To continue pushing the boundaries of healthcare, surgeons look to new tools that will help them perform quicker procedures and do so with the least amount of postprocedure trauma to the patient. [1] Safe interaction with healthy tissue is of great importance when it comes to regions of the body, such as the lungs or the brain, which require low-force interactions during surgery. [2] Minimally invasive surgery (MIS) has become a common technique in these regions of the body for its benefits of less patient pain, quicker recovery times, and less scarring. [3][4][5] Lung cancer is estimated to cause 130 180 deaths in the United States in 2022, continuing to make it the leading cause of cancer-related deaths. [6,7] Traditionally, a flexible bronchoscope is guided to the tumor site to perform tissue biopsy; however, there remains significant variability in diagnostic accuracy from 36% to 88%. Furthermore, the standard % 6mm diameter of the scope diminishes the capabilities of this technique as the majority of lesions lie in the periphery of the lung accessed only by small airways beyond the bronchoscope's reach. [8] The breathing motion, associated with normal bodily function, may contribute to variation in accuracy, changing the position of the target area throughout the entire procedure by an average of 17.6 mm depending on its location in the lungs. [9] This affects the diagnostic yield of the procedure to different degrees, with yields as low as 13.5% being common for tumors smaller than 2 cm. [9] Ultrathin, manually driven scopes have been developed at % 3mm diameters to reach deeper in the lungs; however, they require a flexible needle to be used in their single working channel, which sacrifices force transmission for the dexterity necessary to reach deeper into the lung. [10] To address the shortcomings of those traditional MIS techniques, advancements in robotic tools have been introduced over the past decade. [11] Continuum robots are employed for this task due to their added dexterity and ease of scaling. [12] Commercial platforms have been developed with these robots, such as the Auris Monarch (Auris Health Inc. CA, USA), Ion Endoluminal System (Intuitive Surgical CA, USA), Noah Medical Galaxy (Noah Medical, CA, USA), and Illumisite (Medtronic MN, USA) for bronchoscopies, and have eased procedures with image-guided teleoperation, alleviating the physical effort required by surgeons. [11,13,14] Commercial systems like these have proven scalability with diameters of 4.2 mm for the Monarch and 3.5 mm for the Ion and Noah Medical Galaxy (Noah Medical, CA, USA). [15] Concentric tube robots have been developed using individually controlled, precurved tubes as an easily scaled alternative that can transmit sufficient forces due to the use of metal materials. [16][17][18] Soft robots have recently been introduced as an alternative to traditional MIS robots due to their advantages of inherently safe
