Invasive Surgical Instruments Research Articles

Design and validation a minimally invasive robotic surgical instrument with decoupled pose and multi-DOF.

High-performance miniature surgical instruments play an important role in complicated minimally invasive surgery (MIS). Based on in-depth analysis of the requirements of MIS and the characteristics of the existing minimally invasive surgical instruments, a multiple degrees of freedom (DOF) robotic surgical instrument with decoupled pose was proposed. Firstly, the design concept of the pose decoupling instrument was described in detail, and its physical structure, transmission structure, and mechanical properties were designed and analyzed. A surgical instrument control algorithm based on the master-slave mode was established. Finally, a physical prototype was developed, and its motion ranges of joints, load capacity, and suture operation performance were comprehensively evaluated, which confirmed the effectiveness of the proposed minimally invasive robotic surgical instrument.

The Future of Artificial Intelligence in Surgery.

Until recently, innovations in surgery were largely represented by extensions or augmentations of the surgeon's perception. This includes advancements such as the operating microscope, tumor fluorescence, intraoperative ultrasound, and minimally invasive surgical instrumentation. However, introducing artificial intelligence (AI) into the surgical disciplines represents a transformational event. Not only does AI contribute substantively to enhancing a surgeon's perception with such methodologies as three-dimensional anatomic overlays with augmented reality, AI-improved visualization for tumor resection, and AI-formatted endoscopic and robotic surgery guidance. What truly makes AI so different is that it also provides ways to augment the surgeon's cognition. By analyzing enormous databases, AI can offer new insights that can transform the operative environment in several ways. It can enable preoperative risk assessment and allow a better selection of candidates for procedures such as organ transplantation. AI can also increase the efficiency and throughput of operating rooms and staff and coordinate the utilization of critical resources such as intensive care unit beds and ventilators. Furthermore, AI is revolutionizing intraoperative guidance, improving the detection of cancers, permitting endovascular navigation, and ensuring the reduction in collateral damage to adjacent tissues during surgery (e.g., identification of parathyroid glands during thyroidectomy). AI is also transforming how we evaluate and assess surgical proficiency and trainees in postgraduate programs. It offers the potential for multiple, serial evaluations, using various scoring systems while remaining free from the biases that can plague human supervisors. The future of AI-driven surgery holds promising trends, including the globalization of surgical education, the miniaturization of instrumentation, and the increasing success of autonomous surgical robots. These advancements raise the prospect of deploying fully autonomous surgical robots in the near future into challenging environments such as the battlefield, disaster areas, and even extraplanetary exploration. In light of these transformative developments, it is clear that the future of surgery will belong to those who can most readily embrace and harness the power of AI.

Advances in Multifunctional Electronic Catheters for Precise and Intelligent Diagnosis and Therapy in Minimally Invasive Surgery.

The advent of catheter-based minimally invasive surgical instruments has provided an effective means of diagnosing and treating human disease. However, conventional medical catheter devices are limited in functionalities, hindering their ability to gather tissue information or perform precise treatment during surgery. Recently, electronic catheters have integrated various sensing and therapeutic technologies through micro/nanoelectronics, expanding their capabilities. As micro/nanoelectronic devices become more miniaturized, flexible, and stable, electronic surgical catheters are evolving from simple tools to multiplexed sensing and theranostics for surgical applications. The review on multifunctional electronic surgical catheters is lacking and thus is not conducive to the reader's comprehensive understanding of the development trend in this field. This review covers the advances in multifunctional electronic catheters for precise and intelligent diagnosis and therapy in minimally invasive surgery. It starts with the summary of clinical minimally invasive surgical instruments, followed by the background of current clinical catheter devices for sensing and therapeutic applications. Next, intelligent electronic catheters with integrated electronic components are reviewed in terms of electronic catheters for diagnosis, therapy, and multifunctional applications. It highlights the present status and development potential of catheter-based minimally invasive surgical devices, while also illustrating several significant challenges that remain to be overcome.

Biomimetic Ultrasonic Vibrator with Broadband Characteristics Inspired by Leaf-Cutting Ants.

