The role of technology in minimally invasive surgery: state of the art, recent developments and future directions

The diffusion of minimally invasive surgery has thrived in recent years, providing substantial benefits over traditional techniques for a number of surgical interventions. This rapid growth has been possible due to significant advancements in medical technology, which partly solved some of the technical and clinical challenges associated with minimally invasive techniques. The issues that still limit its widespread adoption for some applications include the limited field of view; reduced manoeuvrability of the tools; lack of haptic feedback; loss of depth perception; extended learning curve; prolonged operative times and higher financial costs. The present review discusses some of the main recent technological advancements that fuelled the uptake of minimally invasive surgery, focussing especially on the areas of imaging, instrumentation, cameras and robotics. The current limitations of state-of-the-art technology are identified and addressed, proposing future research directions necessary to overcome them.

[1]  D. Mant,et al.  Systematic review and validation of prediction rules for identifying children with serious infections in emergency departments and urgent-access primary care. , 2012, Health technology assessment.

[2]  J. Bisley,et al.  Evaluating tactile feedback in robotic surgery for potential clinical application using an animal model , 2016, Surgical Endoscopy.

[3]  A. Cuschieri,et al.  Methods for improving performance under reverse alignment conditions during endoscopic surgery , 1999, Surgical Endoscopy.

[4]  A. Darzi,et al.  Navigation systems and platforms in natural orifice translumenal endoscopic surgery (NOTES). , 2009, International journal of surgery.

[5]  K. Nishiyama,et al.  A novel three-dimensional and high-definition flexible scope , 2014, Acta Neurochirurgica.

[6]  S. Hofmann,et al.  Patient-specific total knee arthroplasty: the importance of planning by the surgeon , 2013, Knee Surgery, Sports Traumatology, Arthroscopy.

[7]  R. Dubois,et al.  Minimally invasive repair of pectus excavatum using the Nuss technique in children and adolescents: indications, outcomes, and limitations. , 2014, Orthopaedics & traumatology, surgery & research : OTSR.

[8]  Cecilie Våpenstad,et al.  Procedural virtual reality simulation in minimally invasive surgery , 2013, Surgical Endoscopy.

[9]  Jacques Marescaux,et al.  A computed stereoscopic method for laparoscopic surgery by using feature tracking , 2015, 2015 IEEE International Conference on Consumer Electronics - Taiwan.

[10]  S. Lipsitz,et al.  Use, costs and comparative effectiveness of robotic assisted, laparoscopic and open urological surgery. , 2012, The Journal of urology.

[11]  ROBOTICALLY-ASSISTED SURGICAL DEVICES , 2015 .

[12]  W. Yue,et al.  Does Minimally Invasive Surgery Have a Lower Risk of Surgical Site Infections Compared With Open Spinal Surgery? , 2013, Clinical orthopaedics and related research.

[13]  N. Kitchen,et al.  Pre-operative planning and intra-operative guidance in modern neurosurgery: a review of 300 cases. , 1999, Annals of the Royal College of Surgeons of England.

[14]  A. Korge,et al.  Minimally invasive total disc replacement: surgical technique and preliminary clinical results , 2002, European Spine Journal.

[15]  G. Damiani,et al.  Complications in thyroid surgery. Harmonic Scalpel, Harmonic Focus versus Conventional Hemostasis: A meta-analysis. , 2016, International journal of surgery.

[16]  Likun Zhang,et al.  Effect of automatic image realignment on visuomotor coordination in simulated laparoscopic surgery. , 2012, Applied ergonomics.

[17]  Guang-Zhong Yang,et al.  A Smart Haptic Hand-Held Device for Neurosurgical Microdissection , 2015, Annals of Biomedical Engineering.

[18]  Suvranu De,et al.  Common uses and cited complications of energy in surgery , 2013, Surgical Endoscopy.

[19]  Lawrence H. Kim,et al.  Effects of master-slave tool misalignment in a teleoperated surgical robot , 2015, 2015 IEEE International Conference on Robotics and Automation (ICRA).

[20]  Mark Stevenson,et al.  Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation. , 2013, Health technology assessment.

[21]  Alfred Cuschieri,et al.  Economic evaluation of da Vinci-assisted robotic surgery: a systematic review , 2012, Surgical Endoscopy.

[22]  K. Shroyer,et al.  Early detection of carcinoma in situ of the bladder: a comparative study of white light cystoscopy, narrow band imaging, 5-ALA fluorescence cystoscopy and 3-dimensional optical coherence tomography. , 2012, The Journal of urology.

[23]  Ravishankar K. Iyer,et al.  Adverse Events in Robotic Surgery: A Retrospective Study of 14 Years of FDA Data , 2015, PloS one.

[24]  D W Rattner,et al.  Optical imaging technology in minimally invasive surgery. Current status and future directions. , 1999, Surgical endoscopy.

