Research Papers

Design and Modeling of a Three-Degree-of-Freedom Articulating Robotic Microsurgical Forceps for Trans-Oral Laser Microsurgery

[+] Author and Article Information
Manish Chauhan

Storm Lab, School of Electronics and
Electrical Engineering,
University of Leeds,
Leeds LS2 9JT, UK
e-mail: m.chauhan@leeds.ac.uk

Nikhil Deshpande

Advanced Robotics Department,
Istituto Italiano di Tecnologia,
Via Morego, 30,
Genova 16163, Italy
e-mail: nikhil.deshpande@iit.it

Darwin G. Caldwell

Advanced Robotics Department,
Istituto Italiano di Tecnologia,
Via Morego, 30,
Genova 16163, Italy
e-mail: darwin.caldwell@iit.it

Leonardo S. Mattos

Advanced Robotics Department,
Istituto Italiano di Tecnologia,
Via Morego, 30,
Genova 16163, Italy
e-mail: leonardo.mattos@iit.it

1Corresponding author.

Manuscript received September 18, 2018; final manuscript received February 25, 2019; published online April 4, 2019. Assoc. Editor: Venketesh Dubey.

J. Med. Devices 13(2), 021006 (Apr 04, 2019) (9 pages) Paper No: MED-18-1170; doi: 10.1115/1.4043017 History: Received September 18, 2018; Revised February 25, 2019

Trans-oral laser microsurgery (TLM) is a surgical procedure for removing malignancies (e.g., cysts, polyps, tumors) of the laryngeal region through laser ablation. Intraoperative microsurgical forceps (i.e., microforceps) are used for tissue manipulation. The microforceps are rigid, single degree-of-freedom (DOF) devices (open–close) with precurved jaws to access different parts of the curved cylindrical laryngeal region. These microforceps are manually handled and are subject to hand tremors, poor reachability, and nonergonomic use, resulting in poor efficacy and efficiency in the surgery. A novel 3DOF motorized microforceps device is presented here, integrated with a 6DOF serial robotic manipulator. The device, referred to as RMF-3, offers three motorized DOFs: (i) open–close forceps jaw; (ii) tool rotation; and (iii) tool-tip articulation. It is designed to be compliant with TLM spatial constraints. The manual handling is replaced by tele-operation device, the omega.7. The design of the RMF-3 is characterized through theoretical and experimental analysis. The device shows a maximum articulation of 38 deg and tool rotation of 100 deg. Its performance is further evaluated through user trials using the ring-in-loop setup. The user trials demonstrate benefits of the 3DOF workspace of the device along with its teleoperation control. RMF-3 offers an improved workspace and reachability within the laryngeal region. Surgeons, in their preliminary evaluation of the device, appreciated the ability to articulate the tip, along with rotation, for hard-to-reach parts of the surgical site. RMF-3 offers an ergonomic robotic teleoperation control interface which overcomes hand tremors and extreme wrist excursion which leads to surgeon pain and discomfort.

