Intraluminal surgery is a very attracting technique for surgical procedures in the digestive tract because they limit trauma, avoid any visible scar for the patient and allow direct access to pathology. However, these are very demanding techniques for surgeons when realized with manual flexible endoscopes. On the one hand, conventional instruments lack distal mobilities. On the other hand, surgical platforms are difficult to control from the proximal side and require at least two skilled physicians who must collaborate in a very limited workspace.
As a consequence, only very skilled surgeons and endoscopists are currently able to perform advanced treatments, such as Endoscopic Submucosal Dissection (ESD) with the available manual instruments. This unfortunately limits the availability of interesting treatments for many patients. Robotic flexible systems have been identified as a solution to improve manipulation. We developed a telemanipulated robotic device, called STRAS, which aims at assisting surgeons during intraluminal surgical endoscopy. This is a modular system, based on a flexible endoscope and flexible instruments, which provides 10 degrees of freedom (DoFs). The modularity allows a simple manual navigation of the endoscope towards the operating area and an easy setup of the robot at the table side. The robot can then be teleoperated using master interfaces specifically designed to intuitively control all available DoFs.
In this work, we report the results of a preclinical study for assessing the feasibility of using the STRAS robotic platform for intraluminal surgery. Twelve endoscopic submucosal dissections were successfully performed in the colon of swines. STRAS provides sufficient DoFs, workspace and forces to perform ESD. It allows a single surgeon with no previous experience in intraluminal surgery to safely perform the complete surgical task. The performances in terms of dissection velocities are also improved with respect to manual systems.
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