Enabling Medical Robotics for the Next Generation of Minimally Invasive Procedures

A brief analysis of the case of single port surgery from Howie Choset and Marco Zenati (Biorbotoics Lab, CMU): 

Minimally invasive interventions have the potential to revolutionize surgical practice by offering reduced pain, faster recovery, and fewer complications. We believe the key to achieving such potential is to eliminate the need for multiple (up to 8) ports by using natural orifices, when available, or single port entry, when a natural orifices are not present. Single port access approaches may facilitate existing procedures but perhaps more importantly, they will enable new ones, and at a lower cost. This reduced cost has the added benefit of making therapies available to a larger portion of the general public.
Already, we have seen the single port trend with the introduction of natural orifice transluminal endoscopic surgery (NOTES) where a procedure is performed with a minimally invasive surgical device or endoscope that enters a natural orifice, such as the mouth, nasal passage, vagina, or anus, and then passes through an internal incision to access anatomical targets deep in the body
For the heart, the closest thing to natural orifice access is to reach the pericardium space via a single port in the subxyphoid process using a linear rigid device; this approach does not require general anesthesia nor a heart-lung machine while providing access to a beating heart.
The common denominator for single port entry is the need for dedicated robotic technology that can operate without access limitation and full feedback from a single entry point. Although they have great visual feedback, conventional surgical robots, such as the Intuitive Surgical’s DaVinci System, are not adequate for single port entry because the three or four large robot arms manipulate linear chop-stick laparoscopic-like devices which have limited access to line-of-sight regions from the ports. A small articulated device or a miniature mobile/crawling unit, not a conventional robot, is key to accessing many anatomical targets from a single port..."

Image credit: Medrobotics


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