Endoluminal surgical triangulation 2.0: A new flexible surgical robot. Preliminary pre-clinical results with colonic submucosal dissection.

BACKGROUND: Complex intraluminal surgical interventions of the gastrointestinal tract are challenging due to the limitation of existing instruments. Our group has developed a master-slave robotic flexible endoscopic platform that provides instrument triangulation in an endoluminal environment.

MATERIALS AND METHODS: Colonic endoscopic submucosal dissections (ESD) were carried out in eight pigs. The robot was introduced transanally. A combination of adapted tele-operated instruments was used. Specimens were inspected and measured.

RESULTS: Out of 18 ESDs in total, 12 were successfully completed. Among the completed procedures, two perforations and one system failure occurred and were managed intraoperatively. There was no major bleeding. Mean size of the removed specimens was 18.2 ± 9.8 cm2 and mean total procedure time was 73 ± 35.5 min.

CONCLUSIONS: Experimental colorectal ESDs using the flexible surgical robot were feasible and reflected a short learning curve. After some technical improvements the system might allow for a wider adoption of complex endoluminal surgical procedures.