Total mesorectal excision using a soft and flexible robotic arm: a feasibility study in cadaver models

Area of Science:

• Robotics in Surgery
• Minimally Invasive Procedures
• Surgical Technology Innovation

Background:

• The STIFF-FLOP project developed a novel stiffness-controllable flexible manipulator for surgical applications.
• This research addresses limitations of current rigid-link robotic systems in surgery.
• The study introduces a soft, flexible robotic arm for enhanced optic vision during procedures.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of the STIFF-FLOP robotic optic arm in cadaveric total mesorectal excision (TME).
• To assess the visual field advantages of the flexible robotic optic compared to standard laparoscopic vision.
• To explore the potential of soft robotics in overcoming challenges in difficult laparoscopic surgeries.

Main Methods:

• The STIFF-FLOP robotic optics system was utilized in two embalmed male cadavers for TME procedures.
• The flexible optic prototype comprised two 60 mm modules with a 14.3 mm maximum outer diameter.
• Procedures involved standard laparoscopic instruments and a 6-degree-of-freedom manipulator arm controlled via joysticks.

Main Results:

• Laparoscopic TME was successfully completed in both cadavers using the STIFF-FLOP robotic optics.
• The flexible robotic arm provided superior angles of vision in the pelvis, ensuring an intact mesorectum.
• Procedure times were 165 and 145 minutes, with no intraoperative complications or technical failures recorded.

Conclusions:

• The STIFF-FLOP soft and flexible robotic optic arm is effective for assisting laparoscopic TME in a cadaver model.
• It offers a superior field of vision, particularly in the deep pelvis, compared to standard laparoscopy.
• Soft and flexible robotic devices show promise for improving outcomes in challenging laparoscopic surgeries.