34 Int. J. Mechanisms and Robotic Systems, Vol. 2, No.

1, 2014

Miniature endoscope manipulator for minimally

invasive surgery

Raj Kumar Pal* and Amod Kumar

CSIR-Central Scientific Instruments Organisation,
Sector 30 C, Chandigarh-160030, India
E-mail: [email protected]
E-mail: [email protected]
*Corresponding author

Abstract: This paper deals with the design and analysis of a manipulator to
control the position and orientation of an endoscope during minimally invasive
abdominal surgery. The endoscope manipulator assists the surgeon to
manipulate endoscope orientation for viewing the area of interest inside the
abdomen. The designed manipulator has three degrees of freedom (DOF): one
translational (for taking the endoscope in and out of the abdomen) and two
rotational (for desired orientation of endoscope) and is operated by the surgeon
using a foot-pedal to eliminate the need of an endoscope assistant. Foot pedal
control allows the surgeon to use both hands for the surgery. The elimination of
the need for manual stabilisation of endoscope leads to removal of tremor,
which occurs due to handling of endoscope manually. Thus endoscope can be
placed closer to the target organ with fewer collisions with inner parts of the
body and other surgical tools being used. The designed endoscope manipulator
presented in the study is small in size, light weight, simple, easy to setup and
use, when compared to conventional laparoscopic surgical systems. It has been
tested for its motions at the laboratory, which were found satisfactory.
Keywords: endoscope manipulator; foot pedal; minimally invasive surgery;
robotic surgery.
Reference to this paper should be made as follows: Pal, R.K. and Kumar, A.
(2014) ‘Miniature endoscope manipulator for minimally invasive surgery’,
Int. J. Mechanisms and Robotic Systems, Vol. 2, No. 1, pp.34–50.
Biographical notes: Raj Kumar Pal completed his MTech (Advanced
Instrumentation Engineering) from Academy of Scientific and Innovative
Research (AcSIR), CSIR-CSIO Chandigarh (India) and BTech (Mechanical
Engineering) from VIT University, Vellore (India). He is pursuing his PhD at
the Academy of Scientific and Innovative Research (AcSIR), CSIR-CSIO
Chandigarh. Presently, he is working as a scientist in the area of
opto-mechanical systems at the Department of Optical Devices and Systems,
CSIR-CSIO Chandigarh. His areas of interests include design and mechanics of
mechanisms, advanced manufacturing and robotics.
Amod Kumar obtained his BE (Hons.) in Electrical and Electronics
Engineering, ME in Electronics and PhD in Biomedical Signal Processing. He
has more than 32 years of experience in research and development of different
instruments in the area of process control, biomedical engineering and
prosthetics. He is currently heading the biomedical instrumentation activity in
Central Scientific Instruments Organisation (CSIO), Chandigarh. He has 33
publications in reputed journals. He worked at Technical University Berlin for
one year on a German fellowship in 1987–1988.

Copyright © 2014 Inderscience Enterprises Ltd.

