A new remote-controlled endoscope positioning system for endoscopic solo surgery - The FIPS endoarm

In the field of endoscopic solo surgery, the assistance received by the sur geon from ergonomical positioning devices is extremely important. They aid in both the retracting of instruments and the positioning of the endoscope. However, passive systems derived from open surgery have not proved satisfa ctory. Therefore, we set out to develop a remote-controlled arm capable of moving a rigid endoscope with about four degrees of freedom, while maintain ing an invariant point of constraint motion coincident with the trocar punc ture site through the abdominal wall. The system is driven by means of spea ker-independent voice control or a finger-ring joystick clipped onto the in strument shaft close to the handle. When the joystick is used, the motion o f the endoscope is controlled by the fingertip of the operating surgeon, wh ich is inserted into the small ring of the controller in such a way as to m ake the motion of the fingertip correspond directly to the motion of the ti p of the endoscope. A study was performed to compare the two different inte rfaces available for the system. With both interfaces, the guiding system a llows for transparent and intuitive operation. Its set-up is easy; it is sa fe and reliable to use during the intervention; and it is faster than human assistance. With its improved ergonomy, this new generation of remote-cont rolled endoscope positioning system represents a further step toward the di ffusion of solo surgery techniques in minimally invasive therapy. In our op inion, this prototype creates a valid compromise between human and robotic control of rigid endoscopes.