Patent Application
20110202070
The present invention generally relates to the field of endoluminal surgery and more particularly relates to an endoluminal bimanual micro-robotic platform and a method for deploying the micro-robotic platform in a body cavity such as the gastric cavity.
In traditional open surgery, physical and rigid links exist between the surgeon and the patient's organs. The instruments are hand-held and operated under direct binocular vision.
With the introduction of laparoscopic techniques, the direct physical links between the surgeon and the patient's organs are represented by the trocars, which are used for the insertion of different instruments, energised dissection devices and staplers, all having a remote end-effector and proximal actuation i.e., the surgeon's hand.
Surgical tele-operated robots, such as the Da Vinci® system, are considered an important on-going evolution in minimally invasive surgery because, whilst the main features of surgical execution are retained, the actuation of bimanual tools is remote from the patient and is performed by the surgeon operating from a console. The Da Vinci® wrist is remotely driven by actuators at the proximal end of the tool module through cable drives.
Recent examples of autonomous surgical robots include the inchworm-type devices. Self-propelled robotic endoscopes have been developed for navigation in tubular organs [K. Ikuta et al., Hyper-redundant active endoscope for minimum invasive surgery, Proc. First Int. Symp. on Medical Robotics and Computer Assisted Surgery, Pittsburg, Pa., 1994; A. B. Slatkin et al., The development of a robotic endoscope, Intelligent Robots and Systems 95. ‘Human Robot Interaction and Cooperative Robots’, Proceedings. 1995 IEEE/RSJ International Conference, vol. 2, pp. 162-171, 5-9 Aug. 1995; A. Menciassi et al., Robotic solutions and mechanisms for a semi-autonomous endoscope, Intelligent Robots and System, 2002. IEEE/RSJ International Conference, vol. 2, pp. 1379-1384, 2002].
Hyper-redundant robotic structures, essentially snake-like structures, improve manipulation performance in complex and highly constrained environments. They have been used in several fields of industry as well as bimanual haptic interfaces and have been also proposed for design of endoscopic robots. Existing hyper-redundant robotic structures, also for surgery, are generally cable actuated from external driving systems and thus are mechanically connected with the outside world.
In flexible interventional endoscopy, the rigid link between the surgeon and the organs becomes progressively weaker as the mechanical constraints are transferred from outside the body (e.g. the hand held device, the instruments inside the trocar, etc.) to lumen of an internal hollow organ. Mechanically, as exemplified by the autonomous colonoscopes, the rigid transmission from outside is removed. A surgical robotic system for flexible endoscopy is disclosed in WO2007/111571. A pair of robotic arms ending with surgical tools extend from the distal end of a flexible endoscope. US2005/096502 discloses a surgical device for use in laparoscopy or surgical endoscopy comprising an elongated body with a plurality of arms carrying surgical tools extending from the distal end.
The current robotic solutions for gastric surgical procedures are based on bulky robotic units and still require several incisions in the patient's abdomen. On the other hand, current endoluminal procedures for gastrointestinal tract surgery (a subset of NOTES—Natural Orifice Transluminal Endoscopic Surgery—procedures) are still not effective, since they are usually performed by a single flexible instrument, having external cable actuation. Furthermore, this approach has not yet exploited the benefits of robotics. Significant advance is expected with the integration of computer-assisted surgery, flexible endoscopy and tele-operated laparoscopy to access the abdominal cavity through natural orifices
Micro-robots introduced into the peritoneal cavity in pigs through a standard 12 mm laparoscopic trocar after gas insufflation have been reported recently as an adjunct to laparoscopic surgery [D. Oleynikov et al., Miniature robots can assist in laparoscopic cholecystectomy, Surg Endosc., vol. 19, pp. 473-476, DOI: 10.1007/s00464-004-8918-6, 2005]. On this subject see also WO2007/149559, relating to a robotic surgical device insertable in the patient's body and positionable within the patient's body using an external magnet. A pair of arms extend from a body housing magnets interacting with an outer magnetic handle for controlling the positioning of the device. Each arm ends with a surgical tool and is connected to the body through a shoulder joint with two degrees of freedom. Each arm comprises two arm portions connected to one another through an elbow joint with one degree of freedom.
The robotic device according to WO2007/149559, as well those proposed for flexible endoscopy cited above, is unable to perform true bimanual operation due to the fact that the arms bearing the surgical tool extend from a common origin and, despite the degrees of freedom of the arms, their possibility of co-operation is limited by dimensional and spatial factors and the workspace results quite limited. Moreover, the single arms extend from a point which is fixed to the abdominal cavity by magnetic means. All the forces exerted by the arms must be supported by the same force which maintains the common origin in contact with the abdominal wall. This limits the range of force that can be exerted by the tools. In addition to that, a threshold between the working space (proportional to the number of links, thus to the length, of each arm) and the maximum force (limited by the maximum torque that the magnetic link can support, thus inversely proportional to the arm length) must be fixed.
Furthermore, existing research has shown that there is a pressing need for developing a novel surgical approach based on micro-robotics instead of attempting instrumental technologies for the existing operating flexible endoscopes. The multi-capsule robotic device disclosed by Menciassi et al., Biomedical Robotics and Biomechatronics, 2008, BIOROB 2008, 2nd IEEE RAS&EMBS INT. CONF. ON, IEEE, Piscataway, N.J., USA, 238-243, Oct. 19, 2008, follows this trend, but, like the device disclosed in WO2007/149559, cannot work in a bimanual way and hence is affected by the same drawbacks. Moreover, a local self-assembling technique of the device from the single component capsules swallowed by the patient is foreseen which is very difficult to carry out with the required precision and velocity.