Power ultrasound is widely used in industrial production, medical equipment, aerospace, and other fields. Currently, there are two main types of commonly used power generation devices: piezoelectric ultrasonic transducers and magnetostrictive ultrasonic transducers. However, in certain situations with limited external dimensions, the applications of existing power ultrasound devices are limited. In nature, leaf-cutting ants excite vibrations through their tiny organs. Inspired by the vibratory organs of leaf-cutting ants, a new type of biomimetic ultrasonic vibrator (BUV) comprising a scraper, dentate disc, and fixture system was proposed, fabricated, and tested in this study. The experimental results showed that the BUV could operate in the frequency range of 16.8-19 kHz. Within the working frequency range, the vibration of the BUV was stable and the amplitude of the vibration displacement was greater than 22 µm. The operating frequency band of the BUV was broader than those of the piezoelectric and magnetostrictive ultrasonic transducers. In addition, the BUV can cut soft rubber and pig tissues with sufficient output power and load-carrying capacity. The BUV, as a new type of power ultrasonic excitation device, is expected to be applied in high-power micro operating scenarios, such as minimally invasive surgical instruments.

Camera sheath with transformable head for minimally invasive surgical instruments

Introduction This paper presents a camera sheath that can be assembled to various minimally invasive surgical instruments and provide the localized view of the instrument tip. Material and methods The advanced transformable head structure (ATHS) that overcomes the trade-off between the camera resolution and the instrument size is designed for the sheath. Design solutions to maintain the alignment between the camera’s line of sight and the instrument tip direction during the transformation of the ATHS are derived and applied to the prototype of the sheath. Results The design solution ensured proper alignment between the line of sight and the tip direction. The prototype was used with the curved micro-debrider blades in simulated functional endoscopic sinus surgery (FESS). Deep regions of the sinus that were not observable with the conventional endoscopes was accessed and observed using the prototype. Conclusions The presented camera sheath allows the delivery of the instrument and camera to the surgical site with minimal increase in port size. It may be applied to various surgeries to reduce invasiveness and provide additional visual information to the surgeons.

Optical-Waveguide Based 3-Axial Tactile Sensor for Minimally Invasive Surgical Instruments

Optical-Waveguide Based 3-Axial Tactile Sensor for Minimally Invasive Surgical Instruments

Flexible Tactile Sensors Using AlN and MOSFETs Based Ultra-Thin Chips

This paper presents ultrathin chips (UTCs) based flexible tactile sensing system for dynamic contact pressure measurement. The device comprises of an AlN piezocapacitor based UTCs tightly coupled with another UTCs having metal-oxide-semiconductor field-effect transistors (MOSFETs). In this arrangement the AlN piezocapacitor forms the extended gate of MOSFETs. Both AlN piezocapacitor and MOSFET based UTCs are obtained by post-process reduction of wafer thicknesses to ~35μm using backside lapping. The performances of both UTCs were evaluated both before and after thinning and there was no noticeable performance degradation. The UTC-based AlN piezocapacitor exhibited six times higher sensitivity (43.79mV/N) than the thin filmbased AlN sensors. When coupled with MOSFETs based UTC, the observed sensitivity was 0.43N-1. The excellent performance, flexible form factor and compactness shows the potential of presented device in applications such minimal invasive surgical instruments where high-resolution tactile feedback is much needed.

Simultaneous Measurement of Bending and Torsion in Optical Fiber Shape Sensor

Optical fiber shape sensing technology provides an excellent solution for the tracking and guiding of minimally invasive surgical instruments. However, when some large-deformed instrument operation tasks are involved, restricted by the operating environment, a significant torsion will be produced by the curved structure of the instrument, posing a threat to the accuracy of its shape reconstruction notably. In this paper we propose and experimentally illustrate a new distributed curvature and torsion measurement method based on optical frequency domain reflectometer using helical multi-core fibers. A theoretical model of total strain induced by the bending and torsion is established. Two diverse means of inverse algorithms to decouple bending and torsion are explored. The experimental results of two methods demonstrated that the torsion measurement errors are around 6.6% and 7.3%.

