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Design Innovation Paper

Novel Miniature Tip Design for Enhancing Dexterity in 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

Awaz Ali

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

Jovana Janjic

Department Biomedical Engineering,
Erasmus Medical Center,
P.O. Box 2040,
Rotterdam 3000 CA, The Netherlands
e-mail: j.janjic@erasmusmc.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 August 4, 2017; final manuscript received June 4, 2018; published online July 24, 2018. Assoc. Editor: Carl Nelson.

J. Med. Devices 12(3), 035002 (Jul 24, 2018) (9 pages) Paper No: MED-17-1277; doi: 10.1115/1.4040636 History: Received August 04, 2017; Revised June 04, 2018

Even though technological advances have increased the application area of minimally invasive surgery (MIS), there are still hurdles to allow for widespread adoption for more complex procedures. The development of steerable instruments, in which the surgeon can alter the tip orientation, has increased the application area of MIS, but they are bulky, which limits their ability to navigate through narrow environments, and complex, which complicates miniaturization. Furthermore, they do not allow for navigating through complex anatomies. In an effort to improve the dexterity of the MIS instruments, while minimizing the outer dimensions, the previously developed cable-ring mechanism was redesigned, resulting in the thinnest, Ø 2 mm (Ø 1 mm lumen), eight degrees-of-freedom (DOF) multisteerable tip for MIS to date. The multisteerable tip consists of four steerable segments of 2DOF stackable elements allowing for ±90 deg articulation, as well the construction of complex shapes, actuated by 16 Ø 0.2 mm stainless steel cables. In a proof-of-principle experiment, an ultrasound transducer and optical shape sensing (OSS) fiber were inserted in the lumen, and the multisteerable tip was used to perform scanning motions in order to reconstruct a wire frame in three-dimensional (3D). This configuration could in future be used to safely navigate through delicate environments and allow for tissue characterization. Therefore, the multisteerable tip has the potential to increase the application area of MIS in future, as it allows for improved dexterity, the ability to guide several tip tools toward the operation area, and the ability to navigate through tight anatomies.

