Surgical robotic systems have a great impact on the application of laparoscopic surgeries in the operating room. The advent of externally operated surgical robots has prompted the first significant shift in general laparoscopic surgeries. Miniature in vivo robots that can be completely inserted in to the abdomen are also being studied to reduce patient trauma. Whereas external surgical robots have a constrained workspace but provide good speed and force capabilities; miniature surgical robots have good local workspace characteristics, but are generally slower and not as powerful. Current efforts to address these limitations include cooperatively using multiple surgical robots to increase dexterous manipulation capabilities, fault tolerance, and overall robustness. In this paper, a cooperative surgical robot system composed of an externally actuated, compact tool-positioning surgical robot, CoBRASurge (Compact Bevel-geared Robot for Advanced Surgery), and an in vivo fixed-base, task assistant Dexterous Robot, is presented to perform laparoscopic surgical procedures. The CoBRASurge functions as a gross end-effector positioning robot and the Dexterous Robot performs internal surgical tasks with fine accuracy, effectively increasing the flexibility of the robot system. The surgical procedure successfully demonstrates the feasibility of using CoBRASurge to provide the surgeon with stable and remotely adjustable repositioning of in vivo robots for laparoscopic procedures in the peritoneal cavity.

Gaining access to the peritoneal cavity through a natural orifice is potentially the next paradigm shift in minimally invasive surgery. Natural orifice translumenal endoscopic surgery (NOTES) provides distinct patient advantages, but is surgically challenging. Access to the peritoneal cavity is limited by the size and complex geometry of the natural lumen, and existing tools do not adequately address these constraints. A miniature in vivo robot with two "arms" and a central "body" has been developed for NOTES. The robot can be advanced through the esophagus and into the peritoneal cavity using an overtube and endoscope. Once completely inserted, the robot provides a stable platform for visualization and dexterous manipulation from arbitrary orientations. In vivo testing of the NOTES robot in a porcine model has been successful. Using the robot, the surgeon was able to explore the abdominal cavity and perform small bowel dissection. In addition, benchtop testing has demonstrated the ability of the robot arm to follow a predetermined path in Cartesian space and shows good results towards future three- dimensional feedback control.

Long-term human space exploration will require contingencies for emergency medical procedures including some capability to perform surgery. The ability to perform minimally invasive surgery (MIS) would be an important capability. The use of small incisions reduces surgical risk, but also eliminates the ability of the surgeon to view and touch the surgical environment directly. Robotic surgery, or telerobotic surgery, may provide emergency surgical care in remote or harsh environments such as space flight, or extremely forward environments such as battlefields. However, because current surgical robots are large and require extensive support personnel, their implementation has remained limited in forward environments, and they would be difficult, or impossible, to use in space flight or on battlefields. This paper presents experimental analysis of miniature fixed-base and mobile in vivo robots to support MIS surgery in remote and harsh environments. The objective is to develop wireless imaging and task-assisting robots that can be placed inside the abdominal cavity during surgery. Such robots will provide surgical task assistance and enable an on-site or remote surgeon to view the surgical environment from multiple angles. This approach is applicable to long-duration space flight, battlefield situations, and for traditional medical centers and other remote surgical locations.

A mobile in vivo camera robot was developed to provide the ability for a single port biopsy procedure. Such a robot can be inserted into the abdominal cavity through a standard trocar. The surgeon controls the robot using visual feedback from the on-board camera. Measurements were made to identify the forces required to successfully biopsy in vivo tissue, including clamping and tearing forces. The robot design was developed around these parameters and the need to traverse the abdominal environment using specially designed wheels. This mobility allows the biopsy robot to move to the area of interest to sample specific tissues. The lead-screw linkage system that actuated the graspers allows for large force production through careful mechanical design. In vivo testing of this system in a porcine (pig) model has been successful. The robot is capable of traversing the entire in vivo abdominal environment and has successfully been used to biopsy hepatic tissue. In addition, experimental analysis of the biopsy mechanism shows good results towards more elaborate tissue manipulation in the future

Laparoscopy is abdominal surgery performed with long tools inserted through small incisions. The use of small incisions reduces patient trauma, but also eliminates the surgeon's ability to view and touch the surgical environment directly. These limitations generally restrict the application of laparoscopy to procedures less complex than those performed during open surgery. This paper presents a theoretical and experimental analysis of miniature, wheeled, in vivo robots to support laparoscopy. The objective is to develop a wireless mobile imaging robot that can be placed inside the abdominal cavity during surgery. Such robots will allow the surgeon to view the surgical environment from multiple angles. The motion of these in vivo robots will not be constrained by the insertion incisions. Simulation and experimental analyses have led to a wheel design that can attain good mobility performance in in vivo conditions