Surgical treatment for obstructive hypertrophic cardiomyopathy: a five-year single-center experience of 421 cases

Objectives: To examine the short-term and mid-term effects of surgical treatment of obstructive hypertrophic cardiomyopathy (HCM) in one center. Methods: The perioperative data and short-term follow-up outcomes of 421 patients with obstructive HCM who received surgical treatment at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University from January 2017 to December 2021 were analyzed retrospectively. There were 207 males and 214 females, aged (56.5±11.7) years (range: 19 to 78 years). Preoperative New York Heart Association (NYHA) classification included 45 cases of class Ⅱ, 328 cases in class Ⅲ, and 48 cases in class Ⅳ. Fifty-eight patients were diagnosed with latent obstructive HCM and 257 patients had moderate or more mitral regurgitation with 56 patients suffering from intrinsic mitral valve diseases. All procedures were completed by a multidisciplinary team, including professional echocardiologists involving in preoperative planning for proper mitral valve management strategies and intraoperative monitoring. A total of 338 patients underwent septal myectomy alone, and 59 patients underwent mitral valve surgery along with myectomy. A single transaortic approach was used in 355 patients, and a right atrial-atrial septal/atrial sulcus approach was used in 51 other patients. Long-handled minimally invasive surgical instruments were used for the procedures. Student t test, Wilcoxon rank sum test, χ2 test or Fisher exact test were used to compare the data before and after surgery. Results: The aortic cross-clamping time of septal myectomy alone was (34.3±8.5) minutes (range: 21 to 94 minutes). Eighteen patients had intraoperative adverse events and underwent immediate reoperation, including residual obstruction (10 patients), left ventricular free wall rupture (4 patients), ventricular septal perforation (3 patients), and aortic valve perforation (1 patient). Four patients died during hospitalization, and 11 patients developed complete atrioventricular block requiring permanent pacemaker implantation. After discharge, 384 (92.1%) patients received a follow-up visit with a median duration of 9 months. All follow-up patients survived with significantly improved NYHA classifications: 216 patients in class Ⅰ and 168 patients in class Ⅱ (χ2=662.73, P<0.01 as compared to baseline). At 6 months after surgery, follow-up echocardiography showed that the thickness of the ventricular septum ((13.6±2.5) mm vs. (18.2±3.0) mm, t=23.51, P<0.01) and the peak left ventricular outflow tract gradient ((12.0±6.3) mmHg vs. (93.4±19.8) mmHg, 1 mmHg=0.133 kPa, t=78.29, P<0.01) were both significantly lower than baseline values. Conclusion: The construction of the surgical team (including echocardiography experts), proper mitral valve management strategies, identification and management of sub-mitral-valve abnormalities, and application of long-handled minimally invasive surgical instruments are important for the successful implementation of septal myectomy with satisfactory short-and medium-term outcomes.

Additive manufactured continuum mechanisms based on shape-programmable and micro-sized building blocks

ABSTRACT Micro-additive manufacturing techniques have the potential to meet the demand for miniaturised functional components for minimally invasive surgical instruments. These techniques create monolithic, compliant mechanisms with micro-sized free-form structures that can be tailored to patient-specific surgical procedures. The automated design synthesis of the mechanisms using building blocks results in structures that are shape-programmable. This is achieved through an algorithmic-based computational workflow, which automatically converts user-specified 2D and 3D curves into discrete curve segments. The actuated motion of the mechanisms can be designed to move in a specific way, both forwardly and inversely. The mechanisms are manufactured using micro-laser powder bed fusion and hardenable stainless steel 17-4 PH. By carefully selecting the process parameters, it is possible to 3D-print micro-sized features such as a compliant beam thickness of 80 μm and an actuation hole of 100 μm. Both 2D planar curved mechanisms and 3D spatial curved mechanisms have been implemented and experimentally validated.

Design and Modeling of a Bio-Inspired Compound Continuum Robot for Minimally Invasive Surgery

The continuum robot is a new type of bionic robot which is widely used in the medical field. However, the current structure of the continuum robot limits its application in the field of minimally invasive surgery. In this paper, a bio-inspired compound continuum robot (CCR) combining the concentric tube continuum robot (CTR) and the notched continuum robot is proposed to design a high-dexterity minimally invasive surgical instrument. Then, a kinematic model, considering the stability of the CTR part, was established. The unstable operation of the CCR is avoided. The simulation of the workspace shows that the introduction of the notched continuum robot expands the workspace of CTR. The dexterity indexes of the robots are proposed. The simulation shows that the dexterity of the CCR is 1.472 times that of the CTR. At last, the length distribution of the CCR is optimized based on the dexterity index by using a fruit fly optimization algorithm. The simulations show that the optimized CCR is more dexterous than before. The dexterity of the CCR is increased by 1.069 times. This paper is critical for the development of high-dexterity minimally invasive surgical instruments such as those for the brain, blood vessels, heart and lungs.

