Steerable Sheaths That Turn Endoscopes into Robotic Platforms for Colon Interventions.

Abstract

Both the feasibility and clinical benefits of endoscopic interventions for colon lesions have been demonstrated by pioneering surgeons. Yet endoscopic approaches have not been widely deployed clinically because they are challenging to learn and perform with conventional endoscopes. Motivated by this, several robotic platforms have been created over the past few years with the goal of enhancing surgeon dexterity. To date, all such robots have used custom-made endoscopes with integrated manipulators. This typically results in robots significantly larger than conventional endoscopes, and the systems proposed would ultimately require hospitals to completely replace their conventional endoscopes with a new robotic solution, leading to undesirable cost and workflow ramifications. It has never before been possible to use conventional endoscopes directly with this type of system, because there were no robotic manipulators small, dexterous, and strong enough to pass through existing endoscope ports and enable the maneuvers needed to perform the surgery. In this paper, we show that the recent invention of steerable sheaths based on the concentric push-pull principle makes it possible to convert conventional endoscopes into multi-arm robotic platforms for colon procedures. We demonstrate our system in endoscopic submucosal dissection (ESD) in ex vivo porcine feasibility experiments. Even users with no prior experience in endoscopic submucosal dissection were able to successfully perform the procedure using our system.