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Jako, G. J. , 1972, “ Laser Surgery of the Vocal Cords an Experimental Study With Carbon Dioxide Lasers on Dogs,” Laryngoscope, 82(12), pp. 2204–2216. [CrossRef] [PubMed]
Simaan, N. , Taylor, R. , and Flint, P. , 2004, “ A Dexterous System for Laryngeal Surgery,” IEEE International Conference on Robotics and Automation (ICRA'04), New Orleans, LA, Apr. 26–May 1, pp. 351–357.
Simaan, N. , Xu, K. , Wei, W. , Kapoor, A. , Kazanzides, P. , Taylor, R. , and Flint, P. , 2009, “ Design and Integration of a Telerobotic System for Minimally Invasive Surgery of the Throat,” Int. J. Rob. Res., 28(9), pp. 1134–1153. [CrossRef] [PubMed]
Wang, S. , Li, Q. , Ding, J. , and Zhang, Z. , 2006, “ Kinematic Design for Robot-Assisted Laryngeal Surgery Systems,” IEEE/RSJ International Conference on Intelligent Robots and Systems, Beijing, China, Oct. 9–15, pp. 2864–2869.
Rivera‐Serrano, C. M. , Johnson, P. , Zubiate, B. , Kuenzler, R. , Choset, H. , Zenati, M. , Tully, S. , and Duvvuri, U. , 2012, “ A Transoral Highly Flexible Robot: Novel Technology and Application,” Laryngoscope, 122(5), pp. 1067–1071. [CrossRef] [PubMed]
Intuitive Surgical, 2019, “ Da Vinci Surgical System From Intuitive Surgical,” accessed Mar. 20, 2019, https://www.intuitive.com/en-us/products-and-services/da-vinci
Solares, C. A. , and Strome, M. , 2007, “ Transoral Robot‐Assisted CO2 Laser Supraglottic Laryngectomy: Experimental and Clinical Data,” Laryngoscope, 117(5), pp. 817–820. [CrossRef] [PubMed]
Desai, S. C. , Sung, C. K. , Jang, D. W. , and Genden, E. M. , 2008, “ Transoral Robotic Surgery Using a Carbon Dioxide Flexible Laser for Tumors of the Upper Aerodigestive Tract,” Laryngoscope, 118(12), pp. 2187–2189. [CrossRef] [PubMed]
He, C. , Olds, K. , Iordachita, I. , and Taylor, R. , 2013, “ A New ENT Microsurgery Robot: Error Analysis and Implementation,” IEEE International Conference on Robotics and Automation (ICRA), Karlsruhe, Germany, May 6–10, pp. 1221–1227.
Bedell, C. , Lock, J. , Gosline, A. , and Dupont, P. E. , 2011, “ Design Optimization of Concentric Tube Robots Based on Task and Anatomical Constraints,” IEEE International Conference on Robotics and Automation (ICRA), Shanghai, China, May 9–13, pp. 398–403.
Breedveld, P. , 2010, “ Steerable Laparoscopic Cable-Ring Forceps,” ASME J. Med. Devices, 4(2), p. 027518. [CrossRef]
Mols, B. , 2005, “ Movable Tool Kit for Keyhole Surgery,” Delft Outlook, 2005, p. 3. https://www.narcis.nl/publication/RecordID/oai:tudelft.nl:uuid:97f9b553-4bae-4d35-b558-5f221ec9e84e
Nai, T. Y. , Herder, J. L. , and Tuijthof, G. J. , 2011, “ Steerable Mechanical Joint for High Load Transmission in Minimally Invasive Instruments,” ASME J. Med. Devices, 5(3), p. 034503. [CrossRef]
Harada, K. , Tsubouchi, K. , Fujie, M. G. , and Chiba, T. , 2005, “ Micro Manipulators for Intrauterine Fetal Surgery in an Open MRI,” IEEE International Conference on Robotics and Automation (ICRA), Barcelona, Spain, Apr. 18–22, pp. 502–507.
Shang, J. , Noonan, D. P. , Payne, C. , Clark, J. , Sodergren, M. H. , Darzi, A. , and Yang, G. Z. , 2011, “ An Articulated Universal Joint Based Flexible Access Robot for Minimally Invasive Surgery,” IEEE International Conference on Robotics and Automation (ICRA), Shanghai, China, May 9–13, pp. 1147–1152.
Hong, M. B. , and Jo, Y. H. , 2014, “ Design of a Novel 4-DOF Wrist-Type Surgical Instrument With Enhanced Rigidity and Dexterity,” IEEE/ASME Trans. Mechatronics, 19(2), pp. 500–511. [CrossRef]
Hammond, F. L. , Howe, R. D. , and Wood, R. J. , 2013, “ Dexterous High-Precision Robotic Wrist for Micromanipulation,” 16th International Conference on Advanced Robotics (ICAR), Montevideo, Uruguay, Nov. 24–29, pp. 1–8.
Gerboni, G. , Henselmans, P. W. , Arkenbout, E. A. , van Furth, W. R. , and Breedveld, P. , 2015, “ HelixFlex: A Bioinspired Maneuverable Instrument for Skull Base Surgery,” Bioinspiration Biomimetics, 10(6), pp. 1–17. [CrossRef]
Arkenbout, E. , Henselmans, P. J. , Jelinek, F. , and Breedveld, P. , 2015, “ A State of the Art Review and Categorization of Multi-Branched Instruments for NOTES and SILS,” Surg. Endoscopy, 29(6), pp. 1281–1296. [CrossRef]
Jelinek, 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. Devices, 9(1), p. 010801. [CrossRef]
York, P. A. , Swaney, P. J. , Gilbert, H. B. , and Webster, R. J. , 2015, “ A Wrist for Needle-Sized Surgical Robots,” IEEE International Conference on Robotics and Automation (ICRA), Seattle, WA, May 26–30, pp. 1776–1781.
