Enabling Peripheral Vision in Laparoscopic surgery using a Robotic arm integrated with Camera Abstract

Our design idea presents a novel proposition for enabling peripheral vision in laparoscopic surgery. It focuses on a new system of camera assembly employing fish-eye lens with reduced spherical aberration, camera positioning using a robotic arm and integration of the robotic arm with the existing trocar. An electro-mechanically controlled robotic arm enabling efficient camera positioning, camera locking and emergency camera removal is designed to fit and lock into a trocar groove without hindering surgical instrument handling and control. Thus, the design model eliminates the present need of having a separate trocar dedicated for endoscopy. As our camera is placed in an optimum position providing a peripheral vision, the continuous need of adjusting the cameras position during the surgery is absolutely eliminated.

( Fig.1 - An overall diagram explaining our design model )

* All drawings in this abstract have been sketched by hand and scanned.

Background of the invention

The existing endoscope system in laparoscopic surgery is typically used to provide tubular vision of the internal operating organs. This system limits the field of vision of the surgeon and also constrains the position of camera placement limiting the surgeons efficiency. In order to overcome these constraints, a possible solution of assembling a combination of lenses that would replicate the cornea of the human eye was analyzed. The problem of varying refractive index and a high spherical aberration in the cornea made us negate this option. In the present day scenario, fish eye lens assembly is considered to be the best option for providing peripheral vision with reduced spherical aberration. After analyzing various fish eye lens combinations, the best possible combination was chosen to serve our miniature camera requirements. Even though this combination of lens assembly increased the field of vision, the camera assembly and camera position was limited by the angle of insertion of the trocar and the trocar placement. To overcome this problem, an electro-mechanically controlled arm is designed that can position the fish eye lens camera assembly optimally to provide peripheral vision in the region of surgeons interest. In the existing system, a separate trocar is dedicated to the use of an endoscope. As it increases the pain and the healing time for the patient, we extended our design that eliminates the requirement of a separate trocar for endoscope by integrating the robotic arm carrying the camera assembly into one of the trocars used for surgical instruments.
Control Handle Modified Trocar Horizontal Extension Arm Analog TV Output

Surgical Instruments

Peripheral Projector

Console

Image Processing

Power Unit Digital Output

Cropping

Filters

( Fig.2 Components involved in the design )

Individual components explained

The camera assembly
Lens: An 1800 fisheye lens assembly with the aperture ratio F/4 has been selected for use in our camera assembly. The fish eye lens system includes: a pair of negative meniscus lenses (L1 & L2), a negative cemented doublet composite lens (L3) with negative refractive power, and a positive fourth lens (L4) having a convex surface on the object side. A filter (L5) is positioned before the diaphragm. A second lens group is positioned on the image side of the diaphragm and consists of three lenses (L6, L7 & L8) of which at least two are cemented doublet lenses. Replacing the conventional lens with a fish eye lens enables us to converge light at the periphery subtended at an angle of 180o. The lens assembly reduces spherical aberration to a maximum and is convenient for miniaturization.

( Fig.3 Fish-eye lens system)

Lighting: As shown in fig.4, the light coming from an LED is directed onto a collimator, which transforms the light source into a parallel beam. This parallel beam is incident on a partially reflecting mirror and reflected through 900 which are fed into the L8 lens of the fish eye lens assembly. This system of using a fish eye lens for in-vivo illumination provides an even distribution of light around the periphery. Imaging device comprises of a miniature CCD (Charge Coupled Device) which captures light at the focus of the fish eye lens assembly and is sent to the image processing setup (console) through the cabling. A conventional autofocus mechanism can be used to position the CCD for optimal video sharpness. Dual axis control: In spite of the peripheral vision provided by the camera assembly, it is necessary that the camera is initially rotated to view the region of surgeons interest and the position is locked. A miniature spherical pointing motor attached to the camera assembly orients it in the required direction. The assembly: The lens, illuminating source (LED) and the CCD are assembled as shown in fig.4. The partially reflecting mirror permits the use of the same fish eye lens for both illumination and video capture. The power input is provided to a common circuit board, which distributes the power to the LED and the imaging apparatus. A wiper is incorporated at the outer periphery of the assembly to prevent fogging and is controlled at the control handle.
Circuit Board CCD Collimator

LED Illumination Source Partially Refracting Mirror Fish-eye lens Assembly

Wiper Control Mechanism

( Fig.4 The Camera Assembly)

In-vivo surveillance arm

The following presents a step-wise diagram indicating the positioning of the surveillance arm inside the body: Step 1: Insertion of vertical arm Step 2: Vertical arm-trocar groove locking Step 3: Lifting of horizontal arm
Step 1

Step 4: Horizontal arm linkage Locking Step 5: Horizontal arm extension Step 6: Surgical instrument insertion
Step 2 Step 3

Trocar groove Trocar Skin Vertical Arm (2 mm dia)

Trocar Lock

Horizontal arm (7 mm dia)

Step 5 Step 6

Step 4

Surgical Instrument Linkage

Telescopic Horizontal Arm Camera Motor assembly for arm extension/retraction

( Fig.5 Step-wise diagram indicating the positioning of the surveillance arm )

