The usefulness and ergonomics of a new robotic system for flexible ureteroscopy and laser lithotripsy for treating renal stones.

PURPOSE: To investigate the usefulness and ergonomics of a newly developed robotic system for flexible ureteroscopy (easyUretero). MATERIALS AND METHODS: During in vitro testing, six participants performed renal stone removal four times in an artificial kidney-ureter-bladder model. Each participant manipulated a single-use digital flexible ureteroscope (LithoVue) with their hands and the robotic system, sequentially. We compared the task completion times of each participant. The ergonomics of and operational satisfaction with each procedure were assessed by questionnaires. In vivo tests evaluated the operability and safety of the robotic system in two live female pigs. We checked that all the steps of flexible lithotomy for renal stones could be completed individually. RESULTS: The task completion time with the robotic system during in vitro testing was significantly longer than with manual ureteroscopy regardless of the operator's competence level (expert professors: 282.6±92.4 seconds vs. 73.6±43.3 seconds, p<0.001; fellows: 247.5±57.7 seconds vs. 95.8±43.7 seconds, p<0.001; residents: 281.3±111.0 seconds vs. 188.6±138.6 seconds, p<0.001). The residents took more time to remove the upper and mid caliceal stones with the robotic system. The ergonomic evaluation was better for the robotic system, but operational satisfaction was lower, and there was no statistical difference among the groups. In vivo tests showed that all the steps of robotic flexible ureteroscopy could be completed without difficulty. No safety issues were encountered during the procedure. CONCLUSIONS: The robotic system (easyUretero) was ergonomic and safe for flexible ureteroscopy and laser lithotripsy for renal stones.

In Vivo Feasibility Test of a New Flexible Ureteroscopic Robotic System, easyUretero, for Renal Stone Retrieval in a Porcine Model.

PURPOSE: Using a new robotic endoscopic platform system developed for retrograde intrarenal surgery (RIRS) called easyUretero (ROEN Surgical Inc.), we evaluated the feasibility and safety of renal stone retrieval in a porcine model. MATERIALS AND METHODS: Six female pigs were used for our in vivo study. First, 0.3-cm-sized phantom stones were inserted into the kidneys of each pig via the ureteral access sheath. Next, renal stone retrieval was attempted using manual RIRS in three pigs and robotic RIRS in three pigs. Three surgeons performed extraction of 10 stones in each session. RESULTS: The mean stone retrieval time by manual RIRS was significantly shorter than that by robotic RIRS (399.9±185.4 sec vs. 1127.6±374.5 sec, p=0.001). In contrast, the questionnaire regarding usability showed high satisfaction in the surgeons' fatigue category for surgeons using robotic RIRS. The radiation exposure dose was also lower in robotic RIRS than in manual RIRS (0.14 µSv vs. 45.5 µSv). Postoperative ureteral injury assessment revealed Grade 0 in manual RIRS cases and Grades 0, 1, and 2 in robotic RIRS cases. CONCLUSION: The easyUretero system is a new robotic RIRS system that was developed in Korea. The results of the present study suggest that using easyUretero for stone retrieval during RIRS is safe and ergonomic.

Feasibility of Laser Lithotripsy for Midsize Stones Using Robotic Retrograde Intrarenal Surgery System easyUretero in a Porcine Model.

