Robotic Endoscope Holder Research Articles

Stealth Autoguide as Robotic Holder for Cranial Endoscopic Surgery: Technical Note and Proof of Concept

The Stealth Autoguide (Medtronic, Minneapolis, USA) is a robotic auto-targeting device for stereotactic brain biopsy, placement of stereoelectroencephalography electrodes, and laser ablation therapy. This paper evaluates its off-label application as robotic endoscope holder in transnasal and intraventricular neurosurgery. The potential to enhance stability, reduce manual adjustments, and improve surgical precision is discussed, alongside cost-effectiveness and feasibility. Patients who underwent endoscopic endonasal, transventricular, and microsurgical endoscopic-assisted surgeries using the Stealth Autoguide as robotic holder from August 2023 to March 2024 were included. Surgical data and surgeons' remarks on advantages, disadvantages and limitations of the technique were collected. In this preliminary experience, Stealth Autoguide has proven safe and effective for several approaches. It was successfully used for patients with sellar, parasellar and suprasellar lesions. Moreover, the holder was employed in a third ventriculocisternostomy, a septostomy, and a removal of intraventricular lesion. Finally, the Autoguide has been a useful holder for the endoscope after gross total microsurgical excision of a tumor: the robot aligned the endoscope to the chosen trajectory and allowed the surgeon to "look around the corner" and confirm the extent of resection. No complications occurred in the treated cases, and the system provided great stability and usefulness throughout the surgeries. This experience proves that the Stealth Autoguide can be safely and effectively used as a robotic support for endoscopic procedures. This device ensures precise positioning and manipulation of neuroendoscopes, facilitating visualization and targeting of the desired area. Further researches are needed to verify applications and limitations.

The way to control active form robotic endoscope holder.

The way to control active form robotic endoscope holder.

Comparison of active versus passive robotic-endoscope-holder-assisted unisurgeon uniportal thoracoscopic surgery in terms of surgical efficacy and patient safety.

Few studies have compared robotic-arm-assisted unisurgeon uniportal surgeries with conventional human-assisted uniportal video-assisted thoracoscopic surgeries (VATSs) in terms of surgical efficacy and patient safety. In the present study, we compared the aforementioned surgeries. We explored two robotic endoscope holders-a passive robotic platform (ENDOFIXexo, EA group) and a pedal-controlled active robotic platform (MTG-100, MA group)-for unisurgeon uniportal surgeries and compared the surgical outcomes with those of human-assisted uniportal surgeries (HA group) in 228 patients with a lung lesion (size, <5 cm). The primary parameters for this comparison were surgical efficacy, patient safety, and short-term patient outcomes. No significant differences were observed among the EA, MA, and HA groups. The success rate of robotic-arm-assisted unisurgeon uniportal wedge resection was 100%, regardless of the group. No major differences were noted in preparation time between the EA and MA groups. Segmentectomy was more favorable in the EA group than in the MA group. The rates of surgical conversion were 5% and 60% in the EA and MA groups, respectively. The EA and MA groups did not differ considerably from the HA group in terms of postoperative complications. Unisurgeon uniportal wedge resection may be effectively performed using a robotic endoscope holder, without the need for any human assistants with an expert hand. However, the rate of surgical conversion increases with the complexity of uniportal anatomic resections. The passive platform appears to be more suitable for unisurgeon uniportal surgery than the active pedal-controlled platform given the equipment in contemporary operating rooms.

Real-time fundus reconstruction and intraocular mapping using an ophthalmic endoscope.

Robotic ophthalmic endoscope holders allow surgeons to execute dual-hand operations in eye surgery. To prevent needle-like endoscopes from invading the retina when moving, surgeons expect visual and real-time information about the relative special relationship between the endoscope and fundus. This study develops a real-time fundus reconstruction method. First, using deep learning, the method estimates the distance between the fundus part corresponding to every pixel of the RGB endoscopic image and the endoscope. Then, by combining the estimated distance with the kinematics of a robotic holder, the point cloud representing the present fundus area is generated, and by which the size and position of the eyeball are estimated. This method shows a real-time frequency of 10Hz, which is robust to eyeball movement. The error of fundus reconstruction is about 0.5mm, and the error of eyeball estimation is about 1mm. Using this fundus reconstruction method can map the position of the endoscope inside the eyeball when using a robotic endoscope holder in eye surgery. The overall accuracy level meets the ophthalmologists' accuracy requirements of ophthalmologists.

