Design and Experimental Evaluation of a Single Incision Laparoscopic Surgery Camera System for Minimally Invasive Surgery

摘要

Single incision laparoscopic surgery (SILS) offers many benefits over traditional open surgery. SILS is a type of minimally invasive surgery (MIS) which aims to reduce patient trauma by decreasing the number of incisions required for a surgical operation down to one located at the belly button (umbilicus). This offers patient benefits including reduced trauma, risk of infection, post-operative pain, scaring, and a shorter recovery time. SILS remains surgically challenging due to limited surgical tool motion and positioning of the traditional laparoscope through the SILS entry incision.The SILS-specific camera systems presented here integrates all the features of a laparoscopic vision system into a small, inexpensive, portable package that enables point-of-care applications, does not compete for space with the surgical tools, and removes the need for a dedicated laparoscope port. Two different designs were developed by incorporating a camera and viewing system directly into the SILS port (SILS Port Camera) and then by completely decoupling the camera and viewing system from the SILS port (SILS Magnet Camera).Each approach was developed into a prototype and experimentally tested in order to prove initial feasibility and functionality of the device as compared to the traditional industry SILS laparoscopic setup. The first functionality test was performed using an ex vivo participant study pitting the SILS camera against a traditional laparoscopic set up over two different surgical tasks, ball drop and cutting tasks. The participant study indicated the SILS Port Camera performs similarly to a typical SILS setup. However the SILS Magnet Camera approach showed a significant improvement in functionality when compared with the traditional SILS setup.Both devices were tested in an in vivo porcine model by a practicing surgeon. The SILS Port Camera resulted in a premature termination of a cholecystectomy due to tool interference and poor view of the surgical site. The SILS Magnet Camera allowed for successful cystic duct resection and liver biopsy. The surgeon noted increased viewing capacity from the cameras pan/tilt system, enhanced camera system mobility offered by the magnets, the increased range and movement for his hands, and the ability to use the extra port for a third tool for liver retraction.