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Review
. 2016 Jul;13(7):661-72.
doi: 10.1586/17434440.2016.1146585.

Robot-like dexterity without computers and motors: a review of hand-held laparoscopic instruments with wrist-like tip articulation

Patrick L Anderson  1 , Ray A Lathrop  1 , Robert J Webster III  1
Affiliations
Review

Robot-like dexterity without computers and motors: a review of hand-held laparoscopic instruments with wrist-like tip articulation

Patrick L Anderson et al. Expert Rev Med Devices. 2016 Jul.

Abstract

Introduction: Conventional manual laparoscopic instruments for minimally invasive surgery have limited dexterity within the patient, making procedures challenging. Surgical robotic systems offer enhanced articulation, but at substantial financial costs. This has motivated the development of high-dexterity, low-cost laparoscopic instruments.

Areas covered: This article reviews both commercial and academic results on creating fully mechanical (i.e. non-robotic) laparoscopic instruments that provide wrists or wrist-like dexterity within the patient. We review the state of the art in the development of these mechanical instruments, focusing on the surgeon interface, wrist mechanism, and the kinematic mapping between the two. Expert commentary: Current articulated mechanical laparoscopic instruments exhibit a wide range of designs, with no clear consensus on what makes such devices easy to use. As these technologies mature, user studies are needed to determine surgeon preferences. Articulated, low-cost instruments have the potential to impact the minimally invasive surgery market if they provide compelling benefits to surgeons.

Keywords: Surgical robotics; abdominal procedures; laparoscopic; manual instruments; minimally invasive surgery; surgical dexterity; wrist.

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Figures

Figure 1
Figure 1
Comparison of a conventional laparoscopic instrument (top) to a laparoscopic instrument with a wrist (bottom). The instrument used in this example is the Vanderbilt Maestro. A variety of options are available for user interfaces and wrist designs, as reviewed in Section II.
Figure 2
Figure 2
Examples of the two primary types of wrist articulation mechanisms used in the instruments reviewed in this paper. Wrists can be implemented as pin joints or as mechanisms that approximate an arc when deflected.
Figure 3
Figure 3
Control interfaces for articulated mechanical instruments: (a) handle control in which the handle can articulate relative to the instrument shaft, (b) thumb control where the handle is rigidly connected to the shaft and a thumb interface deflects the wrist, and (c) mixed control in which independent knobs and levers control various wrist degrees of freedom.
Figure 4
Figure 4
Kinematic mappings for laparoscopic tools with wrists: parallel (top) and reverse (bottom). The instrument used in this example is the Vanderbilt Maestro.
Figure 5
Figure 5
An example of a laparoscopic tool with a curved, but rigid, shaft: the KARL STORZ ROTATIP (© 2016 Photo Courtesy of KARL STORZ Endoscopy-America, Inc.).
Figure 6
Figure 6
An example of an instrument that can be articulated, but that is designed to be locked during use: the SERPENT from Smith & Nephew [15].
Figure 7
Figure 7
Articulating laparoscopic instruments with pistol grip, handle control method, and curved wrist: (a) RealHand and (b) SILS Hand Instrument. (All rights reserved. Used with the Permission of Medtronic.)
Figure 8
Figure 8
Tuebingen Scientific Radius Surgical System (inset figure: copyright © TransEnterix, Inc. 2015. All rights reserved).
Figure 9
Figure 9
The Maestro articulating laparoscopic instrument: (a) entire instrument, (b) wrist, and (c) handle control interface.
Figure 10
Figure 10
CAD drawing of the Maestro wrist and handle articulation axes. Two rotational axes in the handle are mapped to corresponding axes in the wrist.
Figure 11
Figure 11
The FlexDex articulating laparoscopic instrument (used with permission).
Figure 12
Figure 12
The DragonFlex articulating laparoscopic instrument (used with permission) [43].
Figure 13
Figure 13
The Intuitool, an example of a thumb control method articulating instrument (used with permission).
Figure 14
Figure 14
The Easy Grasp articulating instrument (used with permission) [57].
Figure 15
Figure 15
Demonstration of control point concept in robotic master-slave: the da Vinci robot user interface maps motion of control points located between the user’s fingers to corresponding control points on the instruments inside the patient. Image source: [59], © 2016 Intuitive Surgical, Inc., control point illustrations added.
Figure 16
Figure 16
Comparison of control point location for the Maestro, RealHand, FlexDex (control point located at center of frame ring), and Radius.
See this image and copyright information in PMC

References

    1. Veldkamp R, Kuhry E, Hop WCJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477–484. - PubMed
    1. Reza MM, Blasco JA, Andradas E, et al. Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg. 2006;93(8):921–928. - PubMed
    1. Guller U, Hervey S, Purves H, et al. Laparoscopic versus open appendectomy. Ann Surg. 2004;239:43–52. - PMC - PubMed
    1. Minimally invasive surgery market - global industry analysis, size, share, growth, trends & forecast, 2013 – 2019. Albany (NY): Transparency Market Research; 2014. Transparency Market Research Reports.
    1. Gallagher A, McClure N, McGuigan J, et al. An ergonomic analysis of the fulcrum effect in the acquisition of endoscopic skills. Endoscopy. 1998;30:617–620. - PubMed

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