Sewing up the Wounds: A Robotic Suturing System for Flexible Endoscopy

Abstract

If a perforation occurs as a result of a flexible endoscopic procedure, suturing through urgent laparoscopy or open surgery may be required to repair the perforation because suturing is normally stronger than closure using existing endoscopic devices. Suturing with stitches and knots, widely adopted in open or laparoscopic surgery, is still not possible in flexible endoscopy. This is because of the confined space of the natural orifice and target area, high levels of motion dexterity and force needed for stitching and knot-tying, and critical size and strength requirements of wound closure. We present a novel flexible endoscopic robotic suturing system that is able to suture gastrointestinal defects without opening up the patient's body like in open or laparoscopic surgery. This system features a robotic needle driver and a robotic grasper, both of which are flexible, through-the-scope (small in sizes), and dexterous with five degrees of freedom. The needle driver, facilitated by the grasper, enables the surgeon to control a needle through teleoperation to make stitches and knots in flexible endoscopy. Successful in vivo trials were conducted in the rectum of a live pig to confirm the feasibility of endoscopic suturing and knot-tying using the system in a realistic surgical scenario (not possible with existing devices which are all manually driven). This new technology will change the way how surgeons close gastrointestinal defects.

Robot-Assisted Endoscopic Resection: Current Status and Future Directions

“…Through the pilot animal study, we demonstrated that our novel endoscopic robotic device can be used to suture perforations, and potentially suture bleeding sites and achieve hemostasis in ESD, without the need for additional surgical interventions. 13…”

Clinical adoption of robotics in endoscopy: Challenges and solutions

“…6 The robotic needle holder is a modified grasper with two needle holes that can lock and release a double-pointed lancet needle attached to a suture. 7 ISIS-Scope/STRAS System. The ISIS-Scope/STRAS System (Karl Storz, IRCAD, Tuttlingen, Germany) is a flexible robotic system based on a modified shortened version of the manual Anubiscope.…”

“…This is in contrast to currently available endoscopic suturing devices, such as OverStitch, which relies on fastening elements. 7 In our animal trial, we used the Endomaster EASE System to perform a 10 mm submucosal incision in the colon. We then used the robotic needle holder and robotic grasper to apply a Figure-of-8 stitch.…”

“…23 Animal studies have been performed, which successfully demonstrated the feasibility of suturing and knot tying using this new capability. 7 Atallah et al demonstrated that the next generation robotic platforms can be used to perform a robotic trans-cecal NOTES appendicectomy and a transvaginal unilateral salphingooophorectomy with transvaginal extraction of the ovary and fallopian tube without requiring laparoscopic assistance. 24 We believe that with the existing triangulation features of the Endomaster EASE System and the added-on benefit of the novel suturing device, the Endomaster EASE System would be able to perform NOTES effectively.…”

“…The robotic instruments are interchangeable and include grasper, hook, and needle holder for suturing 6 . The robotic needle holder is a modified grasper with two needle holes that can lock and release a double‐pointed lancet needle attached to a suture 7 …”