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Some phases of laparoscopic interventions, such as suturing, require precise and dexterous movements that are difficult to perform by means of rigid instruments. Multi-DOF hand-held instruments and teleoperated systems have been developed to increase movement dexterity. In this paper, we present the design of a novel hand-held robotic instrument that can be operated by the surgeon with one hand only, while standing at the operating table and acting on a traditional laparoscopic instrument with the other hand. Its main advantages are the low weight, achieved by dislocating the motors and using a flexible transmission, and the possibility to switch end-effector, changing the instrument type according to the phase of the intervention. The instrument can be used easily and rapidly, since it does not require long or complex set-up procedures. We describe the instrument design, the development of the first prototype and compare it to rigid instruments in the ability to approach sutures at various angles.
Focacci et al. (Sun,) studied this question.