Development of a robotic platform for natural orifice transluminal endoscopic surgery

摘要

Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical technique that is widely anticipated to define the next paradigm shift in surgery. Besides leaving no external scar on the patient, the natural orifice approach is envisaged to reduce postoperation morbidity and improve surgical outcomes. However, performing NOTES is technically more demanding than conventional surgery, as the surgical procedure is performed entirely within the small confines of the peritoneal cavity. Current endoscopic systems are not equipped with sufficient dexterity for the intricate maneuvers required in the performance of NOTES. Hence, advanced innovations in endoscopy are called for to circumvent the technical issues commonly encountered in endoscopic surgery. Herein, we describe the development of a robotic NOTES platform that could potentially make the performance of complex endoscopic surgical procedures such as NOTES safer and easier. By applying robotic technology and separating control of instrumental motion from that of endoscopic movement, the robotic system increases dexterity of surgical maneuvers, such as triangulation of instruments, retraction, grasping, approximation, and cutting of tissue, and allows these tasks to be performed with relative ease and precision. The novel robotic NOTES platform discussed herein is nonoperator dependent, is intuitively operated, and comes with force and tactile feedback capability to provide surgeons not just the ease of use, but also a sense of touch while manipulating the tissues. Preliminary evaluations of the platform in animal survival studies and human trials have demonstrated that the system is easy and safe to use. With further development, it may be adapted for highly intricate NOTES, which may otherwise be very difficult to perform using currently available endoscopic tools.