A multitasking platform for natural orifice translumenal endoscopic surgery (NOTES): a benchtop comparison of a new device for flexible endoscopic surgery and a standard dual-channel endoscope

Abstract

A unique endoscopic platform with two independent end-effectors, each with five degrees of freedom, and an ergonomic user interface has been developed to address the needs of complex endolumenal and natural orifice translumenal endoscopic surgery (NOTES) procedures. This study aimed to measure the amount this new platform would improve performance for bimanual coordination compared with a standard dual-channel scope using a benchtop simulation. Task 1 involved 12 individuals performing an identical bimanual coordination task with two different devices: a dual-channel endoscope (DCE) and the EndoSAMURAI prototype. The participants were separated into three groups with different levels of endoscopy and NOTES experience. A complex bimanual coordination task (pin transfer) was used. For this task, 12 pins had to be manipulated in a predetermined order. Performance was measured by movement speed, and accuracy. Comparisons were made between the two devices and the three groups of subjects. Task 2 required the same 12 participants to perform a standardized intracorporeal suture in a NOTES simulation. In the pin transfer task, overall performance speed was significantly faster using the EndoSAMURAI (304 ± 125 s) rather than the DCE (867 ± 312 s; P < 0.001). The difference between the two operating systems was more pronounced in the student group than in the surgeon group: experts (226 ± 41 vs. 620 ± 277 s), surgeons (333 ± 152 vs. 930 ± 283 s), students (318 ± 83 vs. 1021 ± 423 s). Accuracy, as indicated by the number of pin drops, also was significantly better using the EndoSAMURAI (0.4) rather than the DCE (1.8 drops; P = 0.006). In addition, all 12 participants were able to complete a suture using the EndoSAMURAI, but none could complete a suture using the DCE. The EndoSAMURAI enhances performance times and accuracy in complex surgical tasks compared with the conventional therapeutic endoscope.