Concentric Dual-Chamber Pneumatic Artificial Muscles: Miniature Actuators Designed for Use in Minimally Invasive Surgical Instruments

Development of high-performance flexible surgical instruments is important to simplify and enable new minimally invasive surgical procedures. New actuation technologies are necessary to produce flexible instrumentation that is capable of accessing difficult-to-reach anatomy and performing laborious tasks without damaging delicate tissues. Recently, concentric McKibben muscles and dual-chamber pneumatic artificial muscles (PAMs) have been proposed for use in miniature flexible robotic surgical instrumentation. In this study, several varieties of a hybrid concentric dual-chamber PAM design are built and their force generation and stroke length are compared to a contractile McKibben muscle. The concentric dual-chamber PAM is designed to provide surgical access for large diameter (1.5–2.0 mm) instruments to be delivered to the surgical site in a pneumatically sealed actuator suitable for miniaturization and integration into surgical devices used in fluid environments (fetal applications in particular). Force output of the concentric dual-chamber PAM is modeled and compared to experimental results. Initial results suggest that the newly introduced design produces a higher actuation force per unit length than traditional McKibben muscles. The prototype dual-channel PAM produced a maximum 15.25 N of force and 8.39 mm of stroke, in comparison to 13.31 N of force and 19.3 mm of stroke produced by a traditional contractile McKibben muscle of the same length, outer diameter, and materials.

Evaluation of user-interfaces for controlling movements of virtual minimally invasive surgical instruments.

Recent tele-mentoring technologies for minimally invasive surgery (MIS) augments the operative field with movements of virtual surgical instruments as visual cues. The objective of this work is to assess different user-interfaces that effectively transfer mentor's hand gestures to the movements of virtual surgical instruments. A user study was conducted to assess three different user-interface devices (Oculus-Rift, SpaceMouse, Touch Haptic device) under various scenarios. The devices were integrated with a MIS tele-mentoring framework for control of both manual and robotic virtual surgical instruments. The user study revealed that Oculus Rift is preferred during robotic scenarios, whereas the touch haptic device is more suitable during manual scenarios for tele-mentoring. A user-interface device in the form of a stylus controlled by fingers for pointing in 3D space is more suitable for manual MIS, whereas a user-interface that can be moved and oriented easily in 3D space by wrist motion is more suitable for robotic MIS.

Application of Pulsating Vacuum Cleaning Technology to Medical Devices Cleaning

This study aims to solve existing problems in cleaning medical devices, such as the cumbersome loading of minimally invasive surgical instruments, the incomplete cleaning of instruments with complex structures, and the low cleaning efficiency of ordinary instruments. A pulsating vacuum cleaning machine was combined with ultrasonic cleaning and boiling cleaning technology to clean various complex medical devices through a pressure pulsating process (i.e., repetitive pump-out and pumpin until the cleaning results meet the cleaning standards for medical devices). The cleaning results of spay washing, ultrasound cleaning and pulsating vacuum cleaning were compared among four groups of medical devices, including silica gel hoses, chamber instruments, whole box of minimally invasive instruments and surgical instruments. The amount of protein residues was tested using the spectrophotometric method. The testing results revealed that the loading capacity of a pulsating vacuum cleaning machine is 3–4 times as much as that of an ordinary spray cleaning machine, without manual placement and connection operation required, which reduced the workload of pretreatment. The protein residue after cleaning meets the requirements of the YY/T0734 standard for the cleaning effect of medical devices. Pulsating vacuum cleaning technology has an overall better loading capacity, when compared to spay washing and ultrasound cleaning, and this can make up for the shortcomings of commonly used cleaning machines, such as the low cleaning efficiency and unsatisfactory cleaning results of medical devices with complex structures.

Optical-Waveguide Based Tactile Sensing for Surgical Instruments of Minimally Invasive Surgery.

