Magnetically anchored 'reduced trocar' laparoscopy: Evolution of surgical robotics

Laparoscopic surgery has become increasingly popular over the last few years due to its benefits; lower morbidity, less perceived pain, better cosmesis results, and less hospital time. For the surgeon however, there are fundamental issues that can make a laparoscopic procedure more difficult than a simple open surgery; loss of tactile feel, limited working envelope, high demand for hand-eye coordination, and one trocar-port required for each tool. A revolutionary concept of using magnetics to support tooling across the abdominal wall was conceived by Dr. Jeffrey Cadeddu and his colleagues at the University of Texas Southwestern Medical Center (UTSW). A set of tooling was the developed permitting examination of the feasibility of mobile surgical tools that do not require separate ports spanning the abdominal wall: a sling organ retractor, a paddle organ retractor, a camera, and a pneumatically actuated robotic arm configured to operate as a hook cautery. Each tool offers increased degrees of freedom and flexibility, all enter through the same trocar-port, all are positioned where needed inside the abdominal cavity via manipulation of the external magnetic anchor. The anchoring system and tools, collectively referred to as the Magnetic Anchoring System (MAS) have been tested in various porcine surgical procedures at the UTSW animal lab, and on several occasions they have been proven capable of two-trocar-port nephrectomy, something not possible with conventional laparoscopic equipment. The development of the magnetic anchor platform, the cited tools and the evaluation of the system and its components are the topics of this thesis.