Trocar groove

Linear insertion arm (Vertical arm): The vertical arm is 2mm in diameter and is provided with a slider mechanism at the periphery to control the upward and downward movement of the horizontal arm. The vertical arm has two magnets at the periphery, which get attached to an electro magnetic plate provided within the groove of the trocar.
Electro-magnetic lock plate Trocar bore

( Fig.6 Modified Trocar groove for vertical arm insertion)

Horizontal-Vertical Linkage: A metallic string moves the slider along a thin slot that controls the upward and downward motion of the horizontal arm. The joint is covered with a protective elastic membrane to prevent accumulation of impurities within the system.
Metal String Slider Slot Metallic linkage

( Front View ) Elastic membrane

( Fig.7 Horizontal arm lifting )

Extendable arm (Horizontal arm): The fig.8 (a) indicates the position of the horizontal arm when it is fully retracted within the system. By controlling a motor placed as shown, the rotation of the motor causes each extendable telescopic rod to move out thereby moving the camera to an optimal position for best video capture. Each telescopic extendable piece is provided with an end-hooking facility (typically used in a radio aerial antenna) which makes the next outer telescopic sleeve to move along with the extending arm. The gear wheel connected with the motor is spring loaded from the top to continually ensure a downward force to keep it in contact with the telescopic outer periphery teeth. The fig.8 (b) indicates the position of the horizontal arm when it is fully extended. After the horizontal arm is fully extended to the required position, the entire system is locked by means of a universal lock system present in the control handle (discussed below).

Transmission belt Motor Down-Force Spring Gear wheel Teeth for Linear motion Camera Retracted Arm Extended Arm

Fig.8 (a)
( Side view )

Fig.8 (b)
Teeth for Linear motion

Fig.8 (a)
( Top View )

Fig.8 (b)

( Fig.8 Squiggle motor controlled horizontal arm extension )

Trocar Modification:
Existing Design Functionality: The surgeon places the trocar by skin incision on the body cavity and the appropriate surgical instrument is then inserted into the trocar. Presently, several trocars are inserted into the patients body making the area look more like a pin cushion stand. A minimum of three trocars is essential presently - one separately for insertion of the tubular camera for in-vivo viewing and atleast a couple more for surgical instrument insertion. Design Modifications for the trocar: The modified trocar design assembly will be provided with a 3mm diameter groove at one side of the outer periphery of the existing bore having a locking mechanism for fastening the in-vivo surveillance vertical arm (2 mm diameter) to the trocar. A control handle is integrated at the head of the trocar having several functions for controlling the movement of the surveillance arm.
Linkage Control Groove Lock LED Emergency Button Surgical Instrument Extension Arm Control

Trocar Groove with Vertical Arm Horizontal Extension Arm

Universal Lock Camera Rotation Control

Vertical Arm

Wiper Activation

Electrical output to console Modified Trocar

Trocar Lock

Surgical Instrument

( Fig.9 Modified Trocar )

The Control Handle

The control handle is optimally designed to control the functions of positioning and placing the camera for best viewing, activating a wiper system for sweeping the outer spherical dome, providing an electro-magnetic supply for fixing the vertical insertion arm to the trocar groove, a universal lock for holding the assembly in a fixed position and an emergency retrieval system for retracting the entire system assembly.
Linkage Control Groove Lock Extension Arm Control LED Surgical Instrument Emergency Button Horizontal Extension Arm Universal Lock

Camera Rotation Control Wiper Activation Electrical output to console Surgical Instrument Modified Trocar Trocar Lock

( Fig.10 Trocar with control handle)

Wiring and metallic strings: Fig.11 indicates the wiring scheme used in the surveillance arm. A system of pulleys at the joint of the horizontal and vertical arm ensures smooth movement of the metallic strings when it is bent from the vertical to the horizontal arm. The red colored lines represent the electrical wiring and the blue lines represent the mechanically controlled strings. All the electric wires are bundled together through a single cable (red colored and enlarged in the figure).

Control handle

Electrical wire bundle Magnified

Power (CCD & LED) CCD Output

Pulley aiding string movement

Vertical arm

Power (rotation-tilt)

Mechanically controlled Metallic string

( Fig.11 Wiring and metallic strings )

Groove-vertical arm locking: The inner periphery of the groove is fitted with an electro-magnetic plate. Two magnets placed at a strategic position on the outer vertical arm get attracted and fix onto the electro-magnetic plate when a minimum charge is applied to the electro magnetic plate by a push button provided on the handle.

Modified Trocar Bore

Trocar groove with electro-magnetic plate

( Fig.12 Groove-vertical arm locking )

Positioning and Placing of Camera: A rotary cylindrical dial is calibrated with a mechanical stop. Rotation of a dial at the handle winds and unwinds the metallic string around the cylinder to move a slider along a thin slot that controls the upward and downward motion of the horizontal arm through a linkage as shown in the fig.7.
Vertical Arm Motor assembly for arm extension/retraction Telescopic Horizontal Arm

Camera

( Fig.13 Positioning and Placing of Camera )

The extension and retraction of the horizontal arm is controlled by another calibrated push button which when activated controls the rotation of a motor placed on top of the camera that extends each of the telescopic arm as it rolls out in one direction. The rotation of the motor in the opposite direction retracts the telescopic arm.

