Future robotic platforms in urologic surgery: recent developments

Abstract

Purpose of review: To review recent developments at Vanderbilt University of new robotic technologies and platforms designed for minimally invasive urologic surgery and their design rationale and potential roles in advancing current urologic surgical practice.

Recent findings: Emerging robotic platforms are being developed to improve performance of a wider variety of urologic interventions beyond the standard minimally invasive robotic urologic surgeries conducted currently with the da Vinci platform. These newer platforms are designed to incorporate significant advantages of robotics to improve the safety and outcomes of transurethral bladder surgery and surveillance, further decrease the invasiveness of interventions by advancing LESS surgery, and to allow for previously impossible needle access and ablation delivery.

Summary: Three new robotic surgical technologies that have been developed at Vanderbilt University are reviewed, including a robotic transurethral system to enhance bladder surveillance and transurethral bladder tumor, a purpose-specific robotic system for LESS, and a needle-sized robot that can be used as either a steerable needle or small surgeon-controlled micro-laparoscopic manipulator.

Figure 1

(a) Prototype dexterous manipulator robot deployed through sheath into male urethra bladder model [From [14] Goldman et al. IEEE Trans Biomed Eng, 2013 with permission] (b) dexterous segment and end effectors including laser, grasper and fiberscope camera deployed. [From [14] Goldman et al. IEEE Trans Biomed Eng, 2013 with permission] (c) Laser ablation of drawn circle on tissue model [original] (d) before and after laser ablation of marked circle. [original]

Figure 2

The prototype is passed axially through the resectoscope sheath and maneuvered via telemanipulation of the dexterous robot into surveillance and treatment positions with end effectors such as laser and grasper in place. Images recorded via transvesical laparoscope. [From [14] Goldman et al. IEEE Trans Biomed Eng, 2013 with permission].

Figure 3

Overview of ex-vivo bovine bladder experimental set-up. Screen shows endoscopic robot view. Transvesical laparoscope used for procedure monitoring and capture of images. The figure shows the slave robot’s actuation unit and the master manipulator (Sensible Phantom Omni) along with endoscopic view on screen in background. [From [15] Bajo et al. Proceedings of the Hamlyn Symposium on Medical Robotics 2012 with permission.]

Figure 4

A. The dexterous robot in maneuvered into position to laser ablate a lateral submucosal dye “lesion” B. Holmium laser treatment is initiated. C. Grasping end effector is used to elevate and retract tissue as laser energy is used circumferentially for “en-bloc” model resection. [From [15] Bajo et al. Proceedings of the Hamlyn Symposium on Medical Robotics 2012 with permission.]

Figure 5

Next generation prototype. (a) proposed deployment though resectoscope type sheath (b) rigid scope (green) will carry rod lens optical fixed endoscope for wide visual guidance and irrigation and outflow. (c) Dexterous Arm robot (yellow) will carry additional optical fiberscope and end effectors. Grasper and steerable laser fiber shown in diagram. [Original figure from Simaan and Herrell]

Figure 6

The phase I in-vivo single port access system shown in a deployed state with two seven degrees of freedom dexterous arms and a controllable stereovision camera head. [Original figure from Simaan and Herrell]

Figure 7

IREP arms and graspers performing knot tying task in inanimate trainer. [From [24]Simaan et al. Journal of Robotic Surgery 2013 with permission]

Figure 8

Steerable needle robot. [From [39] Webster et al. IEEE Trans Robot 2009 with permission]

Figure 9

Cannula robot with microlaparoscopic sized end effector manipulators. [Original figure from Webster and Herrell]

Figure 10

Cannula robot with microlaparoscopic sized end effector manipulator compared to standard da Vinci instrument. [Original figure from Webster and Herrell]