The mechatronic support system “HVSPS” and the way to NOTES

Abstract

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.

Transrectal robotic natural orifice translumenal endoscopic surgery (NOTES) applied to intestinal anastomosis in a porcine intestine model

“…There are two advantages of robotic NOTES using the da Vinci surgical system compared with NOTES using other newly-developed robotic devices [10][11][12][13][14][15]. First, the range of motion of the arm is wide.…”

“…Experimental gastrointestinal tract surgery on swine and cadavers has also been performed [9]. Most gastrointestinal tract surgeries with NOTES are conducted with automatic anastomosis or suture instruments, and there are numerous reports on the development and use of specialized robots designed to perform surgery requiring a high degree of freedom such as intraperitoneal suturing conducted during NOTES [10][11][12][13][14][15].…”

Advances in laparoscopic surgery in urology

“…Two joysticks are employed as human-machine interfaces using Bowden wires. This device is mainly used experimentally 81 .…”

NOTES: Current Status and Recent Developments

“…There are several surgical platforms being currently developed, such as EndoSAMURAI™ (Olympus Corporation, Tokyo, Japan), Anubis® (Karl Storz, Tuttlingen, Germany), Direct Drive Endoscopic System (Boston Scientific, Natick, MA, USA), TransPort™ (USGI Medical, San Clemente, CA, USA), and HVSPS (Robotics and Embedded Systems, Technische Universität, Munich, Germany). Limited experimental data with the existing platforms are available while further development and technical refinement is pending [60,61,62,63]. A promising project of the European Association for Endoscopic Surgery (EAES) intends to develop a novel robotically-steered endoscopic arm which allows modification of its flexibility and stiffness by application of hydrostatic pressure [64].…”