IEEE Trans Biomed Eng. 2018 Apr;65(4):797-808. doi: 10.1109/TBME.2017.2720739. Epub 2017 Jun 28.
Minimally invasive surgical interventions in the gastrointestinal tract, such as endoscopic submucosal dissection (ESD), are very difficult for surgeons when performed with standard flexible endoscopes. Robotic flexible systems have been identified as a solution to improve manipulation. However, only a few such systems have been brought to preclinical trials as of now. As a result, novel robotic tools are required.
We developed a telemanipulated robotic device, called STRAS, which aims to assist surgeons during intraluminal surgical endoscopy. This is a modular system, based on a flexible endoscope and flexible instruments, which provides 10 degrees of freedom (DoFs). The modularity allows the user to easily set up the robot and to navigate toward the operating area. The robot can then be teleoperated using master interfaces specifically designed to intuitively control all available DoFs. STRAS capabilities have been tested in laboratory conditions and during preclinical experiments.
We report 12 colorectal ESDs performed in pigs, in which large lesions were successfully removed. Dissection speeds are compared with those obtained in similar conditions with the manual Anubiscope platform from Karl Storz. We show significant improvements ( ).
These experiments show that STRAS (v2) provides sufficient DoFs, workspace, and force to perform ESD, that it allows a single surgeon to perform all the surgical tasks and those performances are improved with respect to manual systems.
The concepts developed for STRAS are validated and could bring new tools for surgeons to improve comfort, ease, and performances for intraluminal surgical endoscopy.
在使用标准软性内窥镜进行胃肠道微创手术（如内镜黏膜下剥离术 [ESD]）时，对于外科医生来说极具难度。机器人软性系统已被确定为一种改善操作的解决方案。然而，到目前为止，只有少数此类系统已进行到临床前试验。因此，需要新型的机器人工具。
我们开发了一种名为 STRAS 的远程操控机器人设备，旨在协助外科医生进行腔内手术内窥镜检查。这是一个基于软性内窥镜和软性器械的模块化系统，提供了 10 个自由度（DoFs）。模块化设计允许用户轻松设置机器人并导航至操作区域。然后，用户可以使用专门设计的主接口远程操作机器人，以直观地控制所有可用的自由度。STRAS 的功能已在实验室条件和临床前实验中进行了测试。
我们报告了在猪身上进行的 12 例结直肠 ESD 手术，其中成功切除了大的病变。与手动 Anubiscope 平台（来自 Karl Storz）在类似条件下获得的解剖速度进行了比较。我们显示出显著的改善（）。
这些实验表明 STRAS（v2）提供了足够的自由度、工作空间和力来进行 ESD，它允许单个外科医生执行所有手术任务，并且这些性能相对于手动系统得到了提高。
为 STRAS 开发的概念已得到验证，可为外科医生提供新的工具，以改善腔内手术内窥镜检查的舒适性、简易性和性能。