The object of the present invention is to provide a micro-robotic platform for advanced endoluminal surgery insertable for deployment in a body cavity to perform surgical procedures with a true bimanual robotic operation.
A particular object of the present invention is to provide an endoluminal micro-robotic platform of the above mentioned type formed by at least two deployable surgical robots capable of being coupled in a body cavity.
A further object of the present invention is to provide an endoluminal micro-robotic platform of the above mentioned type in which the surgical robots have an higher number of degrees of freedom and an increased stability, are able to withstand to higher forces and have better manipulation performances than the prior art similar devices.
It is still another object of the present invention to provide a method for deploying the endoluminal micro-robotic platform of the above mentioned type in a body cavity such as the gastric cavity.
These objects are achieved with the endoluminal micro-robotic platform and the method for its deployment in a body cavity according to the invention, the main features of which are stated in the independent claims 1 and 10. Further important features are set forth in the dependent claims.
The features and the advantages of the endoluminal micro-robotic platform and the method for its deployment in a body cavity according to the invention will be apparent from the following description of an embodiment thereof given by way of a non-limiting example with reference to the attached drawings, in which
As used in the present specification the term “robotic platform” is meant as a robotic framework or a set of robotic components when assembled and deployed in a body cavity to perform a surgical procedure. Likewise, the term “bimanual” is meant as having two surgical tools capable of being operated in the same way as the hands of the surgeon, with substantially the same degrees of freedom. A “snake-like robot” is defined as a flexible or articulated robotic functional unit, as in
With reference to
As shown in
Each attachment leg 7a, b, c and 8a, b, c and each operating arm 3 and 4 has four degrees of freedom. In particular, as shown in detail in
In the present embodiment the connection between the two “snake-like” robotic units 11 and 12 of each surgical robot 1 and 2 is carried out in such a way that the portions of proximal legs 16a and 16b of the unit 11 are coplanar to the corresponding portions of proximal legs 16a and 16b of the unit 12 as shown in
It is clear from the foregoing that, once the surgical robot 1 or 2 is secured to the body cavity wall through the attachment legs 7a, b, c or 8a, b, c, the relative positions of the central bodies 10 of the surgical robots 1 and 2 can be varied in a wide range. This results in a far greater number of relative positions and orientations the surgical tools 5 and 6 are able to take on as compared to the prior art devices, such as those according to WO2007/149559 or WO2007/111571, in which the arms bearing the surgical tools extend from a common supporting means having a fixed spatial positioning. Furthermore, since the central bodies 10 are supported by three legs 7a, b, c and 8a, b, c respectively, the arms 3 and 4 bearing the surgical tools 5 and 6 can have better performances in term of force torque and reliability as compared to the prior art.
The motors 21, 25, 28 and 32 can be DC brushless motor and can also be equipped with an encoder, in order to have closed loop control of the motion.
It is worth noting that the various proximal and distal leg portions, as well as the various proximal and distal operative arm portions, are structurally equal, i.e. the attachment legs and the operative arms have a modular structure. This greatly simplifies their production and assembling.
Each snake-like robotic unit is equipped with means for energy and data transmission and with a set of sensors to perceive the robot position in a tri-dimensional space and to monitor in real time its performance. On board battery 34 and a control board 35 can also by mounted on each leg portion.
A laser fibre can also be mounted on the operating arm 3 or 4 and the laser fibre can be passed through the insertion port.
One or more robotic cameras 36 are also inserted in the body cavity and attached to the body cavity wall in the same way as the attachment legs. In particular, a robotic camera 36 comprises an attachment device 9, an active (motorized) joint 37 with one or two degrees of freedom, a CMOS or CCD camera, a lens system, an illumination module and means for energy and data transmission.
The endoluminal micro-robotic platform according to the invention is used in the following way.
A semi-rigid gastro-esophageal insertion port 40 is introduced through the mouth into the gastric cavity of a sedated or anesthetized patient. The main functions of this port are to allow an easy and fast introduction of the different modules of the robotic platform and to maintain the stomach in an insufflated condition. See
A flexible and externally steerable introducer 41 is used to deploy the different parts of the platform in the desired positions. To that end an auxiliary pipe to be inserted through a flexible endoscope can also be used. First a sealing element 42 to close the gastro-duodenal junction is introduced, thus allowing the required stable insufflation of the stomach. The sealing element 42 is basically an inflatable balloon, shown in
After the sealing element 42 has been placed, a set of deployable robotic cameras 36 is introduced, as shown in
Then the first snake-like robotic unit 11 composing a first deployable surgical robot 1 is introduced, as shown in
Once the first snake-like robotic unit composing the first deployable surgical robot holds a stable position, as shown in
The same procedure, as shown in
Even if in the above description of the use of the endoluminal robotic platform according to the invention reference has been made to the gastric cavity as a body cavity, it is understood that the invention is not limited to this use and the endoluminal robotic platform of the invention can be deployed in any other body cavity through any other suitable natural or artificial orifice.
Various modifications and alterations to the invention may be made based on a review of the disclosure. These changes and addition are intended to be within the scope of the invention as set forth in the following claims.
| Filing Document | Filing Date | Country | Kind | 371c Date |
|---|---|---|---|---|
| PCT/IB09/54561 | 10/16/2009 | WO | 00 | 4/15/2011 |
