Page 183 - Flexible Robotics in Medicine

170 Chapter 7

Figure 7.1
Diagram of motion of surgical instrument during single-port surgery (left) and the overall design
concept of the single-port surgical manipulator with multichannel instruments (right).

bone fracture. Hence, plate fixation or implantation of protected weight-bearing is required
to reduce the amount of stress experienced by the weakened tibia bone, thus reducing the
risk of stress fractures. Upon removal of the plate fixation, the weakened tibia bone is again
at higher risk for fracture. Furthermore, by using a plate fixation, the patient is exposed to
the risk of implant failure, and these could lead to further postoperative complications [1].
While the above method can minimize the incidence of local recurrences by ensuring that
the tumor cells are thoroughly washed out, the surgical procedure can be further improved
to preserve maximal function in the patient’s tibia bone.
There has been a paradigm shift toward minimally invasive surgery (MIS) with numerous
benefits, such as faster turnaround times and fewer complications related to overstaying.
However, the cavity created by laparoscopic surgery is reportedly similar in size as
compared to open surgery due to the movement of the traditional stiff surgical instruments,
which would rub against the rim of the bone cavity [2]. It can be observed that
laparoscopic surgery would lead to a different motion scheme, comparing with a flexible
single-port single-port surgical manipulator [2] (Fig. 7.1).
This demand for MIS is further commercially evident, as is projected to reach $21.5 billion
by 2021 [3]. While there exists a small number of minimally invasive surgical instruments,
they still face challenges that hinder its full-scale applications. First, most instruments are
bulky, rigid, and expensive. These problems have impeded their use in the removal of giant
cell bone tumors. Additionally, operators may face problems such as the need for extensive
training with equipment, difficulty in control of equipment, and an unintuitive learning
process. As a result, we have observed a shift in MIS toward robotic-assisted surgery, which