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Modified Robotic Lightweight Endoscope (ViKY) Validation In Vivo in a Porcine Model Andrew A. Gumbs, Fernando Crovari, Clement Vidal, Patrick Henri and Brice Gayet Surg Innov 2007; 14; 261 DOI: 10.1177/1553350607310281 The online version of this article can be found at: http://sri.sagepub.com/cgi/content/abstract/14/4/261
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Modified Robotic Lightweight Endoscope (ViKY) Validation In Vivo in a Porcine Model
Surgical Innovation Volume 14 Number 4 December 2007 261-264 © 2007 Sage Publications 10.1177/1553350607310281 http://sri.sagepub.com hosted at http://online.sagepub.com
Andrew A. Gumbs, MD, Fernando Crovari, MD, Clement Vidal, PhD, Patrick Henri, and Brice Gayet, MD, PhD The added precision and steadiness of a robotically held camera enables the performance of more complex procedures laparoscopically. In contrast to typical laparoscope holders, the modified lightweight robotic endoscope, the ViKY system is particularly compact, simple to set up and use, and occupies no floor space. Ease and safety of setup was confirmed in a porcine model and several common general surgical procedures were performed. The sterilizable endoscope manipulator is sufficiently small to be placed directly on the operating room table without interfering with other handheld instruments during
minimally invasive surgery. The endoscope manipulator and its user interface were tested and evaluated by several surgeons during a series of 5 minimally invasive surgical training procedures in a porcine model. The endoscope manipulator described has been shown to be a practical device with performance and functionality equivalent to those of commercially available models, yet with greatly reduced size, weight, and cost.
Introduction
picture will enable the performance of more complex procedures laparoscopically.1 The first scope holder robot appeared in the late 1990s. Their role is to move the endoscope into position and hold the camera still. They are directly controlled by the surgeon through a voice-recognition system, footswitch, or hand remote control. They provide a “third hand” to the surgeon, who controls it to obtain his or her view of the surgical field. Based on a 6-year research program at the Joseph Fourier University in Grenoble, EndoControl developed an innovative robotized scope holder system, which is much more compact and ergonomic than existing solutions and economically advantageous. In contrast to typical endoscope manipulators, the robot described here is particularly compact and lightweight, is simple to set up and use, occupies no floor or operating table space, and does not limit access to the patient in any way. Endoscope camera trajectoryfollowing accuracy and response-time results were measured using an optical localizer. The endoscope manipulator and its user interface were tested and evaluated by several surgeons during a series of minimally invasive surgical training procedures on cadavers.
Because the surgeon holds instruments in each hand during the procedure, an assistant is needed to hold the endoscope in the desired positions and orientations during laparoscopic surgery. This task is fairly straightforward and well defined yet awkward and tiring for a human assistant; rather than occupying an additional trained professional assistant during the procedure, it is worthwhile using a robotic device as a surgical assistant to hold and move the endoscope. Additionally, as has already been demonstrated, the added precision and steadiness of the From the Department of Digestive Diseases, Institut Mutualiste Montsouris, University René Descartes Paris V, Paris, France. Andrew A. Gumbs, MD, was supported by a fellowship grant from KARL STORZ GmbH & Co. KG, Tuttlingen, Germany. This work was supported by grants from the Association pour la Recherche contre le Cancer (ARC) of France and the Philippe Foundation in Paris, France. Address correspondence to: Pr. Brice Gayet, MD, PhD, Department of Digestive Diseases, Institut Mutualiste Montsouris, University René Descartes, Paris V, 42, Boulevard Jourdan, Paris 75014, France; e-mail:
[email protected].
Keywords: endoscope manipulator; robotic; ViKY system; voice-controlled
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Surgical Innovation / Vol. 14, No. 4, December 2007
Materials and Methods The EndoControl system consists of a compact motorized scope holder placed directly on the patients abdomen (Figure 1). The sterilizable endoscope manipulator is sufficiently small (110 mm in diameter, 1400) to be placed directly on the operating room table without interfering with other handheld instruments during minimally invasive surgery. The robot motors provide 3 degrees of freedom: 2 rotations permitting the viewing of the entire abdominal cavity, and translation allowing the endoscope to get closer to or further from the organs (mechanical zoom). The endoscope insertion depth is controlled by a cable winding acting against a compression spring on the endoscope shaft. It is attached to the endoscope and trocar and is compatible with all types of endoscopes and trocars. A passive arm holds the motorized scope holder just above the patient’s abdomen (Figure 1). It is attached to the rail of the operating table. Unlike other available laparoscopic manipulators, this motorized scope holder and passive arm are submersible and autoclavable. A console, which contains motor controllers and software, analyzes the surgeon’s orders and translates them to commands for the low-level motors (Figure 2a). It contains a touch panel screen for user interface (robot and voice settings). The front panel contains connectors for the different command modes (footswitch or Bluetooth microphone) and motorized scope holder (Figure 2b). The system is controlled either by voice (Bluetooth microphone supervised by a single footswitch for security) or foot (via 6-function footswitch). Voice recognition and miniature keypad user command interfaces are provided, and the manipulator motors are back-drivable for manual repositioning. Trocar placement alteration was defined as any difference in trocar trajectory or placement as determined by the operating surgeon.
Results The endoscope manipulator and its user interface were tested and evaluated by several surgeons during a series of 6 minimally invasive surgical training procedures in a porcine model. The first 2 operations were used to confirm the ease and safety of the setup and use of the ViKY (Vision Kontrol for
Figure 1. Vision Kontrol endoscopY (ViKY) system in vivo in a porcine model.
Figure 2. A: Vision Kontrol endoscopY (ViKY) system console; B: (a) ViKY system console, (b) autoclavable robotic camera holder, (c) safety foot pedal for voice control, and (d) foot pedal without voice control.
endoscopY; ViKY Ste Endocontrol-Medical SAS 38000, Grenoble, France) system. Subsequently, laparoscopic cholecystectomy, hepatectomy, small bowel anastamosis, and pelvic exploration were successfully performed in 4 different pigs. Setup time was compared with setup times for the current robotically controlled camera holder that we use (AESOP 3000—Intuitive Surgical Inc., Sunnyvale, California) in 10 human
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Robotic Endoscope Validation in a Porcine Model / Gumbs et al
Table 1.
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Comparison of the ViKY System in Animal Studies Compared With AESOP in Human Subjects
Average setup time Average removal time Average task time Voice-control success rate Number of trajectory changes due to obstruction (per procedure) Number of port placement modifications (per procedure) Weight (lbs) Sterilizable Projected cost (US dollars)
ViKY
AESOPa
P Value
41 3 2 71% 12 1 3.1 Yes 60 000
253 8 2 67% 15 1 >50 No 100 000
