Research Papers

Development and Feasibility of a Robotic Laparoscopic Clipping Tool for Wound Closure and Anastomosis

[+] Author and Article Information
Axel Krieger

Sheikh Zayed Institute for Pediatric
Surgical Innovation,
Children's National Health System,
111 Michigan Avenue,
NW, Washington, DC 20010;
Department of Mechanical Engineering,
University of Maryland,
2181 Glenn L. Martin Hall, Building 088,
College Park, MD 20742
e-mail: axel@umd.edu

Justin Opfermann

Sheikh Zayed Institute for Pediatric
Surgical Innovation,
Children's National Health System,
111 Michigan Avenue, NW,
Washington, DC 20010
e-mail: jopferma@childrensnational.org

Peter C. W. Kim

Sheikh Zayed Institute for Pediatric
Surgical Innovation,
Children's National Health System,
111 Michigan Avenue, NW,
Washington, DC 20010
e-mail: pkim@childrensnational.org

Manuscript received May 12, 2017; final manuscript received October 17, 2017; published online November 22, 2017. Assoc. Editor: Venketesh Dubey.

J. Med. Devices 12(1), 011005 (Nov 22, 2017) (6 pages) Paper No: MED-17-1219; doi: 10.1115/1.4038335 History: Received May 12, 2017; Revised October 17, 2017

This paper reports the design, development, and initial evaluation of a robotic laparoscopic clipping tool for single manipulator wound closure and anastomosis (tubular reconnection). The tool deploys biodegradable clips and clasps with the goal of (i) integrating grasping and suturing into a single device for single hand or manipulator use, (ii) applying the equivalent of interrupted sutures without the need of managing suture thread, and (iii) allowing for full six degrees-of-freedom (DOFs) laparoscopic control when mounted on a robot arm. The specifications, workflow, and detailed design of the robotic laparoscopic tool and injection molded bio-absorbable T shaped clip and locking clasp are reported. The clipping tool integrates forceps to grab and stabilize tissue and a clip and clasp applier to approximate and fixate the tissue. A curved needle is advanced on a circular needle path and picks up and drags clips through tissue. The clip is then tightened through the tissue and a clasp is clamped around the clip, before the clip is released from the needle. Results of several bench test runs of the tool show: (a) repeatable circular needle drive, (b) successful pick-up and deployment of clips, (c) successful shear of the clip to release the clip from the needle, and (d) closure of clasp on clip with an average of 2.0 N holding force. These data indicate that the robotic laparoscopic clipping tool could be used for laparoscopic wound closure and anastomosis.

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Grahic Jump Location
Fig. 4

Screenshots of FEA analysis of clasp and clip interaction, used to design the latch

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Fig. 3

Microscope picture (scale is 1 mm) of a custom molded size 2-0 polymer T-shaped clip and clasp

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Fig. 2

Surgical workflow for applying a clip and clasp to two layers of tissue with the prototype clipping tool

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Fig. 1

Rendering (top) and picture (bottom) of the prototype of a novel laparoscopic clipping tool to perform anastomosis during robotic MIS, consisting of a motor pack, laparoscopic shaft, and clipping tool head. Included are two ±90 deg pitch and yaw articulation joints. The clipping tool is mounted to an LWR arm.

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Fig. 5

Computer aided design picture of clipping tool head with components of forceps mechanism

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Fig. 6

Computer aided design picture of clipping tool head with components for needle advance drive. Needle is shown in an exploded view.

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Fig. 7

Panel A: Computer aided design picture of clipping head with clasping mechanism. Retracting the forceps actuates a lever that initiates the closing of a Clasp via a Cam. Panel B: Microscope picture of open Clasp inside mechanism. Panel C: Clasp inside mechanism after latch is closed.

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Fig. 9

Microscope picture of an example of a successful latching of a clasp on a clip

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Fig. 8

Schematic of cable actuation of the clipping tool with five control cables



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