In recent years, with the rapid development of minimally invasive surgery (MIS), the lack of force sensing associated with the surgical instrument used in MIS has been increasingly a desirable technology amongst clinicians. However, it is still an open technical challenge to date since most existing tactile sensing principles are not suitable to small 3-dimensional (3D) curved surfaces often seen in surgical instruments, and as a result multi-point force detection cannot be realized. In this paper, a novel optical waveguide-based sensor was proposed to deal with the above research gap. A sensor prototype for curved surfaces resembling the surface of dissection forceps was developed and experimentally evaluated. The static parameters and dynamic response characteristics of the sensor were measured. Results show that the static hysteresis error is less than 3%, the resolution is 0.026 N, and the repeatability is less than 1.5%. Under a frequency of 12.5 Hz, the sensor could quickly measure the variation of the force signal. We demonstrated that this small and high-precision sensitive sensor design is promising to be used for creating multiple-point tactile sensing for minimally invasive surgical instruments with 3D surfaces.

Visual detection and tracking algorithms for minimally invasive surgical instruments: A comprehensive review of the state-of-the-art

Minimally invasive surgical instrument visual detection and tracking is one of the core algorithms of minimally invasive surgical robots. With the development of machine vision and robotics, related technologies such as virtual reality, three-dimensional reconstruction, path planning, and human–machine collaboration can be applied to surgical operations to assist clinicians or use surgical robots to complete clinical operations. The minimally invasive surgical instrument vision detection and tracking algorithm analyzes the image transmitted by the surgical robot endoscope, extracting the position of the surgical instrument tip in the image, so as to provide the surgical navigation. This technology can greatly improve the accuracy and success rate of surgical operations. The purpose of this paper is to further study the visual detection and tracking technology of minimally invasive surgical instruments, summarize the existing research results, and apply it to the surgical robot project. By reading the literature, the author summarized the theoretical basis and related algorithms of this technology in recent years. Finally, the author compares the accuracy, speed and application scenario of each algorithm, and analyzes the advantages and disadvantages of each algorithm. The papers included in the review were selected through Web of Science, Google Scholar, PubMed and CNKI searches using the keywords: “object detection”, “object tracking”, “surgical tool detection”, “surgical tool tracking”, “surgical instrument detection” and “surgical instrument tracking” limiting results to the year range 1985–2021. Our study shows that this technology will have a great development prospect in the aspects of accuracy and real-time improvement in the future.

Characterization and In Vitro Studies of Low Reflective Magnetite (Fe3O4) Thin Film on Stainless Steel 420A Developed by Chemical Method

Stainless steel has been the most demanded material for surgical utensil manufacture due to superior mechanical properties, sufficient wear, and corrosion resistance. Surgical grade 420A stainless steel is extensively used for producing sophisticated surgical instruments. Since these instruments are used under bright light conditions prevalent in operation theatres, the reflection from the material is significant which causes considerable strain to the eye of the surgeon. Surgical instruments with lower reflectance will be more efficient under these conditions. A low reflective thin -film coating has often been suggested to alleviate this inadmissible difficulty. This paper reports the development of an optimum parametric low reflective magnetite coating on the surface of SS 420A with a black color using chemical hot alkaline conversion coating technique and its bioactivity studies. Coating process parameters such as coating time, bath temperature, and chemical composition of bath are optimized using Taguchi optimization techniques. X-ray photoelectron spectroscopy (XPS) analysis was used to identify the composition of elements and the chemical condition of the developed coating. Surface morphological studies were accomplished with a scanning electron microscope (SEM). When coupled with an energy-dispersive X-ray analysis (EDAX), compositional information can also be collected simultaneously. Invitro cytotoxicity tests, corrosion behavior, the effect of sterilization temperature on adhesion property, and average percentage reflectance (R) of the developed coating have also been evaluated. These results suggest adopting the procedure for producing low reflective conversion coatings on minimally invasive surgical instruments produced from medical grade 420A stainless steel.

