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Ghosh NK, Kumar A. Ultra-minimally invasive endoscopic techniques and colorectal diseases: Current status and its future. Artif Intell Gastrointest Endosc 2024; 5:91424. [DOI: 10.37126/aige.v5.i2.91424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/12/2024] [Accepted: 05/06/2024] [Indexed: 05/11/2024] Open
Abstract
Colorectal diseases are increasing due to altered lifestyle, genetic, and environmental factors. Colonoscopy plays an important role in diagnosis. Advances in colonoscope (ultrathin scope, magnetic scope, capsule) and technological gadgets (Balloon assisted scope, third eye retroscope, NaviAid G-EYE, dye-based chromoendoscopy, virtual chromoendoscopy, narrow band imaging, i-SCAN, etc.) have made colonoscopy more comfortable and efficient. Now in-vivo microscopy can be performed using confocal laser endomicroscopy, optical coherence tomography, spectroscopy, etc. Besides developments in diagnostic colonoscopy, therapeutic colonoscopy has improved to manage lower gastrointestinal tract bleeding, obstruction, perforations, resection polyps, and early colorectal cancers. The introduction of combined endo-laparoscopic surgery and robotic endoscopic surgery has made these interventions feasible. The role of artificial intelligence in the diagnosis and management of colorectal diseases is also increasing day by day. Hence, this article is to review cutting-edge developments in endoscopic principles for the management of colorectal diseases.
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Affiliation(s)
- Nalini Kanta Ghosh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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Erozkan K, Gorgun E. Robotic colorectal surgery and future directions. Am J Surg 2024; 230:91-98. [PMID: 37953126 DOI: 10.1016/j.amjsurg.2023.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023]
Abstract
As the adoption of robotic-assisted procedures expands across various surgical specialties, colorectal surgery stands out as a prominent beneficiary. This rise in usage can be traced back to the increased accessibility of robotic platforms and a growing institutional shift towards cutting-edge surgical methods. When compared with traditional laparoscopic methods, robotic techniques offer distinct advantages. Their true potential shines in surgeries involving complex anatomical regions, where the robot's enhanced dexterity and range of motion prove invaluable. The three-dimensional, magnified view provided by robotic systems further boosts surgical precision and clarity. These advantages render robotic assistance especially suitable for colorectal surgeries, notably in intricate areas such as the rectum and endoluminal spaces. As the medical world emphasizes minimally invasive surgical methods, there's a pressing need to evolve and optimize robotic techniques in colorectal surgery. This article traces the evolution of robotic interventions in colorectal surgeries, highlighting both its historical milestones and anticipated future trends. We'll also explore emerging robotic tools and systems set to reshape the colorectal surgical arena.
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Affiliation(s)
- Kamil Erozkan
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
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Ozgur I, Cheong JY, Liska D, Holubar S, Valante MA, Steele SR, Gorgun E. Endorobotic submucosal dissection of rectal lesions using the single port robot DaVinci-SP: initial experience of the first 10 cases. ANZ J Surg 2024; 94:691-696. [PMID: 38012087 DOI: 10.1111/ans.18796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Endoluminal surgery is increasingly recognized as a mode of treatment for colorectal neoplasms with the latest robotic single port platform Da Vinci-SP (Intuitive Surgical, Sunnyvale) facilitating submucosal dissection of benign rectal neoplasm. METHOD In this study, we present our initial experience with endorobotic submucosal dissection in the management of benign rectal neoplasms using the Da Vinci-SP (Intuitive Surgical, Sunnyvale) between 2020 and 2021. The primary endpoint was the successful completion of submucosal dissection. RESULTS During the study period, 10 patients underwent endorobotic submucosal dissection for benign rectal neoplasms. The median age of the patients was 68 (range: 59-78) years, and the mean BMI was 29.38 (range: 22.9-38.5). The mean size of the lesion was 42.3 mm (range: 20-65 mm) and was located 7.3 cm (mean) from the anal verge (range: 2-10 cm). The mean operative time was 91.3 minutes (range: 57-137 minutes). All 10 dissections were completed successfully en bloc. There were no intraoperative complications or mortality. All patients were discharged on the same day and commenced on a normal diet. Late bleeding was observed in one patient receiving anticoagulation, and one patient had urinary retention. Pathology revealed two adenocarcinomas, six tubulovillous adenomas, one tubular adenoma, and one sessile serrated adenoma. There was no recurrence in all other patients during the median follow-up of 6 months (range: 4-16 months). CONCLUSIONS Endorobotic submucosal dissection using a single-port robotic platform is safe and feasible for benign rectal mucosal neoplasms. The semiflexible platform offers an alternative to endoscopic submucosal dissection with favourable outcomes.
