Robotic-Assisted Transrectal Cholecystectomy in a Porcine Model

Abstract

Background. With increasing experience and technological advancement in surgical instruments, surgeons have explored the feasibility of single-incision laparoscopic surgery and natural orifice transluminal endoscopic surgery (NOTES). These techniques aim to further reduce surgical trauma, but are not popular due to their inherent pitfalls including clashing of instruments, lack of counter traction, lengthy operating time, and so on. A novel surgical robotic system was designed to overcome the limitations of the existing technologies. Animal trials were conducted to demonstrate its feasibility in performing robotic-assisted transrectal cholecystectomy in a porcine model. Method. The Novel surgical robotic system is a high dexterity, single access port surgical robotic system that enables surgeons to carry out single-port surgical procedure or NOTES. The proposed system’s main features include the ability to perform intraabdominal and pelvic surgeries via natural orifices like the vagina or rectum. The system is equipped with multiple miniaturized (16 mm diameter) internally motorized robotic arms, each with a minimum of 7 degrees of freedom, a dual in vivo camera system, a cannula, and an external swivel system. Results. Robotic-assisted transrectal cholecystectomy was successfully performed in 3 adult male pigs. The estimated blood loss was <10 mL in all 3 cases. There were no intraoperative complications. The system provided good dexterity and clear vision. Conclusions. The trial demonstrated that the system can provide the surgeon a stable platform with adequate spacing for the transrectal insertion of robotic arms, 3-dimensional vision, and enhanced dexterity in performing NOTES cholecystectomy.

Robotic Natural Orifice Transluminal Endoscopic Surgery Hysterectomy and Salpingo-Oophorectomy in a Porcine Model

“…24 To address current limitations, a new surgical robotic system NISImagine with miniaturized robotic anthropomorphic arms each with 7 DOFs that can replicate the surgeons dexterous hand movements and be fully inserted into the peritoneal cavity was developed. This new surgical robot had previously performed a robotic NOTES cholecystectomy in a porcine model 15 using the forward configuration of the robotic arms in the upper abdomen. In the current study, the same system was deployed but using a reverse configuration of the robotic arms that allowed the positioning and triangulation of the arms toward the pelvic cavity for completing hemi-hysterectomy and unilateral salpingo-oophorectomy procedure in the first animal and a total hysterectomy and bilateral salpingooophorectomy in the second animal.…”

“…The experimental study protocol was approved by the local institutional animal ethical committee on the Use of Live Animals in Teaching and Research (CULATR, HKU). A porcine model that was previously described 15 was used to evaluate the feasibility in performing NOTES gynecological procedures using the NISImagine surgical robotic system. All surgical operations were performed by experienced gynecologists who have extensive experience both in laparoscopic and robotic surgical procedures.…”

“…The framework of the surgical robot comprises of 2 internally motorized robotic arms with a diameter of 16 mm and a dual-camera 3D laparoscopic vision system that is inserted in parallel along the single-port cannula. 15 The camera head is rectangular that has a 12 mm × 10 mm cross section and a length of 25 mm. Camera is anchored to a supporting rod with a diameter of 8 mm.…”

Porcine training models for endoscopic and robotic reconstructive breast surgery: a preliminary study

“…Minimally invasive surgery is employed in various fields to minimize surgical incisions. Various instruments are used, including laparoscopic or endoscopic devices, and recently the trend has moved toward robotic surgery (1). Such trends have also influenced breast surgery, even extending to research on breast reconstruction.…”

“…Therefore, to use endoscopic or robotic surgery for breast reconstruction, a preliminary experimental model for surgical training that enables surgical planning to minimize complications is very important (1)(2)(3)(4)(5)(6).…”