Research Papers

A Specimen Extraction Instrument Based on Braided Fiber Tube for Natural Orifice Translumenal Endoscopic Surgery

[+] Author and Article Information
Jinhua Li

Key Laboratory for Mechanism Theory and
Equipment Design of Ministry of Education,
Tianjin University,
Tianjin 300072, China
e-mail: lijinhua@tju.edu.cn

Zemin Zhang

Key Laboratory for Mechanism Theory and
Equipment Design of Ministry of Education,
Tianjin University,
Tianjin 300072, China
e-mail: zmzhang0526@tju.edu.cn

Shuxin Wang

Key Laboratory for Mechanism Theory and
Equipment Design of Ministry of Education,
Tianjin University, Tianjin 300072, China
e-mail: shuxinw@tju.edu.cn

Zufeng Shang

Key Laboratory for Mechanism Theory and
Equipment Design of Ministry of Education,
Tianjin University,
Tianjin 300072, China
e-mail: szf_rai@tju.edu.cn

Guokai Zhang

Key Laboratory for Mechanism Theory and
Equipment Design of Ministry of Education,
Tianjin University, Tianjin 300072, China
e-mail: zhang_gk@tju.edu.cn

1Corresponding author.

Manuscript received January 26, 2018; final manuscript received June 17, 2018; published online July 24, 2018. Assoc. Editor: Venketesh Dubey.

J. Med. Devices 12(3), 031008 (Jul 24, 2018) (8 pages) Paper No: MED-18-1017; doi: 10.1115/1.4040638 History: Received January 26, 2018; Revised June 17, 2018

Natural orifice translumenal endoscopic surgery (NOTES) has offered significant advantages of less pain, reduced recovery time, and minimized scar after operation, demonstrating a promising development prospect. However, the large-size specimen extraction remains challenging for NOTES, due to the narrow space of the human natural orifices. To address such difficulties, a specimen extraction method that utilizes the braided fiber tube (BFT) structure with excellent retractility to accommodate and bind the bulky specimen has been proposed. Based on the theory of helical spring, the geometric model and the mechanical model of the BFT are established, and experiments have been performed to verify the accuracy of the derived mechanical model. In addition, a tensile test of using the BFT to extract large specimens via a small channel is carried out, which verifies the stable extraction performance of the proposed design. The BFT will not be damaged when extracting the specimen with a diameter less than 1.75 times of the channel diameter. A NOTES-specific specimen extraction instrument is designed according to the characteristics of NOTES, and it has three degrees-of-freedom and is able to actively capture different specimen by using a suction cup. Finally, specimen extraction experiments on NOTES multitasking platform phantom have been conducted using the prototyped instrument to validate its feasibility and effectiveness.

