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복강경 수술기구의 모터구동화 메커니즘 비교연구

황달연1,#orcid, 최준영1, 문대환2, 김형호3

Mechanisms Study for Motor Actuated Laparoscopic Surgical Instruments

Dal Yeon Hwang1,#orcid, Jun Young Choi1, Dae Hoan Moon2, Hyung Ho Kim3
Journal of the Korean Society for Precision Engineering 2019;36(5):471-478.
Published online: May 1, 2019

1 한국산업기술대학교 기계설계공학과

2 한양대학교 기계공학과

3 분당서울대학교병원

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#E-mail: dyhwang@kpu.ac.kr, TEL: +82-31-8041-0427
• Received: May 1, 2018   • Revised: September 10, 2018   • Accepted: December 3, 2018

Copyright © The Korean Society for Precision Engineering

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Laparoscopic surgical instruments have been used widely since 1980s and they are still important tool to the medical field as the surgical robot systems spread. In this study we devised three types of motorized mechanism to reduce the user hand fatigue. We detailed the mechanism of each type and compared the performances with several indices such as a bending angle, response time and number of mechanical components. And also we show the movement relationships among the jaw joint, passive gimbal set and motors in the case of MPDG (Motor Drive with a Push Disk and Driven Disk of Gimbal Mechanism) type during the typical jaw joint motions. MTPS (Modified Two Parallel Semicircle Guide Mechanism) type excels others in response time and number of components while showing the increase of load and kinematic occlusion during the diagonal movement. MBDG (Motor Drive with a Ball-Screw, Link and Disk Type Gimbal Mechanism) type shows the medium level bending performance with slow response time and large number of components. Lastly MPDG type excels in jaw joint bending performance with an unstable rotation motion transfer between pushing disk and driven disk at the large disk rotation angle.
  • KEYWORDS: Laparoscopic surgical instrument, Primary bending, Gimbal structure, Wire actuating, Jaw joint
  • KEYWORDS: 복강경 수술기구, 주 벤딩, 짐벌 구조, 와이어 구동, 말단부 관절
1980년대부터 국내외에서 적용되기 시작한 최소절개수술법(Minimal Invasive Surgery, MIS)인 복강경 수술은 초기 진단의 단계를 거쳐 수술 등으로 확대 되었다.1,2,13 한편 복강경 수술과 같은 미세 침습 수술은 빠른 회복과 상처흔적감소 등 여러 장점을 갖고 있지만 단점도 가지고 있다. 복강경에 사용되는 수술기구들의 특성상 촉각을 느끼기 어렵고, 트로커(Fig. 1(c))를 힌지점으로하는 지렛대효과는 잇점도 있으나, 손과 눈의 자연스런 협조적 운동이 힘들어 수술에 어려움을 주고 장시간경과시 피로감을 증가시킨다. 또한 수술자의 생리적인 떨림 현상이 긴 수술 기구를 통하여 전달되는 문제가 있다.3,4,13 이러한 한계를 극복하기 위하여 개발된 로봇 수술 시스템(예> da Vinci)은 수술자의 생리적인 떨림 현상을 하드웨어와 소프트웨어를 통해 여과할 수 있으며, 조정 손잡이(마스터)의 상대적으로 큰 움직임을 로봇 팔의 섬세한 움직임으로 전환시킬 수 있다. 하지만, 고가의 초기구입비 및 유지보수비용 등으로 인해 복강경 수술기구의 사용이 아직도 큰 비중을 차지하고 있다.13
Fig. 1

Laparoscopic surgery and instruments: (a) Instrument13 used in our study, (b) Various end effector types, (c) Surgical environment with a instrument and a laparoscope

