Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(06): E881-E887
DOI: 10.1055/a-1395-7089
Original article

Evaluation of improved bi-manual endoscopic resection using a customizable 3D-printed manipulator system designed for use with standard endoscopes: a feasibility study using a porcine ex-vivo model

Benjamin Walter
1   Department of Internal Medicine I, University Hospital of Ulm, Ulm, Germany
,
Yannick S. Krieger
2   Department of Mechanical Engineering, Institute of Micro Technology and Medical Device Technology (MIMED), Technical University of Munich, Munich Germany
,
Dirk Wilhelm
3   MITI Research Group, Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
,
Hubertus Feussner
3   MITI Research Group, Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
,
Tim C. Lueth
2   Department of Mechanical Engineering, Institute of Micro Technology and Medical Device Technology (MIMED), Technical University of Munich, Munich Germany
,
Alexander Meining
4   Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims A major drawback of endoscopic en-bloc resection technique is its inability to perform bimanual tasks. Although endoscopic platforms that enable bimanual tasks are commercially available, they are neither approved for various locations nor adaptable to specific patients and indications.

Methods Based on evolution of an adaptive 3D-printable platform concept, system variants with different characteristic properties were evaluated for ESD scenarios, ex-vivo in two locations in the stomach and colorectum.

Results In total 28 ESDs were performed (7 antrum, 7 corpus in inversion, 7 cecum, 7 rectum) in a porcine ex-vivo setup. ESD was feasible in 21 cases. Investigated manipulator variants are differently well suited for performing ESD within the varying interventions scenarios. Dual-arm manipulators allowed autonomous ESD, while single-arm flexible manipulators could be used more universally due to their compact design, especially for lesions difficult to access. Pediatric scopes were too frail to guide the overtube-manipulators in extremely angled positions. Working in the rectum was impaired using long-sized manipulator arms.

Conclusions The presented endoscopic platform based on 3D-printable and customizable manipulator structures might be a promising approach for future improvement of ESD procedure. With regard to localization, especially flexible manipulators attached to standard endoscopes appear to be most promising for further application of specific and individualised manipulator systems.

Supplementary material



Publication History

Received: 26 November 2020

Accepted: 03 February 2021

Article published online:
27 May 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Kim ER, Chang DK. Management of complications of colorectal submucosal dissection. Clin Endosc 2019; 52: 114-119
    CrossrefPubMedGoogle Scholar
  • 3 De Ceglie A, Hassan C, Mangiavillano B. et al. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: A systematic review. Crit Rev Oncol Hematol 2016; 104: 138-155
    CrossrefPubMedGoogle Scholar
  • 4 Oyama T, Yahagi N, Ponchon T. et al. How to establish endoscopic submucosal dissection in Western countries. World J Gastroenterol 2015; 21: 11209-11220
    CrossrefPubMedGoogle Scholar
  • 5 Oyama T. Counter traction makes endoscopic submucosal dissection easier. Clin Endosc 2012; 45: 375-378
    CrossrefPubMedGoogle Scholar
  • 6 Tsuji K, Yoshida N, Nakanishi H. et al. Recent traction methods for endoscopic submucosal dissection. World J Gastroenterol 2016; 22: 5917-5926
    CrossrefPubMedGoogle Scholar
  • 7 Nishizawa T, Yahagi N. Endoscopic mucosal resection and endoscopic submucosal dissection: technique and new directions. Curr Opin Gastroenterol 2017; 33: 315-319
    CrossrefPubMedGoogle Scholar
  • 8 Diana M, Chung H, Liu K-H. et al. Endoluminal surgical triangulation: overcoming challenges of colonic endoscopic submucosal dissections using a novel flexible endoscopic surgical platform: feasibility study in a porcine model. Surg Endosc 2013; 27: 4130-4135
    CrossrefPubMedGoogle Scholar
  • 9 Walter B, Schmidbaur S, Krieger Y. et al. Improved endoscopic resection of large flat lesions and early cancers using an external additional working channel (AWC): a case series. Endosc Int open 2019; 7: E298-E301
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 de Melo SW, Cleveland P, Raimondo M. et al. Endoscopic mucosal resection with the grasp-and-snare technique through a double-channel endoscope in humans. Gastrointest Endosc 2011; 73: 349-352
    CrossrefPubMedGoogle Scholar
  • 11 Kantsevoy SV, Bitner M, Piskun G. New endoscopic platform for endoluminal en bloc tissue resection in the gastrointestinal tract (with videos). Surg Endosc 2016; 30: 3145-3151
    CrossrefPubMedGoogle Scholar
  • 12 Zizer E, Roppenecker D, Helmes F. et al. A new 3D-printed overtube system for endoscopic submucosal dissection: first results of a randomized study in a porcine model. Endoscopy 2016; 48: 765
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Krieger YS, Roppenecker DB, Kuru I et al. Multi-Arm Snake-Like Robot. in IEEE International Conference on Robotics and Automation (ICRA 2017). Singapore, May 20-June 03, 20172017; 2490-2495
    PubMedGoogle Scholar
  • 14 Takeshita N, Ho KY, Phee SJ. et al. Feasibility of performing esophageal endoscopic submucosal dissection using master and slave transluminal endoscopic robot. Endoscopy 2017; 49: E27-E28
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Peters BS, Armijo PR, Krause C. et al. Review of emerging surgical robotic technology. Surg Endosc 2018; 32: 1636-1655
    CrossrefPubMedGoogle Scholar