Robotic Surgical Instruments Research Articles

HybGrip: a synergistic hybrid gripper for enhanced robotic surgical instrument grasping.

A fundamental task of a robotic scrub nurse is handling surgical instruments. Thus, a gripper capable of consistently grasping a wide variety of tools is essential. We introduce a novel gripper that combines granular jamming and pinching technologies to achieve a synergistic improvement in surgical instrument grasping. A reliable hybrid gripper is constructed by integrating a pinching mechanism and a standard granular jamming gripper, achieving enhanced granular interlocking. For our experiments, our prototype is affixed to the end-effector of a collaborative robot. A novel grasping strategy is proposed and utilized to evaluate the robustness and performance of our prototype on 18 different surgical tools with diverse geometries. It is demonstrated that the integration of the pinching mechanism significantly enhances grasping performance compared with standard granular jamming grippers, with a success rate above 98%. It is shown that with the combined use of our gripper with an underlying grid, i.e., a complementary device placed beneath the instruments, robustness and performance are further enhanced. Our prototype's performance in surgical instrument grasping stands on par with, if not surpasses, that of comparable contemporary studies, ensuring its competitiveness. Our gripper proves to be robust, cost-effective, and simple, requiring no instrument-specific grasping strategies. Future research will focus on addressing the sterilizability of our prototype and assessing the viability of the introduced grid for intra-operative use.

Minimal Access vs Conventional Nipple-Sparing Mastectomy

While nipple-sparing mastectomy (NSM) for breast cancer was only performed using the open method in the past, its frequency using endoscopic and robotic surgical instruments has been increasing rapidly. However, there are limited studies regarding postoperative complications and the benefits and drawbacks of minimal access NSM (M-NSM) compared with conventional NSM (C-NSM). To examine the differences in postoperative complications between C-NSM and M-NSM. This was a retrospective multicenter cohort study enrolling 1583 female patients aged 19 years and older with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. Those with mastectomy without preserving the nipple-areolar complex (NAC), clinical or pathological malignancy in the NAC, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, or insufficient medical records were excluded. Data were analyzed from November 2021 to March 2024. M-NSM or C-NSM. Clinicopathological factors and postoperative complications within 3 months of surgery were assessed. Statistical analyses, including logistic regression, were used to identify the factors associated with complications. There were 1356 individuals (mean [SD] age, 45.47 [8.56] years) undergoing C-NSM and 227 (mean [SD] age, 45.41 [7.99] years) undergoing M-NSM (35 endoscopy assisted and 192 robot assisted). There was no significant difference between the 2 groups regarding short- and long-term postoperative complications (<30 days: C-NSM, 465 of 1356 [34.29%] vs M-NSM, 73 of 227 [32.16%]; P = .53; <90 days: C-NSM, 525 of 1356 [38.72%] vs M-NSM, 73 of 227 [32.16%]; P = .06). Nipple-areolar complex necrosis was more common in the long term after C-NSM than M-NSM (C-NSM, 91 of 1356 [6.71%] vs M-NSM, 5 of 227 [2.20%]; P = .04). Wound infection occurred more frequently after M-NSM (C-NSM, 58 of 1356 [4.28%] vs M-NSM, 18 of 227 [7.93%]; P = .03). Postoperative seroma occurred more frequently after C-NSM (C-NSM, 193 of 1356 [14.23%] vs M-NSM, 21 of 227 [9.25%]; P = .04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis (odds ratio [OR], 4.75; 95% CI, 1.66-13.60; P = .004 and OR, 8.78; 95% CI, 1.88-41.02; P = .006, respectively). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (OR for other incisions, 32.72; 95% CI, 2.11-508.36; P = .01). Necrosis occurred significantly less often in direct-to-implant breast reconstruction compared to other breast reconstructions (OR, 2.85; 95% CI, 1.11-7.34; P = .03). The similar complication rates between C-NSM and M-NSM demonstrates that both methods were equally safe, allowing the choice to be guided by patient preferences and specific needs.

A dual-instrument Kalman-based tracker to enhance robustness of microsurgical tools tracking.