KSPE_2019_v36n5_471_f001.jpg
복강경 수술기구 설계의 핵심은 다양한 수술동작(절개, 봉합, 소작 등)이 가능한 말단동작(툴팁그리퍼)부(Jaw Gripper or Endeffector) (Fig. 1(b))가 원활히 움직일 수 있도록 충분한 자유도와 관절각범위를 주는 것이다. 또한, 복부등의 절개크기를 작게하는 샤프트직경 소형화, 그리고 사용자의 피로도를 줄이기 위한 경량화 및 인간공학적설계(Ergonomic Design)가 중요하다.4-7,13 수동식의 경우, 보통 인체외부의 핸드그립부 쪽에서 힘을 주어 동작을 발생시키고 이를 중간기구부를 통해 환자인 체내의 말단툴부에 전달한다.4,6,7,8,9,13 탄성체(Flexure Hinge)를 수 mm에서 수십 mm 구간에 걸쳐 휘거나 구부리며 관절이 회전하는 것과 같은 효과를 내고 이를 말단작동부에 전달하는 것이다. 기존의 경우, 수술기구 핸들부를 손으로 굽혀 고정(Lock) 또는 비고정상태로 말단부 관절(Jaw-Joint)을 작동하여 여러가지 수술동작(절개, 잡아채기제거, 전기소작 등)을 수행한다. 이때, 핸들부가 꺽이는 방향과 말단부 관절이 꺽이는 방향은 툴샤프트기준으로 같은 방향이거나 반대방향인 두종류가 있으며 메이커별로 다르다.9,10 말단부 관절을 임의의 굽힘방향으로 일정 크기의 굽힘각으로 설정하기위해 핸들부를 꺾는 동작이 자주반복되거나, 굽힘각이 큰 경우, 또는 장시간 굽힘 Lock 기능을 사용하지 않고 사용할 경우, 사용자가 느끼는 피로도는 증가하며, 사용자의 신체조건이나 숙련도에 따라 다를 것이다.
본 연구에서는 주(1차) 벤딩(Primary Bending) 변형을 수동이 아닌 모터구동으로 하여 사용자의 피로도를 줄이고자 한다. 이를 위해 3가지 방식으로 수술기구 모터구동화를 위한 메커니즘을 설계 제작하여 기본적인 말단부 관절의 굽힘 동작특성을 비교 분석하였다. 논문의 구성으로 2장에서는 기존 수동식 복강경수술기구의 구성에 대해 설명하고, 3장에서는 3가지 방식의 모터구동에 의한 벤딩 생성 및 전달메커니즘에 대해 설명한다. 4장에서는 실험을 통한 3가지 메커니즘의 성능과 특성을 비교 분석하고, 마지막 5장에서는 3가지 모터구동방식에 대한 결론 및 향후 제품화를 위해 필요한 사항을 서술한다.
2.1 수동식 기구의 구조 및 모터구동대상 모션자유도
기존 수동식 수술기구의 주요구성(Fig. 1)은 핸드그립부(Hand and Grip Part), 주(1차) 벤딩부(Main Bending Coupler)(Fig. 2), 샤프트, 2차 벤딩부, 말단 장치부(툴팁부, Distal Part of Jaw Joint) (Fig. 3)로 구성된다. 말단장치부기준의 자유도는 그립퍼동작을 제외할 경우, Jaw Joint의 임의 방향 벤딩에 2자유도, 샤프트 축 중심 회전의 1자유도 등 총 3자유도를 갖으며, 본 논문에서는 이들을 모터구동화 대상으로 하였다.
Fig. 2

Primary (1st) bending coupler of Fig. 1 with four wires for bending transfer to distal jaw joint at end effector

KSPE_2019_v36n5_471_f002.jpg
Fig. 3

Distal jaw joint (2nd) bending coupler structure of Fig. 1(a)

