Статті в журналах: "Robotic flexible endoscopes"

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Zhang, Aoyu, Zhimin Han, Xiguang Wang, Randall Briggs, and Tianyu Xie. "Mixed control scheme for accurate control of robotic flexible endoscope." International Journal of Advanced Robotic Systems 14, no. 2 (March 1, 2017): 172988141770250. http://dx.doi.org/10.1177/1729881417702506.

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Tendon-driven endoscopes are mainly used in the current practice. Their flexible bodies may change frequently during the processes of biopsy, endoscopic mucosal resection or endoscopic submucosal dissection. These changes lead to backlash hysteresis and nonlinear friction effects, which make it difficult to achieve accurate control. To address this problem, a mixed control scheme based on the combination of discrete and continuous models was proposed and quantitatively compared with a conventional feedback control scheme, a feedforward control scheme and an adaptive control scheme. These experiments were conducted using a robotic gastroscope. The results showed that our control scheme can achieve more accurate tracking performance when the configuration changes frequently, with mean square error of tracking performance decreased by 50–75%.

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García, Gabriela, Nikola Fischer, Christian Marzi, and Franziska Mathis-Ullrich. "Robotic Sensorized Gastroendoscopy with Wireless Single-Hand Control." Current Directions in Biomedical Engineering 8, no. 1 (July 1, 2022): 66–69. http://dx.doi.org/10.1515/cdbme-2022-0017.

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Abstract The manipulation of flexible endoscopes is a procedure that requires great dexterity since it requires the synchronization and use of both hands in parallel. Imprecise handling during gastroendoscopy could harm the digestive tract. Our solution allows the physician to use only one hand to wirelessly control the forward, backward, and tip bending motion. The proposed system provides endoscopic vision and tactile impact force sensing at the tip to detect the force applied to tissue and thus avoid damage. We experimentally evaluate the handling of the robotic system in open space and inside a medical phantom. The results revealed a training effect with less time demand for task completion and reduction of average impact force after only 5 runs. The proposed system was successfully controlled using one hand and, together with the force information, could enhance the physician’s experience during endoscopy. Future work will address axial control and an intensive user study with clinical experts.

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Rassweiler-Seyfried, Marie-Claire, Jonas Herrmann, Jan Klein, Maurice-Stephan Michel, Jens Rassweiler, and Britta Grüne. "Robot-assisted flexible ureterorenoscopy: state of the art in 2022." Mini-invasive Surgery 6 (2022): 41. http://dx.doi.org/10.20517/2574-1225.2022.41.

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Due to the technical improvements in endoscopes and armamentarium, flexible ureterorenoscopy (fURS) has increased in the management of nephrolithiasis over the last decade. fURS is a challenging procedure and therefore limited in some regions. To overcome these challenges, a master-slave robotic system might help dominate fURS. As with other robotic systems, the ergonomic deficits of fURS play an important role in the development of a new robot. All ureterorenoscopy (URS) robots thus far consist of a surgeon’s console and the manipulator of a flexible ureterorenoscope. Handling and maneuverability of the different systems vary, but the master-salve system is common to all robots. Optimal ergonomics and comparable surgical results to conventional flexible URS demonstrate the successful use of some of these robots. In this narrative review, we provide an update on the robot-assisted flexible ureterorenoscopy, the different systems, and the final role and future perspective of robotic fURS.

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Zeng, Ming, Yu-Jia Li, Tao Ren, and Qing Tu. "Material stiffness control of compliant tools by using electromagnetic suction." Proceedings of the Institution of Mechanical Engineers, Part C: Journal of Mechanical Engineering Science 233, no. 13 (February 28, 2019): 4719–28. http://dx.doi.org/10.1177/0954406219834059.

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Variable rigidity materials that are safe, controllable, reversible, and repeatable have potentially widespread implications in robotic technologies. This paper presents a method for controlling the stiffness of materials for compliant tools, such as grippers, soft robots, and endoscopes. The force of electromagnetic suction transforms two structures from their relaxed-state into a more rigid state. The system presented here has the ability of quickly increasing the stiffness with increased current in the coils that create electromagnetic suction, wherein the stiffness can be controlled by the variation of supply current. The process of controlling stiffness variation is reversible and repeatable under the safe voltage of human body. The system can lead to the production of tools that are small, flexible, dexterous, and safe. Suction force, friction force, and rotational stiffness were calculated to evaluate the performance of the system. Experiments were carried out to verify the proposed concept and the calculations.

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Nakayama, Meijin, Ryan K. Orosco, F. Christopher Holsinger, Giuseppe Spriano, Giovanni Succo, Armando De Virgilio, and Nobuhiko Oridate. "Endoscopic Transoral Hybrid Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy." Annals of Otology, Rhinology & Laryngology 129, no. 3 (October 31, 2019): 273–79. http://dx.doi.org/10.1177/0003489419885139.

