System Architecture and Demonstration System for Robotic Natural Orifice Transluminal Endoscopic Surgery

Type: Master Thesis
Student: RistoKojcev
Advisor: Nassir Navab
Supervisors: Kevin Cleary, PhD, Kevin Gary, PhD, Tobias Reichl, Ali Bigdelou

Abstract

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an emerging paradigm for minimally invasive surgery. In NOTES, an endoscope is passed through a natural orifice, eliminating the need for external incisions. Compared to laparoscopic surgery, this procedure may be safer for the patient due to decreased risk of complications such as postoperative infections, adhesions, and pain. While these advantages are subject to debate, what is clear is that the NOTES approach requires new technology and improved instruments.

NOTES is technically challenging as minimally invasive surgical tools have a limited number of degrees of freedom and range of motion. All instruments in a NOTES procedure are introduced through a single natural orifice, leading to increased potential for instrument collisions and inadequate triangulation for surgical site visualization. Furthermore, depth perception, hand eye coordination and lack of haptic feedback are problems with current surgical instruments. These challenges lead to difficulty performing NOTES procedures, which have seen very limited clinical adoption to date.

This thesis contributes to the active exploration of NOTES as a viable minimally invasive technique. This thesis presents the design and implementation of a Robotic NOTES (R-NOTES) system, with particular emphasis on gross positioning tasks using an industrial robot and Magnetic Anchoring and Guidance System, and internal positioning using an embedded device, wireless communication protocol, and human-computer interface. A R-NOTES system is intended to be a teleoperated system, where the surgeon will operate the system from a surgical console. This thesis includes a reference integration architecture for further exploration of the NOTES concept. Furthermore, integration of the system components, and the development of a wirelessly controlled robotic surgical tool, the MicroBot, are presented. The wireless control of the MicroBot uses the ZigBee protocol, which enables the robot to be self-contained without any external wires.

The thesis makes the following technical contributions. First, the thesis enabled wireless control of the MicroBot. This was done by development of a printed circuit board (PCB) using Pulse Width Modulated (PWM) signals and the ZigBee protocol. Second, the thesis enabled wireless communication. This was done by development of an embedded application for wireless communication and PWM signal generation using the ZigBee protocol. Third, the thesis enabled the KUKA robot to control the gross positioning of the MicroBot. This was done by development of a software application using a Magnetic Anchoring and Guidance System and the KUKA Fast Research Interface and integration of two user input devices, a six degrees of freedom mouse and a Phantom Omni haptic device to control the KUKA robot end-effector.

It is hoped that the advancements made by this thesis are steps toward enabling NOTES procedures that can lead to improved patient care.