 Miniature endoscope manipulator for minimally invasive surgery 35

1 Introduction

In laparoscopic surgery the surgical tools and endoscope are inserted into patient’s body
through small surgical holes in the abdomen. The surgeon performs the surgery while
viewing images from endoscope on a monitor (Nishikawa et al., 2010; Camarillo et al.,
2004; Lanfranco et al., 2004). Laparoscopic surgery has gained popularity in recent years
not only because it is minimally invasive thus causing less visible scars but also because
of its benefits in terms of healthcare economy such as shorter hospital stay (Lobontiu and
Loisance, 2007).
During laparoscopic surgery manipulation of endoscope is required for controlling its
position and orientation towards the body parts requiring surgery. Fine adjustments can
be made to ensure correct field of view, distance etc for the surgical operation. The
camera assistant operates the camera as per the instructions of operating surgeon;
however, sufficient skills are required to make independent decisions for operating
endoscope as per surgeon’s intention. It is not uncommon for camera assistants to be
inexperienced and unable to maintain a suitable field of view thus hindering the progress
of the operation (Nishikawa et al., 2010). Light endoscope-holding robots were
introduced to do away with the need for an assistant (Berkelman et al., 2003).
Many researchers have tried to improve the functionality and performance of the
existing surgical robotic manipulators. A bevel-geared ‘spherical mechanism’ based
compact multifunctional robotic manipulator, a cable-driven manipulator using
pneumatic artificial muscle actuators and many more were experimented (Nelson et al.,
2009; Berkelman et al., 2002). Another prototype tele-operated robotic surgical system
was also tested with human operators and results were analysed to prove the advantages
of tele-operated robotic system (Ma and Berkelman, 2007). Every developed mechanism
had some drawbacks which did not allow them to be used successfully for the
laparoscopic surgery (Taniguchi et al., 2010).
LapMan® (Laparoscopic Manipulator), AESOP® (automated endoscopic system for
optimal positioning) and EndoAssist® are the three main Endoscope positioning systems
available in the market. The LapMan is a dynamic laparoscope holder guided by a
joystick clipped onto the laparoscopic instruments under the index finger of the operator.
It confers optimal control of the visual field while operating, ensures stable and smooth
displacement of the laparoscope, and allows the operator to work in conditions of
restricted surgical assistance (Polet and Donnez, 2008). AESOP is a four-degree-of-
freedom (DOF) robotic endoscope manipulator with selective compliant articulated robot
arm-type (SCARA) articulated serial link architecture. Here DOF refers to set of
independent displacements and/or rotations that specify completely the displaced or
deformed position and orientation of the body or system. The wrist of the robot contains a
two-DOF passive gimbal joint for holding endoscope. The base of the robot is clamped to
a rail on the side of the operating table (Berkelman and Ma, 2009). The EndoAssist is a
free-standing device which holds the laparoscope and is controlled by the operating
surgeon instead of the assistant. It is activated by a foot pedal and controlled by the
surgeon’s head movement (Gilbert, 2009).
36 R.K. Pal and A. Kumar

The above mentioned systems have been reported to be effective in ensuring a stable
image and reducing operation times but all of them have limited market due to their large
dimension and high price (Long et al., 2007). The aim of this work is to create a
miniaturised compact endoscope-manipulator which is simple in design.

2 Design considerations

The main considerations taken into account while designing the manipulator mechanism
are:
a sufficient DOFs providing enough dexterity
b stability of mechanism
c controlled movement
d switching between manual and automatic operation
e compact and easy manufacturing.
f light weight and easy assembly.
The three DOFs of endoscope correspond to motion constrained by a ‘trocar’. Two
rotational DOF are achieved by ‘spur gear’ and ‘bevel gear’ mechanisms respectively
and the translational stage is achieved by ‘rack and pinion’ mechanism. Three
miniaturised back-drivable motors are integrated for achieving the three DOFs. One
motor is used to control the endoscope’s insertion depth, second enables the whole
moving part to rotate along an axis and third enables endoscope pan-tilt as shown in
Figure 1. The basis of the whole mechanism (Figure 2) is that all the motion axes
(rotation axes or translation direction) pass through a common pivot point located at the
abdominal surface incision.

Figure 1 (a) Translation mechanism (b) Rotation mechanism (c) Inclination mechanism
(see online version for colours)

(a) (b) (c)

 Miniature endoscope manipulator for minimally invasive surgery 37

Figure 2 Compact mechanism of the endoscope manipulator (see online version for colours)

The three DOFs (two rotations about a common point and one translation through the
same point) in this mechanism have the same function when compared with other
mechanisms having four DOFs. The designed endoscope manipulator has the wrist
motion along with zoom in and out provision for endoscope with the following
advantages:
a reduced size
b reduction in weight as only three motors are used
c easy to control
d lesser price.
However, some initial training is required for the surgeon to perform operation using the
designed mechanism.

3 Mechanism kinematics

3.1 Velocity of translation stage

The translation stage of the manipulator is achieved by a rack and pinion arrangement
actuated by the motor. The insertion depth of the endoscope depends upon the number of
rotations of motor shaft and pitch circle diameter (PCD) of the pinion gear fixed to the
motor shaft. Thus, the rate of linear motion (insertion or extension) is given by:
v = (πND) / 60 (1)
38 R.K. Pal and A. Kumar

where
v speed of translation (mm/sec)
N rpm of the motor (rev/min)
D PCD of the pinion gear (mm).
The rolling stage of the manipulator is achieved by a spur gear mating. So the rate of
rolling of the endoscope depends upon various parameters such as PCD of the spur gear.

3.2 Position of endoscope tip

Inverse kinematics is used to determine angle by which three motors should rotate to
reach a particular point in surgical space. Inverse Kinematics is a branch of robotics
which deals with the study and application of process of determining the parameters of a
flexible object in order to achieve a desired pose.
The different coordinate systems are assigned to various links in the mechanism for
example, 0th coordinate system to fixed plate, 1st to rotating plate, 2nd to housing lower
edge and 3rd to the endoscope tip. Then, homogenous transformation matrices have been
defined for each pair of coordinate systems.

