Robotics in Gastrointestinal Endoscopy

Recent advances in endoscopic technology allow clinicians to not only detect digestive diseases early, but also provide appropriate treatment. The development of various therapeutic endoscopic technologies has changed the paradigm in the treatment of gastrointestinal diseases, contributing greatly to improving the quality of life of patients. The application of robotics for gastrointestinal endoscopy improves the maneuverability and therapeutic ability of gastrointestinal endoscopists, but there are still technical limitations. With the development of minimally invasive endoscopic treatment, clinicians need more sophisticated and precise endoscopic instruments. Novel robotic systems are being developed for application in various clinical fields, to ultimately develop into minimally invasive robotic surgery to lower the risk to patients. Robots for endoscopic submucosal dissection, autonomous locomotive robotic colonoscopes, and robotic capsule endoscopes are currently being developed. In this review, the most recently developed innovative endoscopic robots were evaluated according to their operating mechanisms and purpose of use. Robotic endoscopy is an innovative treatment platform for future digestive endoscopy.

A Digital Twin Approach for Contextual Assistance for Surgeons During Surgical Robotics Training

Minimally invasive robotic surgery copes with some disadvantages for the surgeon of minimally invasive surgery while preserving the advantages for the patient. Most commercially available robotic systems are telemanipulated with haptic input devices. The exploitation of the haptics channel, e.g., by means of Virtual Fixtures, would allow for an individualized enhancement of surgical performance with contextual assistance. However, it remains an open field of research as it is non-trivial to estimate the task context itself during a surgery. In contrast, surgical training allows to abstract away from a real operation and thus makes it possible to model the task accurately. The presented approach exploits this fact to parameterize Virtual Fixtures during surgical training, proposing a Shared Control Parametrization Engine that retrieves procedural context information from a Digital Twin. This approach accelerates a proficient use of the robotic system for novice surgeons by augmenting the surgeon’s performance through haptic assistance. With this our aim is to reduce the required skill level and cognitive load of a surgeon performing minimally invasive robotic surgery. A pilot study is performed on the DLR MiroSurge system to evaluate the presented approach. The participants are tasked with two benchmark scenarios of surgical training. The execution of the benchmark scenarios requires basic skills as pick, place and path following. The evaluation of the pilot study shows the promising trend that novel users profit from the haptic augmentation during training of certain tasks.

A world-first thorascopic surgical instrument for minimally invasive robotically-enabled transplantation of 3D bioprinted heart patches for myocardial regeneration

Patch-based approaches to regenerating damaged myocardium include 3D bioprinting of heart patches for epicardial transplantation. By the time this is ready for widespread clinical use, it will be important that patches can be delivered via minimally invasive and robotic surgical approaches. Here, we aimed to design a minimally invasive patch transplantation surgical device for human operation as well as master-slave and fully automated robotic control. METHOD: Over a 12-month period (2019-20) in our multidisciplinary team we designed a surgical instrument to transplant 3D bioprinted heart patches to the epicardial surface. The device was designed for use via uni-portal or multi-portal Video-Assisted Thorascopic Surgery (VATS). Forpreliminary feasibility and sizing, we used a 3D printer to produce a flexible resin model from a computer-aided design (CAD) software platform in preparation for more robust high-resolution metal manufacturing. RESULTS: The instrument was designed as a sheath containing foldable arms, less than 2 cm in diameter when infolded to fit minimally invasive thoracic ports. The total length was 35 cm. When the arms were projected from the sheath, three moveable mechanical arms at the distal end were designed to hold the 3D bioprinted patch. A rotational head allowing for the arms to be angled in real time, a surface with micro-attachment points for patches and a releasing mechanism to release the patch was included. At the proximal end, right-angled handles corresponding to each distal arm could be used to control the distal arms, either manually, or by robotic hardware attached to the arms. CONCLUSION: This world-first design paves the way for a new approach for epicardial patch transplantation via minimally invasive robotic surgery. Full prototyping, proof-of-concept and efficacy trials will be needed to confirm the utility of this approach for translation from bench to bedside.

The first single-incision plus one-port transverse colon resection using Senhance Digital Laparoscopy System: a case report

Background We have introduced the Senhance Digital Laparoscopy System and actively use for colorectal cancer surgery. Recently, we also try to perform surgery by reduce port as less invasive method. For the first time, we report a case of single-incision plus one-port transverse colectomy using Senhance system. Case presentation The case was a 57-year-old woman, diagnosed with transverse colon cancer referred to our department. The preoperative diagnosis was cT1bN0M0, Stage I. We performed single-incision plus one-port transverse colon resection using Senhance system without any problems. The operative time was 203 min and the blood loss was 35 ml. Conclusion We report the first case of single-incision plus one-port transverse colectomy using Senhance system. We trust this approach will find increasing use, enabling a safer means of minimally invasive robotic surgery.