This research presents the design, fabrication and controller development of a robotic retractor which driven by a robotic manipulator for laparoscopic colorectal surgery. The system consists of a dual-head fan retractor and a manipulator. The dual-head fan retractor comprises two fan devices, retractor wrist, tubular element and handle. The fan device is facilitated with a fan end-effector, an expansion mechanism and a clutchspring mechanism. Two fan devices have been used in the system to provide an anthropoid hand-holding shape which is specifically advanced for surgical purpose because intestine tends to slip when subject to disturbance and the anthropoid handholding shape can effectively halt that. One of the two fan devices is rotatable which makes the anthropoid hand-holding shape achievable. The retractor wrist possesses a triggering device, based on clutch-spring mechanism, for rotating the rotatable fan device. The clutch-spring mechanism has an impact on rotating the palms of the fan devices. In front of the handle, it is the so called front body which includes two fan devices, retractor wrist and tubular element. The front body can be controlled and is motorised using two motors fixed to the tubular element. The dual-head fan retractor is modelled in SolidWorks, and stress analysis of the retractor has been carried out by SolidWorks Simulation. Then, the mathematical model of the fan blades is developed. A 3-joint manipulator is modelled and controlled by a computed torque PD control approach as part of an investigative study to fit such a system to the retractor for robotic manipulation. Based on this investigation, the retractor is attached to a 2-joint robotic manipulator which has one rotational joint and a prismatic joint. This manipulator is mathematically modelled, and the dynamic equations are obtained. Control methods from Azenha and Khatib are simulated and compared. Azenha & Machado's method has fewer input parameters and less oscillation when utilising the same control gains. Timeoptimal control is then successfully developed for the above 2-joint manipulator. This study clearly indicates that a retractor to be used for laparoscopic surgery can be effectively controlled using a multi-joints and multi degrees of freedom robotic manipulator.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13166号 / 論医博第2153号 / 新制||医||1029(附属図書館) / (主査)教授 一山 智, 教授 松原 和夫, 教授 万代 昌紀 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

The doctoral dissertation analyses and compares general endotracheal and combined endotracheal epidural anesthesia’s impact on organ systems and describes the systems parameters in laparoscopic colorectal surgery. Comparing two perioperative analgesia techniques used in laparoscopic colorectal surgery the hemodynamic and respiratory parameters trends; the impact of anesthesia and postoperative analgesia methods on patients’ tracheal extubation time, intestinal motility recovery rate, duration of hospitalization and inflammatory response have been determined. Laparoscopic colorectal resection, even being a minimally invasive technique for laparoscopic surgery, stimulates the body's response to stress and pro-inflammatory mediator’s secretion. Perioperative pain management may also influence the immune response. The doctoral dissertation analyses the impact of epidural analgesia method on the body stress response, investigating variations of cortisol and interleukin-6 levels. The results showed that analgesia and patient satisfaction using epidural analgesia method for perioperative pain management were better. Tracheal extubation time was significantly shorter. Recovery of intestinal motility using epidural analgesia was significant and much prior than using intravenous analgesia. The use of epidural analgesia in laparoscopic colorectal surgery caused less stress response – less cortisol levels increase. It has not showed the increase in number of complications. / Disertacijoje analizuojama ir lyginama bendrosios endotrachėjinės ir kombinuotos endotrachėjinės epiduralinės anestezijos įtaka atskiroms organų sistemoms ir tas sistemas apibūdinantiems rodikliams laparoskopinių kolorektalinių operacijų metu. Darbe nagrinėjama dviejų perioperacinių skausmo malšinimo būdų įtaka hemodinamikos ir kvėpavimo sistemos parametrų kitimo tendencijoms, pacientų trachėjos ekstubacijos laikui, žarnyno motorikos atsinaujinimo greičiui, hospitalizacijos trukmei bei organizmo uždegiminiam atsakui. Laparoskopinės storosios žarnos rezekcinės operacijos, net ir būdamos minimaliai invazinės dėl laparoskopinės operacijos technikos, sužadina stresinį organizmo atsaką bei uždegimo mediatorių išskyrimą. Perioperacinis skausmo valdymas taip pat gali daryti įtaką imuniniam atsakui. Disertacijoje nagrinėjama epiduralinės analgezijos metodo įtaka organizmo stresiniam atsakui tiriant kortizolio kiekio kitimus ir interleukino-6, kaip vieno pagrindinių uždegimą skatinančių citokinų, koncentracijos kitimą taikant epiduralinę analgezijos metodiką. Gauti rezultatai parodė, kad analgezijai pasitelkiant epiduralinį skausmo malšinimo metodą, perioperacinis pacientų skausmo valdymas ir pasitenkinimas yra geresnis, trachėjos ekstubacijos laikas patikimai trumpesnis, žarnyno peristaltikos atsitaisymas ankstyvesnis, sukeliamas stresinis organizmo atsakas mažesnis (mažesnis kortizolio koncentracijos padidėjimas) ir nenustatyta komplikacijų padaugėjimo.