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Objectives: The hybrid supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP, that is, open partial horizontal laryngectomies OPHL Type IIa) has been described using a flexible next generation robotic surgical platform for manipulation. We sought to evaluate the feasibility of performing this procedure using endoscopic transoral (EndoT) surgical techniques without robotics. Methods: Preclinical cadaveric study using two human cadavers. Hybrid SCPL-CHEP was performed with a flexible endoscope for visualization and hand-held instruments for manipulation (SILS Hook monopolar and Dissect, HAVAS LaryngoFIT malleable straight jaw instruments, and Stratafix 4-0 spiral knotless barbed suture). Results: EndoT hybrid SCPL-CHEP was successfully performed. The hand-manipulated rigid instruments allowed for transoral incisions and mucosal suturing. We provide the procedural steps of EndoT hybrid techniques. Conclusions: EndoT hybrid SCPL-CHEP was technically feasible in the preclinical cadaveric laboratory setting and appeared comparable to the hybrid SCPL-CHEP via transoral robotic surgery (TORS). Selected handheld instruments and flexible endoscopy appear to facilitate minimally invasive surgery of the larynx. This novel procedure and technique warrant further clinical study for consideration of feasibility, applicability, and patient benefit.

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Boškoski, Ivo, Beatrice Orlandini, Luigi Giovanni Papparella, Maria Valeria Matteo, Martina De Siena, Valerio Pontecorvi, and Guido Costamagna. "Robotics and Artificial Intelligence in Gastrointestinal Endoscopy: Updated Review of the Literature and State of the Art." Current Robotics Reports 2, no. 1 (February 1, 2021): 43–54. http://dx.doi.org/10.1007/s43154-020-00040-3.

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Abstract Purpose of Review Gastrointestinal endoscopy includes a wide range of procedures that has dramatically evolved over the past decades. Robotic endoscopy and artificial intelligence are expanding the horizons of traditional techniques and will play a key role in clinical practice in the near future. Understanding the main available devices and procedures is a key unmet need. This review aims to assess the current and future applications of the most recently developed endoscopy robots. Recent Findings Even though a few devices have gained approval for clinical application, the majority of robotic and artificial intelligence systems are yet to become an integral part of the current endoscopic instrumentarium. Some of the innovative endoscopic devices and artificial intelligence systems are dedicated to complex procedures such as endoscopic submucosal dissection, whereas others aim to improve diagnostic techniques such as colonoscopy. Summary A review on flexible endoscopic robotics and artificial intelligence systems is presented here, showing the m3ost recently approved and experimental devices and artificial intelligence systems for diagnosis and robotic endoscopy.

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Kim, Sang Hyun, Hyuk Soon Choi, Jae Min Lee, Bora Keum, Byung Gon Kim, Daehie Hong, Yoon Tae Jeen, and Hoon Jai Chun. "Gastric endoscopic submucosal dissection using a detachable assistant robot." Journal of Clinical Oncology 40, no. 4_suppl (February 1, 2022): 318. http://dx.doi.org/10.1200/jco.2022.40.4_suppl.318.

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318 Background: Effective traction and counter-traction for visualizing the dissection plane in endoscopic submucosal dissection (ESD) is difficult to be achieved with a conventional endoscope. We developed a robotic assistive traction device for flexible endoscopy that provides multi-directional traction during ESD. We compared its safety and efficiency in ESD between experienced and novice endoscopists. Methods: Robotic ESD was performed by experienced and novice endoscopist groups (n = 2, each). The outcomes included time to complete each ESD step, total procedure time, size of the dissected mucosa, rate of en bloc resection, and major adverse events. Furthermore, incision and dissection speeds were compared between groups. Results: Twenty gastric lesions were resected from nine live pigs. The submucosal incision speed was significantly faster in the expert group than in the novice group (P = 0.002). There was no significant difference in the submucosal dissection speed between the groups (P = 0.365). No complications were reported in either group. Conclusions: When the robot was assisting in the ESD procedure, the dissection speed improved significantly, especially in the novice surgeons. Our robotic device can provide simple, effective, and safe multidirectional traction during ESD.

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Nakadate, Ryu, Tsutomu Iwasa, Shinya Onogi, Jumpei Arata, Susumu Oguri, Yasuharu Okamoto, Tomohiko Akahoshi, Masatoshi Eto, and Makoto Hashizume. "Surgical Robot for Intraluminal Access: An Ex Vivo Feasibility Study." Cyborg and Bionic Systems 2020 (December 5, 2020): 1–9. http://dx.doi.org/10.34133/2020/8378025.