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Pearl, J. P. , and Ponsky, J. L. , 2008, “ Natural Orifice Translumenal Endoscopic Surgery: A Critical Review,” J. Gastrointest. Surg., 12(7), pp. 1293–1300. [CrossRef] [PubMed]
Sg, D. L. F. , Demaria, E. J. , Reynolds, J. D. , Portenier, D. D. , and Pryor, A. D. , 2007, “ New Developments in Surgery: Natural Orifice Transluminal Endoscopic Surgery (NOTES),” Arch. Surg., 142(3), pp. 295–297. [CrossRef] [PubMed]
Nesargikar, P. N. , and Jaunoo, S. S. , 2009, “ Natural Orifice Translumenal Endoscopic Surgery (NOTES),” Int. J. Surg., 7(3), pp. 232–236. [CrossRef] [PubMed]
Rattner, D. , and Kalloo, A. , 2006, “ ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery,” Surg. Endoscopy Other Interventional Tech., 20(2), pp. 329–333. [CrossRef]
Lima, E. , Rolanda, C. , Pego, J. M. , Henriques-Coelho, T. , Silva, D. , Carvalho, J. L. , and Correia-Pinto, J. , 2006, “ Transvesical Endoscopic Peritoneoscopy: A Novel 5 Mm Port for Intra-Abdominal Scarless Surgery,” J. Urol., 176(2), pp. 802–805. [CrossRef] [PubMed]
Mcgee, M. F. , Rosen, M. J. , Marks, J. , Onders, R. P. , Chak, A. , Faulx, A. , Chen, V. K. , and Ponsky, J. , 2006, “ A Primer on Natural Orifice Translumenal Endoscopic Surgery: Building a New Paradigm,” Surg. Innovation, 13(2), pp. 86–93. [CrossRef]
Zuo, S. Y. , and Wang, S. X. , 2016, “ Current and Emerging Robotic Assisted Intervention for NOTES,” Expert Rev. Med. Devices, 13(12), pp. 1095–1105. [CrossRef] [PubMed]
Daher, R. , Chouillard, E. , and Panis, Y. , 2014, “ New Trends in Colorectal Surgery: Single Port and Natural Orifice Techniques,” World J. Gastroenterol., 20(48), pp. 18104–18120. [CrossRef] [PubMed]
Santos, B. F. , and Hungness, E. S. , 2011, “ Natural Orifice Translumenal Endoscopic Surgery: Progress in Humans Since White Paper,” World J. Gastroenterol., 17(13), pp. 1655–1665. [CrossRef] [PubMed]
Sumer, F. , Kayaalp, C. , Polat, Y. , Ertugrul, I. , and Karagul, S. , 2016, “ Transgastric Removal of a Polycystic Liver Disease Using Mini-Laparoscopic Excision,” Interventional Med. Appl. Sci., 8(2), pp. 89–92. [CrossRef]
Wei, D. , Han, Y. , Li, M. , Wang, Y. , Chen, Y. , Luo, Y. , and Jiang, Y. G. , 2016, “ Pure Retroperitoneal Natural Orifice Translumenal Endoscopic Surgery (NOTES) Transvaginal Nephrectomy Using Standard Laparoscopic Instruments: A Safety and Feasibility Study in a Porcine Model,” BMC Urol., 16(1), pp. 1–6. [CrossRef] [PubMed]
Firaza, P. N. , Lorenzo, E. I. , Rd, B. J. , Reyes, E. L. , and Patron, N. A. , 2016, “ Hybrid Natural Orifice Translumenal Endoscopic Surgery Transvaginal Nephrectomy in a Low-Resource Setting,” J. Laparoendosc. Adv. Surg. Tech. A, 26(2), pp. 99–102. [CrossRef] [PubMed]
Schellpfeffer, M. A. , 2011, “ A Novel Laparoscopic Tissue Retrieval Device,” J. Soc. Laparoendosc. Surg., 15(4), pp. 527–532. [CrossRef]
Smorgick, N. , 2014, “ Laparoscopic Specimen Retrieval Bags,” J. Obstet. Gynecol. India, 64(5), pp. 370–372. [CrossRef]
Isakov, A. , Murdaugh, K. M. , Burke, W. C. , Zimmerman, S. , Roche, E. , Holland, D. , Einarsson, J. I. , and Walsh, C. J. , 2014, “ A New Laparoscopic Morcellator Using an Actuated Wire Mesh and Bag,” ASME J. Med. Devices, 8(1), pp. 1113–1121. [CrossRef]
Singh, M. , and Rastogi, A. , 2013, “ Endoloop-Assisted Polypectomy Technique,” Video J. Encycl. GI Endoscopy, 1(2), pp. 323–324. [CrossRef]
Rengen, M. R. , and Adler, D. G. , 2006, “ Detachable Snares (Endoloop),” Tech. Gastrointest. Endoscopy, 8(1), pp. 12–15. [CrossRef]
Palanivelu, C. , Rajan, P. S. , Rangarajan, M. , Parthasarathi, R. , Senthilnathan, P. , and Prasad, M. , 2008, “ Transvaginal Endoscopic Appendectomy in Humans: A Unique Approach to NOTES—World's First Report,” Surg. Endoscopy, 22(5), pp. 1343–1347. [CrossRef]
Zorron, R. , Filgueiras, M. , Maggioni, L. C. , Pombo, L. , Lopes, C. G. , and Lacerda, O. A. , 2007, “ NOTES. Transvaginal Cholecystectomy: Report of the First Case,” Surg. Innovation, 14(4), pp. 279–283. [CrossRef]
Decarli, L. , Zorron, R. , Branco, A. , Lima, F. C. , Tang, M. , Pioneer, S. R. , Zahin , I., Jr , Schulte, A. A. , Bigolin, A. V. , and Gagner, M. , 2008, “ Natural Orifice Translumenal Endoscopic Surgery (NOTES) Transvaginal Cholecystectomy in a Morbidly Obese Patient,” Obesity Surg., 18(7), pp. 886–889. [CrossRef]
Hu, J. , 2008, 3-D Fibrous Assemblies: Properties, Applications and Modelling of Three-Dimensional Textile Structures, CRC Press/Woodhead Publishing, Boca Raton, FL.
Ma, D. , Dargush, G. F. , Natarajan, S. K. , Levy, E. I. , Siddiqui, A. H. , and Meng, H. , 2012, “ Computer Modeling of Deployment and Mechanical Expansion of Neurovascular Flow Diverter in Patient-Specific Intracranial Aneurysms,” J. Biomech., 45(13), pp. 2256–2263. [CrossRef] [PubMed]
Bouillot, P. , Brina, O. , Ouared, R. , Yilmaz, H. , Farhat, M. , Erceg, G. , Lovblad, K. O. , Vargas, M. I. , Kulcsar, Z. , and Pereira, V. M. , 2016, “ Geometrical Deployment for Braided Stent,” Med. Image Anal., 30, pp. 85–94. [CrossRef] [PubMed]
Jedwab, M. R. , and Clerc, C. O. , 1993, “ A Study of the Geometrical and Mechanical Properties of a Self-Expanding Metallic Stent—Theory and Experiment,” J. Appl. Biomater., 4(1), pp. 77–85. [CrossRef] [PubMed]
Garbey, M. , Salmon, R. , Fikfak, V. , and Clerc, C. O. , 2016, “ Esophageal Stent Migration: Testing Few Hypothesis With a Simplified Mathematical Model,” Comput. Biol. Med., 79, pp. 259–265. [CrossRef] [PubMed]
De, B. M. , Van, C. S. , Mortier, P. , Van, L. D. , Van, I. R. , Verdonck, P. , and Verhegghe, B. , 2009, “ Virtual Optimization of Self-Expandable Braided Wire Stents,” Med. Eng. Phys., 31(4), pp. 448–453. [CrossRef] [PubMed]
Stipa, F. , Burza, A. , Curinga, R. , Santini, E. , Delle, S. P. , Avantifiori, R. , and Picchio, M. , 2015, “ Laparoscopic Colon and Rectal Resections With Intracorporeal Anastomosis and Transvaginal Specimen Extraction for Colorectal Cancer. A Case Series and Systematic Literature Review,” Int. J. Colorectal Dis., 30(7), pp. 955–962. [CrossRef] [PubMed]
Diana, M. , Perretta, S. , Wall, J. , Costantino, F. A. , Leroy, J. , Demartines, N. , and Marescaux, J. , 2011, “ Transvaginal Specimen Extraction in Colorectal Surgery: Current State of the Art,” Colorectal Dis., 13(6), pp. 104–111. [CrossRef]
Leung, A. L. H. , Cheung, H. Y. S. , and Li, M. K. W. , 2014, “ Advances in Laparoscopic Colorectal Surgery: A Review on NOTES and Transanal Extraction of Specimen,” Asian J. Endoscopic Surg., 7(1), pp. 11–16. [CrossRef]
Han, F. H. , Hua, L. X. , Zhao, Z. , Wu, J. H. , and Zhan, W. H. , 2013, “ Transanal Natural Orifice Specimen Extraction for Laparoscopic Anterior Resection in Rectal Cancer,” World J. Gastroenterol., 19(43), pp. 7751–7757. [CrossRef] [PubMed]


