Flexible platforms for natural orifice transluminal and endoluminal surgery

The flexible endoscope is playing an increasingly pivotal role in minimally invasive transluminal and endoluminal surgery. Whilst the flexible nature of the platform is desirable in order to navigate through the abdominal cavity or through a lumen, there are a number of issues with using the platform for this purpose.

The challenges associated with using flexible endoscopes such as a lack of triangulation of instruments and force transmission, which is often inadequate for endoscopic surgery are discussed in this review.

As a result of these difficulties, a number of mechanically and robotically driven devices based upon the flexible endoscope are emerging. The design of these devices and potential problems are also reviewed. Finally, future robotic systems which are still in the development and validation stage are briefly discussed.

The field of gastroenterology is diverging. The narrowing divide between minimally invasive and endoluminal surgery has led to a surge of innovative and novel devices which may in the future enable precise, seamless and scar less surgery.

• References

• 1 Bozzini P. Light conductor, an invention for examining internal parts and diseases, together with illustrations. J Pract Med Surg 1806; 24: 107-124
• 2 Meining A, Spaun G, Fernández-Esparrach G et al. NOTES in Europe: summary of the working group reports of the 2012 EURO-NOTES meeting. Endoscopy 2013; 45: 214-217
• 3 Rattner D, Kalloo A. SAGES/ASGE Working Group. ASGE/SAGES working group on natural orifice translumenal endoscopic surgery. October 2005. Surg Endosc 2006; 20: 329-333
• 4 Cosentino F, Tumino E, Passoni GR et al. Functional evaluation of the endotics system, a new disposable self-propelled robotic colonoscope: in vitro tests and clinical trial. Int J Artif Organs 2009; 32: 517-527
• 5 Valdastri P, Ciuti G, Verbeni A et al. Magnetic air capsule robotic system: proof of concept of a novel approach for painless colonoscopy. Surg Endosc 2012; 26: 1238-1246
• 6 Ciuti G, Valdastri P, Menciassi A et al. Robotic magnetic steering and locomotion of capsule endoscope for diagnostic and surgical endoluminal procedures. Robotica 2010; 28: 199-207
• 7 Bessler M, Stevens P, Milone L et al. Transvaginal laparoscopic cholecystectomy: laparoscopically assisted. Surg Endosc 2008; 22: 1715-1716
• 8 Mintz Y, Horgan S, Cullen J et al. NOTES: the hybrid technique. J Laparoendosc Adv Surg Tech 2007; 17: 402-406
• 9 Spaun GO, Zheng B, Swanström LL. A multitasking platform for natural orifice translumenal endoscopic surgery (NOTES): a bench top comparison of a new device for flexible endoscopic surgery and a standard dual-channel endoscope. Surg Endosc 2009; 23: 2720-2727
• 10 Fuchs KH, Breithaupt W. Transgastric small bowel resection with the new multitasking platform EndoSamurai™ for natural orifice transluminal endoscopic surgery. Surg Endosc 2012; 26: 2281-2287
• 11 Dallemagne B, Marescaux J. The ANUBIS project. Minim Invasive Ther Allied Technol 2010; 19: 257-261
• 12 Allemann P, Perretta S, Asakuma M et al. Multimedia manuscript. NOTES retroperitoneal transvaginal distal pancreatectomy. Surg Endosc 2009; 23: 882-883
• 13 Leroy J, Cahill RA, Perretta S et al. Natural orifice translumenal endoscopic surgery (NOTES) applied totally to sigmoidectomy: an original technique with survival in a porcine model. Surg Endosc 2009; 23: 24-30
• 14 Dallemagne B, Perretta S, Allemann P et al. Transgastric hybrid cholecystectomy. Br J Surg 2009; 96: 1162-1166
