In otolaryngologic surgery, endoscopy is increasingly used to provide a better view of hard-to-reach areas and to promote minimally invasive surgery. However, the need to manipulate the endoscope limits the surgeon's ability to operate with only one instrument at a time. Currently, several robotic systems are being developed, demonstrating the value of robotic assistance in microsurgery. The aim of this literature review is to present and classify current robotic systems that are used for otological and endonasal applications. For these solutions, an analysis of the functionalities in relation to the surgeon's needs will be carried out to produce a set of specifications for the creation of new robots.

To improve the prevalence of screening for gastric cancer in low-income areas, a low-cost endoscope based on a novel wire-driven rotary valve and water-jet mechanism is proposed. The primary component of this endoscope is a rotary valve whose core is driven by a stepper motor through a flexible wire, which controls the direction of the water jet. This enables it to reach any point in the workspace by controlling the valve core angle and water-jet intensity. The envelope surface of the endoscope tip trajectory is likely a hemisphere. The horizontal diameter of the working space projection is approximately 350 mm, which is sufficient to observe most parts of the greater curvature of the stomach. The image-acquisition performance of the designed endoscope was satisfactory in a phantom experiment. The introduction of the novel rotary valve greatly simplifies the structure and reduces the cost of the proposed endoscope. With low cost and high portability, this endoscope provides a good alternative for early gastric cancer screening in low- and middle-income areas.

In this paper, we present an integrated robotic arm with a flexible endoscope for laparoscopy. The endoscope holder is built to mimic a human operator that reacts to the surgeon's push while maintaining both the incision opening through the patient's body and the center of the endoscopic image. An impedance control algorithm is used to react to the surgeon's push when the robotic arm gets in the way. A modified software remote center-of-motion (RCM) constraint formulation then enables simultaneous RCM and impedance control. We derived the kinematic relationship between the robotic arm and line of sight of the flexible endoscope for image center control. Using this kinematic model, we integrated the task control for RCM and surgeon cooperation and the endoscope image centering into a semi-autonomous system. Implementation of the control algorithm with both matlab simulation and the HIWIN RA605-710 robotic arm with a MitCorp F500 flexible endoscope demonstrated the feasibility of the proposed algorithm.

Endoscopic endonasal surgery is a commonly practiced minimally invasive neurosurgical operation for the treatment of a wide range of skull base pathologies including pituitary tumors. A common shortcoming of this surgery is the necessity of a third hand when the endoscope has to be handled to allow active use of both hands of the main surgeon. The robot surgery assistant NeuRoboScope system has been developed to take over the endoscope from the main surgeon's hand while providing the surgeon with the necessary means of controlling the location and direction of the endoscope. One of the main novelties of the NeuRoboScope system is its human–robot interface designs which regulate and facilitate the interaction between the surgeon and the robot assistant. The human–robot interaction design of the NeuRoboScope system is investigated in two domains: direct physical interaction (DPI) and master–slave teleoperation (MST). The user study indicating the learning curve and ease of use of the MST is given and this paper is concluded via providing the reader with an outlook of possible new human–robot interfaces for the robot assisted surgery systems.

Colonoscopy is a minimally invasive procedure to examine the large intestine using a flexible endoscope. Currently, colonoscopic procedures require physically pushing the endoscope through the large intestine which potentially imparts damaging forces on the intestinal wall, requires a high level of expertise to perform safely, and can require extensive procedure time. This paper presents the use of inverted tubular element locomotion (ITEL) for improved endoscope translation and positioning that works via tip eversion of inverted plastic tubes. Experiments were performed to examine the fluid pressure required for locomotion through a large intestinal model and in both straight and curved paths and determine the optimal tube dimensions for insertion via ITEL. Experiments were then performed to compare intestinal forces during manual and ITEL-based insertion. The experiments established a relationship between the tip eversion pressure and the tube thickness and diameter. In addition, it was found that pressure required for locomotion was only minimally impeded by being enclosed in the intestinal manikin but significantly impacted by the curvature of the turn. Measured insertion forces for ITEL were found to be 10.1% less compared to traditional insertion. These results will aid in the future design and development of ITEL for endoscopic positioning.

