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Research Papers

Design of a Novel Three-Dimensional-Printed Two Degrees-of-Freedom Steerable Electrosurgical Grasper for Minimally Invasive Surgery

[+] Author and Article Information
Aimée Sakes

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

Kevin Hovland

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

Gerwin Smit

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

Jo Geraedts

Department Design Engineering,
Faculty Industrial Design Engineering,
Delft University of Technology,
Mekelweg 2,
Delft 2628 CD, The Netherlands
e-mail: j.m.p.geraedts@tudelft.nl

Paul Breedveld

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

1Corresponding author.

Manuscript received June 19, 2017; final manuscript received November 1, 2017; published online January 10, 2018. Assoc. Editor: Venketesh Dubey.

J. Med. Devices 12(1), 011007 (Jan 10, 2018) (15 pages) Paper No: MED-17-1253; doi: 10.1115/1.4038561 History: Received June 19, 2017; Revised November 01, 2017

In current bipolar electrosurgical instruments, a high frequency electrical sinusoidal wave is passed through the patient's body from an active electrode to the return electrode to cut, coagulate, or desiccate tissues. Even though current bipolar electrosurgical instruments have proven effective in minimizing blood loss, advancement is needed to allow for improved dexterity and adaptability. With current advances in three-dimensional (3D)-print processes and its integration in the medical field, it has become possible to manufacture patient-and operation-specific instruments. In this study, we introduce the first 3D-printed steerable bipolar grasper (◻ 5 mm) for use in minimal invasive surgery. The grasper significantly improves dexterity by the addition of two planar joints allowing for ±65 deg for sideways and ±85 deg for up- and downward movement. The joints enable a significantly higher bending stiffness, 4.0 N/mm for joint 1 and 4.4 N/mm for joint 2, than that of currently available steerable instruments. The tip consists of two metallic movable jaws that can be opened and closed with angles up to 170 deg and allows for grasping and coagulating of tissues; reaching tissue temperatures of over 75 °C for an activation time of ∼5 s, respectively. In order to actuate the joint, tip, and electrosurgical system, as well as to tension the steering cables, a ring handle was designed. In summary, the 3D-printed steerable bipolar grasper provides the surgeon with electrosurgical capabilities, improved dexterity, improved stiffness, and the versatility that is needed to provide patient- and operation-specific care.

Copyright © 2018 by ASME
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References

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Figures

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Fig. 1

Degrees-of-freedom and workspace of bipolar electrosurgical tools. Left: DOF of currently clinical available electrosurgical tools. Right: DOF of the proposed minimally invasive bipolar electrosurgical instrument. Number indications: 1: axial rotation, 2: axial translation or sliding, 3 and 4: radial rotation or pivoting in two perpendicular planes, 5: pivoting of the instrument tip, and 6: pivoting of the instrument tip in a perpendicular plane to 5.

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Fig. 2

Tip requirements of the proposed minimally invasive bipolar electrosurgical instrument. The tip should contain two movable jaws out of a conducting material with a tip profile to increase grip on the tissue. The movable jaws should open up to at least 60 deg. An insulating layer separates the two movable jaws.

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Fig. 3

Final tip design working principle. Left: tip in the closed (0 deg) configuration with the tip joint in the minimum curve angle (straight: 0 deg). An insulating plate is present to prevent short-circuiting the instrument. Middle: tip in the open (180 deg) configuration with the tip joint in the minimum curve angle (straight: 0 deg). Right: tip in the closed (0deg) configuration with the tip joint in the maximum curve angle (±90 deg). The steering ribbon for the more proximal joint is connected to the shaft between the joints using a hook.

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Fig. 4

Final shaft design. Left: total shaft design. Middle: distal end of shaft with the rounded rectangular lumens for the electrode cables and steering ribbons and the cylindrical recess for the planar joint. Right: proximal end of shaft with the rounded rectangular lumens for the electrode cables and steering ribbons, the cylindrical recess for mirrored planar joint, two fork structures to increase the stability of the joint, and stops to prevent over-bending the joints.

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Fig. 5

Final handle design. The handle allows for steering the two joints by mirroring the joint in the handle, opening and closing of the tip jaws, tensioning the steering ribbons and electrode cables, and connecting the electrosurgical unit. Left: total handle design in the closed configuration. Middle: Handle in the open configuration. Right; exploded view of the handle.

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Fig. 6

Final design. The final design consists of two movable tip jaws, joint 1 to move the tip up- and downward with curve angles of ±90 deg, joint 2 to move the tip sideways (left-right) with curve angles of ±65 deg, a rectangular 5 mm shaft to guide the steering ribbons and electrode cables toward the handle, the two mirrored joints in the handle, two ring handle parts to open and close the tip jaws, two tension mechanisms to tension the electrode cables (consisting of a tension bolt and ring; situated in the handle) and steering ribbons (consisting of a rectangular box, a tension plate and M2 set screw; situated in the mirrored joint 1), 2 Ø0.45 mm electrode cables, and 2 (4 mm wide; 0.2 mm thick) polymeric steering ribbons.