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References

Fuchs, K. , 2002, “ Minimally Invasive Surgery,” Endoscopy, 34(2), pp. 154–159. [CrossRef] [PubMed]
Taylor, G. , Barrie, J. , Hood, A. , Culmer, P. , Neville, A. , and Jayne, D. , 2013, “ Surgical Innovations: Addressing the Technology Gaps in Minimally Invasive Surgery,” Trends Anaesth. Crit. Care, 3(2), pp. 56–61. [CrossRef]
Vitiello, V. , Lee, S.-L. , Cundy, T. P. , and Yang, G.-Z. , 2013, “ Emerging Robotic Platforms for Minimally Invasive Surgery,” IEEE Rev. Biomed. Eng., 6, pp. 111–126. [CrossRef] [PubMed]
Dogangil, G. , Davies, B. , and Rodriguez y Baena, F. R. , 2010, “ A Review of Medical Robotics for Minimally Invasive Soft Tissue Surgery,” Proc. Inst. Mech. Eng. H, 224(5), pp. 653–679. [CrossRef] [PubMed]
Reynoso, J. , Meyer, A. , Unnirevi, J. , and Oleynikov, D. , 2012, “ Robotics for Minimally Invasive Surgery (MIS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES),” Medical Robotics: Minimally Invasive Surgery, Woodhead Publishing Limited, Philadelphia, PA, pp. 210–230. [CrossRef]
IntuitiveSurgical, 2016, “ EndoWrist Instruments,” Intuitive Surgical, Sunnyvale, CA, accessed May 1, 2017, http://www.intuitivesurgical.com/products/instruments/
News Medical Life Sciences, 2007, “ Anatomy Laparo-Angle Instrumentation from Cambridge Endo,” News Medical Life Sciences, Manchester, UK, accessed July 5, 2018, https://www.news-medical.net/news/2007/04/20/23917.aspx
Catherine, J. , Rotinat-Libersa, C. , and Micaelli, A. , 2011, “ Comparative Review of Endoscopic Devices Articulations Technologies Developed for Minimally Invasive Medical Procedures,” Appl. Bionics Biomech., 8(2), pp. 151–172. [CrossRef]
Anderson, P. L. , Lathrop, R. A. , and Webster , R. J., III , 2016, “ Robot-like Dexterity Without Computers and Motors: A Review of Hand-Held Laparoscopic Instruments With Wrist-Like Tip Articulation,” Expert Rev. Med. Device, 13(7), pp. 661–672. [CrossRef]
Jelínek, F. , Pessers, R. , and Breedveld, P. , 2014, “ DragonFlex Smart Steerable Laparoscopic Instrument,” ASME J. Med. Device, 8(1), p. 015001. [CrossRef]
Jelínek, F. , Arkenbout, E. A. , Henselmans, P. W. J. , Pessers, R. , and Breedveld, P. , 2015, “ Classification of Joints Used in Steerable Instruments for Minimally Invasive Surgery—A Review of the State of the Art,” ASME J. Med. Device, 9(1), p. 010801. [CrossRef]
Robinson, G. , and Davies, J. B. C. , 1999, “ Continuum Robots—A State of the Art,” IEEE International Conference on Robotics and Automation (ICRA), Detroit, MA, May 10–15, pp. 2849–2854.
Arkenbout, E. A. , Henselmans, P. W. J. , Jelínek, F. , and Breedveld, P. , 2015, “ A State of the Art Review and Categorization of Multi-Branched Instruments for NOTES and SILS,” Surg. Endosc., 29(6), pp. 1281–1296. [CrossRef] [PubMed]
Scali, M. , Pusch, T. P. , Breedveld, P. , and Dodou, D. , 2017, “ Needle-Like Instruments for Steering Through Solid Organs: A Review of the Scientific and Patent Literature,” Proc. Inst. Mech. Eng. H, 231(3), pp. 250–265. [CrossRef] [PubMed]
KLSMartin, 2016, “ MarCore,” KLSMartin, Freiburg, Germany, accessed May 1, 2017, https://www.klsmartin.com/catalog/de/
IntuitiveSurgical, 2015, “ EndoWrist/Single-Site Instrument & Accessoiry Catalog,” Intuitive Surgical, Sunnyvale, CA, accessed May 1, 2017, http://www.intuitivesurgical.com/assets/docs/1021625-EUrA_Si_System_I&A_Catalog_no_pricing_EU_highres.pdf
Breedveld, P. , and Scheltes, J. S. , 2008, “ Instrument for Fine-Mechanical or Surgical Applications,” U.S. Patent No. 20080234545 A1.
Breedveld, P. , Sheltes, J. , Blom, E. M. , and Verheij, J. E. , 2005, “ A New, Easily Miniaturized Steerable Endoscope,” IEEE Eng. Med. Biol. Mag., 24(6), pp. 40–47. [CrossRef] [PubMed]
Jelínek, F. , Gerboni, G. , Henselmans, P. W. J. , Pessers, R. , and Breedveld, P. , 2015, “ Attaining High Bending Stiffness by Full Actuation in Steerable Minimally Invasive Surgical Instruments,” Minim. Invasive Ther., 24(2), pp. 77–85. [CrossRef]
Janjic, J. , Leistikow, M. , Sakes, A. , and Soest, G. , 2016, “ 3D Imaging With a Single-Element Forward-Looking Steerable IVUS Catheter: Initial Testing,” IEEE International Ultrasonics Symposium (IUS), Tours, France, Sept. 18–21, pp. 1–4.
Younge, R. G. , Ramamurthy, B. S. , Tanner, N. , Schlesinger, R. L. , and Udd, E. , 2011, “ Optical Fiber Shape Sensing Systems,” Patent No. U.S. 8050523 B2.
Duncan, R. G. , Frogatt, M. E. , Kreger, S. T. , Seeley, R. J. , Gifford, D. K. , Sang, A. K. , and Wolfe, M. S. , 2007, “ High-Accuracy Fiber-Optic Shape Sensing,” Proc. SPIE, 6530, p. 65301S .
Fan, C. , Dodou, D. , and Breedveld, P. , 2013, “ Review of Manual Control Methods for Handheld Maneuverable Instruments,” Minim. Invasiv. Ther., 22(3), pp. 127–135. [CrossRef]

Figures

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Fig. 1

Multisteerable instrument design and functionality. Left: Steerable instrument tip. Right: Multisteerable instrument tip. Multisteerable instruments consist of at least two steerable segments stacked on top of each other. Each steering segment can be steered independent from the other(s), allowing the instrument to form complex shapes, such as S-curves, and to reach behind objects.

