A Master-Slave Controlled Flexible Robotic System for Endoscopic Submucosal Dissection: Integrated Endoscope Guidance...

Area of Science:

• Gastroenterology
• Robotics
• Medical Devices

Background:

• Endoscopic submucosal dissection (ESD) faces challenges including unstable visualization, inadequate traction, and ergonomic strain, especially in colorectal procedures.
• Manual endoscope manipulation limits precision and efficiency during complex dissections.

Purpose of the Study:

• To develop and evaluate EndoDreams, a flexible robotic assistant for ESD.
• To assess the system's ability to improve endoscope guidance and dual-arm tissue handling.
• To validate the feasibility and safety of robotic-assisted ESD.

Main Methods:

• Developed EndoDreams, a robotic ESD assistant with master-slave control for endoscope guidance and dual-arm instrumentation.
• Quantified master-slave responsiveness through benchtop latency and repeatability tests.
• Evaluated in vivo feasibility in a porcine model (n=24) for gastric and colorectal lesion resection using standardized ESD protocols.

Main Results:

• Bench testing demonstrated minimal master-slave latency (<300ms).
• In vivo studies showed EndoDreams significantly increased dissection efficiency (shorter time, higher speed) and improved submucosal exposure.
• The system demonstrated potential safety benefits, including reduced muscular injury and perforation in colorectal lesions, and decreased operator workload (NASA-TLX).

Conclusions:

• The EndoDreams system effectively overcomes limitations of conventional ESD by providing precise endoscope delivery and dual-arm tissue manipulation.
• Master-slave control framework enhances precision and reduces surgeon strain.
• Benchtop and in vivo validations confirm the feasibility and clinical safety of EndoDreams for robotic-assisted ESD.