Enhancement of a master-slave robotic system for natural orifice transluminalendoscopic surgery

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 effectiveinstrumentations 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,maneuver ability 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 NOTESprocedure, respectively. Results: Successful ESD (endoscopic submucosal dissection) and wedge hepatic resection have been performed on live pigs with our Master And SlaveTransluminal Endoscopic Robot (MASTER) system, showing its capability to performadvanced endoscopic surgical and NOTES procedures. It is found that the MASTER exhibited good grasping and cutting efficiency. And the lesion resection time could besignifi cantly reduced with more practice between the endoscopist and the robot operator.Conclusion: This study evaluates the feasibility of MASTER system as a platformovercoming the barriers to NOTES. It is also demonstrated that the MASTER could effectively mitigate the technical constraints normally encountered in NOTES procedures.link_to_subscribed_fulltex