A New Robotic System for Single-incision Laparoscopic Surgery: Preliminary Experience

Introduction: The concept of single access procedures has gained a greater attention of general surgeons over the last four years. Despite such a wide momentum, these procedures pose several changes for the operating surgeon, such as impaired eye-hand coordination and restricted manipulation. In this context, robotic-assisted surgery represents a growing discipline designed to enhance the dexterity of the laparoscopic surgeons. A representative example of these benefits is offered by the daVinci Single-Site Surgical System, which allows the surgeon to perform complex tasks avoiding the frequent clashing of the standard single-access instruments. However, enhanced dexterity in terms of instrumentations tip maneuverability remains unresolved and, moreover, the large size and the high cost of the system itself will limit its uptake amongst surgeons. We have developed a novel teleoperated robotic system for minimally invasive surgery called SPRINT (Single-Port lapaRoscopy bimaNual roboT). The main goal of our experiments was to demonstrate the feasibility of performing complex abdominal procedures by using the proposed system.

Methods: “SPRINT” is a master-slave teleoperated robotic platform designed for bimanual interventions by means of a single access port. The system is composed by two main arms having a maximum diameter of 18 mm, a stereoscopic-camera (Karl-Storz, Tuttlingen, Germany), and additional devices, e.g. retractor or other assistive instruments that can be inserted through a central lumen left free in the access port after the introduction. The arms are inserted in a cylindrical introducer which has a diameter of 30 mm. As the arms reach the bottom of the introducer, the base link of each one has to be rotated by 90°. The proximal joints comprise the shoulder and the elbow mechanisms, which are operated by external and on-board motors respectively. As for the elbow, the actuation of the distal joints is operated by embedded motors, while the actuation of the gripper is performed by another external motor. The surgeon console is composed of two master manipulators, a foot-switch and a 3D full-HD display. Cholecystectomy and small bowel resection were performed. The experiments were carried out in an authorized laboratory.

Results: As it is a preliminary experience, the system was placed within the peritoneal cavity through an incision of about 8-10 centimeters. The robot was suspended in an open fashion. Working space was created by using hooks attached to the pig itself. The 3D display and the image stability allow the surgeon to perform the reported procedures similarly as the standard minimally invasive counterpart.

Discussion: The concept behind the “SPRINT” is to bring the operating room inside the patient’s insufflated peritoneal cavity, with the objective to overcome the limits of current technologies. In our platform the robotic arms are introduced into the abdomen through a cylindrical introducer specifically designed to allow the insertion of each arm separately. During the operation, each arm may be removed in order to clean or replace the tool, or in case of system failure. “SPRINT” could pave the way for the next generation of surgical robots both for single access and for multi-port laparoscopic surgery.
 

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