title: Articulated minimally invasive surgical instrument based on compliant mechanism.
abstract: OBJECTIVE
  In minimally invasive surgery, instruments are inserted from the exterior of the patient's body into the surgical field inside the body through the minimum incision, resulting in limited visibility, accessibility, and dexterity. To address this problem, surgical instruments with articulated joints and multiple degrees of freedom have been developed. The articulations in currently available surgical instruments use mainly wire or link mechanisms. These mechanisms are generally robust and reliable, but the miniaturization of the mechanical parts required often results in problems with size, weight, durability, mechanical play, sterilization, and assembly costs.
  
  
  METHODS
  We thus introduced a compliant mechanism to a laparoscopic surgical instrument with multiple degrees of freedom at the tip. To show the feasibility of the concept, we developed a prototype with two degrees of freedom articulated surgical instruments that can perform the grasping and bending movements. The developed prototype is roughly the same size of the conventional laparoscopic instrument, within the diameter of 4 mm. The elastic parts were fabricated by Ni-Ti alloy and SK-85M, rigid parts ware fabricated by stainless steel, covered by 3D- printed ABS resin. The prototype was designed using iterative finite element method analysis, and has a minimal number of mechanical parts.
  
  
  RESULTS
  The prototype showed hysteresis in grasping movement presumably due to the friction; however, the prototype showed promising mechanical characteristics and was fully functional in two degrees of freedom. In addition, the prototype was capable to exert over 15 N grasping that is sufficient for the general laparoscopic procedure. The evaluation tests thus positively showed the concept of the proposed mechanism.
  
  
  CONCLUSIONS
  The prototype showed promising characteristics in the given mechanical evaluation experiments. Use of a compliant mechanism such as in our prototype may contribute to the advancement of surgical instruments in terms of simplicity, size, weight, dexterity, and affordability.
authors.affiliation: Department of Mechanical Engineering, Faculty of Engineering, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan. jumpei@mech.kyushu-u.ac.jp.
authors.forename: Jumpei
authors.initials: J
authors.lastname: Arata
authors.affiliation: Department of Engineering Physics, Electronics and Mechanics, Nagoya Institute of Technology, Nagoya, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kogiso
authors.affiliation: Department of Engineering Physics, Electronics and Mechanics, Nagoya Institute of Technology, Nagoya, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Sakaguchi
authors.affiliation: Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan.
authors.forename: Ryu
authors.initials: R
authors.lastname: Nakadate
authors.affiliation: Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Oguri
authors.affiliation: Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Munenori
authors.initials: M
authors.lastname: Uemura
authors.affiliation: Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Cho
authors.initials: C
authors.lastname: Byunghyun
authors.affiliation: Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.affiliation: Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
mesh_terms: D004867:Equipment Design; D020342:Finite Element Analysis; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D065287:Robotic Surgical Procedures / Q000295:instrumentation*; D013525:Surgical Instruments
keywords: Articulated surgical instrument; Compliant mechanism; Minimally invasive surgery; Robotic surgery