Introduction: A novel robotic platform for Natural Orifice Transluminal Endoscopic Surgery (NOTES) is presented in this paper. It aims to tackle two crucial technical barriers which hinder its smooth transition from animal studies to clinical trials: providing effective instrumentations to perform complex NOTES procedures and maintaining the spatial orientation for endoscopic navigation.Materials and Methods: The technical barriers are overcome by the design of the robotic system considering size, triangulation, dexterity, maneuverability and complexity. It is also shown that haptic feedback and interventional navigation system could solve the problem of off-axis manipulation of the camera angle and loss of spatial orientation upon entering the peritoneal cavity in transgastric NOTES procedure, respectively. Results: Successful ESD (endoscopic submucosal dissection) and wedge hepatic resection have been performed on live pigs with our Master And Slave Transluminal Endoscopic Robot (MASTER) system, showing its capability to perform advanced endoscopic surgical and NOTES procedures. It is found that the MASTER exhibited good grasping and cutting efficiency. And the lesion resection time could be significantly reduced with more practice between the endoscopist and the robot operator. Conclusion: This study evaluates the feasibility of MASTER system as a platform overcoming the barriers to NOTES. It is also demonstrated that the MASTER could effectively mitigate the technical constraints normally encountered in NOTES procedures.
Minimally invasive surgery has been widely accepted clinically and developed rapidly in the past decades. It has become the method of choice in many surgical procedures, such as laparoscopic reflux surgery, cholecystectomy, appendectomy, etc. The benefits to patients include less trauma, decreased morbidity, shorter hospital stay as well as better cosmetic results. Most recently, with the growing capabilities of therapeutic flexible endoscopy, it is feasible for surgical interventions to be performed in an even less invasive manner. This is where the concept of Natural Orifice Transluminal Endoscopic Surgery (NOTES) becomes appealing.
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