be reached (up to 3 N) with further improvements, as demonstrated in this article.

Telemedicine and telerobotics: from science fiction to reality

Advances in communication technologies have paved the way for telemedicine to transform the delivery of medical care throughout the world. Coinciding developments in minimally invasive surgery and in particular teleoperated robotic surgical systems will allow the surgeon to deliver expert care in remote locations. This study presents a systematic review of telemedicine, focusing on telerobotic surgical systems. A brief historical review of telemedicine and telerobotics is provided, including a description of the various subtypes of telemedicine. Currently available systems and recent experimental utilization, including long-distance remote telesurgery, are discussed. Experimental telerobotic surgical systems and future developments in the field are reviewed and the potential applications are considered. Future challenges to the implementation and opinions on the future direction of telerobotics are provided in this review.

Concept design of robotic modules for needlescopic surgery

BACKGROUND

Many minimally invasive surgical procedures and assisting robotic systems have been developed to further minimize the number and size of incisions in the body surface. This paper presents a new idea combining the advantages of modular robotic surgery, single incision laparoscopic surgery and needlescopic surgery.

MATERIAL AND METHODS

In the proposed concept, modules carrying therapeutic or diagnostic tools are inserted in the abdominal cavity from the navel as in single incision laparoscopic surgery and assembled to 3-mm needle shafts penetrating the abdominal wall.

RESULTS

A three degree-of-freedom robotic module measuring 16 mm in diameter and 51 mm in length was designed and prototyped. The performance of the three connected robotic modules was evaluated.

CONCLUSION

A new idea of modular robotic surgery was proposed, and demonstrated by prototyping a 3-DOF robotic module. The performance of the connected robotic modules was evaluated, and the challenges and future work were summarized.

Current and emerging robotic assisted intervention for Notes

INTRODUCTION

Natural orifices transluminal endoscopic surgery (notes) procedures are limited by a number of factors including closure of the internal entry point, loss of triangulation, and unstable operative platform. Areas covered: In this paper, new technical developments in different aspects of robotic assisted NOTES interventions are reviewed. We further address new research opportunities for more widespread clinical acceptance of robotic assisted NOTES procedures. Expert commentary: The application of robotics in NOTES intervention is still in its infancy. The development of more compact, smart and intuitive robotic NOTES systems holds much promise for the future of NOTES application.