A Specimen Extraction Instrument Based on Braided Fiber Tube for Natural Orifice Translumenal Endoscopic Surgery

2018 ◽  
Vol 12 (3) ◽  
Author(s):  
Jinhua Li ◽  
Zemin Zhang ◽  
Shuxin Wang ◽  
Zufeng Shang ◽  
Guokai Zhang
Keyword(s):  
Endoscopic Surgery ◽  
Mechanical Model ◽  
Degrees Of Freedom ◽  
Geometric Model ◽  
Natural Orifice ◽  
Specimen Extraction ◽  
Channel Diameter ◽  
Suction Cup ◽  
Narrow Space ◽  
Promising Development

Natural orifice translumenal endoscopic surgery (NOTES) has offered significant advantages of less pain, reduced recovery time, and minimized scar after operation, demonstrating a promising development prospect. However, the large-size specimen extraction remains challenging for NOTES, due to the narrow space of the human natural orifices. To address such difficulties, a specimen extraction method that utilizes the braided fiber tube (BFT) structure with excellent retractility to accommodate and bind the bulky specimen has been proposed. Based on the theory of helical spring, the geometric model and the mechanical model of the BFT are established, and experiments have been performed to verify the accuracy of the derived mechanical model. In addition, a tensile test of using the BFT to extract large specimens via a small channel is carried out, which verifies the stable extraction performance of the proposed design. The BFT will not be damaged when extracting the specimen with a diameter less than 1.75 times of the channel diameter. A NOTES-specific specimen extraction instrument is designed according to the characteristics of NOTES, and it has three degrees-of-freedom and is able to actively capture different specimen by using a suction cup. Finally, specimen extraction experiments on NOTES multitasking platform phantom have been conducted using the prototyped instrument to validate its feasibility and effectiveness.

Appraisal and Consideration of Natural Orifice Specimen Extraction Surgery in Colorectal Cancer

Nano LIFE ◽  
2019 ◽  
Vol 09 (04) ◽  
pp. 1930001
Author(s):  
Zheng-Wei Fu ◽  
Li-Xia Wang ◽  
Hai-Yan Ge
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Colectomy ◽  
Endoscopic Surgery ◽  
Surgical Approach ◽  
Oncologic Outcomes ◽  
Natural Orifice ◽  
Specimen Extraction ◽  
Short Term ◽  
Natural Orifice Specimen Extraction ◽  
The Times

Although laparoscopic colectomy shows superior short-term outcomes and similar oncologic outcomes in comparison to conventional open colectomy, incision-related complications have weakened its advantages. The natural orifice transluminal endoscopic surgery (NOTES) has been considered as the most perfect surgical approach. However, monumental technical hurdles have precluded widely adoption of this technique. As a transient mode, the natural orifice specimen extraction surgery (NOSES) emerges as the times require. Although it is accepted by surgeons for the treatment of colorectal cancer, there are still many disputes that need to be solved.

scholarly journals Design of an Adjustable Table Mount for Multifunctional NOTES Robot

2017 ◽  
Author(s):  
Shannon Fischer ◽  
Tao Shen ◽  
Carl Nelson ◽  
Dmitry Oleynikov
Keyword(s):  
Endoscopic Surgery ◽  
Degrees Of Freedom ◽  
Natural Orifice ◽  
End Effector ◽  
Surgical Method ◽  
Limited Space ◽  
External Incisions

Natural orifice transluminal endoscopic surgery (NOTES) is a method in which tools are passed through a natural orifice to the surgical site. This removes the need for external incisions, which can allow patients to recover more quickly without any visible abdominal scarring. This surgical method also has several limitations including limited space, complex lumen geography, and difficult visualization [1]. To address these problems, researchers have developed various tools, including endoscope-based robots [2], and insertable bimanual robots [3]. However, some of the aforementioned constraints/limitations remain, and consideration of accessories for use with these tools remains relevant. Our lab designed a multifunctional NOTES robot, which consists of a snakelike linkage driven by cables that are attached to motors in an external housing to navigate through the lumen geometry; it also includes a bimanual end effector with interchangeable tool tips [4]. This paper introduces the design of an adjustable table mount to address the limitations related to transluminal insertion. It provides four passive degrees of freedom (DOFs) to grossly place the robot, and enables the robot to be fixed on surgical tables with different sizes. Benchtop testing on a surgical table with a patient mannequin demonstrates its functionality.

