Instruments with All Degrees of Freedom for Suturing the Radius Surgical System

Following early experience with conventional endoscopic suturing systems, we began with the research center in Karlsruhe, Germany, in the development of instruments with all degrees of freedom [7]. In the early 1990s, we could already perform experimental tests with the use of angulating instruments that could turn at the tip. In the following years, we developed the first robotic systems for endoscopic surgery, and performed the first animal experiments and distant operations [8].

The application of robotic systems in endoscopic surgery demonstrates that this technology is highly complex and expensive, and that only few hospitals succeeded to integrate the robotic systems into routine surgery on an economical acceptable basis [7]. We therefore decided to start our own company, Tübingen Scientific [9], with a program to develop a suturing system with intuitive and ergonomic handling that allows deflection and rotation of the tip of the instruments so that comparable free placement of the direction of suture is given as in the use of robotic systems. Figure 12.9 demonstrates the place of the radius surgical

Fig. 12.9 The radius surgical system between conventional instruments and robotics. This system allows deflection of the tip and rotation of the tip in a deflected position. A specific new handle design is necessary to enhanced the degrees of freedom

Fig. 12.9 The radius surgical system between conventional instruments and robotics. This system allows deflection of the tip and rotation of the tip in a deflected position. A specific new handle design is necessary to enhanced the degrees of freedom

Fig. 12.11 The ball trocar of the endofreeze system. The ball represents the invariant point for turning the instrument. One screw at the trocar shaft and one at the metal ring allow adjustment for the friction of movement

system between conventional instruments and robotic systems. This can also be defined as a mechanical manipulator. When the handle of the system is brought forward, the tip is straight; when the handle is flexed to 45°, the tip of the instrument is flexed to a 70° position. Rotation of the tip is accomplished by rotating the knob at the tip of the handle. Complete rotation of the instrument tip is in this way possible. The whole system can be completely dismantled and cleaned without problem. One of the most important applications of the suturing system in our hands is in the moment the suturing of meshes to the abdominal wall to the inguinal ligament in case of an inguinal hernia.

In this way, we have for the first time enabled the ability to perform a precise suture inside the abdomen for optimal mesh fixation. Experiments [10, 11] have demonstrated that the preciseness of the stitches is much higher and the strength of the stitches is stronger compared with sutures using conventional needle drivers. Figure 12.10 demonstrates the suturing of a mesh with the use of radius.

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