Tyler D Wortman, BS, Oleg Dolghi, MD, Amy C Lehman, MS, Ryan L McCormick, Shane M Farritor, PhD, Dmitry Oleynikov, MD. University of Nebraska-Lincoln, University of Nebraska Medical Center
Introduction: The objective of this study is to demonstrate the effectiveness of using a multi-functional miniature in vivo robotic platform to perform a single- incision colectomy. Standard laparoscopic techniques require multiple ports to perform the operation. Conventional single-incision colectomy is very complicated due to lack of triangulation of instruments and the restriction of single fixed port position. A miniature robotic platform that is completely inserted into the peritoneal cavity through a single incision has been designed and built. The robot can be quickly repositioned, thus enabling multiquadrant access to the abdominal cavity and providing improved visualization and articulation as well as better triangulation control.
Methods and Procedures: The miniature in vivo robotic platform used in this study consists of a multi-functional robot and a remote surgeon interface. The robot is comprised of two arms with shoulder and elbow joints. Each forearm is equipped with specialized interchangeable end effectors. Between the arms, near the body of the robot, is a pan and tilt camera that can provide stereoscopic visualization capabilities. Each arm is inserted separately into a single two-inch incision and then assembled within the peritoneal cavity. The robot is then mated to a support rod and rotated towards the pelvis. A surgeon is able to perform standard surgical tasks by utilizing the surgeon interface that is located near the patient in the operating room. The interface consists of a monitor, a foot pedal for locking, clutching, and scaling the workspace, and a custom master-slave control device to operate the robot arms.
Results: Five robotic colectomies were performed in a porcine model. For each procedure, the robot was completely inserted into the peritoneal cavity and the surgeon manipulated the user interface to control the robot to perform the colectomy. The robot was positioned over the sigmoid colon in the left pelvis of the swine and was used, with one grasper hand and one cautery hand, to dissect out the mesentery of the sigmoid colon down to the pelvis. The colon was mobilized from its lateral attachments. The robot was used to assist in a placement of an EEA stapler to transect a sigmoid colon in a standard fashion. Robotic mobilization was accomplished easily.
Conclusions: The adoption of both laparoscopic and single-incision colectomies is currently constrained by the inadequacies of existing instruments. This multi-functional robot provides a platform that overcomes existing limitations by operating completely within the peritoneal cavity and improving visualization and dexterity. By repositioning the small robot to the area of the colon to be mobilized the ability of the surgeon to perform complex surgical tasks was improved. Further, the success of the robot performing a completely in vivo colectomy suggests the feasibility of using this robotic platform to perform other complex surgeries through a single incision.
Program Number: S052