KSPE_2019_v36n5_471_f003.jpg
2.2 설계 조건들
제안하는 3가지 방식에 공통적으로 적용되는 설계조건들은 다음과 같다.
(1) 말단장치부 Jaw-Joint의 벤딩방향은 360° 임의의 방향으로 가능해야 하며, 최대굽힘각은 일부 제품의 경우 8 0°까지이나 본연구에서는 9 0°를 목표로 한다. 굽힘방향별로 최대굽힘각의 편차를 최소화한다.
(2) 말단장치부는 샤프트 축1, 2(Fig. 1)를 중심으로 각각 회전할 수 있어야 한다.
(3) 1차 벤딩 커플러(Fig. 2)는 필요시 유사한 기능을 하는 다른 모듈로 대체할 수 있어야 한다.
(4) 부품 및 모듈의 재활용성을 높이도록 샤프트 및 툴팁부와 나머지 몸체를 분리할 수 있어야 한다.
3.1 모터구동화를 위한 3가지 메커니즘
본 절에서는 기존의 수동식 복강경 수술기구(Fig. 1(a))를 개조하여 주(1차, Primary)벤딩을 손의 힘을 이용하지 않고, 모터구동에 의해 할 경우 이를 위한 3가지 방안을 제시한다. 이 때 첫 번째 방식은 Fig. 1(a)의 디스크 적층형 주 벤딩 커플러를 주벤딩용으로 사용하는 방식이며 둘째와 셋째 방식은 디스크 적층형 벤딩 커플러를 제거한 방식으로 대신에 피동형 짐벌 구조가 탑재된다.

3.1.1 MTPS 방식

MTPS (Modified Two Parallel Semicircle Guide Mechanism) 방식(Fig. 4)은 여러 개의 디스크를 적층한 1차 벤딩 커플러(Fig. 2)를 수동식 수술기구처럼 사용하되, 원하는 굽힘 방향 및 굽힘량을 얻기 위해 병렬구조인 2개의 반원형 아크 가이드를 2개의 모터(Fig. 4(a) Motor-1,2)로 각각 회전시켜 샤프트축 끝단(핸들부쪽)을 원하는 방향으로 일정 각도만큼 밀어준다. 이는 1차 벤딩 커플러의 굽힘 변형을 일으키게 되며, 이 때 커플러 내부에 9 0° 간격으로 배치된 4개의 와이어에 의해 말단부 관절이 굽힘 변형을 하게 된다. 이 때 두 굽힘 변형 간에 비는 약 3-4배정도 된다.7,11,13 Fig. 4(a)의 Motor-3는 툴팁부전체를 축중심으로 회전시켜준다. Fig. 4(b)는 1차 벤딩 커플러와 이를 변형시키는 2개의 아크형 가이드 및 구동부를 상세하게 표시한 것이다.
Fig. 4

MTPS type mechanism with two semicircle guides

KSPE_2019_v36n5_471_f004.jpg

3.1.2 MBDG 방식

제안된 두 번째 모터구동화 방식은 MBDG (Motor Drive with a Ball-Screw, Link and Disk Type Gimbal Mechanism)방식(Fig. 5)으로서, 첫 번째 MTPS 방식과 달리 적층형 벤딩 커플러를 사용하지 않고, 대신에 2자유도 짐벌 구조의 내부디스크를 핀 조인트링크로 밀거나 당기는 방식이다.
Fig. 5

MBDG type mechanism with a ball-screw, link, driven disk and motors

KSPE_2019_v36n5_471_f005.jpg
링크 구조는 36 0° 회전이 가능하여 피동디스크가 회전되는 방향을 선택할 수 있다. Fig. 5(b) 상부좌측의 Push 모듈은 볼베어링 스크류에 의해 우측으로 이동하여 짐벌 내부디스크를 밀어 회전시키면, 내부디스크에 연결된 4개의 와이어(Fig. 5(c))가 샤프트 내부를 통해 말단 관절부에 굽힘 변형을 주게 된다. 내부디스크와 Push 모듈을 연결하는 링크의 분해를 통해 툴팁부의 탈·부착이 가능하다.