scholarly journals Robotic natural orifice specimen extraction surgery versus traditional robotic-assisted surgery (NOTR) for patients with colorectal cancer: a study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rui Luo ◽  
Fangfang Zheng ◽  
Haobo Zhang ◽  
Weiquan Zhu ◽  
Penghui He ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Natural Orifice ◽  
Specimen Extraction ◽  
Natural Orifice Specimen Extraction ◽  
Robotic Assisted ◽  
Randomized Controlled ◽  
Robotic Assisted Surgery ◽  
Secondary Outcomes

Abstract Background Natural orifice specimen extraction surgery for colorectal cancer has been introduced in order to reduce the abdominal incision, demonstrating major development potential in minimally invasive surgery. We are conducting this randomized controlled trial to assess whether robotic NOSES is non-inferior to traditional robotic-assisted surgery for patients with colorectal cancer in terms of primary and secondary outcomes. Method/design Accordingly, a prospective, open-label, randomized controlled, parallel-group, multicenter, and non-inferiority trial will be conducted to discuss the safety and efficacy of robotic natural orifice extraction surgery compared to traditional robotic-assisted surgery. Here, 550 estimated participants will be enrolled to have 80% power to detect differences with a one-sided significance level of 0.025 in consideration of the non-inferiority margin of 10%. The primary outcome is the incidence of surgical complications, which will be classified using the Clavien-Dindo system. Discussion This trial is expected to reveal whether robotic NOSES is non-inferior to traditional robotic-assisted surgery, which is of great significance in regard to the development of robotic NOSES for patients with colorectal cancer in the minimally invasive era. Furthermore, robotic NOSES is expected to exhibit superiority to traditional robotic-assisted surgery in terms of both primary and secondary outcomes. Trial registration ClinicalTrials.govNCT04230772. Registered on January 15, 2020.

scholarly journals Role of robotic natural orifice specimen extraction surgery in colorectal neoplasms

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hongliang Yao ◽  
Tiegang Li ◽  
Weidong Chen ◽  
Sanlin Lei ◽  
Kuijie Liu ◽  
...  
Keyword(s):  
Colorectal Neoplasms ◽  
Average Distance ◽  
Neoadjuvant Chemoradiotherapy ◽  
Operation Time ◽  
Patient Characteristics ◽  
Safe Procedure ◽  
Natural Orifice ◽  
Specimen Extraction ◽  
Natural Orifice Specimen Extraction

AbstractNatural orifice specimen extraction surgery (NOSES) is especially suitable for colorectal surgery. Until now, most of the reports published were about laparoscopic NOSES, the reports about robotic NOSES are extremely rare. This study aims to explore the safety and feasibility of robotic NOSES for colorectal neoplasms. All patients underwent robotic NOSES from March 2016 to October 2019 in our hospital were enrolled for retrospective analysis. Clinicopathological data including patient characteristics, perioperative information and pathological information were collected and analyzed. According to the distance between tumor and anus or whether neoadjuvant chemoradiotherapy (nRCT) is performed, we grouped the cases and studied its influence on robotic NOSES. Also, we compared the previous reports on laparoscopic NOSES with our study and revealed advantages of robotic NOSES in terms of safety and feasibility. A total of 180 patients were enrolled. The average distance from the lower edge of the tumor to the anus was (8.64 ± 3.64) cm and maximum circumferential diameter (CDmax) of specimen was (3.5 ± 1.6) cm. In terms of safety, the average operation time, intraoperative blood loss, and postoperative hospital stay were (187.5 ± 78.3) min, (47.4 ± 34) mL, and (11.3 ± 7.5) days, respectively. In terms of feasibility, the average number of lymph node harvested was (14.8 ± 5). Robotic NOSES shows advantages in terms of safety and feasibility compared with laparoscopic NOSES. This procedure could not only be a safe procedure but also could achieve good oncological outcomes.

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