Most devices for single-site or natural orifice transluminal surgery are very application specific and, hence, capable of effectively carrying out specific surgical tasks only. However, most of these instruments are rigid, lack a sufficient number of degrees of freedom (DOFs), and/or are incapable of modifying their mechanical properties based on the tasks to be performed. The current philosophy in commercial instrument design is mainly focused on creating minimally invasive surgical systems using rigid tools equipped with dexterous tips. Only few research efforts are aimed at developing flexible surgical systems, with many DOFs or even continuum kinematics. The authors propose a radical change in surgical instrument design: away from rigid tools toward a new concept of soft and stiffness-controllable instruments. Inspired by biology, we envision creating such soft and stiffness-controllable medical devices using the octopus as a model. The octopus presents all the capabilities requested and can be viewed as a precious source of inspiration. Several soft technologies are suitable for meeting the aforementioned capabilities, and in this article a brief review of the most promising ones is presented. Then we illustrate how specific technologies can be applied in the design of a novel manipulator for flexible surgery by discussing its potential and by presenting feasibility tests of a prototype responding to this new design philosophy. Our aim is to investigate the feasibility of applying these technologies in the field of minimally invasive surgery and at the same time to stimulate the creativeness of others who could take the proposed concepts further to achieve novel solutions and generate specific application scenarios for the devised technologies.
Get full access to this article
View all access options for this article.
References
1.
PonskyTA, KhoslaA, PonskyJL. Minimally Invasive Surgery. Textbook of Clinical Gastroenterology and Hepatology, 2nd ed. Oxford: Wiley-Blackwell, 2012.
2.
DingJ, XuK, GoldmanR, AllenP, FowlerD, SimaanN. Design, simulation and evaluation of kinematic alternatives for insertable robotic effectors platforms in single port access surgery. IEEE International Conference on Robotics and Automation (ICRA), 2010, pp. 1053–1058.
3.
DeganiA, ChosetH, ZubiateB, OtaT, ZenatiM. Highly articulated robotic probe for minimally invasive surgery. IEEE International Conference on Medicine and Biology (EMBS), 2008, pp. 3273–3276.
4.
ShangJ, NoonanDP, PayneC, ClarkJ, SodergrenMH, DarziA, YangGZ. An articulated universal joint based flexible access robot for minimally invasive surgery. IEEE International Conference on Robotics and Automation (ICRA), 2011, pp. 1147–1152.
5.
BreedveldP, SheltesJS, BlomEM, VerheijJEI. A new, easily miniaturized steerable endoscope. IEEE Eng Med Biol Mag, 2005; 24:40–47.
6.
PetroniG, NiccoliniM, MenciassiA, DarioP, CuschieriA. A novel intracorporeal assembling robotic system for single-port laparoscopic surgery. Surg Endosc, 2013; 27:665–670.
7.
ZahraeeAH, JéromeS, PaikKJ, GuillaumeM. Robotic Hand-Held Surgical Device: Evaluation of End-Effector's Kinematics and Development of Proof-of-Concept Prototypes. Medical Image Computing and Computer-Assisted Intervention at MICCAI 2010. Berlin: Springer, 2010, pp. 432–439.
8.
GonencB, HandaJ, GehlbachP, TaylorRH, IordachitaI. A comparative study for robot assisted vitreoretinal surgery: Micron vs. the Steady-Hand Robot. IEEE International Conference on Robotics and Automation (ICRA), 2013, pp. 4832–4837.
9.
LoeveA, BreedveldP, DankelmanJ. Scopes too flexible…and too stiff. IEEE Pulse, 2010; 1:26–41.
10.
SlatkinA, BurdickJ, GrundfestW, KhatibO, SalisburyJ, eds. The Development of a Robotic Endoscope Experimental Robotics IV. Berlin: Springer, 1997, pp. 161–169.
11.
PheeL, AccotoD, MenciassiA, StefaniniC, CarrozzaMC, DarioP. Analysis and development of locomotion devices for the gastrointestinal tract. IEEE Trans Biomed Eng, 2002; 49:613–616.
12.
Development of a multi-module STIFF-FLOP manipulator. Available at http://www.stiff-flop.eu (accessed April29, 2014).
13.
TrivediD, RahnC, KierW, WalkerI. Soft robotics: biological inspiration, state of the art, and future research. Appl Bionics Biomech, 2008; 5:99–117.