Purpose: To test the safety and feasibility of laser lithotripsy for midsize renal stones using a newly developed robotic retrograde intrarenal surgery (RIRS) system (easyUretero) in a porcine model. Materials and Methods: Three urologic surgeons representing three different RIRS experience levels (beginner, intermediate, and expert) participated. Four female pigs (aged 6 months) underwent manual or robotic RIRS. Under general anesthesia, a nephrostomy tract was created ventrally, and calcium stones (diameter, 1.0-1.5 cm) were inserted at renal calices. For manual RIRS, surgeons operated a flexible ureteroscope. For robotic RIRS, the ureteroscope was attached to the robotic slave device. The Auriga XL™ Holmium laser was used for lithotripsy. Lasering and stone retrieval time were measured. Kidneys and ureters were inspected for injury at the end of each session. Results: For the expert, both lasering and stone retrieval by manual RIRS were quicker than by robotic RIRS (22.8 ± 11.0 s/stone vs 234.5 ± 102.5 s/stone, p = 0.02; 41.5 ± 0.5 s/stone vs 79.3 ± 8.1 s/stone, p = 0.02). For the intermediate and beginner, lasering and stone retrieval times were not significantly different between manual and robotic procedures (127.8 ± 93.2 s/stone vs 284.8 ± 112.3 s/stone, p = 0.08; 86.0 ± 30.5 s/stone vs 84.1 ± 21.4 s/stone, p = 0.92). All stones were removed. Grade 1 ureteral and renal injuries occurred in both manual RIRS and robotic RIRS. Conclusions: The laser lithotripsy using the easyUretero robotic system is safe and feasible in a porcine model, even for less-experienced surgeons.

Intuitive endoscopic robot master device with image orientation correction.

BACKGROUND: The camera of an endoscope is fixed to the device, and the image rotates together with the endoscope. This can lead to visual confusion for the user and incorrect image reading. The problem also occurs with endoscopic robots. Using a master device with the same degrees of freedom as the endoscope to control an endoscopic robot causes visual-motor misorientation, making intuitive control difficult. METHODS: The roll misorientation between the image and master device handle was removed by measuring and correcting for the roll axis displacement of the master device. This enabled intuitive manipulation of the master device. The work speed and number of mistakes were experimentally measured with and without image correction. RESULTS: The tasks were completed significantly faster and more accurately with image orientation correction than without. CONCLUSIONS: The proposed method enables intuitive manipulation of the master device by correcting the image orientation in endoscopic robot control.

Bed-mounted laparoscopic surgical robot system with novel positioning arm mechanism.

BACKGROUND: Commercialised laparoscopic surgical robotic systems require a large operating room and can only be used in large hospitals. If the robotic system is to be used in a small- or medium-sized hospital, the occupied volume must be reduced further. METHODS: In this paper, we propose a bed-mounted system that can be installed in a general operating room. Furthermore, we proposed a novel positioning arm suitable for a bed-mounted surgical robot system. RESULTS: The surgical possibility of the proposed bed-mounted system has been verified. Furthermore, the surgical possibility of the proposed system was confirmed using in vivo animal experiments. CONCLUSIONS: A bed-mounted laparoscopic robotic system and a novel positioning arm was proposed. The study's ultimate goal is to enable robotic surgery in small and medium-sized hospitals by introducing the proposed bed-mounted laparoscopic robot system, allowing many people to receive high-quality medical services.

Intuitive master device for endoscopic robots with visual-motor correspondence.

BACKGROUND: Master devices exclusively used for endoscopes with position control are being developed as an isomorphic form of endoscopes. These master devices are difficult to intuitively operate because the movement direction of the endoscopic image and control handle do not match. METHODS: To solve this problem, a master device was developed. Its movement direction is compatible with that of the endoscopic image. It analyzes image movements according to flexible endoscopic ureteroscope movements for each degree of freedom. A driving testbed experiment was conducted that modelled the internal structure of a kidney. RESULTS: The time taken in the experiment was shorter when using the proposed master device than the existing isomorphic master device. The proposed device yielded fewer mistakes. CONCLUSIONS: It was confirmed the proposed device is effective in exclusive use for endoscopes because of its feasibility of position control and movement direction's coinciding with that of the endoscopic image.

A novel encountered-type master device with precise manipulation for robot-assisted microsurgery.

