Surgical experience of using the endoscope manipulator robot EMARO in totally extraperitoneal inguinal hernia repair: A case report

Abstract

Robot‐assisted surgery has advanced rapidly since the 1980s. However, new equipment is still needed to overcome problems in conventional endoscopic surgery, including unique risks, such as camera shake and communication difficulties between the operator and the scopist. EMARO, an endoscope manipulator robot, is the world's first pneumatically driven endoscope‐holder robot that can operate flexibly and smoothly with the use of air pressure. We herein report the surgical experience of using EMARO in totally extraperitoneal inguinal hernia repair. A 77‐year‐old Japanese man presented with bulging in the right groin area. After we diagnosed a right inguinal hernia, endoscopic inguinal hernia repair was performed. We selected the totally extraperitoneal approach with EMARO. The endoscopic procedure time was 100 minutes, and no intraoperative complications occurred. EMARO brings together features of smooth motion and good manipulation performance. This operation was performed safely and was comparable to a conventional operation completed with human assistants. Solo surgery with EMARO was beneficial in this inguinal hernia patient.

Robotics in laparoscopic surgery - A review

“…Emaro, the world's first pneumatically driven laparoscope holder robot with smooth operation [64] was launched as a result of a venture originating in universities [10,65]. The robotic arm is a parallel manipulator with pneumatic driving mechanism that has made Emaro's movements smooth and gentle, in addition to keeping the design small and simple.…”

Preliminary design and evaluation of a generic surgical scope adapter

“…Examples of the robotic scope assistant systems are presented in Table 2. These systems are used for different surgical procedures such as cholecystectomy, appendectomy, fundoplication, hernioplasty, and salpingectomy 13,15,17,18,22–25 …”

“…The additional degrees‐of‐freedom (DoF) required for (i) rotation of the scope along its axis (used by angulated and articulated scopes as shown in Figure 1B) and (ii) actuation of knobs located at the scope's rear end (used by articulated scopes as shown in Figure 1C) are absent. There are few robotic scope holders (such as Emaro by Riverfield 17,18 and RoboLens—Sina 19 ) that have integrated an additional DoF for scope rotation along its axis. Though it provides support for angulated scopes, it lacks the DoF required for actuation of an articulated scope's distal end.…”

“…These systems are used for different surgical procedures such as cholecystectomy, appendectomy, fundoplication, hernioplasty, and salpingectomy. 13,15,17,18,[22][23][24][25] However, existing robotic scope holders (such as VIKY by Endocontrol, 13 FreeHand by Prosurgics, 14 SOLOASSIST by AKTORmed 15 ) are limited to mostly zero-degree scopes because the hardware lacks actuators for more complicated scope types.…”

“…The additional degrees-of-freedom (DoF) required for (i) rotation of the scope along its axis (used by angulated and articulated scopes as shown in Figure 1B) and (ii) actuation of knobs located at the scope's rear end (used by articulated scopes as shown in Figure 1C) are absent. There are few robotic scope holders (such as Emaro by Riverfield 17,18 and RoboLens-Sina 19 ) that have integrated an additional F I G U R E 1 Pictorial representation of different scope-types, including: (A) Zero-degree scope, (B) Angulated Scope, and (C) Articulated Scope. Scope with a camera at the distal end is inserted inside the patient's body through an incision via a trocar.…”