The “Highly Versatile Single Port System” for laparoscopic surgery: Introduction and first clinical application
In minimally invasive surgery, trauma to the patient can be reduced by diminishing the number of entry ports. In addition a single port access, attaining “high flexibility” in laparoscopic interventions is also of utmost importance. We developed the “Highly Versatile Single Port System” (HVSPS), a two-armed device with an additional semi-flexible telescope, to meet these requirements. Both manipulators and the telescope are inserted independently through a three-channel trocar which is guided by a four degree of freedom telemanipulator. Furthermore, a simulation of the complete system including the surgical environment is programmed for user training and design optimization. The first gallbladder could be successfully resected in an animal experiment using the HVSPS. The manipulators were introduced into the abdominal cavity through a single incision. After the ligation of the cystic duct and artery with coagulation current, the gallbladder was held with a grasper and dissected using a TT knife. The complete surgical intervention, without technical set-up, was accomplished within 110 minutes. For the first time, the feasibility of laparoscopic cholecystectomy using the HVSPS has been shown in this study. However, such elaborate systems bring up new challenges such as the definition of an adequate human-machine interface and new control approaches for retroflective manipulations which are possible with the kinematic structure of the HVSPS.
Keywordssingle port access flexible instrument laparoscopic telemanipulator laparoscopic surgery minimally invasive surgery
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- 1.Feussner H, Can S, Fiolka A, Schneider A. Hybrid surgery-the way towards notes the challenge for computer science. Biomedical Imaging: From Nano to Macro, 2008 ISBI 2008 5th IEEE International Symposium on 2008;1383–6.Google Scholar
- 2.Ikuta K, Sasaki K, Yamamoto K, Shimada T. Remote Microsurgery System for Deep and Narrow Space-Development of New Surgical Procedure and Micro-robotic Tool, Proc. of 5th International Conference on Medical Image Computing and Computer-Assisted Intervention(2002) 163–172Google Scholar
- 3.Song H, Chung J, Kim K, Lee J. The Development of human-arm like manipulator for Laparoscopic Surgery with Force sensing, Industrial Technology, 2006. ICIT 2006. IEEE International Conference on (2006) 1258–1262.Google Scholar
- 4.Yamashita H, Iimura A, Aoki E, Suzuki T, Nakazawa T, Kobayashi E, et al. Development of endoscopic forceps manipulator using multislider linkage mechanisms. Journal of Japan Society of Computer Aided Surgery 2005;7(2):201–4.Google Scholar
- 8.Thompson CC, Ryou M, Rothstein RI, Fong DG, Pai RD, Smith B.S. P,. Weitzner B.S. BD (May 21 2007). Stomach-Direct Drive Endoscopic System for Endoluminal and NOTES Applications. The DAVE Project. (http://daveproject.org/viewfilms.cfm?film_id=612)Google Scholar
- 9.Gillen S, Doundoulakis E, Schneider A, Fiolka A, von Delius S, Meining A, Friess H, Feussner H. The “ELITE” model: Construct validation of a new training system for Natural Orifice Translumenal Endoscopic Surgery (NOTES), Endoscopy (2008) “submitted”Google Scholar
- 10.Mayer H, Nagy I, Knoll A, Braun EU, Bauernschmitt R. Human Computer Interfaces of a System for Robotic Heart Surgery. Proceedings of the Second IASTED International Conference on Human-Computer Interaction, 31–36. 2007. Chamonix, France.Google Scholar