Evolution of Robotics in Endoscopy—Past and Future

Abstract

The field of flexible endoscopy has evolved rapidly since the introduction of the semiflexible gastroscope. Now, robotic flexible endoscopy is beginning to gain a foothold and mirror the path that laparoscopy has taken. This review describes the development of platforms that have entered the field over the past two decades—from clever enhancements to existing endoscopes to fully robotic platforms with high-tech teleoperational consoles. These advancements improve upon visualization, articulation, and locomotion to reproduce surgery on a miniature scale—both endoluminally and intracorporeally. The field of robotic flexible endoscopy is highly variegated with a multitude of platforms in development, promising a bright future where minimally invasive procedures become safely accessible to patients worldwide.

Keywords

endoscopy - flexible - robotic

Publication History

Article published online:
28 August 2024

• References

• 1 Ponsky JL, Strong AT. A history of flexible gastrointestinal endoscopy. Surg Clin North Am 2020; 100 (06) 971-992
• 2 Bardaro SJ, Swanström L. Development of advanced endoscopes for natural orifice transluminal endoscopic surgery (NOTES). Minim Invasive Ther Allied Technol 2006; 15 (06) 378-383
• 3 Spaun GO, Zheng B, Swanström LL. A multitasking platform for natural orifice transluminal endoscopic surgery (NOTES): a benchtop comparison of a new device for flexible endoscopic surgery and a standard dual-channel endoscope. Surg Endosc 2009; 23 (12) 2720-2727
• 4 Fuchs KH, Breithaupt W. Transgastric small bowel resection with the new multitasking platform EndoSAMURAI™ for natural orifice transluminal endoscopic surgery. Surg Endosc 2012; 26 (08) 2281-2287
• 5 Lomanto D, Wijerathne S, Ho LKY, Phee LSJ. Flexible endoscopic robot. Minim Invasive Ther Allied Technol 2015; 24 (01) 37-44
• 6 Chiu PWY, Phee SJ, Wang Z. et al. Feasibility of full-thickness gastric resection using master and slave transluminal endoscopic robot and closure by Overstitch: a preclinical study. Surg Endosc 2014; 28 (01) 319-324
• 7 Phee SJ, Reddy N, Chiu PWY. et al. Robot-assisted endoscopic submucosal dissection is effective in treating patients with early-stage gastric neoplasia. Clin Gastroenterol Hepatol 2012; 10 (10) 1117-1121
• 8 Phee SJ, Ho KY, 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 (09) 2293-2298
• 9 Dallemagne B, Marescaux J. The ANUBIS™ project. Minim Invasive Ther Allied Technol 2010; 19 (05) 257-261
• 10 Perretta S, Dallemagne B, Barry B, Marescaux J. The ANUBISCOPE® flexible platform ready for prime time: description of the first clinical case. Surg Endosc 2013; 27 (07) 2630-2630
• 11 Diana M, Chung H, Liu KH. et al. 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 2013; 27 (11) 4130-4135
• 12 Nageotte F, Zorn L, Zanne P, De Mathelin M. STRAS: a modular and flexible telemanipulated robotic device for intraluminal surgery. In: Abedin-Nasab MH. ed. Handbook of Robotic and Image-Guided Surgery. Elsevier; 2020: 123-146
• 13 Berthet-Rayne P, Gras G, Leibrandt K. et al. The i²Snake robotic platform for endoscopic surgery. Ann Biomed Eng 2018; 46 (10) 1663-1675
• 14 Berthet-Rayne P, Leibrandt K, Kim K, Seneci CA, Shang J, Yang GZ. Rolling-joint design optimization for tendon driven snake-like surgical robots. IEEE RSJ Int Conf Intell Robots Syst IROS 2018; 4964-4971
• 15 Hwang M, Kwon DS. K-FLEX: a flexible robotic platform for scar-free endoscopic surgery. Int J Med Robot 2020; 16 (02) e2078
• 16 Carmichael H, D'Andrea AP, Skancke M, Obias V, Sylla P. Feasibility of transanal total mesorectal excision (taTME) using the Medrobotics Flex® System. Surg Endosc 2020; 34 (01) 485-491
• 17 Mattheis S, Hasskamp P, Holtmann L. et al. Flex Robotic System in transoral robotic surgery: the first 40 patients. Head Neck 2017; 39 (03) 471-475
• 18 Moura DTH, Aihara H, Thompson CC. Robotic-assisted surgical endoscopy: a new era for endoluminal therapies. VideoGIE 2019; 4 (09) 399-402
• 19 Atallah S, Sanchez A, Bianchi E, Larach SW. Envisioning the future of colorectal surgery: preclinical assessment and detailed description of an endoluminal robotic system (ColubrisMX ELS). Tech Coloproctol 2021; 25 (11) 1199-1207
• 20 Qatomah A, Aihara H. Colorectal endoscopic submucosal dissection in the USA: the current state and future perspectives. DEN Open 2024; 5 (01) e394
• 21 Russo S, Ranzani T, Walsh CJ, Wood RJ. An additive millimeter-scale fabrication method for soft biocompatible actuators and sensors. Adv Mater Technol 2017; 2 (10) 1700135
• 22 Yang GZ, Cambias J, Cleary K. et al. Medical robotics - regulatory, ethical, and legal considerations for increasing levels of autonomy. Sci Robot 2017; 2 (04) eaam8638
• 23 Ding Z, Shi H, Zhang H. et al. Gastroenterologist-level identification of small-bowel diseases and normal variants by capsule endoscopy using a deep-learning model. Gastroenterology 2019; 157 (04) 1044-1054.e5