[25]  A. Solimini Are There Side Effects to Watching 3D Movies? A Prospective Crossover Observational Study on Visually Induced Motion Sickness , 2013, PloS one.

[26]  E. Lehr,et al.  The Role of Computed Tomography Angiography in Patients Undergoing Evaluation for Minimally Invasive Cardiac Surgery: An Early Program Experience , 2015, Innovations.

[27]  A. Okamura Haptic feedback in robot-assisted minimally invasive surgery , 2009, Current opinion in urology.

[28]  C. Tsui,et al.  Minimally invasive surgery: national trends in adoption and future directions for hospital strategy , 2013, Surgical Endoscopy.

[29]  Guang-Zhong Yang,et al.  Force adaptive robotically assisted endomicroscopy for intraoperative tumour identification , 2015, International Journal of Computer Assisted Radiology and Surgery.

[30]  Shahram Payandeh Force propagation models in laparoscopic tools and trainers , 1997, Proceedings of the 19th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 'Magnificent Milestones and Emerging Opportunities in Medical Engineering' (Cat. No.97CH36136).

[31]  Guang-Zhong Yang,et al.  Visual Force Feedback for Hand-Held Microsurgical Instruments , 2015, MICCAI.

[32]  Philippe Cinquin,et al.  Visual servoing of a robotic endoscope holder based on surgical instrument tracking , 2014, 5th IEEE RAS/EMBS International Conference on Biomedical Robotics and Biomechatronics.

[33]  Lakshmana Ayaru,et al.  Fluorescence lifetime spectroscopy of tissue autofluorescence in normal and diseased colon measured ex vivo using a fiber-optic probe. , 2014, Biomedical optics express.

[34]  C. Cao,et al.  Effect of haptic feedback in laparoscopic surgery skill acquisition , 2012, Surgical Endoscopy.

[35]  Paula Gomes,et al.  Surgical robotics: Reviewing the past, analysing the present, imagining the future , 2011 .

[36]  Weiwei Deng,et al.  Easy-to-Use Augmented Reality Neuronavigation Using a Wireless Tablet PC , 2013, Stereotactic and Functional Neurosurgery.

[37]  Nassir Navab,et al.  Modeling and Segmentation of Surgical Workflow from Laparoscopic Video , 2010, MICCAI.

[38]  P. Eldridge Submissions remain healthy, so there is something of a backlog to appear in print. , 2014, British journal of neurosurgery.

[39]  Jeff Hecht,et al.  Understanding Fiber Optics , 1987 .

[40]  Christopher R Mitchell,et al.  Image-guided surgery and emerging molecular imaging: advances to complement minimally invasive surgery. , 2014, The Urologic clinics of North America.

[41]  David C. Miller,et al.  Population level assessment of hospital based outcomes following laparoscopic versus open partial nephrectomy during the adoption of minimally invasive surgery. , 2014, The Journal of urology.

[42]  A. Cerillo,et al.  Minimally invasive and conventional aortic valve replacement: a propensity score analysis. , 2013, The Annals of thoracic surgery.

[43]  Volkmar Falk,et al.  Aortic valve replacement through a minimally invasive approach: preoperative planning, surgical technique, and outcome. , 2009, The Annals of thoracic surgery.

[44]  Tracy L Faber,et al.  Multimodality imaging. , 2003, Seminars in nuclear medicine.

[45]  Soo Jay Phee,et al.  Haptic feedback and control of a flexible surgical endoscopic robot , 2013, Comput. Methods Programs Biomed..

[46]  J. Himpens,et al.  The World's First Obesity Surgery Performed by a Surgeon at a Distance , 1999, Obesity surgery.

[47]  Mark J Sculpher,et al.  Endovascular versus Open Repair of Abdominal Aortic Aneurysm , 2011 .

[48]  Shuming Nie,et al.  The Optical Biopsy: A Novel Technique for Rapid Intraoperative Diagnosis of Primary Pulmonary Adenocarcinomas. , 2015, Annals of surgery.

[49]  R. Smith,et al.  Advanced stereoscopic projection technology significantly improves novice performance of minimally invasive surgical skills , 2012, Surgical Endoscopy.

[50]  R. Schlesinger Vaginal sacrospinous ligament fixation with the Autosuture Endostitch device. , 1997, American journal of obstetrics and gynecology.

[51]  Guang-Zhong Yang,et al.  Emerging Robotic Platforms for Minimally Invasive Surgery , 2013, IEEE Reviews in Biomedical Engineering.

[52]  Benjamin J Vakoc,et al.  Photometric stereo endoscopy , 2013, Journal of biomedical optics.

[53]  K. J. Kuchenbecker,et al.  Surgeons and non-surgeons prefer haptic feedback of instrument vibrations during robotic surgery , 2015, Surgical Endoscopy.