Fischer, H. , Vogel, B. , Pfleging, W. , and Besser, H. , 1999, “ Flexible Distal Tip Made of Nitinol (NiTi) for a Steerable Endoscopic Camera System,” Mater. Sci. Eng.: A, 273–275, pp. 780–783. https://doi.org/10.1016/S0921-5093(99)00415-3
Kutzer, M. D. , Segreti, S. M. , Brown, C. Y. , Armand, M. , Taylor, R. H. , and Mears, S. C. , 2011, “ Design of a New Cable-Driven Manipulator With a Large Open Lumen: Preliminary Applications in the Minimally-Invasive Removal of Osteolysis,” IEEE International Conference on Robotics and Automation (ICRA), Shanghai, China, May 9–13, pp. 2913–2920.
Wei, D. , Wenlong, Y. , Dawei, H. , and Zhijiang, D. , 2012, “ Modeling of Flexible Arm With Triangular Notches for Applications in Single Port Access Abdominal Surgery,” IEEE International Conference on Robotics and Biomimetics (ROBIO), Guangzhou, China, Dec. 11–14, pp. 588–593.
Haga, Y. , Muyari, Y. , Goto, S. , Matsunaga, T. , and Esashi, M. , 2011, “ Development of Minimally Invasive Medical Tools Using Laser Processing on Cylindrical Substrates,” Electr. Eng. Jpn., 176(1), pp. 65–74. [CrossRef]
Bell, J. A. , Saikus, C. E. , Ratnayaka, K. , Wu, V. , Sonmez, M. , Faranesh, A. Z. , Colyer, J. H. , Lederman, R. J. , and Kocaturk, O. , 2012, “ A Deflectable Guiding Catheter for Real‐Time MRI‐Guided Interventions,” J. Magn. Reson. Imaging, 35(4), pp. 908–915. [CrossRef] [PubMed]
Scali, M. , Pusch, P. T. , Dodou, D. , and Breedveld, P. , 2017, “ Needle-Like Instruments for Steering Through Solid Organs: A Review of the Scientific and Patent Literature,” J. Eng. Med., 231(3), pp. 250–265. [CrossRef]
Deshpande, N. , Chauhan, M. , Pacchierotti, C. , Prattichizzo, D. , Caldwell, D. G. , and Mattos, L. S. , 2016, “ Robot-Assisted Microsurgical Forceps With Haptic Feedback for Transoral Laser Microsurgery,” IEEE 38th Annual International Conference of the Engineering in Medicine and Biology Society (EMBC), Orlando, FL, Aug. 16–20, pp. 5156–5159.
Chauhan, M. , Deshpande, N. , Barresi, G. , Pacchierotti, C. , Prattichizzo, D. , Caldwell, D. G. , and Mattos, L. S. , 2017, “ Design and Control of a Novel Robotic Microsurgical Forceps for Transoral Laser Microsurgery,” IEEE International Conference on Advanced Intelligent Mechatronics (AIM), Munich, Germany, July 3–7, pp. 737–742.
Chauhan, M. , Deshpande, N. , Pacchierotti, C. , Meli, L. , Prattichizzo, D. , Caldwell, D. G. , and Mattos, L. S. , 2018, “ A Robotic Microsurgical Forceps for Transoral Laser Microsurgery,” Int. J. Comput. Assisted Radiol. Surg., pp. 1–13.
Brown, S. , Ngan, E. , and Liotti, M. , 2008, “ A Larynx Area in the Human Motor Cortex,” Cereb. Cortex, 18(4), pp. 837–845. [CrossRef] [PubMed]


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Fig. 1

Trans-oral laser microsurgery surgical dimensional overview: (a) traditional access of vocal region, (b) vocal anatomy, and (c) expected access

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Fig. 2

Dimensional requirements of microsurgical forceps in TLM

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Fig. 3

The tool shaft (a) traditional tool dimensions, (b) exploded view of proposed tool, and (c) proposed tool dimensions

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Fig. 4

The tool shaft holder

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Fig. 5

Tool jaw open/close DOF

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Fig. 6

Rotational DOF: (a) subcomponent overview, (b) miter gear, (c) spur gear, and (d) modification in link 5

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Fig. 7

Tool shaft articulation

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Fig. 8

Force measurement experimental setup

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Fig. 9

Force required versus articulation angle

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Fig. 10

Tool shaft rotation characterization (a) without tendon wire and (b) with tendon wire

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Fig. 11

User evaluation setup

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Fig. 12

Number of error over trials

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Fig. 14

Workspace achieved with RMF-3

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Fig. 15

Trials this with surgeons



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