Natural Orifice Cholecystectomy Using a Miniature Robot

Introduction: Natural Orifice Translumenal Endoscopic Surgery (NOTES) is surgically challenging. Current endoscopic tools provide an insufficient platform for visualization and manipulation. This study demonstrates the feasibility of using a miniature in vivo robot to enhance visualization and provide off-axis dexterous manipulation capabilities for NOTES. Methods: We developed a dexterous, miniature robot with six degrees-of-freedom capable of applying significant force throughout its workspace. The robot is introduced through the esophagus and completely enters the peritoneal cavity through a transgastric insertion. The robot design consists of a central “body” and two “arms” fitted with cautery and forceps end-effectors, respectively. The arms of the robot “disconnect” allowing the robot to freely flex for entry through the esophagus. Once in the peritoneal cavity, the arms are “reconnected,” and the robot is attached to the abdominal wall using the interaction of magnets housed in the robot body with those in an external magnetic handle. Video feedback from the on-board cameras is provided to the surgeon throughout a procedure. Results: The efficacy of this robot was demonstrated in a non-survivable cholecystectomy, abdominal exploration, bowel manipulation, and cooperative intracorporeal suturing in a porcine model. Following transgastric insertion, the robot was attached to the interior abdominal wall. The robot was repositioned throughout the procedure to provide optimal orientations for visualization and tissue manipulation. The surgeon remotely controlled the actuation of the robot to assist in the procedures. Conclusion: This study has shown that a dexterous miniature in vivo robot can apply significant forces in arbitrary directions and improve visualization to overcome many of the limitations of using current endoscopic tools for performing NOTES.

Session: Podium Presentation

Program Number: S039

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