The integration of a surgical robotic instrument tracking module within optical microscopes holds the potential to advance microsurgery practices, as it facilitates automated camera movements, thereby augmenting the surgeon's capability in executing surgical procedures. In the present work, an innovative detection backbone based on spatial attention module is implemented to enhance the detection accuracy of small objects within the image. Additionally, we have introduced a robust data association technique, capable to re-track surgical instrument, mainly based on the knowledge of the dual-instrument robotics system, Intersection over Union metric and Kalman filter. The effectiveness of this pipeline was evaluated through testing on a dataset comprising ten manually annotated videos of anastomosis procedures involving either animal or phantom vessels, exploiting the Symani®Surgical System-a dedicated robotic platform designed for microsurgery. The multiple object tracking precision (MOTP) and the multiple object tracking accuracy (MOTA) are used to evaluate the performance of the proposed approach, and a new metric is computed to demonstrate the efficacy in stabilizing the tracking result along the video frames. An average MOTP of 74±0.06% and a MOTA of 99±0.03% over the test videos were found. These results confirm the potential of the proposed approach in enhancing precision and reliability in microsurgical instrument tracking. Thus, the integration of attention mechanisms and a tailored data association module could be a solid base for automatizing the motion of optical microscopes.

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.

Feasibility of initiating robotic surgery during the early stages of gastrointestinal surgery education.

Minimally invasive surgery for gastrointestinal cancers is rapidly advancing; therefore, surgical education must be changed. This study aimed to examine the feasibility of early initiation of robotic surgery education for surgical residents. The ability of staff physicians and residents to handle robotic surgical instruments was assessed using the da Vinci® skills simulator (DVSS). The short-term outcomes of 32 patients with colon cancer who underwent robot-assisted colectomy (RAC) by staff physicians and residents, supervised by a dual console system, between August 2022 and March 2024 were compared. The performances of four basic exercises were assessed after implementation of the DVSS. Residents required less time to complete these exercises and achieved a higher overall score than staff physicians. There were no significant differences in the short-term outcomes, operative time, blood loss, incidence of postoperative complications, and length of the postoperative hospital stay of the two surgeon groups. Based on the evaluation involving the DVSS and RAC results, it appears feasible to begin robotic surgery training at an early stage of surgical education using a dual console system.

Insertion trauma and functional recovery after cochlear implantation

The cochlear implant is considered one of the most successful medical devices. The efficiency and cost-effectiveness of implants making a difference in the life of a person with hearing loss is well recognized. There are approximately 750,000 implant patients worldwide. While implant technology is advancing and clinical indications continue to expand, the focus is increasingly shifting towards improving outcomes and enhancing the quality of patient care. Of particular relevance today is the preservation of delicate intracochlear structures during implant surgery, which provides the best prerequisite for successful hearing rehabilitation. In this regard, the article is devoted to the consideration of peculiarities and methods of detection of tissue traumatization during cochlear implantation, as well as the possibilities of functional recovery after implantation. The methodological basis of the study is a systematic literature search, which was conducted using PubMed Medline, methods of analysis, synthesis, generalization, and grouping, investigation of the results of radiological and histological studies. The analysis describes the possibilities and potential of using contrast-enhanced micro-CT with simultaneous application of a special polyoxometalate staining agent to analyze cochlear implant injuries. Special attention is paid to the prospects of using a robotic surgical instrument that assists the surgeon in the insertion of the electrode array. The advantage of using the growth function of the amplitude of the evoked compound action potential to assess functional responses to electrical stimulation of the cochlea is also noted. Further studies of the geometry of intracochlear structures and compartments will allow developing new and improved electrode designs and introducing atraumatic surgical techniques for cochlear implant insertion.

Comparison of totally robotic and totally laparoscopic gastrectomy for gastric cancer: a propensity score matching analysis.

