SEMI-AUTOMATIC MANIPULATOR FOR LASER PROCTOLOGY

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1 International Journal of Civil Engineering and Technology (IJCIET) Volume 9, Issue 11, November 2018, pp , Article ID: IJCIET_09_11_196 Available online at ISSN Print: and ISSN Online: IAEME Publication Scopus Indexed SEMI-AUTOMATIC MANIPULATOR FOR LASER PROCTOLOGY V. V. Kharlamov, S. A. Nikitin, A. Y. Krylova, A. V. Sinegub, G. S. Kireeva Central Research Institute of Robotics and Technical Cybernetics, Saint-Petersburg, Russia ABSTRACT The aim of this work was to develop a device for semiautomatic manipulation of an optical fiber for laser proctology based on a laser coagulator. Such device is proposed to solve the problem of increasing the positioning accuracy of a light guide during proctological minimally invasive laser surgeries in patients with vascular and oncological diseases. The proposed technical solutions provide improved positioning accuracy due to the fact that the manipulation of the optical light guide is carried out with a device with two degrees of mobility reliably fixed in the proctoscope, which makes a change in the angle by means of a lever mechanism and a linear semiautomatic movement of an optical light guide by means of stepping drives. Preclinical and clinical trials of the developed device are planned. Key words: laser, proctology, hemorrhoids, minimally invasive surgery Cite this Article: V. V. Kharlamov, S. A. Nikitin, A. Y. Krylova, A. V. Sinegub, G. S. Kireeva, Semi-Automatic Manipulator for Laser Proctology, International Journal of Civil Engineering and Technology (IJCIET) 9(11), 2018, pp INTRODUCTION Currently hemorrhoids is one of the most common proctological diseases associated with hemorrhoidal nodes formation due to veins dilatation in the anus. The incidence of this condition around the world is about 15% of population, and this number is not considered completely true by proctologists [1]. Until recently the only method to treat hemorrhoids was surgery alone [1]. Now minimally invasive treatment methods are makig their way into wide clinical practice. These methods are based on artificial arrest of blood inflow to venous vessels of the rectum which causes hemorrhoidal nodes shrinkage [2, 3]. Laser coagulation is one of such minimally invasive methods [4]. Blood coagulation is a complex biological process leading to the formation of a blood clot, as well as the formation of a dense embolus in the wall of the vessel due to the denaturation of proteins (mainly collagen). The essence of the coagulation process consists in the possibility of heating the blood to C, so that blood coagulation (conversion of hemoglobin into methemoglobin) is significantly accelerated [5]. Normal blood usually consists of oxyhemoglobin (100% in arterial blood, 70% in venous blood). During heating and coagulation oxyhemoglobin converts into the socalled methemoglobin as a result of deoxidization. Vascular coagulation is required to stop bleeding in cases of traumas of large blood vessels, as well as to stop the blood supply of editor@iaeme.com

2 V. V. Kharlamov, S. A. Nikitin, A. Y. Krylova, A. V. Sinegub, G. S. Kireeva damaged or otherwise pathologically affected regions, internal organs or neoplasms. The main advantage of a laser surgical device over other medical instruments such as electroknife, ultrasonic dissectors, plasma coagulators, is the high accuracy of laser irradiation energy navigation and focus onto the area of interest less that 0.1 mm and possibility to perform selective thermodestruction, coagulation and vaporization of tissues. During the surgery performed with laser radiation sources, the vessels feeding hemorrhoids in the submucosal layer are sclerotized and obliterated. Currently, this treatment method is becoming more and more popular because of the following positive factors: the surgery is normally outpatient, low risk of recurrence, short postoperative and rehabilitation period, the procedure is relatively simple and painless The aim of our work was to develop a device for semiautomatic manipulation of an optical fiber for laser proctology based on a laser coagulator. Such device is proposed to solve the problem of increasing the positioning accuracy of a light guide during proctological minimally invasive laser surgeries in patients with vascular and oncological diseases. 2. MATERIAL AND METHODS To treat hemorrhoids with laser coagulation of vessels the device for manipulation of an optic fiber with increased accuracy of instrument navigation to the irradiated area. The developed design is a device consisting of a body mounted on a proctoscope, a rocker with a through hole for an optical fiber, a helical gear with a cam at the end for changing the angle of the rocker arm, and a linear motion module of the light guide with stepping drives transmitting movement on the principle of a bowden cable. The device consists of 3 parts (Figure 1): 1 manipulation device; 2 proctoscope; 3 remote module for linear motion of optical fiber Part 1 is intended for orientation and changing the angle of irradiation, part 2 is intended for contact with the human mucosa, and for rigid attachment of part 1. Part 3 is connected to the body 1 by means of the bowden cable 4 (Figure 1) and serves as a linear drive of the optical fiber. The body and the proctoscope are connected by means of a bolted junction 6 (Figure 2) along the bogie surface 5 (Figure 3), the equidistant surface of the proctoscope handle. Figure 1 General view of the fiber handling device editor@iaeme.com

3 Semi-Automatic Manipulator for Laser Proctology The optical fiber delivery device 7 has two degrees of mobility, translational and rotational (Figure 2). Figure 2 Frontal view and view from above on the device First degree of mobility (rotational) namely the rotation of the optical light guide 7 around the axis 19, is provided by the operation of a lever mechanism including a ratchet wheel 20, a screw gear 21, a rod 22 and a rocker 23 (Figure 3). Figure 3 Joint A and section of the device editor@iaeme.com

