The transcolonic approach using an innovative guide tube is feasible and safe. The technique described offers mentionable advantages and therefore reduces the known shortcomings of NOTES. However, further studies are needed to approve our results of an initial evaluation.
Since the publication of the first paper on NOTES, a dramatic increase of activities in this new surgical field is to be observed. However, a "pure" NOTES operation does not yet exist. Only NOTES-like operations have been proposed so far. One of the essential barriers is the limited intraoperative performance due to the lack of suitable mechatronic platforms. Some solutions have already been suggested but they are still far from having any practical impact upon the development of more advanced NOTES procedures. The "Highly Versatile Single Port System", a two-armed device with two manipulators and a semi-flexible telescope, was developed to overcome these drawbacks. A transsigmoid cholecystectomy on a NOTES simulator (the ELITE) could be accomplished successfully in 75 minutes. We could therefore show that the HVSPS is in principle applicable for such a NOTES procedure. However, before these mechatronic support systems can be used under clinical conditions, required human machine interface and extended intelligence have to be solved.
Minimal Invasive Surgery demands for utmost precise and reliable camera control to prevent any harm to the patient during operations. We therefore introduce a robotdriven camera that can be controlled either manually by a joystick, or by speech to ensure free hands and feet, and reduced cognitive workload of the surgeon. Speech control is chosen as simple, yet highly robust command and control application. However, due to high stress, and partially fatigue, emotional factors can play a life decisive role in the operational situation. As any misunderstanding of the surgeon's intent can easily lead to patient injuries by mis-movement of the camera, emotional factors are integrated in the human-robot interaction. In this work we therefore discuss the recording of a 3,035 turns database of spontaneous emotional speech in real life surgical operations. Known to be a challenge, we employ a high dimensional acoustic feature space, and subset optimization for recognition of positive versus negative emotion for interaction adaptation, surgeon self-monitoring, and potential adaptation of acoustic models within speech recognition. Promising 75.5% mean accuracy can be reported in a cross-operation recognition task given the severe condition of usage in real medical operations.
Abstract-This work presents a new robot platform developed for laparoscopic single-port surgery. As a new approach, this platform enables the introduction of flexible endoscopic instruments through the designed hollow manipulators with ∅12mm and 6 DOFs. Two such highly versatile manipulators and a 5 DOF telescope are combined in a unit that can be inserted through a 30mm incision into the abdominal cavity. The entire platform is actuated by bowden wires in 2m distance at the periphery. This design overcomes the problem of having a bulky and heavy platform near the patient. The design of the platform and the individual components are presented in this paper. The implemented control and simulation environment are also illustrated. The working range of one manipulator and the applicable forces were measured. Furthermore, the results of the accomplished in-vivo studies are presented.
A set of new instruments was designed to establish an access to the abdominal cavity for NOTES via the rectosigmoid. It comprehends a metal overtube which is positioned using a modified TEM device. The entry point is targeted by transrectal ultrasound and secured by a purse-string suture. Closure is achieved by means of a linear stapler application. The applicability of the system could already be confirmed in animal survival studies.
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