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Nabi Z, Manchu C, Reddy DN. Robotics in interventional endoscopy-evolution and the way forward. Indian J Gastroenterol 2024:10.1007/s12664-024-01663-6. [PMID: 39172182 DOI: 10.1007/s12664-024-01663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/29/2024] [Indexed: 08/23/2024]
Abstract
The integration of robotics into gastrointestinal (GI) endoscopy represents a transformative advancement and bears the potential to bridge the gap between traditional limitations by offering unprecedented precision and control in diagnostic and therapeutic procedures. This review explores the historical progression, current applications and future potential of robotic platforms in GI endoscopy. Originally designed for surgical applications, robotic systems have expanded their reach into endoscopy, potentially enhancing procedural accuracy and reducing ergonomic strain on practitioners. Natural Orifice Transluminal Endoscopic Surgery (NOTES) emerged as a promising technique, leveraging natural orifices to perform minimally invasive surgeries. Despite its initial potential, several factors, including limitations of the available instrumentations and lack of reliable closure techniques, hindered its widespread adoption and progress. Conventional endoscopic tools often fall short in terms of triangulation, traction and degrees of freedom, necessitating the adoption of robotic interventions. Over recent decades, robotic endoscopy has significantly evolved, focusing on both diagnostic and complex therapeutic procedures such as endoscopic sub-mucosal dissection (ESD) and endoscopic full-thickness resection (EFTR). Various robotic platforms demonstrate enhanced safety and efficiency in GI procedures. As the field progresses, the emphasis on clinical validation, advanced training and the exploration of new applications remains crucial. Continuous innovation in robotic technology and endoscopic techniques promises to overcome existing limitations, further revolutionizing the management of GI diseases and improving patient outcomes.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, 500 082, India
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Dreyfus R, Boehler Q, Lyttle S, Gruber P, Lussi J, Chautems C, Gervasoni S, Berberat J, Seibold D, Ochsenbein-Kölble N, Reinehr M, Weisskopf M, Remonda L, Nelson BJ. Dexterous helical magnetic robot for improved endovascular access. Sci Robot 2024; 9:eadh0298. [PMID: 38354258 DOI: 10.1126/scirobotics.adh0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024]
Abstract
Treating vascular diseases in the brain requires access to the affected region inside the body. This is usually accomplished through a minimally invasive technique that involves the use of long, thin devices, such as wires and tubes, that are manually maneuvered by a clinician within the bloodstream. By pushing, pulling, and twisting, these devices are navigated through the tortuous pathways of the blood vessels. The outcome of the procedure heavily relies on the clinician's skill and the device's ability to navigate to the affected target region in the bloodstream, which is often inhibited by tortuous blood vessels. Sharp turns require high flexibility, but this flexibility inhibits translation of proximal insertion to distal tip advancement. We present a highly dexterous, magnetically steered continuum robot that overcomes pushability limitations through rotation. A helical protrusion on the device's surface engages with the vessel wall and translates rotation to forward motion at every point of contact. An articulating magnetic tip allows for active steerability, enabling navigation from the aortic arch to millimeter-sized arteries of the brain. The effectiveness of the magnetic continuum robot has been demonstrated through successful navigation in models of the human vasculature and in blood vessels of a live pig.
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Affiliation(s)
- R Dreyfus
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - Q Boehler
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - S Lyttle
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - P Gruber
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - J Lussi
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - C Chautems
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - S Gervasoni
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - J Berberat
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - D Seibold
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- Institute of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
| | - M Reinehr
- University of Zurich, Zurich, Switzerland
| | - M Weisskopf
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - L Remonda
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - B J Nelson
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
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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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Pan H, Zhang S, Lu Y, Han Z, Li X, Li Z, Cui Y, Han M, Li R. Ultrathin endoscope equipped with ultrasonic miniprobe for upper GI US in a porcine model. Gastrointest Endosc 2024; 99:108-115.e1. [PMID: 37739237 DOI: 10.1016/j.gie.2023.09.009] [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: 06/12/2023] [Revised: 08/08/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Ultrathin EGD (UT-EGD) is an ideal tool for unsedated upper GI examination and pediatric gastroenterology but is rarely competent for EUS miniprobe (EUS-MP). We developed a UT-EGD US method (UT-EUS) and verified its clinical application value through animal experiments. METHODS Five Bama miniature pigs were selected. Using an acoustic medium, we performed US on the duodenum, stomach, and esophagus, respectively, with conventional 20-MHz EUS miniprobe (EUS-MP-20), 20-MHz UT-EUS (UT-EUS-20), and 30-MHz UT-EUS (UT-EUS-30). The times to acquire 5 consecutive stable US images, number of identifiable wall layers, and quality and penetration depth of the images were recorded. RESULTS No significant differences were found in the time required to obtain images between EUS-MP-20 and UT-EUS-20 at each site (P > .05). UT-EUS-30 showed more wall levels than UT-EUS-20 (P < .05). No significant differences were noted between EUS-MP-20 and UT-EUS-20 in imaging quality and penetration depth (P > .05). CONCLUSIONS The UT-EUS is easy to use with a satisfactory image quality and has potential clinical application value.
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Affiliation(s)
- Hanchao Pan
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Siyue Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongda Lu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhile Han
- The Medical Ultrasound Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Xinze Li
- The Medical Ultrasound Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Zhangjian Li
- The Medical Ultrasound Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Yaoyao Cui
- The Medical Ultrasound Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Mei Han
- Department of Health Management Center, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, 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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