Applications of Flexible Robots in Endoscopic Surgery

Abstract Conventional cancer surgery requires making huge incisions to gain access to internal organs for removal of tumors. This often leads to substantial disability and complications; especially in gastrointestinal organ surgery. The invention of optical fiber technology enhanced the development of laparoscopic and endoscopic surgery. However, in endoscopic surgery, some of the key difficulties are still present: lack of tissue retraction, lack of triangulation, and coupled movement between camera view and tools. These difficulties require a high level of surgical skills to compensate and thus increase the training time of surgeons. Gastric and colorectal cancers are the leading causes of cancer death worldwide. The literature shows that the survival rate for patients with these cancers could be improved if the tumors are removed en bloc at an early stage. Endoscopic submucosal dissection (ESD) is a special endoscopic surgery technique which targets the removal of submucosal tissue. Unfortunately, ESD is technically challenging due to the above difficulties in manipulating endoscopic devices. Perforation often happens during this surgery. Therefore, a surgical robotic system is proposed to ease these problems. The dual-arm flexible manipulator is driven by the tendon-sheath mechanism, which is designed as tiny as possible to be inserted into the human body and then controlled remotely. In vivo experiments show that the system increases the safety and reduces the operation time compared to conventional procedures.