Rotation about Z-axis

⎡ cos θ − sin θ 0 0 ⎤
⎢ sin θ cos θ 0 0 ⎥⎥
T1 = ⎢
0
(2)
⎢ 0 0 1 0⎥
⎢ ⎥
⎣ 0 0 0 1⎦

Rotation about Y-axis (Inclination)

⎡ cos ∅ 0 sin ∅ 0⎤
⎢ 0 1 0 0 ⎥⎥
T21 = ⎢ (3)
⎢ − sin ∅ 0 cos ∅ 0 ⎥
⎢ ⎥
⎣ 0 0 0 1⎦

Translation matrix (Linear travel of endoscope)

⎡1 0 0 0⎤
⎢0 1 0 0 ⎥⎥
T32 = ⎢ (4)
⎢0 0 1 L⎥
⎢ ⎥
⎣0 0 0 1⎦

Thus we get the complete transformation matrix by multiplying all the above three
matrices:

T30 = T10 × T21 × T32 (5)

 Miniature endoscope manipulator for minimally invasive surgery 39

⎡ cos θ cos ∅ − sin θ cos θ sin ∅ L cos θ sin ∅ ⎤

⎢ sin θ cos ∅ cos θ sin θ sin ∅ L sin θ sin ∅ ⎥
T30 = ⎢ ⎥ (6)
⎢ − sin ∅ 0 cos ∅ L cos ∅ ⎥
⎢ ⎥
⎣ 0 0 0 1 ⎦
Therefore, we get
x = L × cos θ × sin ∅ (7)
y = L × sin θ × sin ∅ (8)
z = L × cos ∅ (9)
where
θ angle of rotation
∅ angle of inclination
(x, y, z) position coordinates of endoscope tip
L length of endoscope inserted into the abdomen.
Thus, the given position (x, y, z) in surgical space can be reached by rotating different
motors by angles θ, ∅, γ for rotation, inclination and insertion respectively, where
γ = 2 L / D.

Using equation (7) to equation (9), the position coordinates of the endoscope tip were
calculated and plotted, for different angles of rotation of all three motors. Figure 3 to
Figure 5 show the position coordinates of endoscope tip at different angular position of
individual motor keeping the other two motors at fixed angular position.

Figure 3 Variation of endoscope tip position coordinates with respect to variation in angular
position of ‘insertion motor’ keeping the other two motors at fixed angular position
(see online version for colours)
40 R.K. Pal and A. Kumar

Figure 4 Variation of endoscope tip position coordinates with respect to variation in angular
position of ‘rotation motor’ keeping the other two motors at fixed angular position
(see online version for colours)

Figure 5 Variation of endoscope tip position coordinates with respect to variation in angular
position of ‘inclination motor’ keeping the other two motors at fixed angular position
(see online version for colours)
 Miniature endoscope manipulator for minimally invasive surgery 41

Figure 6 Stress analysis of aluminium clamp (a) stress distribution (b) factor of safety (see online
version for colours)

(a)

(b)
42 R.K. Pal and A. Kumar

Figure 7 Stress analysis of steel En8 clamp (a) stress distribution (b) factor of safety (see online
version for colours)

(a)

(b)
 Miniature endoscope manipulator for minimally invasive surgery 43

Table 1 Stress analysis results

Rotating disk Shaft

Parameters
Min value Max value Min value Max value
Von Mises stress (MPa) 0.03 2.221 0.84 97.97
Displacement (mm) 0 6.611e-004 0 0.09004
Factor of safety 15 15 3.57 15

Figure 8 Stress analysis of rotating disk, (a) Von Mises stress distribution (b) resultant
displacement (c) factor of safety; shaft: (d) Von Mises stress distribution (e) resultant
displacement (f) factor of safety (see online version for colours)

(a) (b)

(c) (d)
44 R.K. Pal and A. Kumar

Figure 8 Stress analysis of rotating disk, (a) Von Mises stress distribution (b) resultant
displacement (c) factor of safety; shaft: (d) Von Mises stress distribution (e) resultant
displacement (f) factor of safety (continued) (see online version for colours)

(e) (f)