Manipulation of a robotic endoscope holder with encephalographic signals in a surgical simulator

This paper shows the implementation of a manipulation method based on encephalographic signals for the movement of a robotic endoscope holder in a surgical simulator. This simulator consists of three robots, one endoscope holder robot (Hibou robot) and two surgical robots (Lapbot and PA10 robot). The simulation allows performing a cholecystectomy operation, where the removal of a gallbladder is performed using surgical robots while the endoscope holder robot transmits images from inside the patient's abdomen. For the manipulation of the endoscope holder robot in order to focus on different parts of the abdomen, a joystick device is used, but also a natural interface, which allows the user, after training, to move the camera inside the patient's abdomen by means of his thoughts. Tests performed with several users show promising results regarding the manipulation of objects by thought training, and in particular the manipulation of the endoscope camera in laparoscopy operations, which would allow a better management of the whole operation by the surgeon.

A New Robotic Endoscope Holder for Ear and Sinus Surgery with an Integrated Safety Device.

In the field of sinus and ear surgery, and more generally in microsurgery, the surgeon is faced with several challenges. The operations are traditionally carried out under binocular loupes, which allows for the surgeon to use both hands for a microinstrument and an aspiration tool. More recently, the development of endoscopic otological surgery allowed for seeing areas that are difficult to access. However, the need to handle the endoscope reduces the surgeon’s ability to use only one instrument at a time. Thus, despite anaesthesia, patient motions during surgery can be very risky and are not that rare. Because the insertion zone in the middle ear or in the sinus cavity is very small, the mobility of the endoscope is limited to a rotation around a virtual point and a translation for the insertion of the camera. A mechanism with remote center motion (RCM) is a good candidate to achieve this movement and allow for the surgeon to access the ear or sinus. Since only the translational motion along the main insertion axis is enabled, the ejection motion along the same axis is safe for the patient. A specific mechanism allows for inserting and ejecting the endoscope. In a sense, the position is controlled, and the velocity is limited. In the opposite sense, the energy stored in the spring allows for very quick ejection if the patient moves. A prototype robot is presented using these new concepts. Commercially available components are used to enable initial tests to be carried out on synthetic bones to validate the mobility of the robot and its safety functions.

Comparative early results of a robotics-assisted endoscope holder in single port thoracoscopic surgery in the era of COVID-19.

BackgroundInnovations in surgical instruments have made single-port surgery more widely accepted and lead to a reduced demand for surgical assistants. As COVID-19 has ravaged the world, maintaining minimum medical staffing requirements and proper social distancing have become major topics of interest. We sought to evaluate the feasibility of applying the unisurgeon approach in single-port video-assisted thoracoscopic surgery aided by a robotic camera holder.MethodsOperative time, blood loss, setup time, postoperative hospital stays, and the number of participating surgeons in single-port video-assisted thoracoscopic lung resections were gathered for investigation after the introduction of the ENDOFIXexo robotic endoscope holder system. In this cohort, we collected 213 patients who underwent single port video thoracoscope surgery, including 57 patients underwent robotic endoscope arm assisted surgery and case-matched 52 patients in the robotic arm–assisted group with patients in the human-assisted group through propensity score–matched analysis.ResultsIn wedge resection, a single surgeon was able to completely operate on all lobes of target lesions. However, for anatomical resections, namely segmentectomy, the success rate was 95%, and for lobectomy, the success rate was only 64%. No significant differences between setup times, blood loss, or operative times between the two groups were observed.ConclusionsWhen an experienced uniport surgeon is assisted by a robotic endoscope holder, wedge resection is the most suitable procedure to be performed through unisurgeon single-port video-assisted thoracoscopic surgery without increasing setup time, operative time, or short-term complications. Verification of the technique’s applicability for use in anatomic resections requires further investigation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00464-022-09054-8.

Hybrid Robotics for Endoscopic Transnasal Skull Base Surgery: Single-Centre Case Series.

