Design and analysis of an intra-abdominal wall-lifting device for vNOTES

Abstract

Natural orifice transluminal endoscopic surgery (NOTES) associated with less pain, shorter hospital stay, and outstanding cosmetic results has drawn considerable attention from the academic community. For NOTES, pneumoperitoneum is an essential technology to obtain intraperitoneal surgical space, which, however, can have some serious adverse hemodynamic effects. In this paper, we propose a novel intra-abdominal wall-lifting device that can replace the pneumoperitoneum functionally for transvaginal NOTES (vNOTES). The device consists mainly of two layers of elastic strips, namely, the outer strips that are used to lift the abdominal wall for surgical exposure and the inner strip with a camera mounted that can rotate to provide a wide surgical field of view. With the design, gasless vNOTES can be carried out with 82.74% of the operative field provided by pneumoperitoneum, eliminating all complications associated with gas insufflation. The design principle and kinematic analysis of the device are discussed in detail and validated by experiments. Finally, a prototype is fabricated to demonstrate the feasibility of the proposed concept.