With the improvements in laparoscopic or robotic surgical techniques and instruments, a growing number of surgeons have attempted to complete all digestive tract reconstruction intracorporeally; these procedures include totally robotic gastrectomy (TRG) and totally laparoscopic gastrectomy (TLG). This study aimed to evaluate the safety and feasibility of the TRG and compare the short-term outcomes of the TRG and TLG in patients with gastric cancer. Between January 2018 and June 2023, 346 consecutive patients who underwent TRG or TLG at a high-volume academic gastric cancer specialty center were included. 1:1 propensity score matching (PSM) was performed to reduce confounding bias. The surgical outcomes, postoperative morbidity, and surgical burden were compared in PSM cohort. After PSM, a well-balanced cohort of 194 patients (97 in each group) was included in the analysis. The total operation time of the TRG group was significantly longer than that of the TLG group (244.9 vs. 213.0min, P < 0.001). There was no significant difference in the effective operation time between the 2 groups (217.8 vs. 207.2min, P = 0.059). The digestive tract reconstruction time of the TRG group was significantly shorter than that of the TLG group (39.4 vs. 46.7min, P < 0.001). The mean blood loss in the TRG group was less than that in the TLG group (101.1 vs. 126.8mL, P = 0.014). The TRG group had more retrieved lymph nodes in the suprapancreatic area than that in the TLG group (16.6 vs 14.2, P = 0.002). The TRG group had a lower surgery task load index (38.9 vs. 43.1, P < 0.001) than the TLG group. No significant difference was found in terms of postoperative morbidity between the 2 groups (14.4% vs. 16.5%, P = 0.691). This study demonstrated that TRG is a safe and feasible procedure, and is preferable to TLG in terms of invasion and ergonomics. The TRG may maximize the superiority of robotic surgical systems and embodies the theory of minimally invasive surgery.

Evaluation of microbial occurrence in reusable robotic instruments for minimally invasive surgery: A pilot study.

In recent decades, minimally invasive surgery has become the favoured surgical technique, with increasing utilisation of robotic surgery to enhance patient outcomes. However, the design complexity of surgical robotic instruments can pose challenges in maintaining adequate cleaning, disinfection and sterilisation-particularly of the device's interior. In our hospital, robotic instruments are reused for a maximum of ten successive patients, following the manufacturer's guidelines. To the best of our knowledge, neither the manufacturer nor ISO standards have specified any methods to determine the sterility of robotic instruments after cleaning, disinfection and sterilisation procedures. In a small pilot study, we used a locally developed protocol to evaluate the sterility of 20 da Vinci SI robotic instruments, with the aim of determining whether the recommended cleaning, disinfection and sterilisation process is adequate to achieve safe usage in subsequent patients. None of the 20 instruments showed viable micro-organisms, therefore the robotic instruments were considered sterile, and suitable for re-use. We recommend our protocol to other hospitals, to be used as an essential control element in the assessment of their unique reprocessing technique for robotic instruments.

Cable-Driven Mechanism Models for Sensitive and Actuated Minimally Invasive Robotic Instruments

Cable-driven mechanism models are, usually, included in actuated systems; however, recently, their use for sensitive systems has been explored. In this paper, two cable-driven multi-body mechanism models are compared, underlining advantages and constraints in using sensitive cable-driven mechanisms for minimally invasive robotic instruments. The proposed approach could be useful in bypassing sterilization problems for surgical robotic instruments because our system allows for the separation of the robotic sterilizable part from the sensitive-actuated part of the surgical instrument. The real implementation of the proposed mechanism models, presented partially in other works, are validated in this paper, performing a simulation using a multi-body environment. Results confirm the feasibility of the proposed sensitive-actuated approach, defining new bases for the next challenges of the future.

Intraoperative robotic surgical system-related problems in robot-assisted thoracoscopic surgery

BackgroundMalfunctions of robotic instruments during robotic surgery are well known to occur; however, detailed reports on the inherent problems associated with robotic instruments and robotic surgical systems are scarce. The objective of this study was to retrospectively investigate the intraoperative problems associated with robotic surgical systems and robotic instruments.Materials and methodsThis was a single-center retrospective study. Between April 2012 and December 2022, 544 patients with consecutive lung malignancies and/or mediastinal tumors underwent robot-assisted thoracoscopic surgery. Among these, 15 cases had intraoperative problems associated with the robotic surgical system. Human error was defined as a problem caused by the incorrect operation of the robotic surgical system and human factors as problems in which the robotic surgical system stopped owing to damage to the instruments of the robotic surgical system or the self-diagnosis of the robotic surgical system. We retrospectively investigated the causes of intraoperative problems in these cases.ResultsThere were 4 cases (0.7%) with problems related to the robotic surgical system, 2 of which were human errors, and 11 (2.0%) with problems related to robotic surgical instruments, 6 of these were related to instruments and 5 were related to robotic staplers. Five of these were related to human factors.ConclusionTeams performing robot-assisted thoracoscopic surgery should be familiar with the features of robotic surgical systems and various robotic devices, be aware of reported problems during robot-assisted thoracoscopic surgery, and be prepared for emergencies.