Surgical endoscopy has gained traction over the past several decades as a viable option for therapeutic interventions in the gastrointestinal tract. It utilizes natural orifice access which shortens hospital stay, minimizes patient discomfort, and decreases overall healthcare costs. However, the inability to effectively retract and position target tissue is a significant limitation for these procedures. Current instruments are unable to triangulate and can only be manually withdrawn or advanced through the channels. There is a need to provide better access and control of soft tissue to be able to perform more complex and complete endoscopic resections. We have developed a novel device to provide optimal tissue retraction for endoscopic procedures. Our device consists of an articulating tissue retractor and a specialized handle. Two articulating curves were created that can manipulate the position and direction of the retractor tip. Each curve is independently adjusted by locking thumb sliders, allowing for increased range of motion and retraction independent of endoscope position. With a diameter of 2.8 mm, the proposed device can be used in current endoscopic equipment. Preliminary testing showed that our retractor has comparable slip strength to a commercially available device (1.13 N ± 0.53 N versus 1.10 N ± 0.51 N, p-value: 0.416), but has much greater range of motion (maximum deflection of 72 deg compared to 0 deg). This increased range of motion allows the articulating grasper to better triangulate and preserve visualization of the dissection plane, allowing it to overcome the most significant barrier restricting endoscopic surgery.

Dental caries, the breakdown of tooth enamel by bacteria infection that causes cavities in the enamel, is the most common chronic disease in individuals 6–19 years of age in the U.S. Optical detection of caries has been shown to be sensitive to the presence of bacteria and the resulting demineralization of enamel. The scanning fiber endoscope (SFE) is a miniature camera system that can detect early stages of caries by performing high-quality imaging and laser fluorescence spectroscopy with 405 nm excitation. Because optical imaging of caries does not involve radiation risk, repeated imaging of the teeth is acceptable during treatment of the bacterial infection to monitor healing. A disposable handpiece was designed and fabricated to position the flexible fiber optic SFE probe for quantitative measurements. Plastic 3D-printed handpiece prototypes were tested with the SFE and a fluorescence calibration standard to verify mechanical fit and absence of signal contamination. Design feedback was provided by pediatric dentists and staff engineers to guide iterations. The final design configuration was based on the need to image interproximal regions (contact surfaces between adjacent teeth), ergonomics, and probe safety. The final handpiece design: (1) is safe for both the patient and the probe, (2) allows easy SFE insertion and removal, (3) does not interfere with spectral measurements, (4) standardizes the SFE's positioning during imaging by maintaining a consistent distance from the target surface, and (5) is significantly less expensive to produce and use than purchasing sanitary endoscope sheaths. The device will be used to help determine if new medicinal therapies can arrest caries and repair early interproximal demineralization under the clinical monitoring program. Ultimately, we anticipate that this handpiece will help us move closer toward widespread implementation of a dental diagnostic laser system that is safer and more sensitive than conventional methods for early caries detection.

This paper reports a novel haptic interface to provide haptic feedback during endoscopy simulation. The proposed haptic interface combines two independent mechanisms to provide two decoupled degrees-of-freedom in the translational and the rotational directions. Effects of the apparent inertia–mass and apparent friction to the user's hand are measured in the form of resistive force and torque. The forces and torques that can be manifested by the developed haptic interface are compared with the exerted force data during actual endoscopy.

The scanning fiber endoscope (SFE) is a new ultrathin (1.2 mm diameter) medical imaging device that utilizes a unique mechanical scanning technique to image large (120 deg) fields of view (FOVs). A single 80 μm optical fiber is circularly vibrated by a piezo-electric tube to illuminate a field while the reflected light is collected to construct an image pixel-by-pixel. Accurate scanning of the optical fiber is paramount to image quality. Previously, an optical calibration chamber in the base station was used to calibrate the scanning of the optical fiber. This analytical and experimental work eliminates the use of the calibration chamber by implementing a new piezoelectric sensing approach enabling self-contained recalibration to maintain high-image quality during long medical procedures and also reducing the cost, size, and power consumption of the SFE. This work provides a major step toward self-calibration through adaptive control without additional sensors.

