Endoluminal Robotics for Gastrointestinal Resection

Gastrointestinal cancers are among the commonest cancers worldwide. Recently with increase awareness of early stage gastrointestinal cancers, there is an increase in detection and characterization of gastrointestinal cancers using latest technologies of image enhanced endoscopy. Early gastrointestinal cancers limited to mucosa will be treated by endoscopic resection through endoscopic submucosal dissection (ESD). ESD is increasingly performed worldwide, however it is technically challenging to even experienced endoscopists. One of the challenges to ESD remained the lack of two-hand manipulation and retraction to properly expose submucosa for dissection.
The development of flexible robotics through endoscopy aimed to overcome this challenge and provide endoscopists with two arms for tissue manipulation and dissection. Lead by Singapore team, we first developed Master and Slave Transluminal Endoscopic Robot (MASTER) for preclinical and clinical trials. 5 patients received gastric ESD using prototype MASTER safely. This flexible robotic technology is further developed into second generation system by EndoMaster Pte Co. The new system has newly designed endoscopic platform to enhance performance of robotic ESD using two robotic arms. In preclinical animal study, 5 colorectal ESD was completed using EndoMaster. We have started clinical trial on performance of colorectal ESD using the EndoMaster system. In future, flexible robotic technologies will enhance development in endoluminal surgical procedures, especially with the development of suturing and other therapeutic devices.