The current state of miniature in vivo laparoscopic robotics

Abstract

Minimally invasive surgery (MIS) reduces patient trauma and shortens recovery time, but also limits the dexterity of the surgeon because degrees of freedom are lost due to the fulcrum eVect of the entry incisions. Visual feedback is also limited by the laparoscope, which typically provides two-dimensional feedback and is constrained by the entry incision. Developments within surgical robotics aim to mitigate these constraints. However, these developments have primarily included large external machines that aug- ment vision and improve dexterity, but are still funda- mentally constrained by the use of long tools through small incisions. An alternative concept is the use of miniature in vivo surgical robots that can be placed entirely into the peritoneal cavity through either an abdominal incision, or, after insertion into the stomach through the esophagus, can enter through a gastrot- omy. This paper reviews the development of Wxed-base camera robots for providing auxiliary views of the sur- gical Weld and of mobile robots with a movable plat- form for vision and task assistance in laparoscopic procedures. Moreover, the progress towards the appli- cation of similar robots for natural oriWce transluminal endoscopic surgery (NOTES) and forward environ- ments is discussed.