Otitis media with effusion (OME) is a very common ear disease occurring in adults and children alike when the middle ear is infected or the eustachian tube becomes dysfunctional, resulting in accumulation of fluid in the middle ear space. When medication as the first treatment fails, a grommet is commonly surgically inserted on the tympanic membrane (TM) of the patient to discharge the fluid. In this paper, a novel “all-in-one” device allowing office-based grommet insertion in an awake patient with OME is proposed, designed, fabricated, and tested. It utilizes a highly integrated structure encompassing key components of a mechanical system, a sensing system and a motion control system, all are synergized to enable the surgery to be completed in a short time automatically, precisely, effectively, and safely. The experimental results obtained with the device working on a mock membrane with characteristics representative of the TM are duly furnished, showing a success rate of up to 98%.

The primary focus of the vision systems in current minimally invasive surgery (MIS) surgical systems has been on the improvement of immersive experience through a static approach. One of the current limitations in an MIS robotic surgery is the limited field of view and restricted perspective due to the use of a sole rigid 3D endoscope. We seek to integrate a modular articulable imaging device and the teleoperated surgical robot, RAVEN. Another additional flexible imager can be helpful in viewing occluded surgical targets, giving increased visualization options. Two probe designs are proposed and tested to evaluate a robotized steering mechanism within the MIS robot framework. Both designs, a separate flexible imager and a fixed camera on a tool tip, did not show much improvement in reducing task completion time. The new system may have some potential in improved precise manipulation of surgical tools, which may offer safety benefits once the surgeon is trained. We have demonstrated feasibility of a novel MIS instrument imaging device to aid in viewing potentially occluded surgical targets. A new concept, a modular axis-shared articulable imaging probe located at the vicinity of a tool tip, is proposed for future evaluation. Full integration of the new flexible imaging device into the grasper of the RAVEN surgical robot is under study coordinated with clinicians.

We design an auto-tracking flexible tip for an endoscope to implement the shared control in assistive laparoscopic surgery. The flexible tip can bend in all direction dynamically to keep the target within the visible filed during surgical tools operating on the anatomy. The kinematic model to describe the view filed of the steerable endoscope has been derived for control purpose. Experimental verification on auto-tracking of the target object using visual servo control has also been performed.

The modern laparoscope relies on Hopkins’ glass rod lenses, a fiber-optic light source, a video camera, and external cables. This paper discusses the feasibility of developing an experimental prototype of a completely wireless laparoscope by making use of the latest in electronic and optic miniaturization. Design requirements were defined to mimic a standard 10 mm adult laparoscope. An 8 mm diameter (CMOS) camera was used, which delivered standard definition TV resolution at an image refresh rate of 30 Hz. A wide-angle lens was chosen, and a focusing mechanism was designed. Instead of a fiber-optic cable, illumination was achieved using four miniature LED lights. A 2.4 GHz wireless transmission with adequate range for use in an operating theater was chosen. A wireless receiver on a standard personal computer was used to drive a video monitor using off the shelf image processing software. A built-in rechargeable battery powered the wireless laparoscope. Flicker-free in vitro wireless video transmission was achieved. The laparoscope was made waterproof with a front cover lens and can be gas or chemically sterilized. The prototype laparoscope weights 78 g as compared with 900 g for a typical 10 mm laparoscope, camera, fiber-optic, and camera cables. Drawbacks of the prototype include reduced resolution of the video image as compared to high definition (HD) TV quality available on the most recent commercial camera systems. This experimental prototype has illustrated the feasibility of wireless endoscopy systems. The expected benefits include improved ergonomic maneuverability, reduced weight, and decreased electric power requirements.