4 V. V. Kharlamov, S. A. Nikitin, A. Y. Krylova, A. V. Sinegub, G. S. Kireeva Second degree of mobility (translational) is a linear movement of the optical fiber provided by the stepping motor 8 located in the remote linear motion module of the optical fiber 3. Since the module of linear motion of the optical fiber is moved beyond the structure fixed on the proctoscope, the movement is transmitted by means of a bowden cable (Figure 4). The linear movement of the optical fiber in the device is controlled by means of the buttons 9.1 and 9.2 on the device body (Figure 2). When these buttons are pressed, a signal is sent to the control board (not shown in Figures), which controls the stepper motor 8, which translates the optical fiber. And, when you press the button 9.1, the optical fiber moves forward, and when you press 9.2. it moves back. The structurally remote module of linear displacement is a casing with a lid in which a stepper motor is provided with a shaft at the end of which the driving roller is fixed. The roller is pressed on the bearing by means of a compression spring. When the driving roller is rotated, the optical light guide goes linearly with the aid of a bowden cable system with the elements and the jacket 18. The two types of optical fiber are envisaged (Figure 4). Figure 4 View and section of the block of linear movement of optical fiber 3. RESULTS The developed device operates as follows. The proctoscope is inserted into the patient s rectum, then a doctor adjusts the angle of attack of the light guide by turning the ratchet wheel 20, which drives the screw gear 21. The rod 22 at the end has a ball-shaped part that eccentrically pushes the beam 23, changing its angle. When the nut 24 is rotated by means of the ratchet wheel, the stem extends downward, the rotation of the rod together with the nut is eliminated by the pin connection 25 moving in the recess according to the type of the link mechanism. Then, the doctor supplies the optical fiber by pressing the buttons 9.1 and 9.2 on the device body. When the buttons are pressed, a signal is sent to the board (not shown in Figures), which controls the stepper motor, which ensures the translational movement of the optical fiber. And, after pressing the button 9.1, the optical fiber moves forward, and when after pressing the button 9.2. it moves back. Thus, the doctor places the optical fiber to the desired area. Observation of the supply of an optical light guide is carried out using an ultrasound sensor located in the body of the proctoscope (not shown in Figures). After that the editor@iaeme.com

5 Semi-Automatic Manipulator for Laser Proctology laser irradiation of the vessel is performed. If necessary, during the surgery, the doctor can correct the location of laser radiation application by changing the angle of attack of the optical fiber and performing its linear movement. After the surgery, the proctoscope is removed from the rectum. 4. DISCUSSION The developed device for semiautomatic manipulation of an optical fiber for laser proctology based on a laser coagulator allows increasing the accuracy of optical fiber positioning during proctological minimally invasive laser operations of vascular and oncological diseases. Increased positioning accuracy is achieved due to the fact that the manipulation of the optical fiber is performed with a device with two degrees of mobility, reliably fixed in the proctoscope, which makes a change in the angle by means of a lever mechanism, and a linear semi-automatic movement of an optical light guide by means of stepping drives. Thus, a finer manipulation of the optical fiber during the surgery is realized. It is important to note that in a number of cases it is required to bring the optical waveguide to the vessel with great accuracy, without piercing it. In this regard, the magnitude of the discreteness of linear displacement is of great importance. Stepper motor applied in the device, provides a discreteness of movement up to 0.2 mm, which is difficult to achieve with manual manipulation. The developed device allows minimizing the manipulation of the endoscope manually, which does not exclude fluctuations in the static positions typical for manual control due to tremor in the limbs of the medical staff, which in turn reduces the accuracy of positioning and, accordingly, the quality of the surgery. It is planned to conduct preclinical and clinical trials of the developed device in order to ensure its clinical safety and efficacy. ACKNOWLEDGMENTS This article was prepared with financial support from the Ministry of Education and Science of Russian Federation for the research under the Agreement of , grant (unique identifier RFMEFI57816X0207) for the implementation of the federal target program Research and development on priority directions of scientifictechnological complex of Russia for years. REFERENCES [1] Laufer, M.D. and Farley, B.E., inventors. Vnus Medical Technologies, Inc., assignee. Method for treating hemorrhoids. US patent 6,135,997, [2] Dennison, A.R., Paraskevopoulos, J.A., Kerrigan, D.D. and Shorthouse, A.J. New Thoughts on the Aetiology of Haemorrhoids and the Development of Non-Operative Methods for Their Management. Minerva Chirurgica, 51(4), 1996, pp [3] Muhin, A.G., Volkov, A.V. and Komarova, M.Y. Treating Hemorrhoids in Outpatient Settings. Coloproctologia, 1(31), 2010, pp [4] Nazaria, M.S. and Hedayatib, M.K. Comparison of Intrahemorrhoidal Coagulation with 980 Nanometer Diode Laser and Milligan Morgan hemorrhoidectomy: A Randomized Clinical Trial. Journal of Clinical Research and Governance, 4, 2015, pp [5] Giamundo, P., Cecchetti, W., Esercizio, L., Fantino, G., Geraci, M., Lombezzi, R., Pittaluga, M., Tibaldi, L., Torre, G. and Valente, M. Doppler-Guided Hemorrhoidal Laser Procedure for the Treatment of Symptomatic Hemorrhoids: Experimental Background and Short-Term Clinical Results of a New Mini-Invasive Treatment. Surgical Endoscopy, 25(5), 2011, pp x editor@iaeme.com