Only preclinical studies and case reports have described robotic surgery for endoscopic transnasal skull base surgery. To evaluate the role of a novel robotic endoscope holder, developed for transsphenoidal surgery. Patients were prospectively enrolled for 3 mo at the Neurosurgery Unit of Brescia. Endoscope Robot® was used to assist during the sphenoidal phase of the approach, tumor removal, and skull base reconstruction. A Likert scale questionnaire was given to all surgeons after each procedure. Patients who underwent robotic-assisted surgery were matched with nonrobotic ones for pathology and type of procedure. All surgical videos were evaluated during bimanual phases. Twenty-one patients underwent robot-assisted, endoscopic transsphenoidal surgery for different pathologies (16 pituitary adenomas, 3 chordomas, 1 craniopharyngioma, 1 pituitary exploration for Cushing disease) for a total of 23 procedures (1 patient underwent 2 endoscopic revisions of a skull base reconstruction). Subjective advantages reported by surgeons included smoothness of movement, image steadiness, and improvement of maneuvers in narrow spaces and with angled endoscopes; as the main limitation, Endoscope Robot® appeared to be relatively heavy during the initial endoscope positioning. A comparative analysis with a historical matched cohort documented similar clinical outcomes, while endoscope lens cleaning and position readjustments were significantly less frequent in robotic procedures. Although confirmation in larger studies is needed, Endoscope Robot® was a safe and effective tool, especially advantageous in lengthy interventions through deep and narrow corridors.

Autonomous Endoscope Robot Positioning Using Instrument Segmentation With Virtual Reality Visualization

This paper presents a method for endoscope’s autonomous positioning by a robotic endoscope holder for minimally invasive surgery. The method improves human-robot cooperation in robot-assisted surgery by allowing the endoscope holder to acknowledge the surgeon’s view projection and navigate the camera without manual control. The real-time prediction of next desired camera location is estimated using segmented instrument’s tip locations from endoscope video and surgeon’s attention focus given by tracked virtual reality headset. To tackle the issue of real-time surgical instrument segmentation for more precise instrument tip localization, we propose the YOLOv3 and ResNet Combined Neural Network. The method showed an 86.6% IoU across MICCAI’17 Endovis datasets with 30 frames per second processing speed. The proposed pipeline was implemented in ROS on Ubuntu with visualization running under Windows operating system in Unity3D. The simulation demonstrates the robotic arm, endoscope, and surgical environment visualized in 3D in the virtual reality headset to provide a stable view of the endoscope and improve the surgeon’s perception of the operating environment.

Eye Explorer: A robotic endoscope holder for eye surgery.

BackgroundHolding endoscopes by hand when performing eye surgery reduces the dexterity of the surgeon.MethodsA robotic endoscope holder called “Eye Explorer” is proposed to hold the endoscope and free the surgeon's hand.ResultsThis device satisfies the engineering and clinical requirements of eye surgery. The force for manual operation is less than 0.5 N. The observable ranges inside the patient's eye considering horizontal and vertical perspectives are 118° and 97°, and the motion of the holder does not interfere with the surgeon's hand and other surgical devices. The self‐weight compensation can prevent the endoscope from falling when extra supporting force is released. When comparing the external force exerted on the eye by the Eye Explorer with that in case of manual operation, a decrease of more than 15% can be observed. Moreover, the consumption time of endoscope view adjustment using the Eye Explorer and manual operation does not significantly differ.ConclusionThe Eye Explorer allows dual‐hand operation, facilitating a successful endoscopic eye surgery.

Hybrid Robotics for Endoscopic Skull Base Surgery: Preclinical Evaluation and Surgeon First Impression

A robotic endoscope holder should theoretically provide various advantages in transnasal endoscopic skull base surgery, but only recently has a robotic system become commercially available. The objective of this study was to provide a preclinical evaluation of potential advantages and surgeon first impression of this robotic hybrid solution. Thirty skull base surgeons, attending the Joint European Diploma of Endoscopic Skull Base Surgery 2018-2019 in Paris, France, were enrolled. A questionnaire, mainly concerning personal surgical experience and habits, was administered. The test phase consisted of 2 different dry-lab tasks, performed with and without EndoscopeRobot, according to randomization and on 2 different days. A modified NASA Task Load Index test was subsequently administered via e-mail to all participants. Completion times and modified Global Evaluative Assessment of Robotic Skills in Endoscopy scores of the videotaped tasks were recorded. Nineteen otorhinolaryngologic surgeons and 11 neurosurgeons, with different surgical habits and endoscopic experience, were enrolled. No one appeared unfavorable a priori to robotic endoscopic surgery. Although the robot did not provide an advantage in the simple grasping task 1, a trend toward better completion times and efficacy was evident in the bimanual task 2, when performed with the robot and bimanually. According to the modified NASA Task Load Index test, surgeons felt more successful with the robot in task 2, finding it less stressful and mentally demanding. Endoscopic skull base surgeons seem to view a hybrid robotic solution positively. EndoscopeRobot seems to provide a benefit to the single surgeon with experience in bimanual endoscopic surgery. Further preclinical and clinical evaluation of this technology is necessary.

