Presented at the Doctoral Consortium for Medical Simulation and Robotics held on March 11, 2010 in Chicago, IL in conjunction with the Americal College of Surgeons Accredited Education Institutes Consortium. Cite: http://dx.doi.org/10.6084/m9.figshare.785746

1. Dept. of Mechanical Engineering
Robotic, Multi-Articulated
Endoscopic Surgical Tools for
Natural Orifice Translumenal
Endoscopic Surgery
Devin R. Berg1, Perry Y. Li1, Arthur G. Erdman1, Tianhong Cui1, and Timothy P. Kinney2
1Department of Mechanical Engineering
2Division of Gastroenterology - Hennepin County Medical Center
University of Minnesota, Minneapolis, MN

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Outline
• Background / Introduction to NOTES
• Current developments in the field
• Our approach
• Progress thus far
– Problem characterization
– Concept development
– Prototyping
• Future work

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What is NOTES?
• Natural Orifice: Tool insertion through the
mouth, urethra, vagina, or anus.
• Translumenal: Accessing the abdominal
cavity through an incision in the stomach,
bladder, vagina, or colon.
• Endoscopic Surgery: Typically performed
with a tool resembling a traditional
endoscope.

4. Dept. of Mechanical Engineering
NOTES Advantages
• Faster recovery time
• Less physical discomfort
• No visible scars
• These things may also lead to greater
patient willingness to receive an important
procedure.

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Developing Technology
USGI Medical Olympus
Important features include: Multiple tool channels
Tool articulation
Imaging, suction, and irrigation
Rigidity when necessary
Triangulation

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Our Approach to the Problem
• Achieve teleoperated robotic control
• Produce all necessary device movements from
within the tool end itself
• Device should be portable and field deployable
(taking advantage of teleoperation)
Fluid Power

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Why Fluid Power?
• Remotely located power source
• Can maintain force / torque with minimal
energy consumption
• Precise control
• High power density

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Problem Characterization
Diameter limitation of ~ 18 - 22 mm
Organ manipulation force
requirements of ~ 1.5 - 4 N

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Conceptual Development
Multi-directional articulation
– Spherical joints (prototyped)
– Cantilever beams
Need to be mobilized and
modeled for controls

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Conceptual Development (Cont.)
Force and displacement of articulation joint
– Need high force with limited space
Must balance the force requirement at the tool with the force
input to the joint.

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Conceptual Development (Cont.)
Fluid flow control
– Need to provide bi-direction flow control in small package
– Each actuator requires its own valve
MEMS
Microfluidic
Proportional
Control Valve

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Conceptual Development (Cont.)
Force-Feedback Control Methods
– Provide tool load information to the surgeon
– Enable precise robotic control over tool position

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Prototyping

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Future Work
• Additional characterization of tool force
requirements (e.g. suturing, biopsy, etc.)
• Experimental testing
– Microfluidic valve
– Articulation joint / Actuators / Controls
• Assembly of components into all-inclusive
prototype
• Scaling

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Summary
• NOTES as the next step in MIS
• Other devices currently under development
• Applying fluid power for compact solution
• Progress thus far
– Identifying the problem
– Concept development
– Prototypes have been produced, more coming
• Future work in testing and prototyping

16. Dept. of Mechanical Engineering
References
1. Bardaro, S.J. and Swanstrom, L., 2006. Development of advanced endoscopes for Natural Orifice
Transluminal Endoscopic Surgery (NOTES). Minimally Invasive Surgery, 15(6), pp. 378-383.
2. Bergman, S. and Melvin, W.S., 2008. Natural orifice translumenal endoscopic surgery. Surgical
Clinics of North America, 88, pp. 1131-1148.
3. Caldwell, D.G., Medrano-Cerda, G.A., and Goodwin, M., 1995. Control of pneumatic muscle
actuators. Control Systems Magazine, 15(1), pp. 40-48.
4. Davis, S. and Caldwell, D.G., 2006. Braid effects on contractile range and friction modeling in
pneumatic muscle actuators. The International Journal of Robotics Research, 25(4), pp. 359-369.
5. Granosik, G. and Borenstein, J., 2005. Pneumatic actuators for serpentine robot. 8th International
Conference on Walking and Climbing Robots, pp. 719-726, London.
6. Gostout, C.J., 2009. Update on the use of NOTES procedures. Advances in Endoscopy, 5(6), pp.
401-405.
7. Kalloo, A.N., Singh, V.K., Jagannath, S.B., Niiyama, H., Hill, S.L., Vaughn, C.A., Magee, C.A., and
Kantsevoy, S.V., 2004. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and
therapeutic interventions in the peritoneal cavity. Gastrointestinal Endoscopy, 60(1), pp. 114-117.
8. Rattner, D. and Kalloo, A., 2006. ASGE/SAGES Working Group on Natural Orifice Translumenal
Endoscopic Surgery. Surgical Endoscopy, 20, pp. 329-333.
9. Reynolds, D.B., Repperger, D.W., Phillips, C.A., and Bandry, G., 2003. Modeling the dynamic
characteristics of pneumatic muscle. Annals of Biomedical Engineering, 31, pp. 310-317.
10. Swanstrom, L.L., Khajanchee, Y., and Abbas, M.A., 2008. Natural Orifice Transluminal Endoscopic
Surgery: The future of gastrointestinal surgery. The Permanente Journal, 12(2), pp. 42-47.

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Thank You