The field of minimally invasive surgery (MIS) is continuously changing
with the advancement of surgical instrumentation. To pursue further
minimisation of skin incision and access trauma, the MIS procedures
are evolving from multi-port laparoscopic surgery to single-incision laparoscopic surgery (SILS) and even to scarless natural orifice transluminal endoscopic surgery (NOTES). These new surgical procedures
require the surgical instruments, either rigid or flexible, operating in an
anatomical area that is not directly aligned with the access site. Significant problems are raised in these procedures, such as reduced dexterity, inadequate instrument triangulation and counterintuitive hand-eye
coordination. Suturing -a fundamental surgical technique for wound
closure using stitches made by needles and threads - becomes very
problematic in these new surgical procedures.
In recent decades, one of the most astounding examples of bringing
technology into clinical practice is the adoption of robotic surgical systems in MIS. This research aims to investigate the use of robotic techniques to extend the usability of suturing, boost suturing performance
and eventually push the field towards autonomous suturing in medical and surgical applications. To avoid complex needle manipulation
and facilitate knot tying in MIS, two types of smart and miniaturised
suturing instruments have been developed. The rigid suturing instrument has demonstrated its efficacy for fast and reliable tacking stitches
in the personalised stent graft sewing task, while the flexible suturing
instrument makes it possible for suturing and knot tying in single-port
transanal endoscopic microsurgery. In addition to developing these suturing instruments, the author has proposed and given the method of
3using metal printing to monolithically produce the flexible joints - 3D
compliant mechanisms - for various surgical instruments, for example,
the flexible suturing device and the S-bending flexible endoscope for
single-port surgery. Besides needle manipulation, thread manipulation is another crucial aspect in robotic suturing. Towards automated
thread manipulation, a deep-learning based method has been proposed
for parsing the structural information of a thread in the suturing task.
Finally, a fully automated suturing system integrating the rigid suturing instrument, a dual arm industrial robot, RGBD vision and force
sensing has been demonstrated for stent graft manufacturing. The central part of the thesis is laid in developing smart instrumentation for
robotic sewing and suturing. However, the methods discovered, and
the mechanisms invented during the developing process also provide
valuable insight into developing various future surgical instruments.