3.1.3 MPDG 방식

제안된 세 번째 모터구동화 MPDG (Motor Drive with a Push Disk and Driven Disk of Gimbal Mechanism) 방식은 MBDG방식과 유사하게 주 벤딩용 적층형 벤딩 커플러를 사용하지 않는다. 본 방식은 짐벌 메커니즘의 내부피동디스크와 툴팁 말단부를 4개의 와이어로 연결한 상태에서 Push 디스크가 짐벌 내부의 피동디스크와 접촉하여 특정방향으로 밀어 회전시킨다. 모터에 연결된 Push 디스크의 회전과 압축 스프링(Compression Coil Spring)의 초기 압축력으로 피동부 짐벌 디스크를 움직여 말단부 관절(Jaw Joint)을 동작시킨다(Fig. 6).
Fig. 6

MPDG type mechanism with a push disk, motors and a driven disk of gimbal

KSPE_2019_v36n5_471_f006.jpg
3.2. 모터 및 와이어 구동에 의한 짐벌부와 말단부 동작관계고찰
Table 1은 말단부, 수동짐벌부, 모터 및 구동부 간의 동작 관계를 MPDG 타입을 예로 하여 말단부 움직임 유형별로 표시한 것이다. Case 1, 2는 회전 중심축이 각각 X축과 Y축으로 1자유도 회전을 나타낸다. Case 3은 X축과 Y축 회전을 동시에 구현하는 2자유도 회전으로 X축 회전과 Y축 회전을 조합하여 임의의 방향으로 굽힘이 가능하다. Case 4는 짐벌 내부 피동디스크의 2자유도 회전으로 임의의 굽힘 방향으로 특정각도만큼 말단부가 굽혀진 상태에서 말단부 축 중심으로 회전함을 표시한다(3 자유도 운동). Case 5는 말단부가 Tool-Shaft축 중심으로 회전함을 표시한 것이다. 모터 1은 구동 디스크 벤딩용으로, 모터 2는 굽힘 방향을 지정하는 구동 디스크부 회전용이며, 모터 3은 수술 기구부 말단부 회전용으로 Tool-Shaft축 중심 회전용으로 사용 되었다.12
Table 1

End effector motion by gimbal mechanism and motors of MPDG type

KSPE_2019_v36n5_471_t001.jpg
4.1 말단부 굽힘성능 실험을 위한 메커니즘 제작
Fig. 7은 MTPS 타입의 3D CAD모델(a, d) 및 실제 제작한 프로토타입의 내부 및 외부 사진(b, c)이며, Figs. 8과 9는 MBDG, MPDG 타입의 메커니즘을 구현하여 제작한 기구부사진이다. Fig. 7(d)의 하단부의 파란 원형은 조그조이스틱으로 모터구동화시 굽힘방향과 굽힘각크기를 동시에 지시가능하도록 하여 사용자의 편리성을 증진하고자 하였다. Fig. 10(d)는 MPDG 타입의 동작 시 구동디스크와 피동디스크간의 회전중심간의 거리의 변화량을 나타내며 디스크회전시 불안정성의 원인으로 판단되며 이를 수용하기위해 압축코일스프링을 사용하였다.
Fig. 7

Prototype of MTPS type laparoscopic surgical instrument: (a) 3D CAD interior view, (b) Assembled prototype interior view, (c) Assembled prototype exterior view, (d) 3D CAD control panel with joy stick

KSPE_2019_v36n5_471_f007.jpg
Fig. 8

Experimental set-up of MBDG type

KSPE_2019_v36n5_471_f008.jpg
Fig. 9

Experimental set-up of MPDG type

KSPE_2019_v36n5_471_f009.jpg
Fig. 10

Unstable motion cause of MPDG type push disk (right) and driven disk (left) with a varying distance between two disk pivots

KSPE_2019_v36n5_471_f010.jpg
4.2 말단부 굽힘성능결과
Fig. 11은 앞에 서술한 3가지 모터 구동화 방식 수술기구용 메커니즘 프로토 타입을 이용하여 4회 반복측정하여 평균한 말단부 관절 굽힘각의 분포도를 표시한 것이다. 즉, 굽힘 방향을 툴샤프트 중심축 기준으로 0-360도 방향에 대해 1 0°씩 변화 시키며, 적층형 벤딩 커플러(MTPS Type) 또는 짐벌의 피동디스크(MBDG, MPDG Type)를 움직여 수술기구의 말단부를 9 0°로 굽히고자 하였다.
Fig. 11