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Early-stage gastrointestinal cancer is often treated by endoscopic submucosal dissection (ESD) using a flexible endoscope. Compared with conventional percutaneous surgery, ESD is much less invasive and provides a high quality of life for the patient because it does not require a skin incision, and the organ is preserved. However, the operator must be highly skilled because ESD requires using a flexible endoscope with energy devices, which have limited degrees of freedom. To facilitate easier manipulation of these flexible devices, we developed a surgical robot comprising a flexible endoscope and two articulating instruments. The robotic system is based on a conventional flexible endoscope, and an extrapolated motor unit moves the endoscope in all its degrees of freedom. The instruments are thin enough to allow insertion of two instruments into the endoscope channel, and each instrument has a bending section that allows for up–down, right–left, and forward–backward motion. In this study, we performed an ex vivo feasibility evaluation using the proposed robotic system for ESD in a porcine stomach. The procedure was successfully performed by five novice operators without complications. Our findings demonstrated the feasibility of the proposed robotic system and, furthermore, suggest that even operators with limited experience can use this system to perform ESD.

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Ciuti, Gastone, Karolina Skonieczna-Żydecka, Wojciech Marlicz, Veronica Iacovacci, Hongbin Liu, Danail Stoyanov, Alberto Arezzo, et al. "Frontiers of Robotic Colonoscopy: A Comprehensive Review of Robotic Colonoscopes and Technologies." Journal of Clinical Medicine 9, no. 6 (May 31, 2020): 1648. http://dx.doi.org/10.3390/jcm9061648.

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Flexible colonoscopy remains the prime mean of screening for colorectal cancer (CRC) and the gold standard of all population-based screening pathways around the world. Almost 60% of CRC deaths could be prevented with screening. However, colonoscopy attendance rates are affected by discomfort, fear of pain and embarrassment or loss of control during the procedure. Moreover, the emergence and global thread of new communicable diseases might seriously affect the functioning of contemporary centres performing gastrointestinal endoscopy. Innovative solutions are needed: artificial intelligence (AI) and physical robotics will drastically contribute for the future of the healthcare services. The translation of robotic technologies from traditional surgery to minimally invasive endoscopic interventions is an emerging field, mainly challenged by the tough requirements for miniaturization. Pioneering approaches for robotic colonoscopy have been reported in the nineties, with the appearance of inchworm-like devices. Since then, robotic colonoscopes with assistive functionalities have become commercially available. Research prototypes promise enhanced accessibility and flexibility for future therapeutic interventions, even via autonomous or robotic-assisted agents, such as robotic capsules. Furthermore, the pairing of such endoscopic systems with AI-enabled image analysis and recognition methods promises enhanced diagnostic yield. By assembling a multidisciplinary team of engineers and endoscopists, the paper aims to provide a contemporary and highly-pictorial critical review for robotic colonoscopes, hence providing clinicians and researchers with a glimpse of the major changes and challenges that lie ahead.

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Morino, Mario, and Alberto Arezzo. "Transanal Local Excision or Endoscopic Dissection for Benign and Large Lesions of the Rectum." Clinics in Colon and Rectal Surgery 35, no. 02 (February 28, 2022): 106–12. http://dx.doi.org/10.1055/s-0042-1744356.

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AbstractSince the introduction of transanal endoscopic microsurgery, local excision of “early” rectal lesions has offered the possibility to reduce the invasiveness of treatment for the limited disease. Flexible endoscopy techniques allow today different alternatives consisting of endoscopic mucosal resection or endoscopic submucosal dissection. The first is a straightforward and relatively easy technique, but it prevents a correct pathological staging of the lesion due to fragmentation and the verification of disease-free margins. The second relies on operators' audacity depending on their increasing experience due to the limited progress in technology. What is the preferable technique today is questionable. All the methods have pros and cons. The future certainly will see the use of ideal systems, allowing the possibility of precision surgery for partial- or full-thickness excision, depending on intraoperative findings, and the extension above the rectosigmoid junction. Miniaturized flexible robotic devices may represent the solution for both issues.

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Souza, Thiago F., Manoel Galvao Neto, Vitor M. Sagae, Eduardo Grecco, Luiz G. Quadros, Erik B. Wilson, Todd Wilson, and Fauze Maluf-Filho. "ID: 3523975 FLEXIBLE ENDOSCOPIC ROBOTIC RECTAL ESD." Gastrointestinal Endoscopy 93, no. 6 (June 2021): AB174. http://dx.doi.org/10.1016/j.gie.2021.03.350.

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Lim, Sun Gyo. "The development of robotic flexible endoscopic platforms." International Journal of Gastrointestinal Intervention 9, no. 1 (January 31, 2020): 9–12. http://dx.doi.org/10.18528/ijgii190022.

