An Intra-Abdominal Catheter Placement Device With Automatic and Accurate Mechanical Indication of Abdominal Cavity Entry for Laparoscopic Telesurgery

Abstract Telesurgery applications in laparoscopic surgeries are limited by the need for a surgeon to manually insert the trocar for access to the abdominal cavity. This feasibility study aims to solve this by capitalizing on the biomechanical properties of the abdominal wall to introduce the robotic automated peritoneal insertion device (RAPID), a novel mechanism employing a purely mechanical indication system for accessing the abdominal cavity. The RAPID leverages differences in insufflation pressure between the abdominal wall and the abdominal cavity to indicate entry. In the initial phase of this research, cadaver testing showed that concomitant insufflation can be used to identify peritoneal cavity access in humans, validating a previous finding in a porcine study. Using an optimal pressure value determined from the previous porcine study, the RAPID was then validated in live porcine models. The system operated correctly in 19 out of 21 placements, affirming the feasibility of the entry indication system. This shows that the RAPID can accurately and automatically indicate entry of the trocar into the abdominal cavity. This advancement has the potential to automate initial and subsequent trocar insertions, thus removing one more constraint on laparoscopic telesurgery.