Wiper Activation: Due to the problems of fogging and condensation on the outer surface of the camera dome, a wiper system along the outer contour is provided with a foam material for the wiping action. The wiper is mechanically actuated in one direction using metallic string from the handle. After sweeping 1800 around the outer contour, a spring-loaded mechanism pushes the wiper back to its original position.

Mechanically controlled wiper string Spring-loaded Return Mechanism Wiper Arm

( Front View )

( Lateral View )

( Fig.14 Wiper Mechanism)

Universal Lock: A spring-loaded clamp is used to hold the metallic strings that hold the horizontal arm linkage. This clamp ensures that the whole horizontal assembly is held at a fixed position without proving a hindrance to the surgical instrument movement. Emergency Button: An emergency button is provided at the bottom of the control handle for quick retrieval of the entire assembly out of the trocar. When the emergency button is pressed, a programmed microchip is integrated into the control handle to perform the following sequence of operations: 1) The motor controlling the horizontal arm is rotated in the opposite direction to quickly retract the arm. 2) The universal clamp releases the wires holding the linkage to the horizontal arm causing the slider to make the horizontal arm fall back to its original vertical position. 3) The electric supply to the electro magnetic plate at the inner periphery of the groove is switched off to unlock the vertical arm from the trocar groove. 4) A LED glows to signal that the sequence of operations is complete and the arm maybe pulled out of the trocar.

Peripheral video projection

After a thorough study of the existing peripheral projection methods, the following two projection principles have been chosen for optimal peripheral view. In the first method, the image from the CCD device is directly fed onto a fish-eye projection lens without applying any filters in the image processing stage and the peripheral image is retained. The fish-eye lens projects the image onto a hemi-spherical dome screen, which is located at a position which is best suitable for viewing by the surgeon.
( Fig.15 Hemi-spherical dome video projection )

If a compromise can be made on the peripheral dome imaging option and the surgeons feel that the same image projected on a curved screen would prove sufficient, a simpler and an economically more viable solution maybe opted. In this method, the video from the CCD device is processed with anti-spherical filters in the console and is projected onto a curved screen using a conventional LCD projector.
( Fig.16 Alternative flat screen video projection )

Additional Analog Output: Processed video output from the console is made available simultaneously both on an analog TV device and a computer for recording, freezing frames during surgery and detailed examination.

Economic feasibility
The final design model proposed above has been arrived at after careful synthesis and analysis at every stage for its economic feasibility and ease of material availability. In the first stage, usage of various lenses for obtaining peripheral vision was studied. Though liquid lenses can be effectively customized to replicate the human cornea, this option was negated due to the cost factor involved in fabrication and assembly setup. The above constraints also prohibited us from using dimpled lenses which is again a promising option for enabling peripheral vision. The extensive application of the fish-eye lens assembly in everyday usage like: door pinhole lens, Spy CCD cameras, etc. makes it an easily available and accessible component. Moderate market pricing and extent of miniaturization already achieved made us choose this option. In the second stage, when various operational modes of the robotic arm like pneumatic, hydraulics, electronics and mechanics were taken into consideration, mechanically controlled system was chosen due to its reliability, cost effectiveness, higher precision and ease of operation. In the last stage of video projection, considering the economic demand and space constraints for a peripheral dome setup, the output video is presented on a curved screen using a conventional LCD projector after applying various image processing filters.

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Patents Referred
United States Patent #4070098 Fisheye projection lens system for 35mm motion pictures United States Patent #4966454 3-D Motion Picture Projector United States Patent #4685450 Endoscope United States Patent #4403605 Endoscope Photographing System United States Patent #64716371- Image orientation for endoscopic video displays United States Patent #5949430 Peripheral lenses for simulating peripheral vision on a display device United States Patent #5475420 Video Imaging System with Image Processing optimized for small diameter endoscopes United States Patent #6734893 Endoscopy Illumination system for Stroboscopy United States Patent #4616226 Peripheral Vision Artificial Horizon Device United States Patent #4855838 Remotely Controlled Pan and Tilt Television Camera United States Patent #4678289 Apparatus for Deflection of a Light Beam United States Patent #4639772 Focusable Video Camera for Use with endoscopes United States Patent #5147316 Laparoscopic Trocar with Self-locking port sleeve United States Patent #7256834 Digital Camera with Panning/Tilting functionality United States Patent #6844991 Fish-Eye Lens United States Patent #4647161 Fish-Eye Lens system United States Patent #6301058 Wide Angle Lens United States Patent #5122122 Locking Trocar Sleeve United States Patent #4890713 Pan and Tilt Motor for Surveillance Camera United States Patent #4656506 Spherical Projection System United States Patent #4654030 Trocar United States Patent #4601710 Trocar Assembly United States Patent #5693967 Charged Coupled device with micro-lens

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