Exploring Laparoscopic Surgical Systems (Micro Robots)

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In recent years, surgical robots have been a hot topic, both within the industry and beyond. Of course, at the top of this field is the Da Vinci robot, known for its precision and high level of intelligence, which has been widely discussed. Indeed, Intuitive Surgical (the parent company of the Da Vinci robot) launched its first generation product at the end of the last century, and now it has been over20 years, accumulating a wealth of clinical and technical experience.

However, its price is also very high, and it has not reached the level of completely replacing doctors. Therefore, in recent years, a large number of surgical medical device professionals worldwide have been exploring how to simplify laparoscopic surgery or make a single product multifunctional. Hard work pays off; as of 2022, at least 10 teams globally have made some breakthroughs in this field. Below, I will introduce laparoscopic surgical robotic systems that have achieved commercialization in the market (I will not introduce the Da Vinci robot).

To facilitate understanding, I will introduce them in order from passive to active.

The first model: from the United States FLEXDEX Surgical Company FlexDex® wristed robotic arm (see product in Figure 1).

This device features a very unique user interface, where the device’s axis is connected to the user’s forearm via a bracelet connected to the tool frame, thus placing the wrist joint axis at the center of the surgeon’s wrist.

The surgeon’s wrist deflection is mapped to the patient’s internal wrist effectors through two parallel mapping strips.

FlexDex® separates the wrist degrees of freedom from the traditional four degrees of freedom of standard laparoscopic instruments. The surgeon controls the standard four degrees of freedom with his or her forearm and the instrument deflection with his or her wrist. The axis diameter is 8 mm.

The concept of 1:1 mapping of the surgeon’s wrist to the instrument wrist inside the patient makes this device advanced, but there are two major drawbacks: the device is only equipped with one needle holder, and the forearm attachment cannot be quickly detached, making it cumbersome to change instruments in emergencies. It cannot be adapted to other instruments, such as surgical scissors, monopolar and bipolar cutters, etc. This undoubtedly greatly weakens the product’s competitiveness.

Figure 1 FlexDex instrument

The second model: from Germany Tuebingen Scientific Medical Company’s Radius Surgical System® (see product in Figure 2)

Radius Surgical System® (abbreviated RSS) consists of two manually guided robotic hands and provides a deflectable and rotatable tip, allowing for six degrees of freedom.

The wrist deflection relative to the device’s axis is unidirectional, and axial rotation of the axis is achieved through a thumb knob. A large multi-finger trigger on the handle operates the jaws of the end effector, which cannot be locked. The diameter of the axis is 10 mm.

The reusable instrument is equipped with disposable functional instruments that can be easily fixed to the instrument’s tip according to the required surgical task; in fact, the produced functional instruments are different types of needle holders, non-damaging graspers, and gastric band retractors.

Figure 2 Radius Surgical System and its multifunctional attachments

The third model: from the Netherlands DEAM Company’s LaproFlex® instrument (see Figure 3)

LaproFlex® instrument consists of a handle that can be deflected by the surgeon’s wrist, causing the instrument’s tip to bend in the opposite direction when mapped to wrist movements. The handle has a lever, and the operator determines the closure of the jaws by applying pressure with the middle and ring fingers. Additionally, there is a knob between the handle and the instrument’s axis that can rotate, allowing for 360° rotation of the axis. The diameter of the axis is 5 mm. It is currently the thinnest among commercially available instruments, as well as the most cost-effective, although this product has a lower rotational degree of freedom than other products.

LaproFlex® has different models that vary according to the end instrument: cutting dissectors, various types of graspers, scissors, and electric hooks are available.

Figure 3 LaproFlex® instrument

The fourth model: from the United States UNE Med Company’s Intuitool® instrument (see Figure 4)

Intuitool® instrument consists of a pistol-style handle, which has a trackball that can rotate in four directions in space to deflect the instrument’s tip in the same way (parallel mechanism). The end effector jaws are operated by a trigger on the handle and can also be locked using a button on the handle. The axis diameter is 10 mm.

Figure 4 Intuitool® instrument

The fifth model: from South Korea LIVSMED Company’s ArtiSential® instrument (see Figure 5)

ArtiSential® is a pistol-style handle instrument with a diameter of 8 mm. When deflected, the bending radius is zero; its wrist function is guaranteed by two joints on the end instrument that combine their movement with the handle’s movement.

In fact, the handle can move on the vertical and horizontal axes, transmitting its motion to the end instrument. The handle is equipped with a jaw control ring, allowing the surgeon to open and close the jaws using the thumb and index finger. The end instrument can also be locked using a locking rod located on the handle.

ArtiSential® is designed for single use and offers different forms based on the type of end instrument: needle holders, dissectors, clamps, monopolar hooks, etc.

This product has currently been licensed by the domestic Jian Shi Medical Group from LIVSMED, and during the acceleration of domestic production, it is believed that we will soon see domestically produced instruments.

Figure 5 ArtiSential® instrument

The sixth model: from France DEX Company’s Dex® instrument (see Figure 6)

Dex® also has a diameter of 8 mm and is equipped with a set of instrument boxes containing various instruments that can replace the end instruments. Additionally, this surgical system is equipped with an intelligent host that can connect to monopolar and bipolar products as well as electric hooks. Compared to other products, its system is more comprehensive. It has already been launched simultaneously in the FDA and Europe.

Figure 6 Dex® instrument

The seventh model: from China’s Suzhou Kando Robot Company’s micro laparoscopic surgical robot (see Figure 7)

As the only micro laparoscopic surgical robot currently on the market in China, its product structure is quite similar to that of DEX Company. It is also equipped with an instrument box and main system, and the operation method is quite similar.

The parent company of Suzhou Kando Robot, Harbin Sizerui Intelligent Medical Device Co., Ltd., is a company specializing in the research and development of laparoscopic surgical robots. They currently have multiple products on the market and believe that they will stand out in the field of laparoscopic surgical robots in the future.

Figure 7 Kando® micro laparoscopic surgical robot

Additionally, the National Bureau released the registration guidelines for laparoscopic surgical systems on July 20, 2022, undoubtedly providing direction for companies looking to develop this product. In the future, many instrument companies will certainly participate in the research and production of this product, and whether domestic laparoscopic robots will face the same dilemma as staplers remains to be seen. There are also questions about whether there will be a significant impact on the Da Vinci robot and whether bulk procurement will happen faster. Let us look forward to a brighter future for domestic laparoscopic surgical robots.

This article does not explain the intellectual property of any instruments, and the images cited are all publicly available information from the above companies, nor does it express any investment opinions.

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