Department of Surgery, Stanford School of Medicine and Palo Alto VA HCS, Palo Alto, CA, 94304, USA.
Surg Endosc. 2010 Sep;24(9):2323. doi: 10.1007/s00464-010-0905-5. Epub 2010 Feb 21.
The advancement of natural orifice translumenal endoscopic surgery (NOTES) depends on the availability of a suitable platform. A 2008 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) Working Group identified access, navigation, maneuverability, and stability to withstand instrument forces as the essential requirements for a successful NOTES platform [1]. No single NOTES platform can adequately achieve all four of these key capabilities. In this study, the authors tested a novel flexible endoscopic robotic platform in a cadaver to determine how it performs with respect to these specific requirements.
A highly maneuverable multichannel flexible robotic endoscopic platform developed for NOTES was used transgastrically in an adult cadaver to test the platform's ability to reach multiple intraabdominal targets. The device was under the control of the surgeon throughout the test. The surgeon was blinded to a control laparoscopic view. At each target organ, the platform was maneuvered via a joystick to provide different camera views and tool access orientation appropriate for the surgical tasks of each procedure. Standard endoscopic tools were used in the platform's two working channels to demonstrate the platform's ability to withstand the forces generated during tissue manipulation and clipping.
The platform reached each target organ site without difficulty, relying on the endoscopic view only. The platform's unique ability to maintain stability in two- and three-dimensional space resisted forces exerted by tools in the tool channels used for tissue manipulation and clipping. Endoscopic visualization allowed the surgeon to reposition the platform easily to gain a different camera view or tool access orientation about an organ (see video in Supplementary material).
The authors demonstrated that the four capabilities identified by NOSCAR can be provided by the flexible robotic endoscopic platform. These essential capabilities for the clinical implementation of NOTES were addressed specifically by this platform. The provision of these capabilities in a single device may further the advancement and adoption of NOTES.
自然腔道内镜外科手术（NOTES）的发展依赖于合适平台的出现。2008 年，自然腔道手术评估与研究协会（NOSCAR）工作组确定，进入、导航、操控性和稳定性以承受器械力是成功NOTES 平台的基本要求[1]。没有任何单一的NOTES 平台能够充分实现这四个关键功能。在这项研究中，作者在尸体上测试了一种新型的灵活内镜机器人平台，以确定它在这些特定要求方面的表现如何。
为 NOTES 开发的一种高度灵活的多通道柔性机器人内镜平台被用于经胃进入成年尸体，以测试该平台到达多个腹腔内目标的能力。整个测试过程中，器械均在外科医生的控制之下。外科医生对控制腹腔镜视图是盲视的。在每个目标器官处，通过操纵杆操纵平台，提供适用于每个手术程序的不同的摄像视角和工具进入方向。在平台的两个工作通道中使用标准内镜工具来演示平台承受组织操作和夹闭过程中产生的力的能力。
该平台仅依靠内镜视图即可轻松到达每个目标器官部位。平台在二维和三维空间中保持稳定的独特能力抵抗了用于组织操作和夹闭的工具通道中工具施加的力。内镜可视化允许外科医生轻松重新定位平台，以获得关于器官的不同摄像视角或工具进入方向（见补充材料中的视频）。
作者证明了 NOSCAR 确定的四个能力可以由灵活的机器人内镜平台提供。这些NOTES 临床实施的基本能力是由该平台专门解决的。单一设备提供这些功能可能会进一步推进和采用 NOTES。