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Mo, Hangjie, Xiaojian Li, Bo Ouyang, Ge Fang, and Yuanjun Jia. "Task Autonomy of a Flexible Endoscopic System for Laser-Assisted Surgery." Cyborg and Bionic Systems 2022 (August 26, 2022): 1–11. http://dx.doi.org/10.34133/2022/9759504.

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Laser beam steering has been widely studied for the automation of surgery. Currently, flexible instruments for laser surgery are operated entirely by surgeons, which keeps the automation of endoluminal surgery at the initial level. This paper introduces the design of a new workflow that enables the task autonomy of laser-assisted surgery in constrained environments such as the gastrointestinal (GI) tract with a flexible continuum robotic system. Unlike current, laser steering systems driven by piezoelectric require the use of high voltage and are risky. This paper describes a tendon-driven 2 mm diameter flexible manipulator integrated with an endoscope to steer the laser beam. By separating its motion from the total endoscopic system, the designed flexible manipulator can automatically manipulate the laser beam. After the surgical site is searched by the surgeon with a master/slave control, a population-based model-free control method is applied for the flexible manipulator to achieve accurate laser beam steering while overcoming the noise from the visual feedback and disturbances from environment during operation. Simulations and experiments are performed with the system and control methods to demonstrate the proposed framework in a simulated constrained environment.

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Kume, Keiichiro. "Flexible robotic endoscopy: current and original devices." Computer Assisted Surgery 21, no. 1 (January 1, 2016): 150–59. http://dx.doi.org/10.1080/24699322.2016.1242654.

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SUN, ZHENGLONG, ZHENG WANG, and SOO JAY PHEE. "HAPTIC MODELING OF STOMACH FOR REAL-TIME PROPERTY AND FORCE ESTIMATION." Journal of Mechanics in Medicine and Biology 13, no. 03 (May 14, 2013): 1350021. http://dx.doi.org/10.1142/s0219519413500218.

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Robotic devices are being employed in gastrointestinal endoscopy procedures for diagnostics and surgery. However, force measurement, a very important factor for control and haptic feedback, becomes very challenging due to the strict size limitation of such devices and the flexible nature of the endoscope. This paper focuses on the modeling of the interior stomach wall for tool–tissue interactions from two perspectives: (1) If the interaction force between the robotic tool and the tissue can be measured, we utilize the force information to estimate the mechanical property of the stomach wall in real-time; given the force and position information, we would derive mathematically the only system model that can guarantee identifiability under arbitrary manipulation; (2) in the worst case scenario where force measurement is not available, we propose a viscoelastic model to restore force information solely based on position and motion information available from the robot. Ex-vivo experiments were performed on porcine stomach specimens to demonstrate the performance of the proposed models. Based on these findings, generalization and implementations of the modeling in real-time applications were discussed.

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KUME, Keiichiro. "Ongoing Development and Directions in Flexible Robotic Endoscopy." Journal of UOEH 37, no. 2 (June 1, 2015): 149–56. http://dx.doi.org/10.7888/juoeh.37.149.

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Ruiter, J. G., G. M. Bonnema, M. C. van der Voort, and I. A. M. J. Broeders. "Robotic control of a traditional flexible endoscope for therapy." Journal of Robotic Surgery 7, no. 3 (April 21, 2013): 227–34. http://dx.doi.org/10.1007/s11701-013-0405-4.

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Matviychuk, Bohdan, Artur Hurayevskyy, Andrii Stasyshyn, and Yaroslav Korol. "HISTORY OF DEVELOPMENT OF LAPAROSCOPIC AND ENDOSCOPIC SURGERY IN LVIV CLINICAL EMERGENCY CARE HOSPITAL." Acta Medica Leopoliensia 27, no. 3-4 (December 23, 2021): 160–72. http://dx.doi.org/10.25040/aml2021.3-4.160.

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Aim. The analysis of the history of minimally invasive surgery in a clinical emergency care hospital and the clinical cases associated with first robot-assisted operations. Materials and Methods. We have analyzed 10180 inpatients' maps and protocols of surgical operations from 2002 to 2019. We have also studied the first minimally invasive interventions in the Clinic of Surgery and Endoscopy affiliated to the Faculty of Postgraduate Education of Danylo Halytsky Lviv National Medical University and the municipal non-profit institution "Lviv Clinical Emergency Care Hospital". Results and Discussion. Until the early 1990s, the development of surgical technology took place mainly due to the talents of individual surgeons and their persistence in implementing new treatment methods. The directions of work of our Department of Endoscopic Surgery included the introduction of minimally invasive (laparoscopic) surgical interventions and endoscopic interventions using flexible endoscopy. Robot-assisted operation on a patient with diaphragmatic hernia using da Vinci surgical system was performed with three 8.5 mm robotic instruments and two 5 mm laparoscopic ones. The operation lasted for 6 hours. There were no intra- and postoperative complications. The patient was discharged home in satisfactory condition on the 3rd post-op day. Robot-assisted surgery for complicated gallstone disease was performed with three 8.5 mm robotic instruments and one 5 mm laparoscopic one. The operation lasted for 3 hours. Conclusions. 1. The introduction of modern technologies and minimally invasive interventions results primarily from activities of the clinic's staff, the head of the structural unit and the hospital administration, as well as from the high professional level of surgeons. 2. The usage of minimally invasive, laparoscopic, endoscopic techniques, as well as that of da Vinci surgical system in clinical practice will improve therapeutic outcomes and quality of life among patients with surgical disorders.