Feasibility, Safety and efficacy of 3-mm instruments in laparoscopic right hemicolectomy for cancer: preliminary experience

Abstract INTRODUCTION Nowadays, the evolution of technology has made available instruments of very small caliber without affecting the surgical technique. Mini-laparoscopy (m-Lap) right hemicolectomy is an evolution of classic laparoscopy (c-Lap), consisting of three-port laparoscopic surgery using a 3-mm trocar. METHODS A retrospective analysis of a prospectively constructed database was performed to assess the feasibility, safety, and efficacy of 3-mm instruments. We included patients undergoing a right hemicolectomy with c-Lap or m-Lap for cancer. Patients undergoing emergency, palliative, or open surgery were excluded. Primary outcomes were the rate of anastomotic leakage (AL), surgical site infection (iSSI), organ/space infection (OSI), and disease-free and overall survival. Secondary outcomes were the length of surgery and length of stay (LOS). RESULTS Between January 2015 and December 2020, seventy-five patients met the inclusion and exclusion criteria. Among them, 20 (26,67%) underwent m-Lap and 55 (73,33%) underwent c-Lap. The two groups had homogeneous baseline characteristics. There were no differences in AL (P=0.905), iSSI or OSI (P=0.831), disease-free survival (P=0.340), overall survival (P=0.351), length of surgery (P=0.742), or length of hospital stay (P=0.053). CONCLUSION A 3-mm trocar for right hemicolectomy is feasible, safe, and effective. It does not affect the quality of surgery or the short and long-term outcomes. We hope this study will stimulate further research on less invasive surgical instruments.

Retrospective Non-Inferiority Analysis of Comparative of Performance on Single Incision Laparoscopic Cholecystectomy (SILC) between Using a Conventional Equipment and a Commercially Available Equipment

Background: Single incision laparoscopic cholecystectomy (SILC) is a modern technique for cholecystectomy via a single transumbilical incision. Original surgical equipment including an articulated minimally invasive surgical instrument was necessary for SILC procedures. However, the articulated long length with flexible rotatable tip instrument is expensive and could not be reimbursed by the Thai National Health Insurance. The present study used conventional laparoscopic equipment that is a non-articulated, shorter, and rigid tip to perform SILC. Objective: To compare the effectiveness between conventional and original equipment for the SILC procedure by evaluating the difficulty of SILC indicated by the length of operative time. Materials and Methods: The patients that underwent SILC in Thammasat University Hospital between October 2014 and December 2020 were reviewed from the electronic medical database. The primary outcome was the difficulty of the SILC procedure, determined from the operative time, to evaluate the performance of the SILC procedure between using the conventional or the original equipment in a non-inferiority trial. The secondary outcome was intraoperative and post-operative complications. Results: The eligibility criteria included 592 SILC procedure that was categorized as conventional equipment group with 351 (59.29%) patients and original equipment group with 241 (40.71%) patients. The multivariate analysis reported the number of difficult SILC procedures was less frequent in SILC using conventional equipment when compared with original equipment, significantly with 37 (10.54%) versus 43 (17.84%) relative risk (RR) (1.75, 95% CI 1.081 to 2.822, p=0.023). The intraoperative bile leakage, cystic artery injury, wound infection and 3-months follow-up of incisional hernia were not different in SILC procedures using eithers equipment. Conclusion: The application of conventional equipment that is used in multiple-port LC procedure to perform in SILC procedure was safe and not related to difficulty of SILC. This can reduce the cost of surgery, especially for articulated instrument that cannot be reimbursed from the National Health Insurance in Thailand. Keywords: Laparoscopic cholecystectomy; Single-incision laparoscopic cholecystectomy; Articulated minimally invasive surgical instrument; Difficult laparoscopic cholecystectomy.

A Unique Bone Osteotome Technique for Extraction of Palatally Inclinated Maxillary Impacted Tooth: A Technical Note

Background: There have been reported about impacted tooth[1,2,3], but a very few literature about extraction technique using bone osteotomy. Bone osteotome is routinely used in various oral surgeries. We describe a technique of a unique bone osteotome technique for extraction of palatally inclinated maxillary impacted tooth. Methods: We occasionally encounter the patient with tooth crown of impacted tooth inclinated from the buccal site toward the palatal site. When the use of an elevator and forceps is difficult due to the palatal tilted and interference of neighboring teeth, tooth extraction is a challenge.Using this osteotome from the buccal site causes the canine to easily rise out of the socket in the palatal direction. Results and Conclusion: This bone osteotome technique for extraction of palatally inclinated maxillary impacted tooth was very useful and convenient.This is because the impacted canine can be removed with a bone osteotome, a minimally invasive surgical instrument. No appreciable disadvantages are noted with this bone osteotomy. Keywords: Unerupted Tooth; Impacted Canine; Supernumerary Teeth