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.

Highlights

  • Invasive surgery (MIS) allows surgical techniques that minimize damage to healthy tissues

  • Five endoscopic submucosal dissection (ESD) trials were performed by five participants, and all ESD procedures were successfully completed with en bloc

  • Our trials in ex vivo animal stomachs showed that ESD using the proposed robot system was feasible

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Summary

Introduction

Invasive surgery (MIS) allows surgical techniques that minimize damage to healthy tissues. Laparoscopic surgery involves inserting long, rigid instruments (a camera and surgical tools) through a small incision in the patient’s skin to access the lesion. This approach results in a smaller incision in a healthy part of the patient compared with conventional open surgery, which usually involves a large incision. MIS offers various benefits to the patient, such as quick recovery and minimal blood loss and scarring. One type of MIS, flexible endoscopic surgery, enables an additional minimally invasive approach for many conditions, such as early-stage gastrointestinal cancer

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