The influence of the da Vinci surgical robot on electromagnetic tracking in a clinical environment

Robot-assisted surgery is increasingly used in surgery for cancer. Reduced overview and loss of anatomical orientation are challenges that might be solved with image-guided surgical navigation using electromagnetic tracking (EMT). However, the robot’s presence may distort the electromagnetic field, affecting EMT accuracy. The aim of this study was to evaluate the robot’s influence on EMT accuracy. For this purpose, two different electromagnetic field generators were used inside a clinical surgical environment: a table top field generator (TTFG) and a planar field generator (PFG). The position and orientation of sensors within the electromagnetic field were measured using an accurate in-house developed 3D board. Baseline accuracy was measured without the robot, followed by stepwise introduction of potential distortion sources (robot and robotic instruments). The absolute accuracy was determined within the entire 3D board and in the clinical working volume. For the baseline setup, median errors in the entire tracking volume within the 3D board were 0.9 mm and 0.3° (TTFG), and 1.1 mm and 0.4° (PFG). Adding the robot and instruments did not affect the TTFG’s position accuracy (p = 0.60), while the PFG’s accuracies decreased to 1.5 mm and 0.7° (p < 0.001). For both field generators, when adding robot and instruments, accuracies inside the clinical working volume were higher compared to the entire tracking 3D board volume, 0.7 mm and 0.3° (TTFG), and 1.1 mm and 0.7° (PFG). Introduction of a surgical robot and robotic instruments shows limited distortion of the EMT field, allowing sufficient accuracy for surgical navigation in robotic procedures.

Task Accuracy Enhancement for a Surgical Macro-Micro Manipulator With Probabilistic Neural Networks and Uncertainty Minimization

Accurate robot kinematic modelling is a major component for autonomous robot control to guarantee safety and precision during task execution. In surgical robotics complex robotic structures and actuation mechanisms are generally employed, therefore machine learning techniques can be adopted to build the model of the robot. Probabilistic neural networks are a class of learning approaches that provide information about the uncertainty of the learnt models. In this work we compare two different probabilistic neural networks (Bayesian and Evidential Neural Networks) to model the kinematics of a surgical robotic instrument and propose a control strategy based on Hierarchical Quadratic Programming (HQP) capable of exploiting the model uncertainty to improve the accuracy and safety of the controller. Simulation and real world experiments on different autonomous path tracking tasks show that the model uncertainty highly affects the control performances and prove the effectiveness of the proposed controller in improving task execution. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —The push towards reducing invasiveness and patient’s traumas in surgery has lead to the requirement of miniaturized and highly articulated robots. This however comes at the cost of having systems that are hard to model and control, which is one of the major limitations for autonomy in surgical robotics. Machine learning has become very effective in modelling complex systems and probabilistic approaches additionally allow estimating the confidence of the learnt model. In robotics field where high precision is required to perform an autonomous task, like in minimally invasive surgery, the robot model needs to be very accurate and controllers need to guarantee safety in performing the desired task, while satisfying additional motion constraints imposed by the application scenario. This work proposes the use of probabilistic neural networks to model the complexity of a surgical robotic instrument and a control strategy capable of ensuring safety by maximizing model’s confidence and guaranteeing satisfaction of imposed motion constraints. In this work a macro-micro manipulator setup is employed, consisting of an articulated surgical robotic instrument connected to a serial-link manipulator. The proposed modelling and control approaches can be used in any other field where controllers need to highly rely on the robot model due to limitations in using external sensors and where leveraging information about model’s confidence can be beneficial. Currently, the work focuses only on pure kinematic modelling and control, thus neglecting any possible interaction with the environment. Future work will focus on addressing this limitation in order to ensure proper force control and effective autonomy.

