Dept. of Mechanical Engineering

Robotic, Multi-Articulated Endoscopic Surgical Tools for Natural Orifice Translumenal

Endoscopic Surgery

Devin R. Berg1, Perry Y. Li1, Arthur G. Erdman1, Tianhong Cui1, and Timothy P. Kinney2

1Department of Mechanical Engineering 2Division of Gastroenterology - Hennepin County Medical Center

University of Minnesota, Minneapolis, MN

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Outline • Background / Introduction to NOTES • Current developments in the field • Our approach • Progress thus far

– Problem characterization – Concept development – Prototyping

• Future work

Dept. of Mechanical Engineering

What is NOTES? • Natural Orifice: Tool insertion through the

mouth, urethra, vagina, or anus. • Translumenal: Accessing the abdominal

cavity through an incision in the stomach, bladder, vagina, or colon.

• Endoscopic Surgery: Typically performed with a tool resembling a traditional endoscope.

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NOTES Advantages • Faster recovery time • Less physical discomfort • No visible scars

• These things may also lead to greater

patient willingness to receive an important procedure.

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Developing Technology

USGI Medical Olympus

Important features include: Multiple tool channels Tool articulation Imaging, suction, and irrigation Rigidity when necessary Triangulation

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Our Approach to the Problem • Achieve teleoperated robotic control • Produce all necessary device movements from

within the tool end itself • Device should be portable and field deployable

(taking advantage of teleoperation)

Fluid Power

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Why Fluid Power? • Remotely located power source • Can maintain force / torque with minimal

energy consumption • Precise control • High power density

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Problem Characterization Diameter limitation of ~ 18 - 22 mm

Organ manipulation force

requirements of ~ 1.5 - 4 N

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Conceptual Development Multi-directional articulation

– Spherical joints (prototyped) – Cantilever beams

Need to be mobilized and

modeled for controls

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Conceptual Development (Cont.) Force and displacement of articulation joint

– Need high force with limited space

Must balance the force requirement at the tool with the force input to the joint.

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Conceptual Development (Cont.) Fluid flow control

– Need to provide bi-direction flow control in small package – Each actuator requires its own valve

MEMS Microfluidic Proportional Control Valve

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Conceptual Development (Cont.) Force-Feedback Control Methods

– Provide tool load information to the surgeon – Enable precise robotic control over tool position

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Prototyping

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Future Work • Additional characterization of tool force

requirements (e.g. suturing, biopsy, etc.) • Experimental testing

– Microfluidic valve – Articulation joint / Actuators / Controls

• Assembly of components into all-inclusive prototype

• Scaling

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Summary • NOTES as the next step in MIS • Other devices currently under development • Applying fluid power for compact solution • Progress thus far

– Identifying the problem – Concept development – Prototypes have been produced, more coming

• Future work in testing and prototyping

Dept. of Mechanical Engineering

References 1. Bardaro, S.J. and Swanstrom, L., 2006. Development of advanced endoscopes for Natural Orifice

Transluminal Endoscopic Surgery (NOTES). Minimally Invasive Surgery, 15(6), pp. 378-383. 2. Bergman, S. and Melvin, W.S., 2008. Natural orifice translumenal endoscopic surgery. Surgical

Clinics of North America, 88, pp. 1131-1148. 3. Caldwell, D.G., Medrano-Cerda, G.A., and Goodwin, M., 1995. Control of pneumatic muscle

actuators. Control Systems Magazine, 15(1), pp. 40-48. 4. Davis, S. and Caldwell, D.G., 2006. Braid effects on contractile range and friction modeling in

pneumatic muscle actuators. The International Journal of Robotics Research, 25(4), pp. 359-369. 5. Granosik, G. and Borenstein, J., 2005. Pneumatic actuators for serpentine robot. 8th International

Conference on Walking and Climbing Robots, pp. 719-726, London. 6. Gostout, C.J., 2009. Update on the use of NOTES procedures. Advances in Endoscopy, 5(6), pp.

401-405. 7. Kalloo, A.N., Singh, V.K., Jagannath, S.B., Niiyama, H., Hill, S.L., Vaughn, C.A., Magee, C.A., and

Kantsevoy, S.V., 2004. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointestinal Endoscopy, 60(1), pp. 114-117.

8. Rattner, D. and Kalloo, A., 2006. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. Surgical Endoscopy, 20, pp. 329-333.

9. Reynolds, D.B., Repperger, D.W., Phillips, C.A., and Bandry, G., 2003. Modeling the dynamic characteristics of pneumatic muscle. Annals of Biomedical Engineering, 31, pp. 310-317.

10. Swanstrom, L.L., Khajanchee, Y., and Abbas, M.A., 2008. Natural Orifice Transluminal Endoscopic Surgery: The future of gastrointestinal surgery. The Permanente Journal, 12(2), pp. 42-47.

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Thank You