Natural orifice cholecystectomy using a miniature robot

Amy C. Lehman, Jason Dumpert, Nathan A. Wood, Lee Redden, Abigail Q. Visty, Shane M Farritor, Brandon Varnell, Dmitry Oleynikov

Research output: Contribution to journalArticle

122 Scopus citations

Abstract

Background: Natural orifice translumenal endoscopic surgery (NOTES) is surgically challenging. Current endoscopic tools provide an insufficient platform for visualization and manipulation of the surgical target. 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: The authors developed a dexterous, miniature robot with six degrees of freedom capable of applying significant force throughout its workspace. The robot, introduced through the esophagus, completely enters the peritoneal cavity through a transgastric insertion. The robot design consists of a central "body" and two "arms" fitted respectively with cautery and forceps end-effectors. The arms of the robot unfold, allowing the robot to flex freely for entry through the esophagus. Once in the peritoneal cavity, the arms refold, and the robot is attached to the abdominal wall using the interaction of magnets housed in the robot body with magnets 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 three nonsurvivable procedures in a porcine model, namely, abdominal exploration, bowel manipulation, and cholecystectomy. After 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 using an external console 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 current endoscopic tools for performing NOTES procedures.

Original languageEnglish (US)
Pages (from-to)260-266
Number of pages7
JournalSurgical endoscopy
Volume23
Issue number2
DOIs
Publication statusPublished - Feb 2009

    Fingerprint

Keywords

  • Cholecystectomy
  • Surgical, technical

ASJC Scopus subject areas

  • Surgery

Cite this

Lehman, A. C., Dumpert, J., Wood, N. A., Redden, L., Visty, A. Q., Farritor, S. M., ... Oleynikov, D. (2009). Natural orifice cholecystectomy using a miniature robot. Surgical endoscopy, 23(2), 260-266. https://doi.org/10.1007/s00464-008-0195-3