4 Analysis

Finite element stress analysis is done for the clamps used to hold motors. A comparison
of the two materials (aluminium and Steel En8) is made in terms of their strength and
reliability for the desired operation. Figure 6 and Figure 7 show the stress distribution and
factor of safety for clamp made up of Aluminium and Steel En8 respectively. Clamp is
given fixed constraint through two side holes and a load of 5 N was applied vertically
downward on the top face. It was observed that the maximum stress lies near the holes lie
near the bending edge. The minimum factor of safety achieved for Aluminium and Steel
En8 was 4 and 27 respectively. Taking the weight constraint into consideration,
Aluminium was chosen was the Clamp material as its strength to weight ratio is better
compared to Steel En8 for this application.
Table 1 displays the results of stress analysis for the rotating disk and shaft, which are
the load bearing components of the mechanism (Figure 8). The loads acting on the
components due to gravity are taken into consideration for this analysis. Practically there
are no variable loads during the manipulator operation, thus a static load of 10 N is used
for the analysis. It was observed that the components can bear the applied load during
their operation. The average Factor of Safety (FoS) calculated during analysis shows that
the designed mechanism is nearly 15 times stronger for any mechanical failure to take
place due to self-weight or fatigue. The minimum FoS for shaft is approximately 4 which
depict the suitability of the design for the desired operation.
 Miniature endoscope manipulator for minimally invasive surgery 45

5 Materials and methods

The endoscope manipulator is a compact mechanism (Figure 2) to be placed directly on

the patient’s abdomen. The architecture is based on a rotating circle which is the
foundation for the development of the mechanism. The endoscope manipulator is 130 mm
in diameter and 120 mm in height. The endoscope (diameter: 10 mm) is manipulated to
give the required positions and orientations.
This endoscope manipulator has three ranges of movement:
1 360° rotation around the vertical axis
2 120° angular swept (tilt)
3 a linear travel of the endoscope of about 100 mm along its axis.
The compact architecture was designed so as not to hamper the surgeon’s movement and
enable rapid set-up while keeping the cost low.
The following materials have been selected for different parts of the assembly based
on the properties given in Table 2.
Table 2 Properties of materials used

Materials
Carbon steel (steel EN8) Aluminium 1060 Alloy
Properties
Elastic modulus(N/m2) 2.1e + 011 6.9e + 010
Poisson’s ratio 0.28 0.33
Shear modulus (N/m2) 7.9e + 010 2.7e + 010
Mass density (Kg/m3) 7,800 2,700
Tensile strength(N/m2) 3.9983e + 008 6.8936e + 007
Yield strength (N/m2) 2.2059e + 008 2.7574e + 007

5.1 Selection of motor

DC servo motor is chosen for this application considering its following advantages over a
stepper motor:
• closed loop or feedback control
• variable speed control
• low power consumption.
• varying load bearing capacity.
The calculations for selection for parameters of DC servo motor are given below.
Considering the mass of the endoscope and associated mechanism to be translated as M
(in kg) and the maximum speed to achieve as v (in mm/s), the power required can be
calculated as:
P = ωT (10)
T = r.Mg (11)
46 R.K. Pal and A. Kumar

⎛ 2πN ⎞
ω=⎜ ⎟ (12)
⎝ 60 ⎠
where
P power required, in watts
T torque required, in Nm
ω angular speed, in radians/sec
N motor speed, in rpm
g acceleration due to gravity, 9.81 m/s2
r distance between motor axis and axis of gravity.
Taking N = 100 rpm, M = 1 Kg and r = 10 mm

⎛ 2π × 100 ⎞
ω=⎜ ⎟ = 10.47 rad / s
⎝ 60 ⎠

T = 10 ×1× 9.81 = 98.1 Nmm

P = 10.47 × 98.1 = 1.03 W

The motor was selected to satisfy the desired load and speed conditions with a factor of
safety range of 2–5, whose specifications are shown in Table 3.
Table 3 Specifications of motor used

Make Maxon A-max 22

Type DC geared motor with metal brushes
Wattage 5W
Nominal voltage 6V
Speed after gear reduction 100 rpm
Nominal torque 204.33 N-mm
Nominal current 0.84 A
Motor shaft diameter 4 mm

5.2 Foot-pedal control

To make the surgeons’ both hands free for surgery, the foot pedal control mechanism for
the manipulator has been designed. A combination of six micro-switches is used to
control three motors. Figure 9 shows the schematic of foot pedal control mechanism. A
foot-plate is supported by four springs fixed over the base plate to give flexibility to
move it in the required direction to press a particular switch or different switches for
required operation. Foot control is quite intuitive and easy to use for the surgeon after a
little training.
 Miniature endoscope manipulator for minimally invasive surgery 47

Figure 9 Foot pedal control system (see online version for colours)

6 Results and discussion

The endoscope manipulator with foot pedal control (Figure 10 and Figure 11) was
designed and developed. The system is assembled and mounted on an aluminium frame.
It was lubricated using grease to avoid any initial friction between the mating parts,
which also reduced the mechanical sound generated because of rubbing action between
mating parts.

