Performance of a Multifunctional Robot for Natural Orifice Transluminal Endoscopic Surgery.

Natural orifice transluminal endoscopic surgery (NOTES) has gained attention as a revolutionary technique with its potential advantages in eliminating skin incisions, shortening recovery time, and decreasing postoperative complications; however, its practical application is still constrained by the complexity of navigation through the surgical field and paucity of available instruments. Current progress on NOTES focuses on designing flexible articulated robots or fully inserted bimanual robots to address the limitations. However, the lack of multitasking tools, trade-offs between size and power, and lack of sufficient surgical force are too often neglected. The authors designed a bimanual robot with a multifunctional manipulator, which can realize on-site instrument-change according to surgeon needs. An articulated drive mechanism with 2 independent curvature sections was designed to deliver the robot to the surgical site. A corresponding reconfiguration operation sequence was formulated to ease insertion and thereby decrease the design trade-off between size and power. This article presents 3 benchtop and animal tests to evaluate the robotic surgery approach and demonstrate the effectiveness of the robot.