Norihito Wada, MD, PhD, FACS1, Kyoko Okuda, MA1, Kazumi Kuboi, RN1, Hirofumi Tanaka2, Tetsushi Ito3, Takuya Miyazaki4, Yoshihiko Himura4, Yuko Kitagawa, MD, PhD, FACS1. 1Department of Surgery, Keio University School of Medicine, 2Kawasaki Heavy Industries, Ltd., 3Medicaroid Corporation, 4Top Corporation
INTRODUCTION: Robot-assisted surgery allows surgeons to perform many types of complex laparoscopic surgical procedures. More and more patients are treated with this sophisticated system. However, all the instruments used in the currently available surgical robot system is rigid. Therefore, there exists a limitation in the extent of reach to the deeper surgical fields. In order to overcome this difficulty, we are developing a novel flexible endoscopic surgery system (FESS) which has flexible single port platform of 3 cm in diameter, independently controlled endoscope and instruments, open architecture that is compatible with existing flexible devices and a magnified 3D HD camera that has sensors of both RGB and infrared. Furthermore, the system is smaller and would be more cost-effective than existing robotic surgical system. A preliminary experiment was performed in surgical procedures using porcine model to evaluate effectiveness and feasibility of FESS.
METHODS AND PROCEDURES: Experimental protocols were approved by the Animal Research Committees of our institution. We used a female swine of 25 kg. An assistant forcep lifted up the fundus of gallbladder to create good visualization of surgical field. The cystic duct was ligated by laparoscopic clip device from assistant port. Blunt dissection was performed by pushing the forceps and sharp dissection by monopolar electrocoagulation.
RESULTS: The FESS accomplished the dissection of the gallbladder from the liver bed successfully. Two 5 mm forceps had enough grasping and dissecting force and dexterity. The gallbladder was removed from single port site easily.
CONCLUSIONS: This experiment showed that it is feasible to intuitively operate single-site cholecystectomy with FESS. In order to realize a pure FESS procedure, an additional novel device to create good visualization of the surgical field is necessary for the FESS platform. A prototype has already been developed for evaluation in securing the surgical field. The optimal working range, or “sweet spot” of FESS is not relatively large. In addressing this issue, the feature of easy setup is being improved to enable more efficient positioning and shifting of the sweet spot for the surgical field. This mechanism could enhance the expansion of procedures suitable for FESS. The target procedures of FESS are those specifically suitable for single port surgery, such as transanal surgeries and transcervical mediastinoscopic surgeries. Intraluminal procedures and natural orifice translumenal surgery (NOTES), which are not considered suitable for rigid surgical robot, are also good applications of FESS.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87625
Program Number: P370
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster