Review Article

Classification of Joints Used in Steerable Instruments for Minimally Invasive Surgery—A Review of the State of the Art

[+] Author and Article Information
Filip Jelínek

BioMechanical Engineering Department,
Faculty Mechanical, Maritime
and Materials Engineering,
Delft University of Technology,
Mekelweg 2,
Delft 2628 CD, The Netherlands
e-mail: f.jelinek@tudelft.nl

Ewout A. Arkenbout

BioMechanical Engineering Department,
Faculty Mechanical, Maritime
and Materials Engineering,
Delft University of Technology,
Mekelweg 2,
Delft 2628 CD, The Netherlands
e-mail: e.a.arkenbout@tudelft.nl

Paul W. J. Henselmans

BioMechanical Engineering Department,
Faculty Mechanical, Maritime
and Materials Engineering,
Delft University of Technology,
Mekelweg 2,
Delft 2628 CD, The Netherlands
e-mail: p.w.j.henselmans@tudelft.nl

Rob Pessers

Research and Development Group,
Stork Food & Dairy Systems B.V.,
Deccaweg 32,
Amsterdam 1042 AD, The Netherlands
e-mail: rob.pessers@sfds.eu

Paul Breedveld

BioMechanical Engineering Department,
Faculty Mechanical, Maritime
and Materials Engineering,
Delft University of Technology,
Mekelweg 2,
Delft 2628 CD, The Netherlands
e-mail: p.breedveld@tudelft.nl

Manuscript received December 26, 2013; final manuscript received September 19, 2014; published online November 14, 2014. Assoc. Editor: John LaDisa.

J. Med. Devices 9(1), 010801 (Mar 01, 2015) (11 pages) Paper No: MED-13-1304; doi: 10.1115/1.4028649 History: Received December 26, 2013; Revised September 19, 2014; Online November 14, 2014

This review article provides a comprehensive overview and classification of the joint types used in the steerable tips of minimally invasive surgical instruments. The review was carried out with the objective to pinpoint the essence of the joints' fundamental mechanical design and to provide a qualitative comparison of their strengths and weaknesses with respect to a number of straightforward criteria. Besides researching the ASME scientific literature, the entire Espacenet patent database was searched using the keywords endo* or lapar* or surg* in title and steer* or articu* or deflect* in title or abstract. The extensive scope of the patent results was further limited to World (WO), United States (US), and European (EP) patents only as well as to the period of the last decade, 2003–2013, with a few exceptions predating this period. Overall, more than 840 patents were reviewed and categorized on the basis of the joints' mechanical design and supplemented with the scientific papers. A number of joint categories and subcategories were identified. At the fundamental level the joints can be differentiated as planar and spatial, where the spatial are further split as perpendicular mirrored and revolved. Based on the means of establishing rotational motion, the joint types can be discriminated as rolling, sliding, the combination of rolling and sliding, and bending. Lastly, the rolling and sliding categories can be further split with regard to the phenomenon or feature used for transferring the rotational motion, i.e., friction, teeth, belts, curved features, and hinges. In general, the most favored joint types were identified as the sliding and the bending joint categories overall. Nevertheless, it was recognized that no single fundamental joint type can be considered as ideal and that novel and preferably more superior joint configurations can be generated by combining several fundamental categories together.

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Grahic Jump Location
Fig. 1

(a) Rigid [6] and steerable [7] laparoscopic instruments; (b) rigid instrument DOF [8]; (c) additional steerable tip DOF. Adopted from Ref. [10].

Grahic Jump Location
Fig. 2

Graphical summary of the joint type classification, listing all the relevant up-to-date patents for each joint type category. Additional descriptors (C, L, RP, S) highlight various differing joint configurations within several joint type categories.

Grahic Jump Location
Fig. 3

Overview of the rolling joint types adopted from the patents by (a) Parrott et al. [16], (b) Blase [17], (c) Banik et al. [21], (d) Cooper et al. [22], (e) Madhani and Salisbury [26], and (f) Allred and Bingham [27]

Grahic Jump Location
Fig. 4

Overview of the sliding curved joint types adopted from the patents by (a) Stroup and Deptala [35], (b) Tseng [39], (c) Hegeman et al. [56], (d) Marczyk et al. [32], (e) Malkowski et al. [80], and (f) Banik et al. [21]

Grahic Jump Location
Fig. 5

Overview of the sliding hinged joint types adopted from the patents by (a) Brock and Lee [41], (b) Saadat and Peh [55], (c) Jeong and Kim [65], (d) Steege [71], and (e) Wallace et al. [73]

Grahic Jump Location
Fig. 6

Overview of the rolling sliding joint types adopted from the patents by (a) Menn [54], (b) Saadat et al. [57], (c) Heimberger [58], and (d) Boury [85]

Grahic Jump Location
Fig. 7

Overview of the bending flexure joint types adopted from the patents by (a) Stone et al. [34], (b) Shelton and Ortiz [95], (c) Cooper and Anderson [97], (d) Dewaele et al. [104], (e) Lee et al. [66], and (f) Breedveld and Scheltes [109]



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