Grahic Jump Location
Fig. 4

A simplified mechanical model of the BFT carrying a specimen into a channel

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Fig. 3

Schematic of specimen extraction with a BFT in NOTES: (a) the specimen extraction instrument with a BFT arrives at the abdominal cavity via a channel of the NOTES multitasking platform, (b) the operator uses the wire to control the end pose of the instrument and the diameter of the BFT so that the BFT can get close to the specimen tissues, (c) the instrument captures the specimen tissues actively, and (d) the instrument carries the large specimen out via the smaller channel

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Fig. 2

Geometric parameters of the BFT: (a) geometric parameters of the BFT under the action of a load and (b) initial geometric parameters of the BFT

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Fig. 1

Some shortcomings of current specimen extraction processes: (a) specimen retrieval bags with a stiff introducer tube are not suitable for NOTES, (b) it is hard for the snare to capture small or spherical specimens, and natural orifice walls will be unevenly pressed and rubbed when using the snare to extract larger specimens, and (c) both specimen retrieval bag and snare have to cooperate with other surgical instruments to capture the specimen, which is difficult to operate in the narrow surgical space for NOTES

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Fig. 5

The relationship between theoretical maximum diameter, initial diameter, and initial braid angle

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Fig. 11

Prototype of the instrument and demonstration of the end bending angle

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Fig. 12

Prototype simulation experiment: (a) prototype of the instrument arrives at virtual abdominal cavity via a 10 mm diameter tube, (b) by adjusting the pose of the prototype, the suction cup captures the specimen and places it in the BFT, without any assistance, (c) the instrument carries the large specimen out via the tube, and (d) the shape of the specimen is close to cylindrical

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Fig. 6

Experimental setting for mechanical model

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Fig. 7

Test results for the mechanical model: (a) force–displacement curve of a cylindrical rigid body with the diameter of 11 mm, (b) experimental results of using a BFT with a 0.5 mm wire diameter, and (c) experimental results of using a BFT with a 0.8 mm wire diameter

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Fig. 8

Experimental setting for specimen extraction

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Fig. 9

Test results for specimen extraction

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Fig. 10

Assembly drawings of instrument: (a) the deployment of the wire in the connector, (b) the deployment of the wire from the inside to the outside of the multilumen tube, (c) partially enlarged view of the instrument, and (d) BFT and the wires fixed on the slide tube. (1) polyurethane yubing, (2) knob, (3), wire connected to flexible joint, (4) hinge, (5) handle, (6) ring, (7) wire connected to slide tube, (8) connector, (9) multilumen tube, (10) slide tube, (11) spring, (12) BFT, (13) wire steering sleeve, (14) flexible joints, (15) silicone tube, and (16) suction cup.



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