Figure 10 Endoscope manipulator with the three motors mounted (see online version
for colours)
48 R.K. Pal and A. Kumar

Figure 11 Complete system setup showing the endoscope manipulator with foot-control system
(see online version for colours)

The designed foot pedal control mechanism provides control for all three motors
independently as well as simultaneously. The mechanism is simple in design, intuitive
and easy to use. To test the functionality of manipulator, a webcam (instead of
endoscope) is attached to the lower end of the manipulator. The webcam is interfaced
with computer to see the live video on the monitor. When the manipulator is operated
using foot-control system, the live video can be captured using webcam at different
orientations during trials.
During the trials, it was found that it gives a complete 360° rotation about the
endoscope axis with a speed of 30° per second. A translation of 100 mm and an overall
inclination of 120° can be achieved using the designed manipulator. The translation and
rotation motion are almost free from any vibration during its operation. But there is a
little vibration in case of inclination motion. The results of motion analysis
In the reported version, weight of the manipulator is approximately 900 gm which can
be reduced to 600–700 gm using other light weight material instead of Steel En8 for
some of the parts. Figure 12 shows the two different orientations of manipulator to give
different view inside the abdomen when used during surgery.

Figure 12 Different orientations of the manipulator: (a) positioned at one of the extreme angles
of inclination (b) positioned at zero angle of inclination with 2/3rd of the linear rack
out of the housing (see online version for colours)

(a) (b)
 Miniature endoscope manipulator for minimally invasive surgery 49

It is small in size and less in weight when compared to commercially available systems.
The foot pedal control is simple in design and intuitive in its use. As the whole control is
given to surgeon, there will be no conflicts during surgery.

6.1 Collision avoidance

A very simple and practical approach has been applied to avoid collision of endoscope tip
with inner parts of the body during surgery. Before performing the surgery, the patient’s
body registration takes place i.e. mapping of computer model to the patient’s body.
During this registration process, we get to know the coordinates of different internal body
parts with respect to our system’s coordinates. Thus, the complete surgical area along
with internal body parts locations are defined in terms of mathematical coordinates.
Similarly we have also performed point-to-point tracking of endoscope tip with
respect to individual motor’s angular positions (Figure 3 to Figure 5). Thus, we have the
position of the endoscope tip at any particular angular position of the three individual
motors which can also be found out using feedback system of servo-motors during actual
surgery.
In order to avoid collision of endoscope tip with internal body parts, we must ensure
that, the position coordinates of endoscope tip should not overlap or exceed than that of
inner body parts. In case, the endoscope tip crosses the limit, it gives an alarm and locks
the motors. Using reset switch in foot-pedal, motors can be unlocked again.

7 Conclusions

A lab prototype of miniaturised endoscope manipulator with foot pedal control is

designed, developed and tested for its motions at the laboratory. This manipulator will be
operated using foot-control system in order to make the surgeon’s hands free for
performing surgical operations. Thus it assists the surgeon for required positioning of
endoscope during surgery. It also avoids any collision with internal body parts during
surgery.
The manipulator allows the mobility with 3 DOFs: a 360° rotation around the trocar
axis, a 120° angular sweep (for desired orientation of endoscope) and a 100 mm linear
travel of the endoscope along its axis (for taking the endoscope in and out of abdomen),
which allow the surgeon to have a proper view of surgical area. The manipulator has been
miniaturised to the extent that it can compete with the existing manipulators in terms of
size. Further miniaturisation will be possible as far as further miniaturisation of actuation
components will be reached.
In future, the mechanism designed for manipulation of endoscope can be extended to
have 6–7 DOFs to manipulate the surgical tools when fixed to the operation table by a
rigid articulated arm. An entire telesurgical system can be developed by fixing multiple
manipulators to the operation table. Other lightweight materials like Teflon or Nylon
having good strength will be taken into account to reduce the weight of the system while
maintain the strength and reliability. A force feedback system will be developed so that
endoscope should not hurt inner part of the body during surgery.
50 R.K. Pal and A. Kumar

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