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Morino, M., E. Forcignanò, and A. Arezzo. "Initial clinical experience with a novel flexible endoscopic robot for transanal surgery." Techniques in Coloproctology 26, no. 4 (January 29, 2022): 301–8. http://dx.doi.org/10.1007/s10151-022-02577-1.

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Abstract Background The Flex® Robotic System (Medrobotics, Raynham, MA, USA) is the first miniaturised flexible endoscopic robot that aims to allow surgical manoeuvres beyond the area currently reached by transanal endoscopic microsurgery. The aim of this study is to evaluate our initial clinical experience with this novel tool. Methods We prospectively collected all consecutive cases of local excisions of rectal lesions performed with the Flex® Robotic System performed at the Department of Surgical Sciences of the University of Turin between October 2018 and December 2019. Indications were benign, or early rectal lesions judged unsuitable for endoscopic removal, within 20 cm of the anal verge. Debriefing meetings after each procedure allowed technology assessment leading to the modification, development, and implementation of tools according to the clinical experience. We analysed the data in terms of the safety and efficacy of treatment. Results Between October 2018 and February 2020, 26 patients were treated. We performed a full-thickness excision in 14 patients and a submucosal dissection in 12. The median operating time was 115 min (range 45–360 min). In six patients (23.1%), we converted to standard transanal endoscopic operation (TEO®) (Karl Storz, Tuttlingen, Germany) to complete the procedure. The 30-day morbidity rate was 11.5% (3/26). Positive resection margins were detected in 4 (15.4%) patients. At a minimum follow-up of 12 months, 2 (7.7%) local recurrences were observed. Conclusions This first clinical series demonstrates that the Flex® Robotic System is a fascinating technology that deserves further development to increase surgical dexterity, thereby overcoming current technical limitations and improving clinical outcomes.

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Ott, L., F. Nageotte, P. Zanne, and M. de Mathelin. "Robotic Assistance to Flexible Endoscopy by Physiological-Motion Tracking." IEEE Transactions on Robotics 27, no. 2 (April 2011): 346–59. http://dx.doi.org/10.1109/tro.2010.2098623.

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Zhang, Xue, Weibing Li, Philip Wai Yan Chiu, and Zheng Li. "A Novel Flexible Robotic Endoscope With Constrained Tendon-Driven Continuum Mechanism." IEEE Robotics and Automation Letters 5, no. 2 (April 2020): 1366–72. http://dx.doi.org/10.1109/lra.2020.2967737.

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Ruiter, Jeroen G., Mascha C. van der Voort, and G. Maarten Bonnema. "User-centred System Design Approach Applied on a Robotic Flexible Endoscope." Procedia Computer Science 16 (2013): 581–90. http://dx.doi.org/10.1016/j.procs.2013.01.061.

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Deng, Zhen, Peijie Jiang, Yuxin Guo, Shengzhan Zhang, Ying Hu, Xiaochun Zheng, and Bingwei He. "Safety-aware robotic steering of a flexible endoscope for nasotracheal intubation." Biomedical Signal Processing and Control 82 (April 2023): 104504. http://dx.doi.org/10.1016/j.bspc.2022.104504.

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Busto, Eduardo, and Marta Patrucco. "Experiencia inicial en Buenos Aires con la cirugía transoral robótica (TORS)." Revista Argentina de Cirugía 112, no. 2 (June 1, 2020): 141–56. http://dx.doi.org/10.25132/raac.v112.n2.1459.es.

