Robotic-assisted surgical endoscopy: a new era for endoluminal therapies

Abstract

Minimally invasive endoscopic procedures are associated with lower adverse events and shorter hospital stays compared with conventional open surgery.1Lomanto D. Wijerathne S. Ho L.K. et al.Flexible endoscopic robot.Minim Invasive Ther Allied Technol. 2015; 24: 37-44Crossref PubMed Scopus (30) Google Scholar, 2Farias G.F.A. Bernardo W.M. De Moura D.T.H. et al.Endoscopic versus surgical treatment for pancreatic pseudocysts: systematic review and meta-analysis.Medicine (Baltimore). 2019; 98: e14255Google Scholar However, some advanced endoscopic procedures, including endoscopic submucosal dissection (ESD), natural orifice transluminal endoscopic surgery (NOTES), and suturing, have typically required specialized training and a certain amount of experience to achieve competency. Therefore, these procedures are not widely performed in nonspecialized centers.3Boškoski I. Costamagna G. Endoscopy robotics: current and future applications.Dig Endosc. 2018; 31: 119-124Google Scholar, 4de Moura D.T.H. Sachdev A.H. Thompson C.C. Endoscopic full-thickness defects and closure techniques.Curr Treat Options Gastroenterol. 2018; 16: 386-405Crossref PubMed Google Scholar, 5Yeung B.P. Chiu P.W. Application of robotics in gastrointestinal endoscopy: a review.World J Gastroenterol. 2016; 22: 1811-1825Crossref PubMed Scopus (57) Google Scholar, 6De Moura D.T. Mestieri L.H. Cheng S. et al.Natural orifice transluminal endoscopic surgery to salvage a migrated stent during EUS-guided hepaticogastrostomy.Gastrointest Endosc. 2016; 83: 656-657Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Despite the availability of a wide range of accessory devices, including distal attachment caps, electrosurgical knifes, hemostatic forceps, and suturing devices, the conventional flexible endoscopes used in clinical practice struggle to support the performance of advanced endosurgical procedures. They lack the dexterity required to perform useful maneuvers, such as triangulation of instruments and nonaxial tissue manipulation. Transmission of force from operator to point of action is often suboptimal because of the instability of the flexible endoscope. Additionally, the visual field is fixed by the direction of the endoscope, making visualization difficult when the field is constantly reoriented with any movement of the endoscope.3Boškoski I. Costamagna G. Endoscopy robotics: current and future applications.Dig Endosc. 2018; 31: 119-124Google Scholar, 5Yeung B.P. Chiu P.W. Application of robotics in gastrointestinal endoscopy: a review.World J Gastroenterol. 2016; 22: 1811-1825Crossref PubMed Scopus (57) Google Scholar, 7Wong J.Y.Y. Ho K.Y. Robotics for advanced therapeutic colonoscopy.Clin Endosc. 2018; 51: 552-557Crossref PubMed Scopus (13) Google Scholar, 8Hourneax de Moura D.T. Aihara H. Jirapinyo P. et al.Robot-assisted endoscopic submucosal dissection versus conventional ESD for colorectal lesions: outcomes of a randomized pilot study in endoscopists without prior ESD experience (with video).Gastrointest Endosc. 2019; (Epub Mar 25)Google Scholar Owing to the limitations of conventional flexible endoscopes and the long learning curves required for some technically challenging procedures, many different types of endoscopic robotic systems have been developed.3Boškoski I. Costamagna G. Endoscopy robotics: current and future applications.Dig Endosc. 2018; 31: 119-124Google Scholar The main goal of robotic endoscopy is to improve precision, effectiveness, safety, and reliability to enhance the interventional capabilities of endoscopists and to augment the field of possible interventions. Available instruments include dissection tools, graspers, electrocautery devices, and sutures. However, some problems still need to be addressed, including locomotion and instrument control, along with better understanding of clinical applications.1Lomanto D. Wijerathne S. Ho L.K. et al.Flexible endoscopic robot.Minim Invasive Ther Allied Technol. 2015; 24: 37-44Cro