Allemann Pierre, Ott Laurent, Asakuma Mitsuhiro, Masson Norbert, Perretta Silvana, Dallemagne Bernard, Coumaros Dimitri, De Mathelin Michel, Soler Luc, Marescaux Jacques
IRCAD-EITS Institute, Strasbourg, France.
Surg Innov. 2009 Jun;16(2):111-6. doi: 10.1177/1553350609338181.
NOTES has changed the working environment of endoscopy, leading to new difficulties. The limitations of conventional endoscopes call for the development of new platforms. Robotics may be the answer.
The authors compared human to robotized manipulation of a flexible endoscope into the abdominal cavity, in an animal model. Thirty-two participants were enrolled. Results were analyzed according to the clinical background of the participants: experienced endoscopists, experienced laparoscopists, and medical students. Two single-channel gastroscopes were used. Whereas one was not modified, the other had the handling wheels replaced by motors controlled through a computer and a joystick. A NOTES transgastric approach was used to access the peritoneal cavity. The time to touch previously positioned intra-abdominal numbered plastic targets was recorded 3 times with each endoscope.
Mean time to complete the tasks was significantly shorter using the conventional endoscope (2.71 vs 6.96 minutes, P < .001). When the robotized endoscope was used, the mean times of endoscopists (7.42 minutes), laparoscopists (6.84 minutes), and students (6.77 minutes) were statistically identical. No differences were found between laparoscopists and students in both techniques.
Applying robotics to a flexible endoscope fails to enhance ability to move into the abdominal cavity, partly because of the interface. To overcome the limitations of endoscope when performing complex NOTES tasks, robotics may be useful, especially to control the instruments and to stabilize the endoscope itself.
Robotized endoscope with joystick interface is not sufficient to enhance immediate intuitiveness of flexible endoscopy applied to NOTES.
NOTES改变了内镜检查的工作环境，带来了新的困难。传统内镜的局限性促使新平台的开发。机器人技术可能是答案。
作者在动物模型中比较了人类与机器人操控柔性内镜进入腹腔的情况。招募了32名参与者。根据参与者的临床背景分析结果：经验丰富的内镜医师、经验丰富的腹腔镜医师和医学生。使用了两台单通道胃镜。其中一台未作修改，另一台将操作轮替换为由计算机和操纵杆控制的电机。采用NOTES经胃途径进入腹腔。每种内镜均记录3次触碰先前放置在腹腔内带编号塑料靶标的时间。
使用传统内镜完成任务的平均时间明显更短（2.71分钟对6.96分钟，P <.001）。使用机器人内镜时，内镜医师（7.42分钟）、腹腔镜医师（6.84分钟）和学生（6.77分钟）的平均时间在统计学上相同。两种技术在腹腔镜医师和学生之间均未发现差异。
将机器人技术应用于柔性内镜并不能提高进入腹腔的能力，部分原因在于接口。为克服内镜在执行复杂NOTES任务时的局限性，机器人技术可能有用，特别是在控制器械和稳定内镜本身方面。
带有操纵杆接口的机器人内镜不足以增强应用于NOTES的柔性内镜检查的即时直观性。
