title: Natural orifice cholecystectomy using a miniature robot.
abstract: BACKGROUND
  Natural orifice translumenal endoscopic surgery (NOTES) is surgically challenging. Current endoscopic tools provide an insufficient platform for visualization and manipulation of the surgical target. This study demonstrates the feasibility of using a miniature in vivo robot to enhance visualization and provide off-axis dexterous manipulation capabilities for NOTES.
  
  
  METHODS
  The authors developed a dexterous, miniature robot with six degrees of freedom capable of applying significant force throughout its workspace. The robot, introduced through the esophagus, completely enters the peritoneal cavity through a transgastric insertion. The robot design consists of a central "body" and two "arms" fitted respectively with cautery and forceps end-effectors. The arms of the robot unfold, allowing the robot to flex freely for entry through the esophagus. Once in the peritoneal cavity, the arms refold, and the robot is attached to the abdominal wall using the interaction of magnets housed in the robot body with magnets in an external magnetic handle. Video feedback from the on-board cameras is provided to the surgeon throughout a procedure.
  
  
  RESULTS
  The efficacy of this robot was demonstrated in three nonsurvivable procedures in a porcine model, namely, abdominal exploration, bowel manipulation, and cholecystectomy. After insertion, the robot was attached to the interior abdominal wall. The robot was repositioned throughout the procedure to provide optimal orientations for visualization and tissue manipulation. The surgeon remotely controlled the actuation of the robot using an external console to assist in the procedures.
  
  
  CONCLUSIONS
  This study has shown that a dexterous miniature in vivo robot can apply significant forces in arbitrary directions and improve visualization to overcome many of the limitations of current endoscopic tools for performing NOTES procedures.
authors.affiliation: N104 Walter Scott Engineering Center, University of Nebraska-Lincoln, P.O. Box 880656, Lincoln, NE 68588-0656, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Lehman
authors.forename: Jason
authors.initials: J
authors.lastname: Dumpert
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Wood
authors.forename: Lee
authors.initials: L
authors.lastname: Redden
authors.forename: Abigail Q
authors.initials: AQ
authors.lastname: Visty
authors.forename: Shane
authors.initials: S
authors.lastname: Farritor
authors.forename: Brandon
authors.initials: B
authors.lastname: Varnell
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
mesh_terms: D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods; D004210:Dissection; D004867:Equipment Design; D005240:Feasibility Studies; D008904:Miniaturization; D023421:Models, Animal; D012371:Robotics; D013552:Swine; D020535:Video-Assisted Surgery