Overall bending test results of three types (MTPS, MBDG, MPDG) of mechanisms

KSPE_2019_v36n5_471_f011.jpg
4.3 모터구동화를 위한 3가지 메커니즘 특성 비교
Table 2에 3가지 타입 모터구동화 메커니즘의 성능평가 결과를 프로토타입 부품 수, 응답속도, 방향 별 굽힘각 평균치 및 표준편차 지표로 정리하였다. 부품수 나 응답속도 면에서는 MTPS타입이, 굽힘방향별 균일성 및 굽힘각 평균 및 표준편차 면에서는 MPDG 타입이 우수함을 보였다. 3가지 타입 모두 대각선방향에서 굽힘각이 평균치보다 작게 나옴을 보이고 있다. 이는 툴팁부와 말단부 관절 내의 힘 및 변형전달용 4개 와이어의 단면 내 위치와 관련성이 크다고 보인다(Fig. 3 하단, Fig. 5(c)). 한편, MTPS의 경우, 특정위치에서 두개의 반원가이드와 샤프트의 접촉점에서의 힘 벡터 또는 속도벡터가 상충될 때 움직임이 멈추는 교착(Lock) 현상을 발견할 수 있었다. 이것은 기구학적 특이점(Singularity)과 유사한 측면이 있다. 이를 해결하는 방안으로 위치센서를 사용하고, 교착예상지역에서 시차를 두어 가이드를 각각 구동 제어하는 것을 생각해볼 수 있다. 전체적으로 MPDG 타입이 우수하나, 작동 중에 구동디스크가 피동디스크를 타고 올라가는 Slide Up 현상이 나타나기도 하는 단점이 있다. 원인은 Fig. 10으로 추정되며, 이점은 별도의 논문에서 다루고자 한다.
Table 2

Key features of three type mechanisms

Table 1
Type # of components Response time [s] Average bending angle [°] Std deviation of bending angle [°]
Min. Max Avg. Std. Dev.
MTPS 30 3 30° 70 54.4 10.54
MBDG 79 23 50 80 66.4 9.61
MPDG 50 5 81 90 86.2 2.80
본 연구에서는 수동형 복강경 수술기구의 모터구동화를 위해 3가지 방식의 메커니즘(MTPS, MBDG, MPDG)을 제안하고, 프로토타입을 제작하여 성능을 비교 평가하였다.
(1) MTPS 방식은 응답속도가 빠르고 부품수가 적어 원가 및 경량화에 유리하다. 반면에 4개 와이어의 대각선방향으로 굽힘 시 부하가 급증하고 동작이 경색할 가능성이 있다. 굽힘방향별 균일성과 굽힘각 평균치도 제일 작게 나타났다.
(2) MBDG 방식은 굽힘성능(굽힘각 평균치, 균일성)은 3방식 중 중간정도이나, 응답속도가 느리고, 부품수가 많은 단점이 있다.
(3) MPDG 방식은 굽힘성능(굽힘각 평균치, 균일성)은 3방식 중 가장 우수하나, 피동디스크의 굽힘각이 커질 때 구동디스크가 피동디스크를 타고 올라가는 불안정 현상이 나타나는 단점이 있다.
결과적으로 3가지 방식중 모든 면에서 우수한 타입은 없으며 각각의 장점과 단점을 가지고 있음을 확인하였다. 한편, MPDG타입에대해 말단부 관절의 동작유형별로 중간 짐벌메커니즘 및 모터구동부의 관계를 도시하였다. 위 3가지 이외에도 더 적합한 메커니즘이 있을 것이며, 제품화를 위해서는 경량화, 소형화 등과 의료분야와의 협업 등 많은 노력이 더 필요하다고 판단된다. 모터구동화시 가장 큰 제약은 수술기구의 1) 기존대비 질량의 증가 최소화 2) 기존대비 부피의 증가 최소화 3) 비용 증가의 최소화 4) 오작동 방지 등 안정성 및 신뢰성 확보 등을 극복해야하며, 1단계 > 기구부설계(구동기, 센서 등 포함) 2단계 > 제어부(센서계측 및 동작프로그래밍) 3단계 > 사용자 평가 및 제품화단계 4단계> 제품인증단계 등으로, 본 연구는 주로 1단계에 대한 것으로 볼 수 있다.
본 연구는 산업통상자원부 양자국제공동 기술개발사업의 연구비 지원에 의해 수행되었습니다.
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Dal Yeon Hwang
KSPE_2019_v36n5_471_bf001.jpg
Professor in the Department of Mechanical Design Engineering, Korea Polytechnic University. His research interest is robot mechanism, control, and telerobotics.
Jun Young Choi
KSPE_2019_v36n5_471_bf002.jpg
Researcher in Korea Polytechnic University. His research interest is Medical Surgery Robot, Smart manufacturing and Semiconductor gas line.
Dae Hwan Moon
KSPE_2019_v36n5_471_bf003.jpg
Ph.D. candidate in the Department of Mechanical Convergence Engineering, Hanyang University. His research interest is Reliability Optimization using Artificial Intelligence.
Hyung-Ho Kim
KSPE_2019_v36n5_471_bf004.jpg
Professor in the Department of surgery, Seoul National University college of Medicine. His research interest is Minimally invasive oncologic surgery and peritoneal malignancy of solid tumor.

