Snap-on robotic wrist module for enhanced dexterity in endoscopic surgery
Snap-on robotic wrist module for enhanced dexterity in endoscopic surgery
复制标题
卡扣式机器人手腕模块可增强内窥镜手术的灵活性
DOI：
10.1109/icra.2016.7487639
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
C. Walsh
中科院分区：
文献类型：
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作者：
Joshua B. Gafford;Tommaso Ranzani;S. Russo;H. Aihara;C. Thompson;R. Wood;C. Walsh
新兴的经内镜手术，如内镜粘膜下剥离术（ESD），提供了一种有前途的手段，治疗早期胃肿瘤的微创方式。然而，这些病变的偏远位置，加上其起源于胃肠道的粘膜下层，往往导致极端的技术，认知和人体工程学的挑战，打击这些技术的广泛适用性和采用。这些挑战之一是实现牵开和解剖组织所需的体内灵活性。通过利用通过临床研究获得的工作空间和力数据，我们开发了一种模块化的、一次性的、远端安装的致动器（“主动端盖”），该致动器可以以内窥镜内置自由度无法实现的方式增强内窥镜医生的远端灵活性。该器械由通过印刷电路MEMS（PCMEMS）制造的柔性关节“外骨骼”组成，该外骨骼接合并偏转通过内窥镜工作通道的电外科工具。嵌入式本体感受传感器使用分布式LED/光电晶体管对和光强度调制（LIM）原理在板上实现。远端自由度使用形状记忆合金（SMA）技术致动，并且致动传输系统完全包含在1英寸长的端盖内，该端盖可以安装在内窥镜的远端上，从而避免了对近端源的机械连接的需要。概念验证试验证明，致动器为现有工具增加了超过50度的远端关节连接，并可产生450 mN的侧向力，临床上已确定该侧向力足以在ESD中进行周向切口。
Burgeoning transendoscopic procedures, such as endoscopic submucosal dissection (ESD), provide a promising means of treating early-stage gastric neoplasia in a minimally-invasive way. However, the remote locations of these lesions, coupled with their origination in the submucosal layers of the gastrointestinal tract, often lead to extreme technical, cognitive and ergonomic challenges which combat the widespread applicability and adoption of these techniques. Among these challenges is achieving the in vivo dexterity required to retract and dissect tissue. By leveraging workspace and force data obtained through clinical studies, we developed a modular, disposable, distally-mounted actuator (an `active endcap') that can augment an endoscopist's distal dexterity in ways that are not achievable with the endoscope's built-in degrees-of-freedom. The device consists of a flexible articulating `exoskeleton' manufactured via printed-circuit MEMS (PCMEMS) which engages and deflects electrosurgical tools that are passed through the endoscopic working channel. Embedded proprioceptive sensing is implemented on-board using distributed LED/phototransistor pairs and the principle of light intensity modulation (LIM). The distal degree-of-freedom is actuated using shape memory alloy (SMA) technology, and the actuation transmission system is fully contained within a 1-inch-long end cap that can be mounted on the distal end of the endoscope, thereby obviating the need for a mechanical connection to a proximal source. Proof-of-concept tests demonstrate that the actuator adds over 50 degrees of distal articulation to existing tools and can generate 450 mN of lateral force which has been clinically determined to be sufficient for performing circumferential incisions in ESD.