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Robotic-assisted trans-rectal cholecystectomy in a porcine model.

Chi Chung Foo, MBBS1, Chung Kwong Yeung, MBBS, MD, PhD1, Wai Lun Law, MBBS, MS1, Biji Sreedhar, Msc, PhD2. 1University of Hong Kong, 2Bio-Medical Engineering (HK) Limited

Objective of the technology or device

The advent of minimally invasive surgery techniques has brought a major breakthrough in modern surgery. With increasing experience and technological advancement in surgical instruments, surgeons have explored the feasibility of single-incision laparoscopic surgery and natural orifice transluminal surgery (NOTES). These techniques aim to further reduce surgical trauma, but are not popular due to their inherent pitfalls including clashing of instruments, lack of counter traction, lengthy operating time etc.

A novel surgical robotic system (NSRS) was designed to overcome the limitations of existing technologies. Previous animal trials have demonstrated its feasibility in performing robotic-assisted trans-rectal cholecystectomy in porcine model.

Description of the technology and method of its use or application

NSRS is a high dexterity, single access port surgical robotic system which enables surgeons to carry out the next generation of single-port surgical procedure or NOTES. The proposed system’s main innovative features and state-of-the-art technology include the ability to perform all intra-abdominal and pelvic surgeries via natural orifices like the vagina or rectum. The system is equipped with multiple miniaturized (16mm diameter) internally motorized robotic arms, each with a minimum of seven DoFs, a dual in -vivo camera system that provides both panoramic and high definition magnified 3D views of the abdominal cavity for added safety, a cannula and an external swivel system. The cannula system is operable to leave an unobstructed central passageway any time, allowing for the insertion of additional laparoscopic instruments or the extraction of tissue during a variety of surgical procedures. Sophisticated swivel mechanisms enable robotic arms to precisely access all quadrants of the abdominal cavity. In vitro surgeon’s manipulators are designed to map the delicate motions of the surgeon’s finger and wrist movements, which are subsequently transformed into precise and dexterous robotic motions.

The animal was positioned in a supine position after the induction of general anesthesia. After the correct alignment and positioning of the cannula for the surgical procedure, the cannula was securely anchored in place by the external swivel system. An incision was made in the rectum using a long laparoscopic cautery scissor. The obturator was then inserted though the anus. The cannula and sheath assembly were then inserted trans-rectally into the pig’s abdominal cavity under close surveillance of the laparoscopic camera. An insufflation line was then connected to the cannula assembly and the abdomen was insufflated. The 3D camera and the robotic arms were then inserted in sequential manner into the abdominal cavity and cholecystectomy procedure was performed.

Preliminary results if available

Robotic-assisted trans-rectal cholecystectomy was successfully performed in three adult male pigs. The estimated blood loss was less than 10 ml in all three cases. Gallbladder was dissected out intact in two cases..

Conclusions / future directions

The trial demonstrated the feasibility of the surgical robotic system in performing a technically challenging trans-rectal cholecystectomy. . The system provided the surgeon a stable platform with adequate spacing for the trans-rectal insertion of robotic arms, 3-dimensional vision and enhanced dexterity in performing NOTES surgery while successfully maintaining pneumoperitoneum.


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

Abstract ID: 91089

Program Number: ETP873

Presentation Session: Emerging Technology iPoster Session (Non CME)

Presentation Type: Poster

67

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