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Mechanisms Study for Motor Actuated Laparoscopic Surgical Instruments
J. Korean Soc. Precis. Eng.. 2019;36(5):471-478.   Published online May 1, 2019
DOI: https://doi.org/10.7736/KSPE.2019.36.5.471
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Mechanisms Study for Motor Actuated Laparoscopic Surgical Instruments
J. Korean Soc. Precis. Eng.. 2019;36(5):471-478.   Published online May 1, 2019
DOI: https://doi.org/10.7736/KSPE.2019.36.5.471
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Mechanisms Study for Motor Actuated Laparoscopic Surgical Instruments
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Fig. 1 Laparoscopic surgery and instruments: (a) Instrument13 used in our study, (b) Various end effector types, (c) Surgical environment with a instrument and a laparoscope
Fig. 2 Primary (1st) bending coupler of Fig. 1 with four wires for bending transfer to distal jaw joint at end effector
Fig. 3 Distal jaw joint (2nd) bending coupler structure of Fig. 1(a)
Fig. 4 MTPS type mechanism with two semicircle guides
Fig. 5 MBDG type mechanism with a ball-screw, link, driven disk and motors
Fig. 6 MPDG type mechanism with a push disk, motors and a driven disk of gimbal
Fig. 7 Prototype of MTPS type laparoscopic surgical instrument: (a) 3D CAD interior view, (b) Assembled prototype interior view, (c) Assembled prototype exterior view, (d) 3D CAD control panel with joy stick
Fig. 8 Experimental set-up of MBDG type
Fig. 9 Experimental set-up of MPDG type
Fig. 10 Unstable motion cause of MPDG type push disk (right) and driven disk (left) with a varying distance between two disk pivots
Fig. 11 Overall bending test results of three types (MTPS, MBDG, MPDG) of mechanisms

Fig. 1

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Fig. 11

Mechanisms Study for Motor Actuated Laparoscopic Surgical Instruments

End effector motion by gimbal mechanism and motors of MPDG type

Key features of three type mechanisms

Type # of components Response time [s] Average bending angle [°] Std deviation of bending angle [°]
Min. Max Avg. Std. Dev.
MTPS 30 3 30° 70 54.4 10.54
MBDG 79 23 50 80 66.4 9.61
MPDG 50 5 81 90 86.2 2.80
Table 1 End effector motion by gimbal mechanism and motors of MPDG type
Table 2 Key features of three type mechanisms

Table 1

Table 2

JKSPE : Journal of the Korean Society for Precision Engineering

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