A novel microwave tool for robotic liver resection in minimally invasive surgery.

INTRODUCTION: During the last two decades, many surgical procedures have evolved from open surgery to minimally invasive surgery (MIS). This limited invasiveness has motivated the development of robotic assistance platforms to obtain better surgical outcomes. Nowadays, the da Vinci robot is a commercial tele-robotic platform widely used for different surgical applications. MATERIAL AND METHODS: In this work, the da Vinci Research Kit (dVRK), namely the research version of the da Vinci, is used to manipulate a novel microwave device in a teleoperation scenario. The dVRK provides an open source platform, so that the novel microwave tool, dedicated to prevention bleeding during hepatic resection surgery, is mechanically integrated on the slave side, while the software interface is adapted in order to correctly control tool pose. Tool integration is validated through in-vitro and ex-vivo tests performed by expert surgeons, meanwhile the coagulative efficacy of the developed tool in a perfused liver model was proved in in-vivo tests. RESULTS AND CONCLUSIONS: An innovative microwave tool for liver robotic resection has been realized and integrated into a surgical robot. The tool can be easily operated through the dVRK without limiting the intuitive and friendly use, and thus easily reaching the hemostasis of vessels.

A new microwave applicator for laparoscopic and robotic liver resection.

PURPOSE: Bleeding from parenchyma transection during a robotic hepatic surgery remains the most critical point affecting postoperative recovery and long-term survival. Various robotic devices with different types of energies have been proposed; however, each of these lack in steerability, efficacy, or accuracy. The aim of this work is to evaluate the feasibility and performance of a new steerable microwave resection device intended for minimizing intraoperative blood loss during laparoscopic and robotic liver resections. METHODS: The new device operating at 2.45 GHz was designed to accommodate the engineering constraints derived from its use for robotic surgery or laparoscopy, in which a steerable head is required and the internal cooling of forced gas or water is undesirable. The device design, analysis, and optimization were addressed using the most advanced commercial electromagnetic and thermal solvers to achieve the best results. To experimentally validate the results of the numerical analysis, many ablations were performed on a freshly explanted bovine liver by using a single device prototype with three levels of energy supplied to the tissue. During the ablation procedures, the time, temperature, and shape of the thermal lesion were recorded using thermocouples and an infra-red thermos camera. SUMMARY: Ex vivo tests showed good agreement with the numerical simulations, demonstrating the validity of the simplifications adopted to deal with the complex phenomena involved in the extreme hyperthermia of a living tissue. The high performance, thermal reliability, and robustness of the developed device were also demonstrated along with the possibility of reducing operation time and blood loss.

Dual applicator thermal ablation at 2.45 GHz: a numerical comparison and experiments on synchronous versus asynchronous and switched-mode feeding.

PURPOSE: This paper compares the results obtained with numerical simulations and ex vivo experiments involving a dual applicator microwave thermal ablation system operating at a 2.45 GHz frequency, both in synchronous and asynchronous modes. Our purpose was to demonstrate that at this frequency an asynchronous or switched-mode system performs essentially as well as the synchronous one, in spite of the prevailing belief that coherence would assure better thermal (TH) synergy. Numerical analysis: The calculations of temperature fields were based on the Pennes bioheat equation, taking into account the effects of blood perfusion by means of a full-wave 3D simulator that allows numerical electromagnetic (EM) and TH analyses. MATERIALS AND METHODS: Experiments were done using a 100 W microwave (MW) power generator and a fast switched-mode sequential 'active' power splitter. By adding a further passive power splitter we arranged a test bed for an accurate experimental comparison of synchronous versus switched-mode TH ablations. RESULTS: The experimental ablation zones produced by a dual applicator array on ex vivo swine tissue corresponded well with the simulated ones, confirming that the simplifications assumed in the full-wave analysis were compatible with the aim of our work. CONCLUSIONS: Numerical simulations and experiments show that at a 2.45 GHz industrial, scientific and medical (ISM) frequency, synchronous, asynchronous and switched-mode multi-probe systems are substantially equivalent in terms of ablative performance. Moreover, the switched-mode solution offers simpler operation along with lesser sensitivity to the placement of applicators in the tissue.