Using a Flexible Robotic Endoscopic NOTES Platform Transgastrically in a Cadaver to Test Access, Navigation, Maneuverability and Stability

OBJECTIVE: The advancement of NOTES highly depends on the availability of suitable platforms and instruments. A NOSCAR working group has identified access, navigation, maneuverability and stability to withstand instrument forces as essential requirements for a successful NOTES platform. No platform used for NOTES to date can adequately achieve all four of these key capabilities. Here we test a novel flexible endoscopic robotic platform in a cadaver to determine how it performs with respect to these requirements.
METHOD: A highly maneuverable multi-channel flexible robotic endoscopic platform developed for NOTES was used in a transgastric NOTES procedure in an adult cadaver to test the system’s ability to reach regions within the abdomen for cholecystectomy, appendectomy, oophorectomy and splenectomy. A laparoscopic surgeon was under complete control of the device throughout the procedure and was blinded to a laparoscopic camera placed for documentation. At each target organ, the platform was maneuvered via joystick to provide different camera views and tool access orientation appropriate for the surgical tasks of each procedure. Standard non-articulating endoscopic tools were used in the platform’s two working channels to demonstrate the platform’s ability to withstand the forces generated during dissection, clipping and tissue manipulation.
RESULTS: The platform was able to reach each target organ site without difficulty and without relying on the laparoscopic image. The platform was able to maintain stability by resisting the forces exerted by tools in the tool channels used for dissection, tissue manipulation and clipping. Visualization was determined to be adequate and the surgeon could easily reposition the platform to gain a different camera view or tool access orientation about an organ.
DISCUSSION:
The access, navigation, maneuverability and stability identified as critical by NOSCAR were demonstrated by the flexible robotic endoscopic platform in this study and may therefore further the advancement and adoption of NOTES by providing four essential capabilities in a single device.


Session: Podium Presentation

Program Number: S060

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