A team of surgeons and engineers at Hong Kong Polytechnic Institute (PolyU) is creating robots that they claim will “minimize surgical trauma and improve the safety of current robotic surgery.”

These robots – referred to as “novel surgical robotic systems” or “NSRS” for short – would be able to perform surgery through an incision that is no wider than three centimeters, half the size of an incision that is normally considered “minimally invasive.”

Certain procedures may not even require any cutting, as the robots can enter people’s bodies through natural orifices.

Doctors hope that the less-invasive techniques used by these robots could reduce post-operative trauma, which is normal in patients after surgery.
NSRS machines have three or more arms, which can be removed before surgery. Once a tiny incision has been made, the robot’s parts can be inserted through the cut, and its arms can be reattached inside the patient’s body. While inside, doctors can maneuver the machines through the patient’s abdominal cavity.

The robots are controlled by surgeons via a control board. A camera gives doctors a three-dimensional image of the patient’s insides.
The machines are also equipped with “haptic feedback,” which measures the amount of force the robot is using and reduces the likelihood of injury.

“It is comparable to handling eggs,” said Professor Yung Kai-leung, who headed the NSRS project. “Too much force would crush the shell, while with too little force we are unable to take away what needs to be removed. Blood vessels and tissues are also fragile, requiring that surgeons handle them warily,”

Since December of last year, the university has been trial testing these robots on animals. According to PolyU’s website, NSRS have been successfully used in three consecutive animal experiments, one of which involved a live pig.

To minimize surgical trauma and improve the safety of current robotic surgery, an innovative project to develop a novel surgical robotic system (NSRS) with haptic (tactile) feedback and capable of single incision or natural orifice (incision-less) robotic surgery has been initiated by Professor Yeung Chung-Kwong (Prof Yeung), Honorary Clinical Professor, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong (HKU). A team of experienced engineers led by Professor Yung Kai-Leung (Prof Yung), Professor and Associate Head of the Department of Industrial and Systems Engineering of The Hong Kong Polytechnic University (PolyU) was invited to develop the system as an engineering partner since 2012. Through applying Prof Yung's expertise in making precision instrument in space, and with important input of expertise in robotic surgery from Prof Yeung, the team has made the breakthrough possible recently. A NSRS with surgical robotic arms that are driven by internal micro-motors and capable of up to 10 degrees of freedom in movement has been developed and successfully utilised in three consecutive animal surgical experiments by Professor Law Wai-Lun (Prof Law), the Anthony and Anne Cheung Professor in Innovative and Minimally Invasive Surgery, Clinical Professor, Director of Surgical Skills Centre, Department of Surgery, and Associate Dean of Li Ka Shing Faculty of Medicine, HKU together with Prof Yeung. This innovative project is funded by NISI (HK) Limited (NISI), a company specializing in non-invasive surgical innovations, and supported by the Innovation and Technology Commission of the Hong Kong SAR Government.
Currently there is only one dominant surgical robotic system on the market. The system is expensive and has many limitations, including the need for multiple incisions, lack of haptic (force or tactile sensation) feedback, and bulkiness. Furthermore, it is not designed for natural orifice (NOTES, or incision-less) robotic surgery. By contrast NSRS, the new robotic system, can be inserted through a single, small incision or even a natural orifice and expanded inside the human body to perform various surgical operations.
Compared with currently available surgical robots, which require multiple (3-6) abdominal incisions, NSRS has fully internally motorized surgical arms which can enter the human body through one tiny incision, or even a natural orifice, for various abdominal or pelvic surgical operations. Since the robotic arms are driven by custom-made micro-motors adjacent to the end-effectors, they can operate with high precision and provide a good sensation of the force applied (haptic feedback). NSRS is the first robotic system in the world with arms having in-vivo motors that are both small enough and able to generate sufficient force to perform various surgical operations inside the human body, paving the way for future non-invasive surgery.

Never be discouraged. If I were sunk in the lowest pits of Nova Scotia, with the Rocky Mountains piled on me, I would hang on, exercise faith, and keep up good courage, and I would come out on top.

Abstract
Objective To compare the safety and efficacy of hysteroscopic sterilization with the “Essure” device with laparoscopic sterilization in a large, all-inclusive, state cohort.

Design Population based cohort study.

Settings Outpatient interventional setting in New York State.

Participants Women undergoing interval sterilization procedure, including hysteroscopic sterilization with Essure device and laparoscopic surgery, between 2005 and 2013.

Main outcomes measures Safety events within 30 days of procedures; unintended pregnancies and reoperations within one year of procedures. Mixed model accounting for hospital clustering was used to compare 30 day and 1 year outcomes, adjusting for patient characteristics and other confounders. Time to reoperation was evaluated using frailty model for time to event analysis.

Results We identified 8048 patients undergoing hysteroscopic sterilization and 44 278 undergoing laparoscopic sterilization between 2005 and 2013 in New York State. There was a significant increase in the use of hysteroscopic procedures during this period, while use of laparoscopic sterilization decreased. Patients undergoing hysteroscopic sterilization were older than those undergoing laparoscopic sterilization and were more likely to have a history of pelvic inflammatory disease (10.3% v 7.2%, P<0.01), major abdominal surgery (9.4% v 7.9%, P<0.01), and cesarean section (23.2% v 15.4%, P<0.01). At one year after surgery, hysteroscopic sterilization was not associated with a higher risk of unintended pregnancy (odds ratio 0.84 (95% CI 0.63 to 1.12)) but was associated with a substantially increased risk of reoperation (odds ratio 10.16 (7.47 to 13.81)) compared with laparoscopic sterilization.

Conclusions Patients undergoing hysteroscopic sterilization have a similar risk of unintended pregnancy but a more than 10-fold higher risk of undergoing reoperation compared with patients undergoing laparoscopic sterilization. Benefits and risks of both procedures should be discussed with patients for informed decisions making.