FlexDex^™: A Minimally Invasive Surgical Tool With Enhanced Dexterity and Intuitive Control

This paper presents a new minimally invasive surgical (MIS) tool design paradigm that enables enhanced dexterity, intuitive control, and natural force feedback in a low-cost compact package. The paradigm is based on creating a tool frame that is attached to the surgeon’s forearm, making the tool shaft an extension of the latter. Two additional wristlike rotational degrees of freedom (DoF) provided at an end-effector that is located at the end of the tool shaft are manually actuated via a novel parallel-kinematic virtual center mechanism at the tool input. The virtual center mechanism, made possible by the forearm-attached tool frame, creates a virtual two-DoF input joint that is coincident with the surgeon’s wrist, allowing the surgeon to rotate his/her hand with respect to his/her forearm freely and naturally. A cable transmission associated with the virtual center mechanism captures the surgeon’s wrist rotations and transmits them to the two corresponding end-effector rotations. This physical configuration allows an intuitive and ergonomic one-to-one mapping of the surgeon’s forearm and hand motions at the tool input to the end-effector motions at the tool output inside the patient’s body. Moreover, a purely mechanical construction ensures low-cost, simple design, and natural force feedback. A functional decomposition of the proposed physical configuration is carried out to identify and design key modules in the system—virtual center mechanism, tool handle and grasping actuation, end-effector and output joint, transmission system, tool frame and shaft, and forearm brace. Development and integration of these modules leads to a proof-of-concept prototype of the new MIS tool, referred to as FlexDex^™, which is then tested by a focused end-user group to evaluate its performance and obtain feedback for the next stage of technology development.