Natural Orifice Translumenal Endoscopic Surgery with a Miniature in Vivo Surgical Robot

Introduction: The application of flexible endoscopy tools for Natural Orifice Translumenal Endoscopic Surgery (NOTES) is constrained due to limitations in dexterity, instrument insertion, navigation, visualization, and retraction. Miniature endolumenal robots that are not constrained by the natural orifice can mitigate these constraints through providing a stable platform for visualization and dexterous manipulation. This video demonstrates the feasibility of using an endolumenal miniature robot to improve vision and to apply off-axis forces for task assistance in NOTES procedures. Methods: A two-armed miniature in vivo robot has been developed for NOTES. The robot is remotely controlled, has on-board cameras for guidance, and forceps and cautery end-effectors for manipulation. Two basic configurations of the robot allow for flexibility for insertion, and rigidity for visualization and tissue manipulation. In the insertion configuration, the arms are “disconnected” from the central body, allowing the robot to freely flex for entry through the natural orifice. Once fully inserted into the peritoneal cavity, the arms are “reconnected,” providing a stable platform for robot articulation and visualization. Embedded magnets in the body of the robot and an exterior magnetic handle are used for attaching the robot to the interior abdominal wall. This enables the surgeon to grossly manipulate the robot throughout a procedure by simply repositioning the exterior magnet handle. Results: The visualization and task assistance capabilities of the miniature robot were demonstrated in a non-survivable NOTES procedure in a porcine model. An endoscope was used to create a transgastric incision and advance an overtube into the peritoneal cavity. The robot was then inserted through the overtube and into the peritoneal cavity using an endoscope. The surgeon successfully used the robot to explore the peritoneum and perform small bowel dissection. Conclusion: This study has demonstrated the feasibility of inserting an endolumenal robot per os. Once deployed, the robot provided visualization and dexterous capabilities from multiple orientations. Further miniaturization and increased dexterity will enhance future capability.

Session: Podium Presentation

Program Number: V019