A new robotic-assisted flexible endoscope with single-hand control: endoscopic submucosal dissection in the ex vivo porcine stomach
Difficulties in endoscopic operations and therapeutic procedures seem to occur due to the complexity of operating the endoscope dial as well as difficulty in performing synchronized movements with both hands. We developed a prototype robotic-assisted flexible endoscope that can be controlled with a single hand in order to simplify the operation of the endoscope. The aim of this study was to confirm the operability of the robotic-assisted flexible endoscope (RAFE) by performing endoscopic submucosal dissection (ESD).
Study 1: ESD was performed manually or with RAFE by an expert endoscopist in ex vivo porcine stomachs; six operations manually and six were performed with RAFE. The procedure time per unit circumferential length/area was calculated, and the results were statistically analyzed. Study 2: We evaluated how smoothly a non-endoscopist can move a RAFE compared to a manual endoscope by assessing the designated movement of the endoscope.
Study 1: En bloc resection was achieved by ESD using the RAFE. The procedure time was gradually shortened with increasing experience, and the procedure time of ESD performed with the RAFE was not significantly different from that of ESD performed with a manual endoscope. Study 2: The time for the designated movement of the endoscope was significantly shorter with a RAFE than that with a manual endoscope as for a non-endoscopist.
The RAFE that we developed enabled an expert endoscopist to perform the ESD procedure without any problems and allowed a non-endoscopist to control the endoscope more easily and quickly than a manual endoscope. The RAFE is expected to undergo further development.
KeywordsFlexible endoscopy Robotic-assisted flexible endoscope Endoscopic submucosal dissection Laparoscopic surgery Natural orifice transluminal endoscopic surgery
Compliance with ethical standards
Tsutomu Iwasa, Ryu Nakadate, Shinya Onogi, Yasuharu Okamoto, Jumpei Arata, Susumu Oguri, Haruei Ogino, Eikichi Ihara, Kenoki Ohuchida, Tomohiko Akahoshi, Tetsuo Ikeda, Yoshihiro Ogawa, and Makoto Hashizume have no conflicts of interest or financial ties to disclose.
Supplementary material 1 (MP4 20981 KB)
- 11.Diana M, Chung H, Liu KH, Dallemagne B, Demartines N, Mutter D, Marescaux J (2013) 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 27:4130–4135CrossRefPubMedGoogle Scholar
- 12.Nakadate R, Nakamura S, Moriyama T, Kenmotsu H, Oguri S, Arata J, Uemura M, Ohuchida K, Akahoshi T, Ikeda T, Hashizume M (2015) Gastric endoscopic submucosal dissection using novel 2.6-mm articulating devices: an ex vivo comparative and in vivo feasibility study. Endoscopy 47:820–824CrossRefPubMedGoogle Scholar