The RAFE that we developed enabled an expert endoscopist to perform the ESD procedure without any problems and allowed a non-endoscopist to control the endoscope more easily and quickly than a manual endoscope. The RAFE is expected to undergo further development.

Physicians use ultrasound scans to do diagnosis by making real-time images of internal organs, because such scans are safe, inexpensive, and non-invasive. However, aging society and limited numbers of physician make it difficult for patients in remote areas to be diagnosed. Besides, physician's technical skills affect the interpretation of the scans and thus the results of the examination. Thus, development of a robotic system for remote diagnosis is required to solve the problems. For this purpose, we proposed the development of a robotic system for automatic ultrasound imaging focusing on human liver. In this paper, we present several elements developed for the robotic system. First element is an algorithm for estimating the position of liver to guide the probe to scan initial position which is the epigastric region. Second element is ultrasound probe scanning protocol design to obtain whole image of the liver. Third element is force control algorithm to maintain the contact between the probe and human body even though the patient is breathing. Fourth element is an algorithm for detecting and correcting the probe's position when improper ultrasound images occurred. These algorithms with an implementation program control the apparatus: a Mitsubishi Electric's MELFA RV-1 six axis manipulator and tested on human subjects. The results confirmed the effectiveness of the approach.

ESD using novel articulating devices was feasible. These devices were able to reduce the procedure time for novices.

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Early-stage gastrointestinal cancer is often treated by endoscopic submucosal dissection (ESD) using a flexible endoscope. Compared with conventional percutaneous surgery, ESD is much less invasive and provides a high quality of life for the patient because it does not require a skin incision, and the organ is preserved. However, the operator must be highly skilled because ESD requires using a flexible endoscope with energy devices, which have limited degrees of freedom. To facilitate easier manipulation of these flexible devices, we developed a surgical robot comprising a flexible endoscope and two articulating instruments. The robotic system is based on a conventional flexible endoscope, and an extrapolated motor unit moves the endoscope in all its degrees of freedom. The instruments are thin enough to allow insertion of two instruments into the endoscope channel, and each instrument has a bending section that allows for up–down, right–left, and forward–backward motion. In this study, we performed an ex vivo feasibility evaluation using the proposed robotic system for ESD in a porcine stomach. The procedure was successfully performed by five novice operators without complications. Our findings demonstrated the feasibility of the proposed robotic system and, furthermore, suggest that even operators with limited experience can use this system to perform ESD.

Use of the new ESD method allows for reduced adverse events and a shortened resection time.

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