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Background: robotic surgery is an alternative to open surgery, CO2 laser microsurgery, or chemoradiation for the upper aero-digestive tract. This system allows surgeons to use the open surgical technique in a minimally invasive approach through the mouth to treat benign and malignant disorders. Different treatments are currently used with similar oncologic outcomes. Objective: the aim of this study was to introduce a surgical tool through transoral approach, report the initial experience with the use of the robotic system, evaluate respiratory and digestive functional preservation and analyze the variables associated with shorter hospital length of stay. Material and methods: A total of 24 patients (13 women and 11 men, mean age 55.08 years [16-82]) were included. Eight patients had chronic inflammatory disease, four had benign tumors and 12 had cancer. The variables considered in robotic surgery were hospital length of stay, place of postoperative care, complications, respiratory and swallowing function and use of reconstructive techniques. Flexible endoscopic evaluation of swallowing was performed to document safe function. Results: mean length of stay was 1.92 days; 83.3% stayed for one day; 79.9% were admitted to the general ward and 20.1% stayed in intensive or intermediate care units. None of the patients required tracheostomy. Healing of the surgical bed occurred by secondary intention. There were no complications. Tongue edema occurred in two patients. Conclusions: robotic surgery favors tumor removal with low morbidity and maximum preservation of healthy tissues while reducing postoperative edema, use of flaps for reconstruction, temporary tracheostomy and hospital length of stay. Flexible endoscopic evaluation of swallowing is useful to determine safe swallowing function. The main limitation of our study is the sample size. It is important to increase the number of patients to evaluate survival and quality of life.

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Lau, Ka Chun, Yeung Yam, and Philip Wai Yan Chiu. "An advanced endoscopic surgery robotic platform for removal of early-stage gastrointestinal cancer using endoscopic submucosal dissection." Special Issue with Awarded and Shortlisted Papers from the HKIE Outstanding Paper Award for Young Engineers/Researchers 2021 28, no. 4 (December 31, 2021): 186–98. http://dx.doi.org/10.33430/v28n4thie-2021-0008.

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Two gastrointestinal (GI) cancers, stomach and colorectal cancer, have the fifth and third highest incident rates and the fourth and second highest mortality rates among all cancers, respectively. Combined, they had 2.8 million new cases and 1.6 million deaths annually. Fortunately, early-stage GI cancer has a high five-year survival rate if the tumour can be removed completely. Endoscopic Submucosal Dissection (ESD) is the gold standard for the removal of early-stage GI cancer as it has a high rate of en-bloc resection and a low rate of recurrence. However, ESD is a very technically challenging surgical operation. It has a relatively high rate of failure, including perforation of the stomach or colon. Therefore, a surgical robotic platform with high dexterity and better ergonomics is in high demand, which can ease the technical problems induced by conventional ESD procedures. In our previous study, a prototype of an endoscopic surgery robotic platform was built and the preliminary experimental results showed that the dual flexible arm robotic platform with wire-driven continuum structure was capable of increasing the efficiency and safety in performing ESD under the master-slave controlling scheme. An advanced robotic platform was built based on this prototype to achieve higher flexibility and production requirements. The design of these two platforms and experimental results will be presented in detail.

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Iwasa, Tsutomu, Ryu Nakadate, Shinya Onogi, Yasuharu Okamoto, Jumpei Arata, Susumu Oguri, Haruei Ogino, et al. "A new robotic-assisted flexible endoscope with single-hand control: endoscopic submucosal dissection in the ex vivo porcine stomach." Surgical Endoscopy 32, no. 7 (April 17, 2018): 3386–92. http://dx.doi.org/10.1007/s00464-018-6188-y.

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Mamunes, Alexander P., Federico Campisano, James Martin, Bruno Scaglioni, Evangelos Mazomenos, Pietro Valdastri, and Keith L. Obstein. "Magnetic flexible endoscope for colonoscopy: an initial learning curve analysis." Endoscopy International Open 09, no. 02 (January 25, 2021): E171—E180. http://dx.doi.org/10.1055/a-1314-9860.

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Abstract Background and study aims Colonoscopy is a technically challenging procedure that requires extensive training to minimize discomfort and avoid trauma due to its drive mechanism. Our academic team developed a magnetic flexible endoscope (MFE) actuated by magnetic coupling under supervisory robotic control to enable a front-pull maneuvering mechanism, with a motion controller user interface, to minimize colon wall stress and potentially reduce the learning curve. We aimed to evaluate this learning curve and understand the user experience. Methods Five novices (no endoscopy experience), five experienced endoscopists, and five experienced MFE users each performed 40 trials on a model colon using 1:1 block randomization between a pediatric colonoscope (PCF) and the MFE. Cecal intubation (CI) success, time to cecum, and user experience (NASA task load index) were measured. Learning curves were determined by the number of trials needed to reach minimum and average proficiency—defined as the slowest average CI time by an experienced user and the average CI time by all experienced users, respectively. Results MFE minimum proficiency was achieved by all five novices (median 3.92 trials) and five experienced endoscopists (median 2.65 trials). MFE average proficiency was achieved by four novices (median 14.21 trials) and four experienced endoscopists (median 7.00 trials). PCF minimum and average proficiency levels were achieved by only one novice. Novices’ perceived workload with the MFE significantly improved after obtaining minimum proficiency. Conclusions The MFE has a short learning curve for users with no prior experience—requiring relatively few attempts to reach proficiency and at a reduced perceived workload.

