Wang Haibo, Bing Yuanqiang, Liu Xinwei, Chang Zongyu
College of Engineering, Ocean University of China, Qingdao, China.
Key Laboratory of Ocean Engineering of Shandong Province, Qingdao, China.
J Robot Surg. 2025 May 3;19(1):195. doi: 10.1007/s11701-025-02366-6.
Flexible surgical instruments with multiple degrees of freedom or continuum surgical instruments demonstrate significant advantages in Natural Orifice Transluminal Endoscopic Surgery (NOTES), particularly when navigating the complex anatomical pathways of the human gastrointestinal tract. However, conventional endoscopic instruments with fixed diameters and stiffness profiles risk exerting excessive mechanical stress on esophageal tissues, with clinical studies documenting mucosal tears and hemorrhagic complications in up to 15% of transgastric cholecystectomy procedures. To address these limitations, we developed a structured fabric-based guiding sheath featuring dynamic diameter modulation and tunable stiffness. This structured fabric construct enables the creation of a stable internal channel (15 mm working diameter) while demonstrating remarkable radial expandability from 15 to 20 mm outer diameter. Through pneumatic control systems, the guiding sheath achieves a 7.3-fold increase in stiffness under negative pressure conditions (0-80 kPa), significantly enhancing endoscopic maneuverability while maintaining patient safety. Phantom experiments demonstrated that the structured fabric-based guiding sheath establishes a consistently internal channel (15 mm inner diameter) while maintaining radial stability, effectively securing the insertion of endoscopic instruments and showing its potential for enhancing the safety and efficiency of NOTES procedures.
具有多个自由度的柔性手术器械或连续体手术器械在自然腔道内镜手术（NOTES）中显示出显著优势，尤其是在导航人体胃肠道复杂的解剖路径时。然而，具有固定直径和刚度分布的传统内镜器械有对食管组织施加过大机械应力的风险，临床研究记录了在高达15%的经胃胆囊切除术过程中出现黏膜撕裂和出血并发症。为了解决这些局限性，我们开发了一种基于结构化织物的引导鞘，其具有动态直径调节和可调刚度。这种结构化织物构造能够创建一个稳定的内部通道（工作直径为15毫米），同时显示出从15毫米外径到20毫米外径的显著径向可扩展性。通过气动控制系统，引导鞘在负压条件（0 - 80千帕）下刚度增加7.3倍，在保持患者安全的同时显著增强了内镜的可操作性。模拟实验表明，基于结构化织物的引导鞘在保持径向稳定性的同时建立了一致的内部通道（内径为15毫米），有效地确保了内镜器械的插入，并显示出其在提高NOTES手术安全性和效率方面的潜力。
