Recent developments in MIS

I Introduction
Minimally invasive surgery (MIS) is becoming more and more common in hospitals. These procedures are performed through tiny incisions instead of one large opening. Because the incisions are small, patients tend to have quicker recovery time and less discomfort than with conventional surgery all with the same benefits. However, with this method, a surgical operation is performed by the help of: a small endoscopic camera; several long, thin, rigid instruments.

II Bionic Design of Microjoint for Minimally Invasive Surgical Instrument

A microjoint for minimally invasive surgery based on bionic design like an insect leg has been developed. This microjoint is comprised of two materials which have different stiffness characteristics. First of all, the microjoint was designed based on analythical approach and determined the using of SU-8 and PDMS as materials of designed joint. The advantages of proposed microjoint are as follows: (1) Small (less than 2 mm), (2) Flexibility, (3) High I/O ratio, and (4) Biocompatibility. Through the basic experiment, it has been confirmed that the developed joint has a potential for application of endoscopic surgery such as Endoscopic Sub-mucosal Dissection (ESD). Proposed joint is small (2 mm), and it can insert to the channel of oral endoscope to assist of the surgical procedure, as shown in Fig.1 followed. Fig.2 below shows the fabrication process flow, SU-8 and PDMS for proposed joint. This exoskeletal structure of microjoint is fabricated by stacking the several layers, which are made by photolithography. The fabrication process is after the design of the dimensions and the simulation or calculation for enough bend and stiffness.

Fig.1 Concept of bionic design and application to the medical device

Fig.2 Process flow of the joint

III A Piezoresistive Based Tactile Sensor

A novel tactile sensor is proposed for use in minimally invasive surgery to provide surgeons with tactile information. The sensing element of the sensor relies on a piezoresistive material. The proposed sensor measures contact force as well as the relative hardness of soft contact objects. Experimental test results confirm the ability of the sensor to distinguish between two different elastomeric materials. Such materials resemble two different biological tissues.

As a result, the sensor would be miniaturized enough for integration into the small space available at the tips of MIS graspers.

IV A PZT Bimorph Actuator

By optimizing the thickness of the piezoceramic layers, and by allowing the voltage applied to each segment to vary, dramatic improvements in deflection and force are obtained when compared to a standard straight bimorph actuator. The motivation for this design is the need in the field of minimally invasive surgery for improved grasping tools, where a pair of optimized bimorph actuators can be used as a simple grasping device.

Fig.3 Sensor Design

As illustrated in Fig.3, the proposed sensor consists of an elastic beam laid on two supports located on both right and left sides of the sensor. In fact, piezoresistive films are selected as the sensing elements of the sensor because of: (1) their fast response to static and dynamic loads, (2) their ability to be micro fabricated, and (3) their low sensitivity to external noise. The three piezoresistive films that are placed in the bottom of the sensor structure measure the total contact force applied to the top of the sensor. At the same time, the fourth film, which is placed between the sensor beam and the filler material, measures the deflection of the beam, caused by contacting a soft object. The more the deformation of the contact object, the more the deflection of the beam and the more the output of the middle top piezoresistive film. The range and the resolution of the sensor can be fine-tuned by changing the design parameters of the sensor. A piezoelectric bimorph actuator is created by laminating layers of piezoelectric ceramic material (PZT) onto a thin sandwich beam or plate. When opposing voltages are applied to the two ceramic layers, a bending moment is induced in the beam Fig.4. A pair of cantilevered piezoelectric bimorph actuators can be used as a simple grasping device, where the bimorph actuators are used as active fingers as shown in Fig.5.

Fig.4 PZT Bimorph.

Fig.5 Bimorph Grasper

V Conclusions
This report has showed several state-of-the-art researches in MIS (Minimally Invasive Surgery) related about bio-micromachine. From microjoint, piezoresistive tactile sensor to PZT bimorph, it implies that MEMS technology could be highly applied at any aspects in any fields relevant to bio-micromachine.

VI References
[1] Hirofumi O., Tomohiro K., and Fumihito A., Bionic Design of Microjoint for Minimally Invasive Surgical Instrument IEEE Biomechnics., pp. 297299, 2011. [2] Atieh A. et al., A Piezoresistive Based Tactile Sensor for Use in Minimally Invasive Surgery IEEE Bioengineering Conference, pp. 12, 2011. [3] David J. et al., Optimal Design of a PZT Bimorph Actuator for Minimally Invasive surgery SPIE Smart Structures and Materials, pp. 321-335, 2000.