• 15 Perretta S, Dallemagne B, Coumaros D et al. Natural orifice transluminal endoscopic surgery: transgastric cholecystectomy in a survival porcine model. Surg Endosc 2008; 22: 1126-1130
• 16 Perretta S, Dallemagne B, Barry B et al. The ANUBISCOPE^(®) flexible platform ready for prime time: description of the first clinical case. Surg Endosc 2013; 23: 2630
• 17 Neuhaus H, Costamagna G, Devière J et al. Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the “R-scope”). Endoscopy 2006; 38: 1016-1023
• 18 Ishii K, Tajiri H, Fujisaki J et al. The effectiveness of a new multibending scope for endoscopic mucosal resection. Endoscopy 2004; 36: 294e7
• 19 Sumiyama K, Kaise M, Nakayoshi T et al. Combined used of a magnifying endoscope with a narrow band imaging system and a multibending endoscope for en bloc EMR of early stage gastric cancer. Gastrointest Endosc 2004; 60: 79-84
• 20 Sumiyama K, Gostout CJ, Rajan E et al. Transgastric cholecystectomy: transgastric accessibility to the gallbladder improved with the SEMF method and a novel multibending therapeutic endoscope. Gastrointest Endosc 2007; 65: 1028-1034
• 21 Ryou M, Fong DG, Pai RD et al. Dual-port distal pancreatectomy using a prototype endoscope and endoscopic stapler: a natural orifice transluminal endoscopic surgery (NOTES) survival study in a porcine model. Endoscopy 2007; 39: 881-887
• 22 Lee SH, Gromski MA, Derevianko A et al. Efficacy of a prototype endoscope with two deflecting working channels for endoscopic submucosal dissection: a prospective, comparative, ex vivo study. Gastrointest Endosc 2010; 72: 155-160
• 23 Moyer MT, Haluck RS, Gopal J et al. Transgastric organ resection solely with the prototype R-scope and the self-approximating transluminal access technique. Gastrointest Endosc 2010; 72: 170-176
• 24 Astudillo JA, Sporn E, Bachman S et al. Transgastric cholecystectomy using a prototype endoscope with 2 deflecting working channels (with video). Gastrointest Endosc 2009; 69: 297-302
• 25 Swain P, Ewers R, Peh R et al. New measurement methods and a randomized comparison of force transmission using flexible endoscopes and instruments before and after the application of Shapelock technology. Gastrointest Endosc 2005; 61: AB241
• 26 Swanstrom LL, Swain P, Denk P. Development and validation of a new generation of flexible endoscope for NOTES. Surg Innov 2009; 16: 104e10
• 27 Horgan S, Thompson K, Talamini M et al. Clinical experience with a multifunctional, flexible surgery system for endolumenal, single-port, and NOTES procedures. Surg Endosc 2011; 25: 586-592
• 28 Horgan S, Jacobsen G, Weiss GD et al. Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicentre registry results. Surg Obes Relat Dis 2010; 6: 290-295
• 29 Pai RD, Fong DG, Bundga ME et al. Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). Gastrointest Endosc 2006; 64: 428
• 30 Swain P, Rothe C, Bergstrom M et al. Development and testing of a new platform for retroflexed flexible transgastric surgery: cholecystectomy, fundoplication, gastric restriction and diaphragmatic repair. Gastrointest Endosc 2006; 63: 725
• 31 Bardaro SJ, Swanstrom LL. Development of advanced endoscopes for natural orifice translumenal endoscopic surgery (NOTES). Minim Invasive Ther Allied Technol 2006; 15: 378-383
• 32 Thompson CC, Ryou M, Soper NJ et al. Evaluation of a manually driven, multitasking platform for complex endoluminal and natural orifice translumenal endoscopic surgery applications (with video). Gastrointest Endosc 2009; 70: 121-125