TortoraG, RanzaniT, De FalcoI, DarioP, MenciassiA. A miniature robot for retraction tasks under vision assistance in minimally invasive surgery. Robotics, 2014; 3:70–82.
MirfakhraiT, MaddenJDW, BaughmanRH. Polymer artificial muscles. Mater Today, 2007; 10:30–38.
22.
FunakuboH. Shape Memory Alloys. New York: Gordon and Breach Science Publishers, 1987.
23.
CianchettiM. Fundamentals on the use of shape memory alloys in soft robotics. In: HabibMK, DavimJP, eds. Interdisciplinary Mechatronics: Engineering Science and Research Development. New York: Wiley-ISTE, 2013, pp. 227–254.
24.
SunL, HuangWM, DingZ, ZhaoY, WangCC, PurnawaliH, TangC. Stimulus-responsive shape memory materials: a review. Mater Des, 2012; 33:577–640.
25.
YiS, SongYS, PaikJ. Characterization of silicone rubber based soft pneumatic actuators. 2013 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), 2013.
26.
MartinezVR, BranchLJ, FishRC, JinL, ShepherdFR, NunesMDR, SuoZ, WhitesidesMG. Robotic tentacles with three-dimensional mobility based on flexible elastomers. Adv Mater, 2013; 25:205–212.
27.
De GreefA, LambertP, DelchambreA. Towards flexible medical instruments: review of flexible fluidic actuators. Precision Eng, 2009; 33:311–321.
28.
GravagneI, WalkerI. Manipulability, force, and compliance analysis for planar continuum manipulators. IEEE Trans Robot Automat, 2002; 18:263–273.
29.
KimYJ, ChengS, KimS, IagnemmaK. A stiffness-adjustable hyperredundant manipulator using a variable neutral-line mechanism for minimally invasive surgery. IEEE Trans Robot, 2013; 30:1–14.
30.
WebsterRJ, RomanoJM, CowanNJ. Mechanics of precurved-tube continuum robots. IEEE Trans Robot, 2009; 25:67–78.
31.
DupontPE, LockJ, ItkowitzB, ButlerE. Design and control of concentric-tube robots. IEEE Trans Robot, 2010; 26:209–225.
32.
MahvashM, DupontP. Stiffness control of surgical continuum manipulators. IEEE Trans Robot, 2011; 27:334–345.
33.
GuidaneanK, LichodziejewskiD. An inflatable rigidizable truss structure based on new sub-TgPolyurethane composites. Proceedings of the AIAA/ASME/ASCE/AHS/ASC Structures, Structural Dynamics, and Materials Conference, Denver, 2002.
34.
RedellFH, LichodziejewskiD, KleberJ, GreschikG. Testing of an inflation-deployed sub-Tg rigidized support structure for a planar membrane waveguide antenna. Proceedings of the Collection of Technical Papers—AIAA/ASME/ASCE/AHS/ASC Structures, Structural Dynamics and Materials Conference, 2005, pp. 920–927.
35.
ChengN, IshigamiG, HawthorneS, HaoC, HansenM, TelleriaM, PlayterR, IagnemmaK. Design and analysis of a soft mobile robot composed of multiple thermally activated joints driven by a single actuator. IEEE International Conference on Robotics and Automation (ICRA), 2010, pp. 5207–5212.
36.
TelleriaMJ, HansenM, CampbellD, ServiA, CulpepperM. Modeling and implementation of solder-activated joints for single-actuator, centimeter-scale robotic mechanisms. IEEE International Conference on Robotics and Automation (ICRA), 2010, pp. 1681–1686.
37.
LoeveAJ, BosmaJH, BreedveldP, DodouD, DankelmanJ. Polymer rigidity control for endoscopic shaft-guide “Plastolock” a feasibility study. J Med Devices, 2010; 4:1–6.
38.
DongH, WalkerGM. Adjustable stiffness tubes via thermal modulation of a low melting point polymer. Smart Mater Struct, 2012; 21(4).
39.
WanliangS, LuT, MajidiC. Soft-matter composites with electrically tunable elastic rigidity. Smart Mater Struct, 2013; 22(8).
40.
ParkG, BementMT, HartmanDA, SmithRE, FarrarCR. The use of active materials for machining processes: a review. Int J Mach Tools Manuf, 2007; 47:2189–2206.
