Optimal port placement could improve the ergonomic design of laparoscope manipulating robot

Laparoscope manipulating robot is useful for maintaining a stable view during a laparoscopic operation. However, a large apparatus can interfere with surgical space, set-up time and repositioning. Furthermore, it consumes a lot of initial and maintenance cost. Ten consecutive robotic assisted laparoscopic pelvic surgeries were performed in order to study the maximum and optimal motion-angle in difference port placements. The maximum horizontal angle(X) for right pelvic view (Mx Rt X) was 30 degree and the maximum horizontal angle(X) for left pelvic view (Mx Lt X) was -25 degree. The median of maximum vertical angle (Y) for upward motion (Mx Up Y) was 44 degree (range 32-55 degree) and the median of maximum vertical angle (Y) for downward motion (Mx Dn Y) was 24 degree. The median optimal angle in operation of right uterine horn was 14 degree (range 3-30 degree) in horizontal plane (Opt Rt X) and 28 degree (range 24-43 degree) in vertical plane (Opt Rt Y). The median optimal angle in operation of left uterine horn was -10 degree (range -4--25 degree) in horizontal plane (Opt Lt X) and 29 degree (range 24-51 degree) in vertical plane (Opt Lt Y). The median optimal depth (Z) of endoscope position in right uterine horn operation (Opt In Rt Z) was 9.5 cm (range 7.5-12.5 cm) and left(Opt In Lt Z) was 9.5 cm (range 6-12.5 cm). L, U, +1U ports were selected by an experience gynecologic laparoscopist as the suitable port mimicked to human pelvic surgery. Then we concluded that the endoscope camera needed to move from -30 degree to +30 degree in the left to right direction (X) and from 0 degree to +60 degree in the up/down (Y) direction and, 15 cm for in/out motion (Z) in order to reach the maximum angle for full pelvic operation. From this results, we hope to design an ergonomic robot with less interferes with the surgeon.