A Novel Telemanipulated Robotic Assistant for Surgical Endoscopy: Preclinical Application to ESD

Lucile Zorn (1) , Florent Nageotte (1) , Philippe Zanne (1) , Andras Legner (1) , Bernard Dallemagne (1) , Jacques Marescaux (2, 1) , Michel de Mathelin (1)

1 ICube - Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie
2 IHU Strasbourg - L'Institut hospitalo-universitaire de Strasbourg

Objective: Minimally invasive surgical interventions in the gastrointestinal tract, such as Endoscopic Submucosal Dissection (ESD), are very difficult for surgeons when performed with standard flexible endoscopes. Robotic flexible systems have been identified as a solution to improve manipulation. However, only a few such systems have been brought to preclinical trials as of now. As a result, novel robotic tools are required. Methods: We developed a telemanipulated robotic device, called STRAS, which aims to assist surgeons during intraluminal surgical endoscopy. This is a modular system, based on a flexible endoscope and flexible instruments, which provides 10 degrees of freedom (DoFs). The modularity allows to easily set up the robot and to navigate towards the operating area. The robot can then be teleoperated using master interfaces specifically designed to intuitively control all available DoFs. STRAS capabilities have been tested in laboratory conditions and during preclinical experiments. Results: We report twelve colorectal ESDs performed in pigs, in which large lesions were successfully removed. Dissection speeds are compared with those obtained in similar conditions with the manual Anubiscope TM platform from Karl Storz. We show significant improvements (p = 0.01). Conclusion: These experiments show that STRAS (v2) provides sufficient DoFs, workspace and force to perform ESD, that it allows a single surgeon to perform all the surgical tasks and that performances are improved with respect to manual systems. Significance: The concepts developed for STRAS are validated and could bring new tools for surgeons to improve comfort, ease and performances for intraluminal surgical endoscopy.

Mots clés: Medical robotics; Intraluminal surgery; Teleoperation; Endoscopic Submucosal Dissection

Domaines: Ingénierie biomédicale; Automatique / Robotique

Lucile Zorn, Florent Nageotte, Philippe Zanne, Andras Legner, Bernard Dallemagne, et al.. A Novel Telemanipulated Robotic Assistant for Surgical Endoscopy: Preclinical Application to ESD. IEEE Transactions on Biomedical Engineering, 2018, 65 (4), pp.797-808. ⟨10.1109/TBME.2017.2720739⟩. ⟨hal-02377106⟩