A Study on Speech Recognition Control for a Surgical Robot

Speech recognition is common in electronic appliances and personal services, but its use for industrial and medical purposes is rare because of the presence of motion ambiguity. For minimally invasive surgical robotic assistants, this ambiguity arises because the robotic motion is not calibrated to the camera images. This paper presents a design for a speech recognition interface for an HIWIN robotic endoscope holder. A new intentional speech control is proposed to control movement over long distances. To decrease ambiguity, a method is proposed for voice-to-motion calibration that compares the degree of change in the endoscope image for a voice command. A speech recognition algorithm is implemented on Ubuntu OS, using CMU Sphinx. The control signal is sent to the robot controller using serial-port communication through a RS232 cable. The experimental results show that the proposed intentional speech control strategy has a navigation precision of up to 3.1° of angular displacement for the endoscope. The overall system processing time, including robotic motion, is 3.22 s for ∼1.8-s speech duration. The reference image navigation range is from 2.5 mm for ∼0.5-s speech duration up to 6 mm for ∼1.8-s speech duration, using a setup with camera tip that is located at a distance of 5 cm from the remote center of motion point.

Compact teleoperated laparoendoscopic single-site robotic surgical system: Kinematics, control, and operation.

To date a variety of teleoperated surgical robotic systems have been developed to improve a surgeon's ability to perform demanding single-port procedures. However typical large systems are bulky, expensive, and afford limited angular motion, while smaller designs suffer complications arising from limited motion range, speed, and force generation. This work was to develop and validate a simple, compact, low cost single site teleoperated laparoendoscopic surgical robotic system, with demonstrated capability to carry out basic surgical procedures. This system builds upon previous work done at the University of Hawaii at Manoa and includes instrument and endoscope manipulators as well as compact articulated instruments designed to overcome single incision geometry complications. A robotic endoscope holder was used for the base, with an added support frame for teleoperated manipulators and instruments fabricated mostly from 3D printed parts. Kinematics and control methods were formulated for the novel manipulator configuration. Trajectory following results from an optical motion tracker and sample task performance results are presented. Results indicate that the system has successfully met the goal of basic surgical functionality while minimizing physical size, complexity, and cost.

Foot-controlled robotic-enabled endoscope holder for endoscopic sinus surgery: A cadaveric feasibility study.

To evaluate the feasibility of a unique prototype foot-controlled robotic-enabled endoscope holder (FREE) in functional endoscopic sinus surgery. Cadaveric study. Using human cadavers, we investigated the feasibility, advantages, and disadvantages of the robotic endoscope holder in performing endoscopic sinus surgery with two hands in five cadaver heads, mimicking a single nostril three-handed technique. The FREE robot is relatively easy to use. Setup was quick, taking less than 3 minutes from docking the robot at the head of the bed to visualizing the middle meatus. The unit is also relatively small, takes up little space, and currently has four degrees of freedom. The learning curve for using the foot control was short. The use of both hands was not hindered by the presence of the endoscope in the nasal cavity. The tremor filtration also aided in the smooth movement of the endoscope, with minimal collisions. The FREE endoscope holder in an ex-vivo cadaver test corroborated the feasibility of the robotic prototype, which allows for a two-handed approach to surgery equal to a single nostril three-handed technique without the holder that may reduce operating time. Further studies will be needed to evaluate its safety profile and use in other areas of endoscopic surgery. NA. Laryngoscope, 126:566-569, 2016.

First Clinical Experience in Urologic Surgery with a Novel Robotic Lightweight Laparoscope Holder

To report the feasibility and the safety of a surgeon-controlled robotic endoscope holder in laparoscopic surgery. From March 2010 to September 2010, 20 patients were enrolled prospectively to undergo a laparoscopic procedure using an innovative robotic endoscope holder. Two surgeons performed six adrenalectomies, four sacrocolpopexies, five pyeloplasties, four radical prostatectomies, and one radical nephrectomy. Demographic data, overall setup time, operative time, number of assistants needed were reviewed. Surgeon satisfaction regarding the ergonomics was assessed using a 10-point scale. Postoperative clinical outcomes were reviewed at day 1 and 1 month postoperatively. The per-protocol analysis was performed on 17 patients for whom the robot was effectively used for surgery. Median age was 63 years; 10 (59%) patients were female. Median body mass index was 26.8. Surgical procedures were completed with the robot in 12 (71%) cases. Median number of surgical assistant was 0. Overall setup time with the robot was 19 minutes; operative time was 130 minutes during which the robot was used 71% of the time. Mean hospital stay was 6.94 ± 2.3 days. Median score regarding the easiness of use was 7. Median pain level was 1.5/10 at day 1 and 0 at 1 month postoperatively. Open conversion was needed in one (6%) case, and four minor complications occurred in two (12%) patients. This use of this novel robotic laparoscope holder is safe, feasible, and provides good comfort to the surgeon.

