Innovative surgical endoscopes in video-assisted thoracic surgery

Abstract

In the past three decades, rod lens endoscopes had facilitated the development and wide spread applications of video-assisted thoracic surgery (VATS). With the rise of uniportal VATS in recent years, innovations in surgical instruments should once again complement the advancement in surgical technique. While articulated flexible endoscopes have expand the field of view, and can alter viewing direction with minimal maneuvers, they still suffer from problems like trocar crowding and interference with other instruments. Magnetic anchored endoscopes, on the other hand, may provide unique benefits to VATS by replacing the endoscope rigid rod body with magnetic linkage, thus overcoming the challenge of port crowding in single incision surgery. Most magnetic anchored endoscopes reported in literature are not designed for thoracic surgeries. Many of these designs do not allow tilting of endoscopic view, rely on micromotors for actuation, or are ergonomically unfit to be operated within the spatial constraints seen in VATS application. Considering these limitations, we have designed two novel magnetic anchored and steered endoscopes targeted for uniportal VATS. Both designs could be wirelessly actuated by magnetic interaction. One has a silicone rubber formed soft body for compactness, lightweight and safety, while another is a 40 mm long capsule optimized for VATS spatial constraints.

Keywords: Video-assisted thoracic surgery (VATS); endoscope; magnetic anchored and guided system (MAGS); single-port; uniportal.

Figure 1

Typical VATS setup using rigid endoscope. (A) Illustration of a typical 3-port VATS setup; (B) rigid endoscopes with 0° or 30° tip. VATS, video-assisted thoracic surgery.

Figure 2

Flexible endoscopes. (A) ENDOEYE FLEX 3D; (B) cardioscope prototype; (C,D) retroflexion of cardioscope, viewing backside of target; (E) cardioscope demo in animal model, notice LED spot in wound from cardioscope under retroflexion.

Figure 3

Soft MAGS endoscope. (A) Schematics of soft bodied MAGS endoscopic system; (B) illustration of tilting actuation principle; (C) performance evaluation in porcine cadaver; (D) endoscope tilting and panning sequence in benchtop settings.

Figure 4

Magnetic anchored and steered endoscope. (A) Schematics of endoscope design; (B) endoscope prototype, with transparent capsule revealing inner components; (C,D) set-up for evaluation in porcine cadaver. EPMs controller shown in (C), and eye-tracker with display screen in (D); (E,F,G) endoscope actuation inside cadaver, including translation (E), tilting (F), and panning (G), as observed by standard laparoscope.