Hand-held transendoscopic robotic manipulators: A transurethral laser prostate surgery case study

Area of Science:

• Minimally Invasive Surgery
• Robotics in Medicine
• Surgical Instrumentation

Background:

• Natural orifice endoscopic surgery offers incisionless approaches but faces challenges with instrumentation dexterity.
• Existing surgical robots can disrupt clinical workflows.
• There is a need for integrated, dexterous tools for minimally invasive procedures.

Purpose of the Study:

• To describe the design and evaluation of a hand-held robotic system for transurethral laser prostate surgery.
• To demonstrate the potential of integrated robotic manipulators and endoscopes for enhancing surgical dexterity.
• To facilitate the adoption of a superior procedure for benign prostatic hyperplasia.

Main Methods:

• Development of a hand-held robotic system with two concentric tube manipulators passing through a 5 mm port in a rigid endoscope.
• Evaluation of the surgeon's functional workspace and accuracy using the robotic system.
• Testing through phantom and cadaver experiments for transurethral laser prostate surgery.

Main Results:

• The hand-held robotic system was successfully designed and integrated.
• Experiments demonstrated the system's capability to enhance dexterity and accuracy.
• Successful completion of prostate lobe resection via the target procedure was achieved in phantom and cadaver models.

Conclusions:

• Hand-held robots integrating thin manipulators and endoscopes can seamlessly enhance clinical workflows and dexterity in natural orifice endoscopic surgery.
• The described system shows promise for enabling complex, minimally invasive procedures like transurethral laser prostate surgery.
• This robotic approach can catalyze the use of clinically superior, yet underutilized, surgical techniques for benign prostatic hyperplasia.