Instituto de Ciencias Aplicadas y Tecnología (ICAT), 7180Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México.
Posgrado de Ingeniería Mecánica, Centro de Ingeniería Avanzada, Departamento de Mecatrónica, Facultad de Ingeniería, 7180Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México.
Surg Innov. 2022 Jun;29(3):449-458. doi: 10.1177/15533506211037091. Epub 2021 Aug 6.
This article aims to present an innovative design of a steerable surgical instrument for conventional and single-site minimally invasive surgery (MIS), which improves the dexterity and maneuverability of the surgeon while offering a solution to the limitations of current tools. The steerable MIS instrument consists of a deflection structure with a curved sliding joints design that articulates the distal tip in two additional degrees of freedom (DoFs), relative to the instrument shaft, using transmission by cables. A passive ball-joint mechanism articulates the handle relative to the instrument shaft, improves wrist posture, and prevents collision of instrument handles during single-site MIS procedures. The two additional DoFs of the articulating tip are activated by a thumb-controlled device, using a joystick design mounted on the handle. This steerable MIS instrument was developed by additive manufacturing in a 3D printer using PLA polymer. Prototype testing showed a maximum tip deflection of 60° in the left and right directions, with a total deflection of 120°. With the passive ball-joint fully offset, the steerable tip achieved a deflection of 90° for the right and 40° for the left direction, with a total deflection of 130°. Furthermore, the passive ball-joint mechanism in the handle obtained a maximum range of motion of 60°. This steerable MIS instrument concept offers an alternative to enhance the application fields of conventional and single-site MIS, increasing manual dexterity of the surgeon and the ability to reach narrow anatomies from other directions.
本文旨在介绍一种用于传统和单孔微创外科手术（MIS）的可控式手术器械的创新设计，该设计提高了外科医生的灵巧性和可操作性，同时解决了现有工具的局限性问题。可控式 MIS 器械由带有弯曲滑动关节设计的偏转结构组成，通过电缆传动，使远端尖端相对于器械轴在两个额外的自由度（DoF）上进行铰接。一个被动球窝关节机构使手柄相对于器械轴进行铰接，改善了手腕姿势，并防止了单孔 MIS 手术过程中器械手柄的碰撞。铰接尖端的两个额外自由度通过安装在手柄上的操纵杆设计，由拇指控制的装置来激活。这款可控式 MIS 器械是通过 3D 打印机使用 PLA 聚合物增材制造而成的。原型测试显示，在左右方向上最大尖端偏转 60°，总偏转 120°。在被动球窝关节完全偏置的情况下，可控尖端的右侧偏转 90°，左侧偏转 40°，总偏转 130°。此外，手柄中的被动球窝关节机构获得了 60°的最大运动范围。这种可控式 MIS 器械概念提供了一种替代方案，可以增强传统和单孔 MIS 的应用领域，提高外科医生的手动灵巧性，并能够从其他方向到达狭窄的解剖结构。
