Review of surgical robotic systems for keyhole and endoscopic procedures: state of the art and perspectives

doi:10.1007/s11684-020-0781-x

Front. Med.

2020, Vol. 14

Issue (4) : 382-403 https://doi.org/10.1007/s11684-020-0781-x

REVIEW

Review of surgical robotic systems for keyhole and endoscopic procedures: state of the art and perspectives

Yuyang Chen², Shu’an Zhang², Zhonghao Wu², Bo Yang³, Qingquan Luo⁴, Kai Xu¹(

)

¹. State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
². RII Lab (Lab of Robotics Innovation and Intervention), UM-SJTU Joint Institute, Shanghai Jiao Tong University, Shanghai 200240, China
³. Department of Urology, Shanghai Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
⁴. Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China

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Abstract

Minimally invasive surgery, including laparoscopic and thoracoscopic procedures, benefits patients in terms of improved postoperative outcomes and short recovery time. The challenges in hand–eye coordination and manipulation dexterity during the aforementioned procedures have inspired an enormous wave of developments on surgical robotic systems to assist keyhole and endoscopic procedures in the past decades. This paper presents a systematic review of the state-of-the-art systems, picturing a detailed landscape of the system configurations, actuation schemes, and control approaches of the existing surgical robotic systems for keyhole and endoscopic procedures. The development challenges and future perspectives are discussed in depth to point out the need for new enabling technologies and inspire future researches.

Keywords surgical robots keyhole surgery endoscopic surgery

Corresponding Author(s): Kai Xu

Just Accepted Date: 28 June 2020 Online First Date: 27 July 2020 Issue Date: 26 August 2020

Cite this article:

Yuyang Chen,Shu’an Zhang,Zhonghao Wu, et al. Review of surgical robotic systems for keyhole and endoscopic procedures: state of the art and perspectives[J]. Front. Med., 2020, 14(4): 382-403.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-020-0781-x
https://academic.hep.com.cn/fmd/EN/Y2020/V14/I4/382

Fig.1 Typical master–slave setup of a surgical robotic system for keyhole and endoscopic procedures.

Fig.2 PRISMA flow chart for the searches regarding each subsection.

Tab.1 Statistics of the PRISMA flowchart for the applied search terms

Fig.3 Patient-side manipulators: (A) typical configuration for multi-port procedures, (B) X configuration for single-port procedures, and (C) Y configuration for single-port or endoscopic procedures.

Fig.4 RCM mechanisms using (A) parallelograms [¹⁷,¹⁸], (B) equivalent parallelograms with cable transmission [²⁰,²¹], (C) parallelograms with a parallel actuation [²²], (D) serial spherical linkage [²³,²⁴], (E) parallel spherical linkage [²⁵], and (F) goniometer arc tracks [²⁶,²⁷].

Fig.5 Various wrist designs. (A) Cable-driven EndoWrist, reprinted with permission from John Wiley and Sons [²¹], (B) serial-linkage-actuated design, reprinted with permission from IEEE [⁵¹], (C) parallel-linkage-actuated design, reprinted with permission from IEEE [⁵²], (D) bending wrist, reprinted with permission from SAGE [²⁷], (E) concentric-tube wrist (rightmost) compared with EndoWrist (leftmost), reprinted with permission from IEEE [⁵⁴], and (F) deformable wrist, reprinted with permission from IEEE [⁵⁸].

Fig.6 (A) 5-DoF articulated surgical manipulator, reprinted with permission from Springer Nature [²⁸], (B) continuum surgical manipulator with two 2-DoF segments, reprinted with permission from IEEE [⁶¹], and (C) continuum-articulated surgical manipulator, reprinted with permission from IEEE [⁶³].

Fig.7 (A1) da Vinci Single-Site VeSPA surgical platform, reprinted with permission from John Wiley and Sons [⁶⁴], (A2) da Vinci SP surgical system, reprinted with permission from Elsevier [⁵⁶], (A3) Samsung surgical system, reprinted with permission from IEEE [⁶⁵], (B) SPRINT surgical system, reprinted with permission from Springer Nature [⁶⁹], (C) SPS surgical system, reprinted with permission from John Wiley and Sons [⁷²], and (D) SURS system, reprinted with permission from IEEE [⁵⁷].

Fig.8 Representative systems for endoscopic and NOTES procedures. (A1) Articulated cable-driven design, reprinted with permission from John Wiley and Sons [⁷⁹], (B1) reconfigurable design with embedded motors, reprinted with permission from IEEE [⁸¹], (B2) embedded-motor-actuated design, reprinted with permission from Springer Nature [⁸⁰], and (C1 and C2) STRAS and ViaCath systems using continuum surgical manipulators, reprinted with permissions from John Wiley and Sons and IEEE [⁵⁵,⁸⁹].

Fig.9 (A) Gripper design with sensor integrated in the jaws, reprinted with permission from IEEE [⁹⁷], (B) Stewart type sensor embedded in the wrist, reprinted with permission from John Wiley and Sons [¹⁰⁹], and (C) working principle of the intrinsic force sensing.

Fig.10 Various visual modalities. (A) Abdomen tissue 3D reconstruction using MIS-SLAM, reprinted with permission from IEEE [¹²⁴], (B1) comparison between the endoscopic images under white light and NIRF showing the perfusion of the intestinal loop, reprinted with permission from John Wiley and Sons [¹²⁵], (B2) RGB image of the larynx and cancerous tissue classification using the hyperspectral imaging data [¹²⁶], and (C) pCLE mosaic image using spiral scan on ex vivo beef liver, reprinted with permission from IEEE [¹²⁷].

Fig.11 (A) The DELTA-R device with 3-DoF position inputs and 3-DoF force outputs, reprinted with permission from IEEE [156], (B) the laparoscopic interface with 6-DoF position–orientation inputs and 3-DoF force outputs, reprinted with permission from IEEE [157], and (C) the VirtualPoer device with 6-DoF position–orientation inputs and 6-DoF force/torque outputs, reprinted with permission from IEEE [¹⁶³].

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