Concentric Tube Suturing for Dexterous Transurethral Anastomosis
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Solution Overview
Problem
Minimally invasive surgical procedures, such as radical prostatectomy, face challenges with high rates of complications like erectile dysfunction and urinary incontinence due to the need for precise dissection and retraction of nerves and blood vessels, necessitating more dexterous surgical tools for reconstructive suturing.
Innovation Solution
A system using concentric tube manipulators with pre-curved nitinol tubes, deployed through an endoscope, for precise suturing, including a needle arm for piercing and a manipulator arm for grasping, allowing sutures to be applied without knots, especially for trans-urethral radical prostatectomy and anastomotic suturing.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If traditional open surgery procedures are used for radical prostatectomy, then surgical access and manipulation capability are improved, but patient trauma, pain, and recovery time increase
Solution Approach 1:
The patent employs nested concentric tubes that can be inserted through one another, allowing multiple functional components to be delivered through a single endoscope. The innermost tube contains the suture delivery mechanism, while outer tubes provide structural support and additional manipulation capabilities, enabling complex suturing operations through a minimally invasive approach
Solution Approach 2:
The concentric tube manipulators are designed with superelastic nitinol material that allows dynamic bending and shaping. The tubes can be actively manipulated to change their configuration, enabling the distal end to reach and manipulate tissue at various angles and positions while being delivered through a straight endoscope shaft
2Productivity
If dissection and retraction of nerves and blood vessels are performed during radical prostatectomy, then prostate removal is achieved, but nerve damage causing erectile dysfunction and urinary incontinence increases
Solution Approach 1:
The patent replaces traditional mechanical dissection and retraction tools with a suture-based approximation system. Instead of physically separating and manipulating nerves and vessels, the concentric tube manipulators deliver sutures that gently approximate tissue edges, allowing prostate removal while minimizing mechanical stress on surrounding neural structures
3Object-affected harmful factors
If straight, rigid laparoscopic instruments are used for transurethral approaches, then minimally invasive access is achieved, but dexterity for reconstructive suturing is insufficient
Solution Approach 1:
The concentric tube manipulators utilize superelastic nitinol material that allows dynamic bending and active reconfiguration. The tubes can be manipulated to change their spatial arrangement, enabling the distal end to achieve complex movements and angles necessary for dexterous suturing while maintaining a straight profile for minimally invasive delivery
Solution Approach 2:
The patent employs pre-curved and actively bendable concentric tubes that can assume various curved configurations. This curvature capability allows the manipulators to navigate anatomical structures and position the suture delivery tip at optimal angles for reconstructive suturing, overcoming the limitations of straight rigid instruments
4Loss of time
If barbed sutures are used without knots, then suturing time and complexity are reduced, but suture holding capability must be increased
Solution Approach 1:
The patent employs barbed sutures with asymmetric barbs that change their engagement parameters based on direction of force. The barbs are designed to easily penetrate tissue in one direction during suture deployment, then engage and lock in place when tension is applied, providing strong holding capability without requiring knots or additional securing mechanisms
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
Enables precise, minimally invasive suturing with reduced tissue damage, facilitating quicker recovery and minimizing complications by allowing dexterous manipulation of sutures within body lumens, particularly in procedures like trans-urethral anastomosis.
Implementation Method 1
two or more pre-curved tubes, made of nitinol or other materials with super elastic qualities, that are nested inside each other. The tubes can be rotated and translated independently in order to produce dexterity at the tip of the concentric tube manipulator
Data Source
AI summary
A surgical system, method, and apparatus for suturing a first anatomical structure to a second anatomical structure of a subject includes an endoscope tube for being advanced through a lumen of the first anatomical structure to a surgical site near the second anatomical structure. A manipulator arm extends through the endoscope tube to the surgical site, and includes a first concentric tube manipulator with an end effector configured to grasp and manipulate a suture at the surgical site. A needle arm extends through the endoscope tube to the surgical site, and includes a second concentric tube manipulator with a needle tip configured to pierce the tissue of the first and second anatomical structures. The needle arm is also configured to grasp the suture and to retract and pull the suture through the pierced tissue so that the suture extends through and forms stitching that stitches together the first and second anatomical structures.