Natural orifice transluminal endoscopic surgery (NOTES) involves accessing the abdominal cavity via one of the body natural orifices for enabling minimally invasive surgical procedures. However, the constraints imposed by the access modality and the limited available technology make NOTES very challenging for surgeons. Tools redesign and introduction of novel surgical instruments are imperative in order to make NOTES operative in a real surgical scenario, reproducible and reliable. Robotic technology has major potential to overcome current limitations.
The robotic platform described here consists of a magnetic anchoring frame equipped with dedicated docking/undocking mechanisms to house up to three modular robots for surgical interventions. The magnetic anchoring frame guarantees the required stability for surgical tasks execution, whilst dedicated modular robots provide the platform with adequate vision, stability and manipulation capabilities.
Platform potentialities were demonstrated in a porcine model. Assessment was organized into two consecutive experimental steps, with a hybrid testing modality. First, platform deployment, anchoring and assembly through transoral–transgastric access were demonstrated in order to assess protocol feasibility and guarantee the safe achievement of the following experimental session. Second, transabdominal deployment, anchoring, assembly and robotic module actuation were carried out.
This study has demonstrated the feasibility of inserting an endoluminal robotic platform composed of an anchoring frame and modular robotic units into a porcine model through a natural orifice. Once inserted into the peritoneal cavity, the platform provides proper visualization from multiple orientations. For the first time, a platform with interchangeable modules has been deployed and its components have been connected, demonstrating in vivo the feasibility of intra-abdominal assembly. Furthermore, increased dexterity employing different robotic units will enhance future system capabilities.
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The authors wish to thank Mr N. Funaro for manufacturing the prototypes, Professor Sir Alfred Cuschieri for his precious recommendations during the optimization of the platform design, and Dr. S. Schostek and novineon CRO team for their invaluable help during the animal experiments. This work was supported by the European Commission in the framework of the ARAKNES FP7 European Project, Grant No. 224565.
Selene Tognarelli, Marco Salerno, Giuseppe Tortora, Claudio Quaglia, Paolo Dario, Marc Oliver Schurr and Arianna Menciassi have no conflicts of interest or financial ties to disclose.
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Tognarelli, S., Salerno, M., Tortora, G. et al. A miniaturized robotic platform for natural orifice transluminal endoscopic surgery: in vivo validation. Surg Endosc 29, 3477–3484 (2015) doi:10.1007/s00464-015-4097-x
- Laparoscopic surgery
- Miniature robots
- Modular platform