[54]  I. Gill,et al.  Transvesical robotic simple prostatectomy: initial clinical experience. , 2014, European urology.

[55]  Dan Stoianovici,et al.  Robotic ultrasound and needle guidance for prostate cancer management: review of the contemporary literature , 2014, Current opinion in urology.

[56]  B. Stuck,et al.  First use of a new retractor in transoral robotic surgery (TORS) , 2016, European Archives of Oto-Rhino-Laryngology.

[57]  M. Yuksel,et al.  Quality of life of patients who have undergone the minimally invasive repair of pectus carinatum. , 2013, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[58]  T. Mihaljevic,et al.  Preoperative multidetector computed tomograpy angiography for planning of minimally invasive robotic mitral valve surgery: impact on decision making. , 2013, The Journal of thoracic and cardiovascular surgery.

[59]  P. McAfee,et al.  Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery. A prospective multicenter study evaluating open and laparoscopic lumbar fusion. , 1999, Spine.

[60]  Laurent Audigé,et al.  Worldwide survey on the use of navigation in spine surgery. , 2013, World neurosurgery.

[61]  T. Robinson,et al.  Minimally invasive surgery , 1999, European Surgical Research.

[62]  S. Boppart,et al.  Optical Coherence Tomography: Feasibility for Basic Research and Image-guided Surgery of Breast Cancer , 2004, Breast Cancer Research and Treatment.

[63]  C. Lombardi,et al.  What is the appropriate role of minimally invasive vs. open surgery for small adrenocortical cancers? , 2015, Current opinion in oncology.

[64]  Beat P. Müller-Stich,et al.  Computer-assisted abdominal surgery: new technologies , 2015, Langenbeck's Archives of Surgery.

[65]  G. Choi,et al.  Randomized clinical trial of robot‐assisted versus standard laparoscopic right colectomy , 2012, The British journal of surgery.

[66]  Ghulam Abbas,et al.  Outcomes After Minimally Invasive Esophagectomy: Review of Over 1000 Patients , 2012, Annals of surgery.

[67]  N. P. Reddy,et al.  Forces in surgical tools: comparison between laparoscopic and surgical forceps , 1996, Proceedings of 18th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[68]  J. Lau,et al.  Endoscopic suturing is superior to endoclips for closure of gastrotomy after natural orifices translumenal endoscopic surgery (NOTES): an ex vivo study , 2014, Surgical Endoscopy.

[69]  J. Witjes,et al.  The role of urine markers, white light cystoscopy and fluorescence cystoscopy in recurrence, progression and follow-up of non-muscle invasive bladder cancer , 2013, World Journal of Urology.

[70]  J. Maessen,et al.  Preoperative planning of left-sided valve surgery with 3D computed tomography reconstruction models: sternotomy or a minimally invasive approach? , 2016, Interactive cardiovascular and thoracic surgery.

[71]  L. Galuppo,et al.  Laparoscopic ovariectomy using the endo-GIA stapling device and endo-catch pouches and evaluation of analgesic efficacy of epidural morphine sulfate in 10 mares. , 2005, Veterinary surgery : VS.

[72]  Teodor P. Grantcharov,et al.  Validation of a Structured Training and Assessment Curriculum for Technical Skill Acquisition in Minimally Invasive Surgery: A Randomized Controlled Trial , 2013, Annals of surgery.

[73]  Rigoberto Martinez-Mendez,et al.  Minimally invasive surgical skills evaluation in the field of otolaryngology , 2013, Proceedings of the 26th IEEE International Symposium on Computer-Based Medical Systems.

[74]  Hedyeh Rafii-Tari,et al.  A cooperative control framework for haptic guidance of bimanual surgical tasks based on Learning From Demonstration , 2015, 2015 IEEE International Conference on Robotics and Automation (ICRA).

[75]  George Berci,et al.  Initial Clinical Experience With a High‐Definition Exoscope System for Microneurosurgery , 2010, Neurosurgery.

[76]  Joseph C Liao,et al.  Intraoperative Optical Biopsy during Robotic Assisted Radical Prostatectomy Using Confocal Endomicroscopy. , 2016, The Journal of urology.

[77]  Erlend Fagertun Hofstad,et al.  A study of psychomotor skills in minimally invasive surgery: what differentiates expert and nonexpert performance , 2013, Surgical Endoscopy.

[78]  Martin Misfeld,et al.  Learning Minimally Invasive Mitral Valve Surgery: A Cumulative Sum Sequential Probability Analysis of 3895 Operations From a Single High-Volume Center , 2013, Circulation.

[79]  J. Kaouk,et al.  First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform , 2011, Surgical Endoscopy.