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Fig. 7

Exploded view of the final prototype. The final design consists of the two titanium movable tip jaws, joint 1 to move the tip sideways (left-right) with curve angles of ±65 deg, joint 2 to move the tip up- and downward with curve angles of ±90 deg, a rectangular 5 mm shaft to guide the steering ribbons and electrode cables toward the handle, the two mirrored joints in the handle, two ring handle parts to open and close the tip jaws, two tension mechanisms to tension the electrode cables (consisting of a titanium tension bolt and ring; situated in the handle) and steering ribbons (consisting of a stainless steel rectangular box, a stainless steel tension plate and stainless steel M2 set screw; situated in the mirrored joint 1), 2 Ø0.45 mm electrode cables (biocompatible stainless steel AISI 316 1 × 7 cables [LI000017, Carl Stahl Technocables GmbH, Süssen, Germany]), and 2 (4 mm wide; 0.2 mm thick) polymeric steering ribbons.

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Fig. 8

Final prototype. Top: prototype with open tip jaws. Middle: prototype with joint 2 in the maximum curve angle of approximately 85 deg. Bottom: prototype with joint 1 in the maximum curve angle of 65 deg.

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Fig. 9

Schematic representation of the experimental facility movement and mechanical strength and electrosurgical functionalities tests. Top: input–output angle measurement facility consisting of the prototype placed above two protractors and a camera to record the joint angles. Bottom left: bending stiffness measurement facility consisting of the prototype clamped horizontally in the universal testing machine (LS100, Lloyd Instruments, Bognor Regis, UK). Bottom right: the experimental facility for the electrosurgical facility test consisted of the prototype connected to an electrosurgical unit (ICC300, Erbe GmbH, Werkendam, The Netherlands), an infrared camera (LSLT, Optris, Berlin, Germany), and a piece of tofu or pig liver.

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Fig. 10

Electrosurgical grasper coagulating a piece of pig liver. Left: the electrosurgical grasper with pieces of coagulated pig liver (see the cyan rectangle). Middle: infrared image of the grasper during coagulation. Right: graph of the tissue temperature over the time. The temperature of the pig liver reached approximately 75 °C with an activation time of only 5 s, coagulating and desiccating the liver between the tip jaws. The power was set to 80 W.

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Fig. 11

Fundamental joint categorization. The conductive material is indicated with dashed surfaces. The insulating material is indicated with the lightly shaded surfaces. The sealing is indicated with the darkly shaded rectangular surfaces.

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Fig. 12

Fundamental joint categorization based on printability. The one-piece completely conducting joint, one-piece partially conducting joint, and multipiece partially conducting joint are eliminated as flexible conducting materials are currently notavailable for 3D-printing and multimaterial printing is still limited. The conductive material is indicated by the dashed surfaces. The insulating material is indicated by the lightly shaded surfaces. The sealing is indicated by the darkly shaded slender rectangular surfaces at the outer edges of the joint.

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Fig. 13

Fundamental joint design. Top left: one-piece (compliant) planar joint. Top Middle: one-piece (compliant) universal joint. Top right: one-piece (compliant) spherical joint. Bottom left: multipiece planar joint. Bottom middle: multipiece universal joint. Bottom right: multipiece spherical joint.

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Fig. 14

Fundamental joint categorization based on printability and design requirements. The conductive material is indicated by the (dashed) darkly shaded surfaces. The insulating material is indicated by the lightly shaded surfaces. The sealing is indicated by the darkly shaded rectangular surfaces at the outer edges of the joints.

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Fig. 15

Bipolar versions of the Joint designs. Top row from left to right: multipiece completely conducting planar joint (2x), multipiece nonconducting planar joint (2x) with internal electrodes, and multipiece nonconducting planar joint (2x) with external electrodes. Bottom row from left to right: multipiece completely conducting universal joint, multipiece nonconducting universal joint with internal electrodes, and multipiece nonconducting universal joint with external electrodes. Due to the inability to print the multipiece completely conducting joints and the preference that the electrode cables are guided through the instrument, the multipiece nonconducting joints with internal electrodes will be developed further (indicated by the black rectangular boxes). The conductive material is indicated by the darkly shaded surfaces. The insulating material is indicated by the lightly shaded surfaces. The sealing is indicated by the darkly shaded slender rectangular surfaces at the outer edges of the joints. The completely conducting joints are subdivided into an active and return electrode. In the nonconducting joints, the active and return electrode are indicated with the dashed slender rectangular surfaces.

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Fig. 16

Scaled prototype multipiece nonconduction universal joint. Left: renderings of the multipiece nonconduction universal joint consisting of two “shafts” with rounded cylindrical recesses and a spherical cross. Right: scaled (3x) printed prototype. The arrow indicates the weakest part of the prototype, which, when printed on a 5 mm scale, will be too weak. Therefore, this design was eliminated.

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Fig. 17

Conceptual one-piece nonconduction planar joint design

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Fig. 18

Optimization of the one-piece nonconduction planarjoint design; from cables to a ribbon

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Fig. 19

Optimization of the one-piece nonconduction planar joint design: tip and joint integration

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