Sewing up the Wounds: Flexible Endoscopic Surgical Robots
Perforations in the digestive tract are life-threatening, and that is why endoscopic physicians are very cautious when trying to remove cancerous tumors in the stomach or colon: they are afraid of cutting through the organs (i.e., perforations) and they do not have good tools to close the perforation. We developed a flexible endoscopic surgical robot to securely close the perforation by suturing - the gold standard of perforation closure. The tiny, dexterous robotic arms are inserted into the digestive tract via natural orifices (e.g., mouth or anus) and they are teleoperated by the clinician to repair the perforation. In this way, the clinician is able to close the perforation without opening up the patient's body, a big advance compared to open surgery and laparoscopic surgery. Being able to suture perforations, the clinician can then cut deeper (more cleanly) when removing cancerous tumors that are deeply seeded in the digestive tract wall; he/she can even purposely make a hole on the stomach or colon to reach other organs outside for surgery on these organs; once done, the purposely created hole can then be sutured. This would promote a paradigm shift of current minimally invasive surgery from laparoscopic surgery to Natural Orifice Transluminal Endoscopic Surgery (NOTES) which promises scarless and faster recovery. Find the in-vivo trial of this system on a live swine here
When the colon is perforated, the colon would collaspe because of the intra-abdominal pressure and peristalsis of the colon. Once the colon is collapsed, the clinician would lose visualization and task space. Although insufflation is commonly used for expanding the colon, it does not function when there is a perforation on the colon wall. To support the collapsing colon and ensure sufficient visualization and task space even with a perforation, we developed a deployable colon support structure (CSS) that can be seamlessly adapted to the existing procedures. While the CSS is designed to be small and flexible enough to pass through an endoscopic channel that can be tortuous, it becomes steady enough to hold the collapsing/squeezing colon after being deployed. Also, the CSS is collapsible after task completion, for retraction through an endoscopic channel. Through the ex-vivo and in-vivo studies with a swine, we have successfully demonstrated the feasibility of supporting the colon wall during endoluminal interventions with the CSS. We confirmed that the CSS was easily deliverable and deployable and the created space was large enough to perform surgical tasks using robotic arms. Find more in this video.
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