Integration of a Robotic Endoscope Holder with the Surgical Assistant Workstation Software Framework

We have integrated the Philips Research robot arm with the Johns Hopkins cisst library, an open-source platform for computer assisted surgical intervention, for assistance during minimally invasive cardiac surgery using image-based steering of an endoscope. The development of a Matlab to C++ wrapper to abstract away servo-level details facilitates the rapid development of a component-based framework with “plug and play” features. This allows the user to easily exchange the robot with an alternative manipulator while maintaining the same overall functionality.

Decreasing strain on the surgeon in gynecologic minimally invasive surgery by using semi-active robotics

Objective To assess the advantages of a surgeon-controlled robotic endoscope holder in gynecologic minimally invasive solo-surgery as compared with conventional assistance with a second surgeon. Methods One hundred gynecologic laparoscopies were consecutively allocated to surgery with either a robot as the surgical assistant or a conventional assistant surgeon. Total operation time, image stability, and frequency of corrective maneuvers of the camera, in addition to the surgeon's satisfaction regarding the ergonomics of the intervention, were recorded. All interventions were performed by the same surgeon. All laparoscopic surgery was classified as either easy or advanced surgery. Results The image stability score was significantly higher (10 vs 7; P < 0.001) and fewer corrective maneuvers of the robotic endoscope were necessary (1 vs 5; P < 0.001) with the robotic laparoscope holder; in addition, the surgeon recorded a significantly higher satisfaction score for the ergonomics of the semi-active robot (10 vs 7; P < 0.001). Conclusion The robot does not prolong total operation time and increases the surgeon's comfort by improving image stability and laparoscope handling. It could provide major benefit, especially in complex gynecologic laparoscopic surgery.

Projet Rosace : robot sécurisé d’assistance à la chirurgie endoscopique

This article presents work carried out as part of the robot sécurisé d’assistance à la chirurgie endoscopique (Rosace) project (funding ANR TecSan06), involving both academic and clinical partners along with an industrial partner in charge of technology integration. The main subject is a lightweight and compact robot for assistance in the endoscopic surgery field. The goal of the project has been to improve then transfer on a medical-grade product some technologies initially developed by the two academic partners. These technologies are: a first prototype of a robotic endoscope holder, an original method for visual servoing based on instrument tracking and some work done on comanipulation concept which consists in synergic interaction between robot and user. In accordance with the initial goals, major improvements have been obtained on these three aspects of the project. Robotic architecture improvement has contributed to enhance robot's versatility while robot command has been made more efficient and simple to use thanks to instrument tracking and comanipulation. After this 3-year project, initial prototype has turned into a commercially available product integrating (or that will integrate in a few months) these new technologies.

Single‐port, single‐operator‐light endoscopic robot‐assisted laparoscopic urology: pilot study in a pig model

To present our initial operative experience in which single-port-light endoscopic robot-assisted reconstructive and extirpative urological surgery was performed by one surgeon, using a pig model. This pilot study was conducted in male farm pigs to determine the feasibility and safety of single-port, single-surgeon urological surgery. All pigs had a general anaesthetic and were placed in the flank position. A 2-cm umbilical incision was made, through which a single port was placed and pneumoperitoneum obtained. An operative laparoscope was introduced and securely held using a novel low-profile robot under foot and/or voice control. Using articulating instruments, each pig had bilateral reconstructive and extirpative renal surgery. Salient intraoperative and postmortem data were recorded. Results were analysed statistically to determine if outcomes improved with surgeon experience. Five male farm pigs underwent bilateral partial nephrectomy and bilateral pyeloplasty before a completion bilateral radical nephrectomy. There were no intraoperative complications and there was no need for additional ports to be placed. The mean (range) operative duration for partial nephrectomy, pyeloplasty, and nephrectomy were 120 (100-150), 110 (95-130) and 20 (15-30) min, respectively. The mean (range) estimated blood loss for all procedures was 240 (200-280) mL. The preparation time decreased with increasing number of cases (P = 0.002). The combination of a single-port, a robotic endoscope holder and articulated instruments operated by one surgeon is feasible. With a single-port access, the robot allows more room to the surgeon than an assistant.