Enhanced U-Net with GridMask (EUGNet): A Novel Approach for Robotic Surgical Tool Segmentation.

This study proposed enhanced U-Net with GridMask (EUGNet) image augmentation techniques focused on pixel manipulation, emphasizing GridMask augmentation. This study introduces EUGNet, which incorporates GridMask augmentation to address U-Net's limitations. EUGNet features a deep contextual encoder, residual connections, class-balancing loss, adaptive feature fusion, GridMask augmentation module, efficient implementation, and multi-modal fusion. These innovations enhance segmentation accuracy and robustness, making it well-suited for medical image analysis. The GridMask algorithm is detailed, demonstrating its distinct approach to pixel elimination, enhancing model adaptability to occlusions and local features. A comprehensive dataset of robotic surgical scenarios and instruments is used for evaluation, showcasing the framework's robustness. Specifically, there are improvements of 1.6 percentage points in balanced accuracy for the foreground, 1.7 points in intersection over union (IoU), and 1.7 points in mean Dice similarity coefficient (DSC). These improvements are highly significant and have a substantial impact on inference speed. The inference speed, which is a critical factor in real-time applications, has seen a noteworthy reduction. It decreased from 0.163 milliseconds for the U-Net without GridMask to 0.097 milliseconds for the U-Net with GridMask.

Branch Aggregation Attention Network for Robotic Surgical Instrument Segmentation.

Surgical instrument segmentation is of great significance to robot-assisted surgery, but the noise caused by reflection, water mist, and motion blur during the surgery as well as the different forms of surgical instruments would greatly increase the difficulty of precise segmentation. A novel method called Branch Aggregation Attention network (BAANet) is proposed to address these challenges, which adopts a lightweight encoder and two designed modules, named Branch Balance Aggregation module (BBA) and Block Attention Fusion module (BAF), for efficient feature localization and denoising. By introducing the unique BBA module, features from multiple branches are balanced and optimized through a combination of addition and multiplication to complement strengths and effectively suppress noise. Furthermore, to fully integrate the contextual information and capture the region of interest, the BAF module is proposed in the decoder, which receives adjacent feature maps from the BBA module and localizes the surgical instruments from both global and local perspectives by utilizing a dual branch attention mechanism. According to the experimental results, the proposed method has the advantage of being lightweight while outperforming the second-best method by 4.03%, 1.53%, and 1.34% in mIoU scores on three challenging surgical instrument datasets, respectively, compared to the existing state-of-the-art methods. Code is available at https://github.com/SWT-1014/BAANet.

173. FEASIBILITY AND POTENTIAL ADVANTAGE OF ROBOT-ASSISTED ESOPHAGECTOMY FOR CT4B ESOPHAGEAL CANCER

Abstract Background Advantages of robot-assisted esophagectomy (RAMIE) includes operator-led stable surgical field with stereoscopic HD surgical vision and robotic instruments with EndoWrist technology. However, feasibility and potential benefit of RAMIE for cT4b thoracic esophageal cancer remain unclear. Patients A total of 16 cases with cT4b esophageal cancer treated with RAMIE between Feb, 2019 and April, 2023 were reviewed. Surgical technique and peri-operative factors in addition to short term outcome were evaluated in the present study. Results Background parameters of all 16 cases are as follows; median age = 70.5(42–81), gender (male/female) = 10/6, histology (SCC/Adenoca) =13/3, tumor location (Ut/Mt/Lt) = 4/6/6, invaded organs (Tr/Br/Ao/other) = 7/2/2/5, cN0/1/2/3 = 1/10/4/1, cM0/1 = 11/5, cStage3/4 = 11/5, and preoperative treatment (none/chemotherapy/CRT/both) = 0/9/6/1. In terms of surgical outcomes, median operation time/console time (thoracic procedure) were 506 (403–833)/253 (194–459) min while estimated blood loss was 116 (15–2090) ml. R0 resection was achieved in all cases without conversion to open procedure. Overall postoperative morbidity (Clavien-Dindo classification≧grade3) was 31.3% and the common morbidities were palsy of recurrent laryngeal nerve (n = 2) and anastomotic leakage (n = 2), followed by chylothorax (n = 1), pneumonia (n = 1), and non-occlusive mesenteric ischemia (n = 1). No hospital death (within 90 days) was identified and median postoperative hospital stay was 21 (14–142) days. Surgical videos of cT4b cases to show in our presentation include #1; Mt cT4 (Ao, ltPV) case previously treated with definitive CRT followed by immunotherapy where combined resection of aortic adventitia layer was performed by RAMIE and #2; Ut, cT4 (Tr, ltSCA) case previously treated with definitive CRT. We also discuss potential advantages of RAMIE over conventional approach together with protective measures to be taken in cT4b cases. Conclusion RAMIE for cT4b esophageal cancer seems to be feasible and might have potential advantage over conventional approach.

