Abstract
In natural orifice transluminal endoscopic surgery, the insertion of surgical instruments can cause patient discomfort, even bleeding and perforation. This paper proposes a design of an overtube which can vary its radial dimension. It can be inserted through the natural orifice in a small diameter configuration and then enlarge its size and form a hollow and rigid channel to allow passing instruments, while to reduce the friction between the instruments and the surrounding tissue. A Bricard linkage is used as the basic unit of the overtube and a mechanism is designed to drive multiple Bricard units to fold or unfold. Optimization of the design parameters has been studied and comparison experiments have been completed to verify the feasibility of the design on reducing the shear forces and normal forces exerted during surgical instrument insertion. The ex vivo experiment is also completed to prove the protection of the overtube on the esophagus during the insertion.
Highlights
With the rapid development of minimally invasive surgery, natural orifice transluminal endoscopic surgery (NOTES) has been adopted by many surgeons
In NOTES, surgeons need to insert a long instrument via transoral, transcolonic, transvaginal, or transvesical routes and guide the instrument’s tip to the target location to carry out the surgical operation [2]
For the stability of surgical operation and the transmission of force, the outer shafts of most NOTES instruments are made of thermoplastic polyurethanes reinforced with metal braided sleeve [3], [4], such as R-Scope [5], Direct Drive Endoscopic System [6], and ANUBIS [7]
Summary
With the rapid development of minimally invasive surgery, natural orifice transluminal endoscopic surgery (NOTES) has been adopted by many surgeons. The overtube is inserted into the esophagus in a folded and flexible configuration to minimize the shear and normal forces exerted against the inner wall. The variable-dimension overtube proposed in this paper has four main advantages: Firstly, the diameter of the overtube in the folded configuration is much smaller than the surgical instrument, so the insertion of the overtube will not produce significant forces against the esophagus. This allows the central axis of the linkage to be parallel to that of the backbone in both folded and deployed configurations, which is ideal for the design of the overtube
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