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Affiliation(s)
- Ilker Ozgur
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ju Yong Cheong
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Liska
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stefan Holubar
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael A Valante
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott R Steele
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Yang X, Gao H, Fu S, Ji R, Hou C, Liu H, Luan N, Ren H, Sun L, Yang J, Zhou Z, Yang X, Sun L, Li Y, Zuo X. Novel miniature transendoscopic telerobotic system for endoscopic submucosal dissection (with videos). Gastrointest Endosc 2024; 99:155-165.e4. [PMID: 37820930 DOI: 10.1016/j.gie.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/10/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND AIMS The lack of tissue traction and instrument dexterity to allow for adequate visualization and effective dissection were the main issues in performing endoscopic submucosal dissection (ESD). Robot-assisted systems may provide advantages. In this study we developed a novel transendoscopic telerobotic system and evaluated its performance in ESD. METHODS A miniature dual-arm robotic endoscopic assistant for minimally invasive surgery (DREAMS) was developed. The DREAMS system contained the current smallest robotic ESD instruments and was compatible with the commercially available dual-channel endoscope. After the system was established, a prospective randomized controlled study was conducted to validate the performance of the DREAMS-assisted ESD in terms of efficacy, safety, and workload by comparing it with the conventional technique. RESULTS Two robotic instruments can achieve safe collaboration and provide sufficient visualization and efficient dissection during ESD. Forty ESDs in the stomach and esophagus of 8 pigs were completed by DREAMS-assisted ESD or conventional ESD. Submucosal dissection time was comparable between the 2 techniques, but DREAMS-assisted ESD demonstrated a significantly lower muscular injury rate (15% vs 50%, P = .018) and workload scores (22.30 vs 32.45, P < .001). In the subgroup analysis of esophageal ESD, DREAMS-assisted ESD showed significantly improved submucosal dissection time (6.45 vs 16.37 minutes, P = .002), muscular injury rate (25% vs 87.5%, P = .041), and workload (21.13 vs 40.63, P = .001). CONCLUSIONS We developed a novel transendoscopic telerobotic system, named DREAMS. The safety profile and technical feasibility of ESD were significantly improved with the assistance of the DREAMS system, especially in the narrower esophageal lumen.
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Affiliation(s)
- Xiaoxiao Yang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Huxin Gao
- Depart of Biomedical Engineering, National University of Singapore, Singapore; NUS (Suzhou) Research Institute, Suzhou, China; Department of Electronic Engineering and the Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Shichen Fu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Rui Ji
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Cheng Hou
- School of Mechanical and Electric Engineering, Jiangsu Provincial Key Laboratory of Advanced Robotics, Soochow University, Suzhou, China
| | - Huicong Liu
- School of Mechanical and Electric Engineering, Jiangsu Provincial Key Laboratory of Advanced Robotics, Soochow University, Suzhou, China
| | - Nan Luan
- The School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hongliang Ren
- Depart of Biomedical Engineering, National University of Singapore, Singapore; NUS (Suzhou) Research Institute, Suzhou, China; Department of Electronic Engineering and the Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Liping Sun
- Faculty of Medical Instrumentation, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jialin Yang
- Robo Medical Technology Co, Ltd, Shenzhen, China
| | - Zhifeng Zhou
- Huaco Healthcare Technologies Co Ltd, Beijing, China
| | - Xiaoyun Yang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Lining Sun
- School of Mechanical and Electric Engineering, Jiangsu Provincial Key Laboratory of Advanced Robotics, Soochow University, Suzhou, China
| | - Yanqing Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China; Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, China; Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Xiuli Zuo
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China; Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, China; Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
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Kume K. Flexible robotic endoscopy for treating gastrointestinal neoplasms. World J Gastrointest Endosc 2023; 15:434-439. [PMID: 37397973 PMCID: PMC10308274 DOI: 10.4253/wjge.v15.i6.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 06/14/2023] Open
Abstract
Therapeutic flexible endoscopic robotic systems have been developed primarily as a platform for endoscopic submucosal dissection (ESD) in the treatment of early-stage gastrointestinal cancer. Since ESD can only be performed by highly skilled endoscopists, the goal is to lower the technical hurdles to ESD by introducing a robot. In some cases, such robots have already been used clinically, but they are still in the research and development stage. This paper outlined the current status of development, including a system by the author’s group, and discussed future challenges.
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Affiliation(s)
- Keiichiro Kume
- Third Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu 8078555, Japan
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A Look into the Future of Endoscopic Submucosal Dissection and Third Space Endoscopy: The Role for Robotics and Other Innovation. Gastrointest Endosc Clin N Am 2023; 33:197-212. [PMID: 36375883 DOI: 10.1016/j.giec.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Endoscopic resection has been widely applied especially in endoscopic submucosal dissection and third space endoscopy (TSE). Flexible endoluminal robotics allow performance of endoscopic submucosal dissection with exposure of the submucosal plane for precise dissection using two robotic arms. The introduction of TSE revolutionized the horizon of therapeutic endoscopy to the submucosal space beneath and beyond the mucosa. Advantages of TSE include avoidance of full thickness incision in gastrointestinal tract through the submucosal tunneling for performance of peroral endoscopic myotomy and submucosal tunneling endoscopic resection. In future, robotic-driven devices should be developed to enhance performance of complex endoluminal procedures and TSE.
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Cui Y, Thompson CC, Chiu PWY, Gross SA. Robotics in therapeutic endoscopy (with video). Gastrointest Endosc 2022; 96:402-410. [PMID: 35667390 DOI: 10.1016/j.gie.2022.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 02/08/2023]
Abstract
Since its inception, endoscopy has evolved from a solely diagnostic procedure to an expanding therapeutic field within gastroenterology. The incorporation of robotics in gastroenterology initially addressed shortcomings of flexible endoscopes in natural orifice transluminal endoscopy. Developing therapeutic endoscopic robotic platforms now offer operators improved ergonomics, visualization, dexterity, precision, and control and the possibility of increasing proficiency and standardization of complex endoscopic procedures including endoscopic submucosal dissection, endoscopic full-thickness resection, and endoscopic suturing. The following review discusses the history, potential applications, and tools currently available and in development for robotics in therapeutic endoscopy.
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Affiliation(s)
- YongYan Cui
- Department of Gastroenterology, New York University Medical Center, New York, New York, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Wai Yan Chiu
- Department of Surgery, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Seth A Gross
- Department of Gastroenterology, New York University Medical Center, New York, New York, USA
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Affiliation(s)
- A Arezzo
- Department of Surgical Sciences, University of Turin, c.so Dogliotti 14, 10126, Turin, Italy.
| | - G Gagliardi
- Department of Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
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