A New Magnetic Camera-Robot Enabling a Multi-Instrument Procedure in Single Incision Laparoscopic Surgery: Preliminary Experience

Giancarlo Basili (1), MD, Pietro Valdastri (2), PhD MScEE, Dario Pietrasanta (1), MD, Irene Mosca (1), MD, Massimiliano Simi (2), MScBE, Arianna Menciassi (2), Prof, Paolo Dario (2), Prof, Orlando Goletti (1), Prof. General Surgery Unit, Pontedera Hospital, Health Unit 5 Pisa (1) – CRIM Lab, Research Center of Industrial BioEngineering, Scuola Superiore Sant’Anna, Pisa (2), ITALY

Background: Laparoscopic techniques have allowed surgeons to perform complicated intra-abdominal surgery with minimal trauma. Despite such a wide momentum currently surrounding “single access” procedures, this approach is considered to be a more complex procedure because it involves manipulating three articulating instruments through one access port. Concerning the vision system, a very promising approach to allow triangulation and to minimize both internal and external instrument collisions is represented by softly-tethered intra-abdominal cameras. Building on this background, we developed a softly-tethered miniaturized magnetic camera robot with an internal magnetic mechanism allowing for highly precise tilt control. Thanks to its reduced dimensions (12.7 mm diameter, 48 mm length), the proposed system can be introduced through a channel of a standard LESS multiport, thus maximizing the number of surgical tools that can be used at the same time. The main goal of ex vivo tests was to demonstrate the feasibility of performing a complex abdominal procedure by using the proposed magnetic camera robot through a standard SILS port.
Methods: A camera tilting module was developed, hosting a laparoscopic 500×582 CCD imager, LED-based illumination, two donut-shaped magnets, and a robotic mechanism to precisely adjust the tilt angle. This module is connected to a second one (12.7 mm diameter, 12 mm length), hosting a magnet to enable panning, by a 2 mm cable. Manual translation and panning are obtained by moving an external handle, while precise robotic tilting (0°-60° range, resolution<1°) is obtained by operating a pushbutton interface. A small bowel resection with intracorporeal anastomosis was performed by using a SILS port, introducing the camera robot through a 12 mm standard trocar. The experiments were carried out in an authorized laboratory, in accordance with all ethical considerations and the regulations related to animal experiments.
Results: The camera insertion procedure was simple and reliable thanks to the clearance between the robot and the internal lumen of the trocar. Magnetic link was established as soon as the camera robot was inserted inside the abdomen. The insertion of three different articulated instruments was effective and did not conflict with the camera robot and its cable. Bowel manipulation was carried out without too much difficulty as the camera allowed a complete exploration through different points of view. Thanks to fine robotic tilting, the specific site of operation was always centered during bowel resection and anastomosis, minimizing manual movements of the camera, thus enhancing image stability.
Conclusions: Single Incision Laparoscopic Surgery, also known as LESS surgery, represents a good compromise between standard laparoscopy and a totally scarless procedure. The proximity of the ports and the restricted degrees of freedom of movements often requires the crossing of the hands, and can lead to a frequent clashing of the laparoscopic instruments. Improved triangulation, instrument collision prevention, organ inspection from multiple sides, image stability during operation were some features confirmed by this preliminary experience. Applying the proposed device to standard multiport laparoscopic procedures would also reduce surgical invasiveness by eliminating the need for an endoscope-dedicated trocar.
 


Session: Emerging Technology
Program Number: ET001

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