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A novel flexible endoscopic surgery system: preliminary results from prototype model.

Norihito Wada, MD, PhD, FACS1, Kyoko Okuda, MA1, Kazumi Kuboi, RN1, Hirofumi Tanaka2, Tetsushi Ito3, Takuya Miyazaki4, Yoshihiko Himura4, Yuko Kitagawa, MD, PhD, FACS1. 1Keio University School of Medicine, 2Kawasaki Heavy Industries, Ltd., 3Medicaroid Corporation, 4Top Corporation

Background: Endoscopic surgery was developed in 1980’s and widely spread during 1990’s as a standard procedure for simple surgical treatments. In 2000, a master-slave surgical robot with 7 degrees of freedom was launched and enabled surgeons to perform complicated procedures more easily. The currently available system has a magnified 3D HD vision, wristed instruments and tremor reduction, which facilitate difficult surgical procedures. However, its poor cost-effectiveness, bulky configurations and reimbursement issues have impeded the wide-scale adoption and use of the surgical robot. Addressing these issues, by applying and fusing Japan’s strong cutting-edge technologies and expertise in robotics and flexible endoscopies, we aim to realize an innovative flexible endoscopic surgical system that surgeons can intuitively manipulate with a clear panoramic vision during a surgery.

Methods: We have started the R&D project of Flexible Endoscopic Surgery System (FESS) by organizing a consortium consisting of an industrial robot company, an endoscope company, a company of medical devices for endoscope, several medical institutions and engineering academia. With a grant from the government, we started the project of FESS in July 2014. FESS has 7 unique features: (1) more minimally invasive surgical robot system, (2) single port flexible platform for deeper surgical fields, (3) open architecture compatible with existing flexible devices, (4) compact configuration that can be fixed on one side rail of the bed, (5) simple design for set-up and device exchanges, (6) forceps with real haptics, (7) Hyper Eye camera having sensors that can simultaneously detect RGB and near-infrared rays. Our flexible robot add novel values for endoscopic surgery such as allowing independent articulation of the endoscope from the robotic arms, customization of the size and the arrangement of flexible devices, and open architecture of the platform. The flexible structure makes the size of FESS smaller and the cost lower, and enables the tip of the robot to reach deep into the body.

Preliminary results: The initial concept model includes the following features. The flexible platform has several rails to hook the inner tubes. Each tip of the inner tubes bends laterally to obtain triangulation of instruments. The outer diameter of the platform is 30 mm. The outer diameter, length of the shaft and degrees of freedom of robot arms are 5mm, 475 mm (75 mm of active and 400 mm of inactive flexible part) and 7, respectively. The radius of curvature of inactive flexible part is 70 mm under 20 gf. The motion range of insertion/extraction, axial rotation, yaw angle of the first and second joint, tip rotation and grasping are ±50 mm, ±360°, ±70°, ±70°, ±360° and ±80°, respectively. Grasping force is 1N. Suturing and square knot ligation have been successfully performed with this device.

Conclusions and future directions: The flexible robotic forceps controllable separately from the endoscope, allowing a deep reach with a proper grip force will satisfy the needs of versatile surgical tasks. FESS has a potential to overcome the limitations of rigid surgical robots, and to open a door for the next generation minimally invasive treatment.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 84431

Program Number: ET010

Presentation Session: Emerging Technology Session

Presentation Type: Podium

68

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