41.
YalcintasM, DaiH. Magnetorheological and electrorheological materials in adaptive structures and their performance comparison. Smart Mater Struct, 1999; 8:560–573.
42.
SturgesRHJR, LaowattanaS. A flexible, tendon-controlled device for endoscopy. Int J Robot Res, 1993; 12:121–131.
43.
MosesMS, KutzerMDM, MaH, MehranA. A continuum manipulator made of interlocking fibers. 2013 IEEE International Conference on Robotics and Automation (ICRA), 2013, pp. 4008–4015.
44.
YagiA, MatsumiyaK, MasamuneK, LiaoH, DohiT. Rigid-flexible outer sheath model using slider linkage locking mechanism and air pressure for endoscopic surgery. Proceedings of the Medical Image Computing and Computer-Assisted Intervention (MICCAI’06), 2006, pp. 503–510.
45.
KimY-J, ChengS, KimS, IagnemmaK. A novel layer jamming mechanism with tunable stiffness capability for minimally invasive surgery. IEEE Trans Robot, 2013; 29:1031–1042.
46.
LiuAJ, NagelSR. Jamming is not just cool anymore. Nature, 1998; 396:21–22.
47.
BrownE, RodenbergN, AmendJ, MozeikaA, SteltzE, ZakinMR, LipsonH, JaegerHM. Universal robotic gripper based on the jamming of granular material. Proc Natl Acad Sci USA, 2010; 107:18809–18814.
48.
ChengNG, LobovskyMB, KeatingSJ, SetapenAM, GeroKI, HosoiAE, LagnemmaKD. Design and analysis of a robust, low-cost, highly articulated manipulator enabled by jamming of granular media. 2012 IEEE International Conference on Robotics and Automation (ICRA), 2012, pp. 4328–4333.
49.
SteltzE, MozeikaA, RembiszJ, CorsonN, JaegerH. Jamming as an enabling technology for soft robotics. SPIE, 2010; 7642:63.
50.
LoeveA, van de VenOS, VogelJG, BreedveldP, DankelmanJ. Vacuum packed particles as flexible endoscope guides with controllable rigidity. Granular Matter, 2010; 12:543–554.
51.
LettsR, HobsonD. The vacuum splint: an aid in emergency splinting of fractures. Can Med Assoc J, 1973; 109:599.
52.
JiangA, AtaollahiA, AlthoeferK, DasguptaP, NanayakkaraT. A variable stiffness joint by granular jamming. Proceedings of the ASME 2012 International Design Engineering Technical Conferences & Computers and Information in Engineering Conference IDETC/CIE, 2012.
53.
CianchettiM, RanzaniT, GerboniG, De FalcoI, LaschiC, MenciassiA. STIFF-FLOP surgical manipulator: mechanical design and experimental characterization of the single module. Proceedings of the 2013 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), 2013.
54.
Webster IIIRJ, JonesBA. Design and kinematic modeling of constant curvature continuum robots: a review. Int J Robot Res, 2010; 29:1661–1683.
55.
SuzumoriK, IikuraS, TanakaH. Flexible microactuator for miniature robots. Micro Electro Mechanical Systems, 1991, MEMS ’91, Proceedings. An Investigation of Micro Structures, Sensors, Actuators, Machines and Robots. IEEE, 1991, pp. 204–209.
56.
HashmonaiM, KopelmanD. Sling retraction of the falciform ligament to ameliorate exposure in laparoscopic upper abdominal surgery. Surg Laparosc Endosc, 1996; 6:71–72.
57.
LimSK, ShinTY, KimKH, HanWK, ChungBH, HongSJ, ChoiYD, RhaKH. LESS robot-assisted nephroureterectomy: comparison with conventional multiport technique in the management of upper urinary tract urothelial carcinoma. BJU Int, 2013. [Epub ahead of print]
58.
PolygerinosP, SeneviratneLD, AlthoeferK. Modeling of light intensity-modulated fiber-optic displacement sensors. IEEE Trans Instrum Meas, 2011; 60:1408–1415.
59.
SearleTC, AlthoeferK, SeneviratneL, LiuH. An optical curvature sensor for flexible manipulators. 2013 IEEE International Conference on Robotics and Automation (ICRA), 2013, pp. 4415–4420.