Integrated planning and control of robotic surgical instruments for task autonomy

Agile maneuvers are essential for robot-enabled complex tasks such as surgical procedures. Prior explorations on surgery autonomy are limited to feasibility study of completing a single task without systematically addressing generic manipulation safety across different tasks. We present an integrated planning and control framework for 6-DoF robotic instruments for pipeline automation of surgical tasks. We leverage the geometry of a robotic instrument and propose the nodal state space to represent the robot state in SE (3) space. Each elementary robot motion could be encoded by regulation of the state parameters via a dynamical system. This theoretically ensures that every in-process trajectory is globally feasible and stably reached to an admissible target, and the controller is of closed-form without computing 6-DoF inverse kinematics. Then, to plan the motion steps reliably, we propose an interactive (instant) goal state of the robot that transforms manipulation planning through desired path constraints into a goal-varying manipulation (GVM) problem. We detail how GVM could adaptively and smoothly plan the procedure (could proceed or rewind the process as needed) based on on-the-fly situations under dynamic or disturbed environment. Finally, we extend the above policy to characterize complete pipelines of various surgical tasks. Simulations show that our framework could smoothly solve twisted maneuvers while avoiding collisions. Physical experiments using the da Vinci Research Kit validates the capability of automating individual tasks including tissue debridement, dissection, and wound suturing. The results confirm good task-level consistency and reliability compared to state-of-the-art automation algorithms.

Application and Mechanical Evaluation of Polyarylate Fiber Rope in Wire Drive Mechanism of Robotic Surgical Instruments

In this study, a polyarylate fiber rope, which is a high-strength synthetic fiber rope, is used in the wire drive mechanism of a multi-degree of freedom (DOF) robotic forceps to evaluate its mechanical practicability. Using a nonconducting material for the drive wire, different from typical use of metallic wires made of stainless steel and tungsten, a technology is developed to simplify the insulation structure significantly, decrease the diameter of the robotic surgical instrument, and lower its cost. In this study, first, a prototype of the multi-DOF robotic forceps equipped with a polyetheretherketone (PEEK) resin flexible wrist joint part with an external diameter of 5 mm is manufactured. The prototype is used to evaluate the assembling of a polyarylate fiber rope with a diameter of 0.34 mm in a multi-DOF mechanism and examine the endurance of the rope to mechanical motions under a single-use assumption. As fastening structures to assemble the rope – a crimp terminal using a hollow pipe and a thread knot – are examined individually by assembling them in the prototype robotic forceps and conducting strength tests of the tension generated by the drive. The test results show that the thread knot method exerts a stabler fastening strength than the hollow pipe method. However, a problem of the former is that the wire may break because of its strong contact with the edge of the hole of the wire guide. Subsequently, to evaluate the endurance of the rope to single-use operation motion, operation tests are conducted by implementing reciprocating bending motions of the flexible wrist joint part of the robotic forceps 1,000 times. The assembled rope endures the sliding within the flexible wrist joint part and the contact loading with the guide part and the fixed structure within the cartridge repeatedly. The endurance operation test results confirm that the drive transmission of the polyarylate fiber rope has sufficient mechanical endurance to 1,000 reciprocating bending motions of the PEEK flexible wrist joint part.

Investigation into the current status of cleaning, disinfection, and sterilization of da Vinci surgical instruments-a cross-sectional survey.