[80]  A. Darzi,et al.  Augmented reality: 3D image-guided surgery , 2015, Cancer Imaging.

[81]  Maximilian Burger,et al.  Long-term decrease in bladder cancer recurrence with hexaminolevulinate enabled fluorescence cystoscopy. , 2012, The Journal of urology.

[82]  Nassir Navab,et al.  Action- and Workflow-Driven Augmented Reality for Computer-Aided Medical Procedures , 2007, IEEE Computer Graphics and Applications.

[83]  G. Carvalho,et al.  NOTES transvaginal cholecystectomy: preliminary clinical application , 2008, Surgical Endoscopy.

[84]  Guang-Zhong Yang,et al.  Endoscopic and keyhole endoscope-assisted neurosurgical approaches: A qualitative survey on technical challenges and technological solutions , 2014, British journal of neurosurgery.

[85]  R. Thompson,et al.  Platinum Priority – Prostate Cancer Editorial by Yair Lotan on pp . 17 – 18 of this issue Hospitalization Costs for Radical Prostatectomy Attributable to Robotic Surgery , 2013 .

[86]  Claudio Pacchierotti,et al.  Sensory Subtraction in Robot-Assisted Surgery: Fingertip Skin Deformation Feedback to Ensure Safety and Improve Transparency in Bimanual Haptic Interaction , 2014, IEEE Transactions on Biomedical Engineering.

[87]  F. Gazeau Molecular Imaging Techniques: New Frontiers , 2013 .

[88]  J. Marks,et al.  Principles of flexible endoscopy for surgeons , 2013 .

[89]  H. Stepp,et al.  Intraoperative optical coherence tomography imaging to identify parathyroid glands , 2015, Surgical Endoscopy.

[90]  Jacques Marescaux,et al.  Next step in minimally invasive surgery: hybrid image-guided surgery. , 2015, Journal of pediatric surgery.

[91]  M. Sculpher,et al.  The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy. , 2012, Health technology assessment.

[92]  Ravishankar K. Iyer,et al.  Safety Implications of Robotic Surgery: A Study of 13 Years of FDA Data on da Vinci Surgical Systems , 2013 .

[93]  S. A. Boppart,et al.  Optical imaging technology in minimally invasive surgery , 1999, Surgical Endoscopy.

[94]  Voicu Popescu,et al.  Virtual annotations of the surgical field through an augmented reality transparent display , 2016, The Visual Computer.

[95]  Guang-Zhong Yang,et al.  A miniaturised robotic probe for real-time intraoperative fusion of ultrasound and endomicroscopy , 2015, 2015 IEEE International Conference on Robotics and Automation (ICRA).

[96]  N. Uedo,et al.  Efficacy of an Endo-Knife With a Water-Jet Function (Flushknife) for Endoscopic Submucosal Dissection of Superficial Colorectal Neoplasms , 2010, The American Journal of Gastroenterology.

[97]  M. Desai,et al.  Pre-operative 3D CT imaging for virtual planning of minimally invasive aortic valve surgery. , 2013, JACC. Cardiovascular imaging.

[98]  Didier Mutter,et al.  Endoluminal surgical triangulation: overcoming challenges of colonic endoscopic submucosal dissections using a novel flexible endoscopic surgical platform: feasibility study in a porcine model , 2013, Surgical Endoscopy.

[99]  D. Yuh,et al.  Effect of sensory substitution on suture-manipulation forces for robotic surgical systems. , 2005, The Journal of thoracic and cardiovascular surgery.

[100]  Guang-Zhong Yang,et al.  Collaborative eye tracking: a potential training tool in laparoscopic surgery , 2012, Surgical Endoscopy.

[101]  A. Halliday The United Kingdom EVAR Trial Investigators. Endovascular versus Open Repair of Abdominal Aortic Aneurysm , 2010 .

[102]  J. Dunning The elephant in the room. , 2013, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[103]  Brice Gayet,et al.  3D visualization reduces operating time when compared to high-definition 2D in laparoscopic liver resection: a case-matched study , 2016, Surgical Endoscopy.

[104]  A. Darzi,et al.  456 A Novel Flexible Snake Robot for Endoluminal Upper Gastrointestinal Surgery , 2014 .

[105]  A. Darzi,et al.  Robotics in Keyhole Transcranial Endoscope-Assisted Microsurgery: A Critical Review of Existing Systems and Proposed Specifications for New Robotic Platforms , 2014, Neurosurgery.

[106]  Sunil M Prasad,et al.  Surgical robotics: impact of motion scaling on task performance. , 2004, Journal of the American College of Surgeons.

[107]  Septimiu E. Salcudean,et al.  Bimanual telerobotic surgery with asymmetric force feedback: A daVinci® surgical system implementation , 2014, 2014 IEEE/RSJ International Conference on Intelligent Robots and Systems.