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The elimination of all external incisions is an important step in reducing the invasiveness of surgical procedures. Natural Orifice Translumenal Endoscopic Surgery (NOTES) is an incision-less surgery and provides explicit benefits such as reducing patient trauma and shortening recovery time. However, technological difficulties impede the widespread utilization of the NOTES method. A novel robotic tool has been developed, which makes NOTES procedures feasible by using multiple interchangeable tool tips.
The robotic tool has the capability of entering the body cavity through an orifice or a single incision using a flexible articulated positioning mechanism and once inserted is not constrained by incisions, allowing for visualization and manipulations throughout the cavity.
Multiple interchangeable tool tips of the robotic device initially consist of three end effectors: a grasper, scissors, and an atraumatic Babcock clamp. The tool changer is capable of selecting and switching between the three tools depending on the surgical task using a miniature mechanism driven by micro-motors. The robotic tool is remotely controlled through a joystick and computer interface.
In this thesis, the following aspects of this robotic tool will be detailed. The first-generation robot is designed as a conceptual model for implementing a novel mechanism of switching, advancing, and controlling the tool tips using two micro-motors. It is believed that this mechanism achieves a reduction in cumbersome instrument exchanges and can reduce overall procedure time and the risk of inadvertent tissue trauma during exchanges with a natural orifice approach. Also, placing actuators directly at the surgical site enables the robot to generate sufficient force to operate effectively. Mounting the multifunctional robot on the distal end of an articulating tube provides freedom from restriction on the robot kinematics and helps solve some of the difficulties otherwise faced during surgery using NOTES or related approaches.
The second-generation multifunctional robot is then introduced in which the overall size is reduced and two arms provide 2 additional degrees of freedom, resulting in feasibility of insertion through the esophagus and increased dexterity.
Improvements are necessary in future iterations of the multifunctional robot; however, the work presented is a proof of concept for NOTES robots capable of abdominal surgical interventions.