Issues and Challenges of Flexible Endoscopic Surgery Robots

Dong-Soo Kwon

Emeritus Professor, Department of Mechanical Engineering

Korea Advanced Institute of Science and Technology

【Abstract】

The successful clinical adaptation of the da Vinci system in laparoscopic surgeries demonstrated the benefits of robotic assistance such as precise and dexterous instrument motion and intuitive and ergonomic manipulation. In endoscopic surgery, surgical robots are gradually transiting to flexible systems to reach the surgical site via narrow and tortuous pathways.

This presentation discusses the technical issues and challenges of flexible endoscopic surgery robots.  Two types of flexible endoscopic robotic surgical systems have been developing overcoming several technical issues.  The first robot system is for ureter and renal stone removal that is capable of teleoperation of a flexible ureteroscope, a laser fiber, and a stone basket. The system can equip commercial flexible ureteroscopes. The system provides intuitive and comfortable remote manipulation of the ureteroscope and instruments by a single operator without wearing a lead gown. Moreover, the system provides assistive functions such as an automation capability that can record and replay the ureteroscope motion, and the detection of oversized stone retrieval to prevent ureteral injury.  A first-in-human trial for approval by the Korean Ministry of Food and Drug Safety has finished with a favorable stone-free rate and without any major complications.

The second robot system features a bendable overtube and multiple flexible surgical instruments. The robot can enhance the accessibility to the surgical site located in curved and confined spaces, then provide complex surgical tasks such as dissection or suturing with intuitive teleoperation. The feasibility of the system in transoral surgery and gastrointestinal endoscopic submucosal dissection has been demonstrated through several animal trials.

Further advancement of such flexible robotic systems will overcome the limitations of a conventional endoscopy or a surgical robot and broaden the application of a minimum invasive surgery in various fields through transluminal and extraluminal approaches as well as an endoluminal approach.