BACKGROUND: The unconstrained master devices have emerged as attractive alternatives to the existing linkage-based counterparts. However, the conventional unconstrained master device's manipulation methods have several disadvantages in efficiency and precision. METHODS: We propose an encountered-type master device based on an electromagnetic tracking solution with a prismatic joint at the tip, capable of continuous spatial manipulation with the tip supported on the surface. We performed path-following task and pointing tasks to analyze the performance of the master device. RESULTS: The most convenient, efficient, accurate positioning and precise pointing were possible with a closed loop support condition. Moreover, the tasks under this condition were also completed with higher accuracy, and precision when applying lower motion scale factors. CONCLUSIONS: The proposed master device allowed precise and accurate manipulation for microsurgical tasks. Compared with the conventional unconstrained master devices, the proposed master device provides the ability to perform precise work with a clutching-free motion.

easyEndo robotic endoscopy system: Development and usability test in a randomized controlled trial with novices and physicians.

BACKGROUND: Some difficulties are common when using endoscopes. Steering is not intuitive, the endoscope weight is a physical burden to physicians and communication problems often occur between operators. METHOD: To overcome these, we developed a robotic endoscopy system and conducted a usability test to compare conventional and robotic manipulation. Nine novices and eighteen physicians participated with the physicians being divided into intermediate and expert groups. The participants performed endoscope insertion into a simulator (physicians) or lesion marking on a testbed (novices) and simulate biopsies. RESULT: Novices completed the tasks faster and with a lower workload when using robotic manipulation, whereas the experts showed the opposite trend. Still, the intermediates showed no significant difference as trials proceeded. Nevertheless, the learning curve analysis showed that the learning rate in all groups is greater for robotic manipulation (21.02% on average) than for conventional manipulation (13.75%) and predicted that physicians can reach manual performance. CONCLUSION: The proposed robotic endoscopy system may allow solo-manipulation using one controller and may be more intuitive and convenient to use than conventional manipulation.

A master manipulator with a remote-center-of-motion kinematic structure for a minimally invasive robotic surgical system.

BACKGROUND: In robotic surgical systems, commercial master devices have limitations owing to insufficient workspace and lack of intuitiveness. To overcome these limitations, a remote-center-of-motion (RCM) master manipulator was proposed. METHODS: The feasibility of the proposed RCM structure was evaluated through kinematic analysis using a conventional serial structure. Two performance comparison experiments (peg transfer task and objective transfer task) were conducted for the developed master and Phantom Omni. RESULTS: The kinematic analysis results showed that compared with the serial structure, the proposed RCM structure has better performance in terms of design efficiency (19%) and workspace quality (59.08%). Further, in comparison with Phantom Omni, the developed master significantly increased task efficiency and significantly decreased workload in both experiments. CONCLUSIONS: The comparatively better performance in terms of intuitiveness, design efficiency, and operability of the proposed master for a robotic system for minimally invasive surgery was confirmed through kinematic and experimental analysis.

A single port laparoscopic surgery robot with high force transmission and a large workspace.

INTRODUCTION: This study presents the design of a novel single port laparoscopic surgery robot that is actuated by plate-spring-driven mechanisms with high force transmission and a larger workspace. Many ongoing studies aim to develop robotic single port laparoscopic surgery platforms due to the potential advantages in terms of a short recovery period and fewer postoperative scars. Most of these investigations of single port access have focused on resolving the inconvenient maneuverability of manual single port laparoscopic surgery. However, drive mechanism structures are another requirement. MATERIALS AND METHODS: Most of the existing robotic platforms cannot transmit sufficient force, as many of them use wire-driven mechanisms, which are prone to mechanical deformation that also negatively affects the accuracy of the end effector. In addition, even the best-known laparoscopic surgical robot system has instruments with a limited workspace for single port laparoscopic surgery. Therefore, the purpose of this study was to propose a novel robotic single port laparoscopic surgery platform that uses plate springs to transmit higher forces during tissue handling. RESULTS AND CONCLUSION: Compared to wire- or link-driven mechanisms, the plate-spring mechanism provided surpassing force transmission, with >14 N force transmission achieved, which enables most laparoscopic surgery with single port access. In addition, the high degree of freedom structure of the proposed design permitted an expanded workspace, which might be the most competitive characteristic among the single port systems reported to date.