Surgical Robot for Intraluminal Access: AnEx VivoFeasibility Study

Abstract

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.

Advancement of Flexible Robot Technologies for Endoluminal Surgeries

“…One is inserted through a built-in channel of the standard endoscope and the other is inserted through an additional tube attached to the tip of the endoscope. The platform was originally developed as a mechanical system in which both endoscopes and instruments were controlled by a mechanically connected knob or handle [158] and then transformed to a fully motorized system where the endoscope and two instruments were remote controlled [149]. Ex vivo studies using a porcine stomach demonstrated that the platform allowed a novice to perform procedures more easily and quickly than conventional ESD [148], [149], [150].…”

Vision-Based Automated Control of Magnetic Microrobots

“…Micromanipulations based on microrobots provide a variety of flexible and new methods for many biomedical studies, including functional cellular analysis, disease diagnosis and treatment, targeted drug delivery, and microsurgery monitoring [1][2][3]. There are an increasing number of studies on robots, especially microrobots, in the biomedical field [4][5][6][7][8]. Due to their small size, they cannot be powered by a built-in power supply, so they can only use external drive methods such as piezoelectric [9,10], optical [11], magnetic [12,13], acoustic [14][15][16], and electrical technologies [17].…”

Stress Dispersion Design in Continuum Compliant Structure toward Multi-DOF Endoluminal Forceps

“…Previous studies have developed multi-DOF endoluminal forceps with articulated joint structures [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. For instance, Anubiscope [5], STRAS [6], EndoMaster [7], and K-FLEX [8] have improved workability.…”

“…However, their diameters are not sufficiently small to be inserted into the 2.8 mm channel of commercially available prevailing standard flexible endoscopes. Other articulated devices [13][14][15][16][17][18][19] are within 2.6 mm in diameter. Thus, these devices might be used with standard flexible endoscopes even though each mechanism has its own limitations.…”

“…Prasai et al's [15] device has a problem that the bending radius becomes large because it is bent by rotating a multi-layered concentric tube. Nakadate et al's [16][17][18] and Ray et al's [19] mechanisms contain several micro-parts, which increases their cost. Considering size and cost, a mechanism with the simplest possible structure is desirable.…”