• 33 Potter K, Swanstrom L. Natural orifice surgery (NOTES) and biliary disease, is there a role?. J Hepatobiliary Pancreatic Surg 2009; 16: 261-265
• 34 Spaun GO, Zheng B, Martinec DV et al. Bimanual coordination in natural orifice transluminal endoscopic surgery: comparing the conventional dual-channel endoscope, the R-Scope, and a novel direct-drive system. Gastrointest Endosc 2009; 69: 39-45
• 35 Simaan N, Xu K, Wei W et al. Design and integration of a telerobotic system for minimally invasive surgery of the throat. Int J Rob Res 2009; 28: 1134-1153
• 36 Shammas E, Wolf A, Choset H. Three degrees-of-freedom joint for spatial hyper-redundant robots. Mechanism Machine Theory 2006; 41: 170-190
• 37 Petroni G, Niccolini M, Caccavaro S et al. A novel robotic system for single-port laparoscopic surgery: preliminary experience. Surg Endosc 2013; 27: 1932-1937
• 38 Eickhoff A, Jakobs R, Kamal A et al. In vitro evaluation of forces exerted by a new computer-assisted colonoscope (the NeoGuide Endoscopy System). Endoscopy 2006; 38: 1224-1229
• 39 Striegel J, Jakobs R, Van Dam J et al. Determining scope position during colonoscopy without use of ionizing radiation or magnetic imaging: the enhanced mapping ability of the NeoGuide Endoscopy System. Surg Endosc 2011; 25: 636-640
• 40 Eickhoff A, van Dam J, Jakobs R et al. Computer-assisted colonoscopy (the NeoGuide Endoscopy System): results of the first human clinical trial (“PACE study”). Am J Gastroenterol 2007; 102: 261-266
• 41 Bardou B, Nageotte F, Zanne P et al. Design of a telemanipulated system for transluminal surgery. Conf Proc IEEE Eng Med Biol Soc 2009; 5577-5582
• 42 Abbott DJ, Becke C, Rothstein RI et al. Design of an endoluminal NOTES robotic system. IEEE/RSJ International Conference on Intelligent Robots and Systems 2007; 410-416
• 43 Phee SJ, Low SC, Sun ZL et al. Robotic system for no-scar gastrointestinal surgery. Int J Med Robot 2008; 4: 15-22
• 44 Phee SJ, Low SC, Huynh VA et al. Master and slave transluminal endoscopic robot (MASTER) for natural orifice transluminal endoscopic surgery (NOTES). Conf Proc IEEE Eng Med Biol Soc 2009; 1192-1195
• 45 Sun Z, Ang RY, Lim EW et al. Enhancement of a master-slave robotic system for natural orifice transluminal endoscopic surgery. Ann Acad Med Singapore 2011; 40: 223-230
• 46 Phee S, Ho K, Lomanto D et al. Natural orifice transgastric endoscopic wedge hepatic resection in an experimental model using an intuitively controlled master and slave transluminal endoscopic robot (MASTER). Surg Endosc 2010; 24: 2293-2298
• 47 Wang Z, Phee SJ, Lomanto D et al. Endoscopic submucosal dissection of gastric lesions by using a master and slave transluminal endoscopic robot: an animal survival study. Endoscopy 2012; 44: 690-694
• 48 Phee SJ, Reddy N, Chiu PW et al. Robot-assisted endoscopic submucosal dissection is effective in treating patients with early-stage gastric neoplasia. Clin Gastroenterol Hepatol 2012; 10: 1117-1121
• 49 Ho KY, Phee SJ, So BYJ et al. Robotic manipulator for natural orifice transluminal endoscopic surgery. Gastrointest Endosc 2007; 65: AB110
• 50 Shang J, Noonan DP, Payne C et al. An articulated universal joint based flexible access robot for minimally invasive surgery. IEEE 2011; 1147-1152
• 51 Clark J, Sodergren M, Noonan DP et al. A novel articulated robotic laparoscope for single incision and natural orifice surgical applications: preliminary usability trials in a live porcine model. 2010 Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Endosc 2010; 24: S690