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Fig. 2

Schematic illustration of the patented cable-ring mechanism invented at Delft University of Technology [17]. The cable-ring mechanism consists of an outer compression spring, a ring of steering cables, and an inner compression spring.

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Fig. 3

Schematic illustration of the multisteerable tip of Multiflex. The tip of Multiflex has an outer diameter of Ø5 mm and consists of five 2DOF steerable segments; giving a total of 10DOF with a total curve angle up to 225 deg. Each steerable segment consists of two rounded cylinders that fit into a recess in the slotted cylinder; forming one pill-like element, and a ring with holes and two spherical recesses in which the pill-like elements rotate; forming ball-and-socket type joints. The slots in each white element allows for the precise attachment of four cables, resulting in a total of 20 steering cables. The holes in the green elements allow for cable guidance and alignment. A cap is placed on the distal end.

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Fig. 4

Multisteerable tip of Multiflex. The match is illustrated for scale purposes.

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Fig. 5

Schematic illustration of the multisteerable tip of Accura. The tip of Accura has an outer diameter of Ø2 mm and consists of four 2DOF steerable segments; giving a total of 8DOF, allowing for forming complex shapes and single radius curves with a total curve angle of up to 90 deg. Each steerable segment consists of two rounded slotted cylinders and two rings in which the rounded elements rotate; forming ball-and-socket type joints. The slots in the blue element allow for the attachment of four Ø0.2 mm stainless steel cables using glue and provide cable guidance.

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Fig. 6

Multisteerable tip of Accura. Top: Complex single-plane curve side view. Middle: single-plane 90 deg single-radius curve top view. Bottom: Complex 3D-curve side view. The match is illustrated for scale purposes.

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Fig. 7

Total Accura prototype. The Accura steering unit is designed to be easily attachable to a breadboard or optical table using two M6 screws. Each segment is controlled individually using four control elements. Each element can be locked individually to fixate the tip at any given shape or allow for a scanning motion. Amplification is minimized to allow for direct and precise control of the tip.

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Fig. 8

Exploded view of the control elements of the handle of Accura. A control element consists of an: outer cardan part (with a dial controlling sideways motion), inner cardan (with a dial controlling upward/downward motion), conus part (that guides the cables), two axles, four screws (not indicated), and a scale. The tip position can be locked in place by tightening the knobs on the dials. The cables are clamped between the inner cardan and conus part. To allow for smooth movement of the control elements, a bearing is placed over the main axis of the outer cardan part.

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Fig. 9

Sensor-enhanced navigating measurement set-up. Top: Multisteerable instrument Accura with the mounted forward-looking single-element forward-looking ultrasound transducer and integrated OSS fiber inserted in the water tank with the wire frame. Bottom: The measurement setup. The setup consisted of the multisteerable instrument Accura with the forward-looking single-element forward-looking ultrasound transducer incorporated at the tip and internal OSS fiber, a water tank (190 × 130 × 50 mm3 (l × w × h)) filled with demineralized water (not illustrated) and the wire frame, the forward-looking ultrasound signal acquisition setup (consisting of an oscilloscope, a pulse generator, a radiofrequency power amplifier, and an amplification unit), and the OSS system.

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Fig. 10

Wire phantom reconstruction based on the ultrasound signal and the OSS data. The six tungsten wires are reconstructed by fitting lines (black) through the green points, which illustrate the location in 3D space of the wires' ultrasound signal. The red arrows illustrate the scanning pattern of the instrument tip and its direction as obtained from the OSS system.

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Fig. 11

Bending stiffness measurement facility. The measurement setup consisted of the multisteerable instrument, a guiding structure to prevent movement of the instrument shaft, a mass connected to the tip to exert a sideways external force on the multisteerable tip, and a laser interferometer (OptoNCDT 1402, Micro-epsilon) to measure the tip deflection.

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Fig. 12

Multisteerable control strategies. Top: parallel single-segment control, in which each segment is controlled by a separate controller. This way, each segment can be controlled independently. Middle: serial single-segment control, in which each segment is controlled by a separate controller, but the motion of the controller (and thus the tip) is dependent on the position of the adjacent controllers. Bottom: integrated single-segment control, in which only the most distal segment is steered, while the other segments follow the “leader segment” passively.

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