Abstract
Despite early enthusiasm in robotic-assisted NOTES, several technical challenges exist. Various spinopelvic anatomical constraints can significantly act as obstacles and affect entry and space availability for the deployment of straight and rigid transvaginal/transanal NOTES instruments. Anatomical constraints such as the sacral slope, position, and distance to the target organs are defined. Transvaginal access to the surgical site required a high insertion angle between 20° and 30° to overcome the pronounced sacral slope resulting in dexterity and reachability limitations. A new set of robotic parameters was generated to introduce a 7 degrees of freedom robotic arm. Workspace simulation and phantom precision measurements have shown a significant improvement in the reachability and maneuverability of the robotic platform. While the robotic arms provided stable dexterity, it is constrained when reaching target sites in larger patients. This study has provided an insight and a solution in rigid instrument design, paving a safe route for transvaginal/transanal access for abdominal surgeries towards robotic-assisted NOTES.
Highlights
Today, over a million robotic-assisted operations had been performed using the da Vinci Surgical System, a preeminent commercially available surgical robotic system, with increasing popularity among surgeons in various extirpative and reconstructive procedures [1]
End-Effector Displacement and Reachability for Cholecystectomy. e base of the robotic platform inside the abdominal cavity was carefully located in order to maintain the intended workspace for the deployment of the robotic arms to form proper triangulation and reachability in a surgical operation. e base of the robotic platform can be displaced by adjusting the position of the cannula when both robotic arms were securely anchored at its distal end. e orientation of the cannula was crucial to overcome anatomical obstacles according to findings in the current study
Various anatomical constraints can significantly act as obstacles and affect entry and space availability for the deployment of transvaginal instruments. ese constraints may include organs within the pelvic cavity and bony structures like the lower lumbar vertebrae and the sacral promontory. e deployment and maneuverability of surgical instruments for Natural Orifice Transluminal Endoscopic Surgery (NOTES) can be very confined and technically challenging
Summary
Over a million robotic-assisted operations had been performed using the da Vinci Surgical System , a preeminent commercially available surgical robotic system, with increasing popularity among surgeons in various extirpative and reconstructive procedures [1]. Robotic-assisted laparoscopic surgery has allowed surgeons to improve clinical outcomes by minimizing operative trauma, blood loss, infection rate, and shortening recovery time [2]. Laparo-endoscopic Single-site Surgery (LESS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES) advances, these surgical procedures further in reducing invasiveness by minimizing or eliminating all incisions. NOTES can share similar potential complications associated with LESS including overcrowding and collision of instruments, the inability to attain adequate triangulation, Journal of Robotics limited vision due to parallel alignment of instruments to the surgical site, and surgeon ergonomics [8]
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