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Seeliger, Barbara, and Lee L. Swanström. "Robotics in flexible endoscopy: current status and future prospects." Current Opinion in Gastroenterology 36, no. 5 (July 27, 2020): 370–78. http://dx.doi.org/10.1097/mog.0000000000000670.

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Sekiguchi, Yuta, Yo Kobayashi, Yu Tomono, Hiroki Watanabe, Kazutaka Toyoda, Kozo Konishi, Morimasa Tomikawa, et al. "Development of a Tool Manipulator Driven by a Flexible Shaft for Single-Port Endoscopic Surgery." Journal of Robotics and Mechatronics 23, no. 6 (December 20, 2011): 1115–24. http://dx.doi.org/10.20965/jrm.2011.p1115.

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Recently, a robotic system was developed to assist in Single-Port Endoscopic Surgery (SPS). However, the existing system required a manual operation of vision and viewpoint, hindering the surgical task. We proposed a surgical endoscopic robot for SPS with a dynamic vision control, the endoscopic view being manipulated by a master controller. The prototype robot consists of a manipulator for vision control, and dual tool tissue manipulators (gripping: five DOFs; cautery: three DOFs) can be attached at the tip of the sheath manipulator. In particular, this paper focuses on the details of the mechanism and control scheme of the tool manipulator. The experimental results show that our manipulator exhibits a response with a precision of less than 0.15 mm and a time delay of less than 31 ms, when the input frequency is 1.0 Hz.

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Tsang, Raymond K., and F. Christopher Holsinger. "Transoral endoscopic nasopharyngectomy with a flexible next-generation robotic surgical system." Laryngoscope 126, no. 10 (June 16, 2016): 2257–62. http://dx.doi.org/10.1002/lary.25970.

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de Mathelin, Michel, Florent Nageotte, Philippe Zanne, and Birgitta Dresp-Langley. "Sensors for Expert Grip Force Profiling: Towards Benchmarking Manual Control of a Robotic Device for Surgical Tool Movements." Sensors 19, no. 20 (October 21, 2019): 4575. http://dx.doi.org/10.3390/s19204575.

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STRAS (Single access Transluminal Robotic Assistant for Surgeons) is a new robotic system based on the Anubis® platform of Karl Storz for application to intra-luminal surgical procedures. Pre-clinical testing of STRAS has recently permitted to demonstrate major advantages of the system in comparison with classic procedures. Benchmark methods permitting to establish objective criteria for ‘expertise’ need to be worked out now to effectively train surgeons on this new system in the near future. STRAS consists of three cable-driven sub-systems, one endoscope serving as guide, and two flexible instruments. The flexible instruments have three degrees of freedom and can be teleoperated by a single user via two specially designed master interfaces. In this study, small force sensors sewn into a wearable glove to ergonomically fit the master handles of the robotic system were employed for monitoring the forces applied by an expert and a trainee (complete novice) during all the steps of surgical task execution in a simulator task (4-step-pick-and-drop). Analysis of grip-force profiles is performed sensor by sensor to bring to the fore specific differences in handgrip force profiles in specific sensor locations on anatomically relevant parts of the fingers and hand controlling the master/slave system.

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Song, Chengzhi, Xin Ma, Xianfeng Xia, Philip Wai Yan Chiu, Charing Ching Ning Chong, and Zheng Li. "A robotic flexible endoscope with shared autonomy: a study of mockup cholecystectomy." Surgical Endoscopy 34, no. 6 (November 13, 2019): 2730–41. http://dx.doi.org/10.1007/s00464-019-07241-8.

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Cao, Lin, Xiaoguo Li, Phuoc Thien Phan, Anthony Meng Huat Tiong, Hung Leng Kaan, Jiajun Liu, Wenjie Lai, et al. "Sewing up the Wounds: A Robotic Suturing System for Flexible Endoscopy." IEEE Robotics & Automation Magazine 27, no. 3 (September 2020): 45–54. http://dx.doi.org/10.1109/mra.2019.2963161.

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Ng, Tong Yow, Siew Fei Ngu, Tat Yan Deyoung Kam, Sai Yan Ng, and Ping Lai Benny Lo. "First in-human trial and prospective case series of an articulated laparoscopic camera system in minimally invasive surgery in gynecology: an IDEAL stage 1 and 2a study." BMJ Surgery, Interventions, & Health Technologies 4, no. 1 (March 2022): e000117. http://dx.doi.org/10.1136/bmjsit-2021-000117.

