A novel intracorporeal assembling robotic system for single-port laparoscopic surgery

Background: Single-port laparoscopic surgery (SPLS) is a novel surgical approach consisting of a single umbilical incision through which multiple instruments are inserted, thus avoiding additional incisions necessary in traditional multi-port laparoscopic surgery. SPLS imposes a number of ergonomic restrictions on the surgeon. As a partial solution, several dedicated instruments, including hand-held manipulators with 6 degrees of freedom (DOF), have been introduced to overcome these manipulative restrictions. Robotics has the potential to overcome all of the ergonomic restrictions imposed by the SPLS approach. Methods: A novel, teleoperated, robotic platform has been developed. SPRINT (Single-Port lapaRoscopy bImaNual roboT) is a multiarm robot enabling bimanual interventions. The robotic arms are introduced into the abdomen through a cylindrical introducer. The surgeon is able to control the robot in a master-slave configuration through a dedicated console, allowing translation of the surgeon's hand movements to the end-effectors. Results: Laboratory tests have been performed with the prototype by experienced surgeons for pick and place and suturing exercises. These confirmed the fast-learning curve with the use of the SPRINT robot. In the pick and place exercise, the mean successful peg transfer rate decreased from 97 s at the start to 50 s required for the transfer of the seventh peg. Thereafter, the slope of the curve decreased to 31 s after 17 transfers. The percentage error rate declined from an initial value 50 % to 25 % after 15 pegs had been transferred. In the intracorporeal suture test, needle passage and knot tying were completed by four surgeons in 314 s or less. Conclusions: A new surgical robot for SPLS has been developed, and its usability and efficacy have been demonstrated. The SPRINT may pave the way for the next generation of surgical robots, the arms of which are assembled inside the insufflated peritoneal cavity, providing full dexterity and manipulative ability with the SPLS approach.