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Research Paper

Material Handling System for Robotic Natural Orifice Surgery

[+] Author and Article Information
Jeff Midday

Dept. of Mechanical & Materials Engineering,
University of Nebraska-Lincoln,
W342 Nebraska Hall,
Lincoln, NE 68588-0526
e-mail: jeff.midday@yahoo.com

Carl A. Nelson

Dept. of Mechanical & Materials Engineering,
University of Nebraska-Lincoln,
W342 Nebraska Hall
Lincoln, NE 68588-0526;
Dept. of Surgery, Center for Advanced
Surgical Technology,
University of Nebraska Medical Center,
984075 Nebraska Medical Center,
Omaha, NE 68198-4075
e-mail: cnelson5@unl.edu

Alan Goyzueta

Dept. of Mechanical & Materials Engineering,
University of Nebraska-Lincoln,
W342 Nebraska Hall,
Lincoln, NE 68588-0526
e-mail: alangoyzueta@gmail.com

Dmitry Oleynikov

Dept. of Surgery, Center for Advanced
Surgical Technology,
University of Nebraska Medical Center,
984075 Nebraska Medical Center,
Omaha, NE 68198-4075
e-mail: doleynik@unmc.edu

Manuscript received May 9, 2012; final manuscript received November 16, 2012; published online February 4, 2013. Editor: Gerald E. Miller.

J. Med. Devices 7(1), 011003 (Feb 04, 2013) (7 pages) Paper No: MED-12-1069; doi: 10.1115/1.4023265 History: Received May 09, 2012; Revised November 16, 2012

Natural orifice translumenal endoscopic surgery (NOTES) is a relatively new surgical approach that uses no external incisions, thereby improving cosmetic outcomes, decreasing overall recovery time, and reducing the risk of external infection. In standard NOTES, flexible endoscopic tools have been used to carry out a variety of surgical procedures in the abdomen. As an alternative, miniature in vivo robots can be fully inserted into the peritoneal cavity and utilized to perform various surgical procedures. These in vivo robots eliminate tool triangulation issues, improve multitasking capabilities, and greatly increase freedom and dexterity when compared to standard endoscopic and laparoscopic tools. One major limitation is that once inserted, the in vivo robots are isolated within the abdomen and cannot send or receive materials to the external environment. The topic of this paper is a material handling system that has been developed to bridge this deficiency. This system features a flexible silicone overtube and an open-loop control system with manual and automatic operation capabilities. The system utilizes the helix of a spring to advance a payload (staples, robotic tool tips, etc.) along the length of the overtube. The system functioned as intended in benchtop and in vivo testing. Minimum bend radius was identified, and a payload was successfully advanced and retrieved through the shuttling system in porcine surgical procedures. NOTES access was achieved via a custom built transvaginal trocar. This paper presents the design and rationale, control strategy, and in vivo testing results for the NOTES material handling system. The system performs as intended based on functional requirements as demonstrated in benchtop and porcine in vivo testing. The control method is robust even when pushed beyond the physical constraints of the system. Collectively, the material handling system provides a simple, repeatable way for an operator to interface with miniature in vivo robots, improving surgical system flexibility while minimizing impact on the duration of an abdominal surgical procedure.

Copyright © 2013 by ASME
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References

Abbott, D. J., Becke, C., Rothstein, R. I., and Peine, W. J., 2007, “Design of an Endoluminal NOTES Robotic System,” IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS 2007), San Diego, CA, October 29–November 2, pp. 410–416. [CrossRef]
Lehman, A. C., Wood, N. A., Dumpert, J., Oleynikov, D., and Farritor, S. M., 2008, “Dexterous Miniature in Vivo Robot for NOTES,” 2nd IEEE RAS & EMBS International Conference on Biomedical Robotics and Biomechatronics (BioRob 2008), Scottsdale, AZ, October 19–22, pp. 244–249. [CrossRef]
Lehman, A. C., Wood, N. A., Dumpert, J., Oleynikov, D., and Farritor, S. M., 2008, “Robotic Natural Orifice Translumenal Endoscopic Surgery,” IEEE International Conference on Robotics and Automation (ICRA 2008), Pasadena, CA, May 19–23, pp. 2969–2974. [CrossRef]
Dumpert, J., Lehman, A. C., Wood, N. A., Oleynikov, D., and Farritor, S. M., 2009, “Semi-Autonomous Surgical Tasks Using a Miniature in Vivo Surgical Robot,” Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC 2009), Minneapolis, MN, September 3–6, pp. 266–269. [CrossRef]
Rentschler, M. E., Dumpert, J., Platt, S. R., Oleynikov, D., Farritor, S. M., and Iagnemma, K., 2006, “Mobile in Vivo Biopsy Robot,” IEEE International Conference on Robotics and Automation (ICRA 2006), Orlando, FL, May 15–19, pp. 4155–4160. [CrossRef]
Platt, S. R., Hawks, J. A., and Rentschler, M. E., 2009, “Vision and Task Assistance Using Modular Wireless in Vivo Surgical Robots,” IEEE Trans. Biomed. Eng., 56, pp. 1700–1710. [CrossRef] [PubMed]
Midday, J., Goyzueta, A., Nelson, C. A., and Oleynikov, D., 2011, “Material Handling System for Robotic Natural Orifice Surgery,” ASME Design of Medical Devices Conference (DMD 2011), ASME Paper DMD2011-5218.
Midday, J., Nelson, C. A., and Oleynikov, D., 2012, “Material Handling System for Robotic NOTES: Open Loop Control & in Vivo Results,” ASME Design of Medical Devices Conference, DMD 2012, Paper DMD2012-6806.
Auyang, E., Santos, B., Enter, D., Hungness, E., and Soper, N., 2011, “Natural Orifice Translumenal Endoscopic Surgery (NOTES): A Technical Review,” Surg. Endosc., 25(10), pp. 3135–3148. [CrossRef] [PubMed]
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Figures

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Fig. 1

Tract for NOTES transgastric approach

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Fig. 2

In vivo robots [2,5] (copyright [2008], [2006] IEEE)

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Fig. 3

NOTES material handling system

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Fig. 4

Overtube selection array, top to bottom: silicone, braided vinyl, plain vinyl, extreme-temperature PTFE and corona-resistant PTFE

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Fig. 5

Passive Nitinol spring grasper (light lines approximate deflected contour)

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Fig. 6

Shuttle/overtube geometry (a) offset tab configuration, (b) shuttle tab configuration

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Fig. 7

Primary functionality illustration

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Fig. 8

Material handling system cross section

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Fig. 9

Material handling control interface

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Fig. 10

Inserted retention cap (left) and retracted insufflations cap (right). (1) Overtube, (2) grip pad, (3) motor coupling, (4) rotary insufflations seal, (5) magnetic attachment base, (6) fiberscope outlet, (7) 4 mm quick connect suction/irrigation fitting.

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Fig. 11

Repeatability test: 12.7 cm bend radius, 180 deg axial twist test

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Fig. 12

Bend radius orientations

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Fig. 13

System inserted in vivo via GelPort®

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Fig. 15

Transvaginal insertion of MHS: exterior (left), interior (right)

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