In recent years, the use of robotic-assisted surgery has developed rapidly in China and is now widely used in many clinical fields. However, da Vinci robotic surgical instruments are more precise, expensive, and complex than ordinary laparoscopes, have less instrument configuration, involve restrictions on the duration of use, and have cleanliness requirements for supporting instruments. The purpose of this study was to analyze and summarize the current status of cleaning, disinfection, and maintenance of da Vinci robotic surgical instruments in China to improve the management of these devices. A questionnaire survey on the use of da Vinci robotic-assisted surgery at medical institutions in China was designed, distributed, and analyzed. The survey included items regarding general information, management of instrument handling personnel, instrument handling techniques, guidelines, and references for instrument handling. The results and conclusions were formed from the data generated by the analysis system and the answers of respondents to the open-ended questions. (I) All surgical instruments used in domestic surgery practice were imported. There were 25 hospitals that conduct more than 500 da Vinci robotic-assisted surgeries every year. (II) In a relatively high proportion of medical institutions, nurses continued to be responsible for the processes of cleaning (46%), disinfection (66%), and low-temperature sterilization (50%). (III) A total of 62% of the surveyed institutions used fully manual methods for cleaning instruments, and 30% of the ultrasonic cleaning equipment in surveyed institutions did not comply with the standard. (IV) A total of 28% of surveyed institutions used only visual inspection to evaluate cleaning efficacy. Only 16-32% of surveyed institutions regularly used adenosine triphosphate (ATP), residual protein, and other methods to detect sterilization of cavities in instruments. (V) In 60% of the surveyed institutions, robotic surgical instruments have been damaged. Cleaning efficacy detection methods of robotic surgical instruments were not uniform and standardized. The management of device protection operations should be further regulated. In addition, further study of relevant guidelines and specifications as well as the training of operators is warranted.

Optimization of Surgical Robotic Instrument Mounting in a Macro–Micro Manipulator Setup for Improving Task Execution

In minimally invasive robotic surgery, the surgical instrument is usually inserted inside the patient’s body through a small incision, which acts as a remote center of motion (RCM). Serial-link manipulators can be used as macro robots on which microsurgical robotic instruments are mounted to increase the number of degrees of freedom of the system and ensure safe task and RCM motion execution. However, the surgical instrument needs to be placed in an appropriate configuration when completing the motion tasks. The contribution of this article is to present a novel framework that preoperatively identifies the best base configuration, in terms of Roll, Pitch, and Yaw angles, of the microsurgical instrument with respect to the macro serial-link manipulator’s end effector in order to achieve the maximum accuracy and dexterity in performing specified tasks. The framework relies on hierarchical quadratic programming for the control, genetic algorithm for the optimization, and on a resilience to error strategy to make sure deviations from the optimum do not affect the system’s performance. Simulation results show that the mounting configuration of the surgical instrument significantly impacts the performance of the whole macro–micro manipulator in executing the desired motion tasks, and both the simulation and experimental results demonstrate that the proposed optimization method improves the overall performance.

Cost analysis of supply chain management of Da Vinci surgical instruments: A retrospective study.

Da Vinci surgery is used extensively, but the high costs of the surgical instrument are a serious clinical and management problem. To reduce the cost of the Da Vinci robotic surgical instrument supply chain. Patients were selected from the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Control group patients underwent Da Vinci robot-assisted surgery between January 2019 and June 2019 (control group). Patients who were operated with the same robot from July 2019 to December 2019 were selected as the experimental group (SCM group). The cost analysis and comparison were carried out to integrate instrument sets, working hours, workforce expenditure, and direct and indirect expenses. Compared with the control group, the number of instrument packages was lower (4.5 ± 1.4 vs. 11.5 ± 1.6, P< 0.001) and the personnel's awareness of the instruments was higher (92.3 ± 4.2 vs. 83.4 ± 3.7, P< 0.001) in the SCM group. The SCM group showed lower processing time per device (8.1 ± 1.6 vs. 44.2 ± 5.6 min, P< 0.001) and lower costs per surgical instrument (RMB 11.5 ± 2.3 vs. 60.3 ± 10.2, P< 0.001). The application of the supply chain management can reduce the costs of robotic surgery, improve work efficiency and decrease the failure rate of instruments.