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ObjectivesPrecision Robotics’ Sirius Robotic Flexible Endoscopic System is a new, fully integrated, compact three-dimensional laparoscopic camera system with a disposable single-use flexible tip that can change its viewing direction. This IDEAL Stage 1 and 2a study assessed its safety, reliability and potential efficacy particularly for single incision laparoscopic surgery and vaginal natural orifice transluminal endoscopic surgery.DesignProspective single-institution, single-surgeon study.SettingThe study was conducted in a multispecialty hospital.ParticipantsWomen aged 18–70 years scheduled for gynecological laparoscopic surgery were invited to participate. An information sheet and consent was available for the women and an informed consent was obtained. Thirteen participants completed this study.InterventionsThe laparoscopic procedures were done in the usual manner. The only difference was the Sirius System was used in place of the conventional laparoscope. All other procedures and instruments remained the same.Main outcome measuresPrimary outcome was the proportion of women who successfully completed the intended procedure using the Sirius System without conversion to another camera system, camera users and surgeon’s view and experience, and iterations and modifications to the system. Secondary outcomes were the incidence of intraoperative and postoperative complications during the first 6 weeks following surgery, and duration of surgery.Results85% (11/13) of women had their procedure completed successfully using the Sirius System. Two women required immediate conversion to the conventional laparoscope due to technical issues. There were no intraoperative complications. Users agreed that the improved field of view was beneficial for laparoscopic surgery. Iterative improvements were made in the imaging quality, user interface and manufacturing quality.ConclusionsSirius System has early indications for safety and efficacy for intermediate and major minimally invasive laparoscopic procedures in gynecology. Further studies are needed to confirm it can replace a conventional laparoscope in the surgical workflow.Trial registration numberNCT05048407.

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Patel, Sejal, Maroeska M. Rovers, Michiel J. P. Sedelaar, Petra L. M. Zusterzeel, Ad F. T. M. Verhagen, Camiel Rosman, and Janneke P. C. Grutters. "How can robot-assisted surgery provide value for money?" BMJ Surgery, Interventions, & Health Technologies 3, no. 1 (February 2021): e000042. http://dx.doi.org/10.1136/bmjsit-2020-000042.

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ObjectivesTo develop an interactive tool that estimates what potential benefits are needed for the robot to provide value for money when compared with endoscopic or open surgical interventions.DesignA generic online interactive tool was developed to analyze the (health) effects needed to compensate for the additional costs of using a surgical robotic system from a healthcare perspective. The application of the tool is illustrated with a hypothetical new surgical robotic platform. A synthesis of evidence from different sources was used combined with interviews with surgeons.SettingFlexible tool that can be adapted to flexible settings.ParticipantsAny hospital patient group for which robotic, endoscopic or open surgical procedures may be considered as appropriate treatment alternatives (eg, urology, gynecology, and so on).InterventionRobotically assisted surgical interventions.ComparatorEndoscopic or open surgical interventions.Main outcome measuresThresholds of how much (health) effect is needed for robot-assisted surgery to provide value for money and to become cost-effective.ResultsThe utilization rate of the surgical robotic system and a reduction in complications appeared to be important aspects in determining the value for money. To become cost-effective, it was deemed important for new surgical robotic systems to have added clinical benefit and become less costly than the current system.ConclusionsThis paper and its assisting interactive tool can be used by clinicians, researchers, and policymakers to gain insight in the benefit needed to provide value for money when using a (new) surgical robotic system or, when the effects are known or can be estimated, to assess the value for money for a specific indication. For robotic surgery to provide most value for money, we recommend assessing for each indication whether the necessary effects seem achievable.

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Anakievski, Deyan. "LAPAROSCOPIC TRANSPERITONEAL URETEROURETEROSTOMY COMBINED WITH RETROGRADE FLEXIBLE URETEROSCOPY ASSISTANCE FOR URETERAL STRICTURE- CASE SERIES OF SEVEN PATIENTS." Journal of IMAB - Annual Proceeding (Scientific Papers) 27, no. 3 (September 15, 2021): 3947–49. http://dx.doi.org/10.5272/jimab.2021273.3947.

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Most strictures of the ureters are detected and usually occur in the part of the ureter when the calculus has been trapped for a long time, after ESWL or as a complication of transureteral lithotripsy after the introduction of the holmium laser. The treatment of these strictures variesand depends on many parameters, the most important being the type of stricture, severity, length and location. In many cases, endoscopic treatment with stenting is the first choice of treatment performed retro or antegrade. In case of failure or contraindication for endoscopic treatment, ureteral reconstruction can be performed by open, laparoscopic or robotic techniques. Laparoscopic ureteroureterostomy is a preferred minimally invasive technique for the treatment of benign ureteral strictures.

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Wang, Xiaona, and Max Q. H. Meng. "Robotics for Natural Orifice Transluminal Endoscopic Surgery: A Review." Journal of Robotics 2012 (2012): 1–9. http://dx.doi.org/10.1155/2012/512616.

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Natural Orifice Transluminal Endoscopic Surgery (NOTES) involves accessing the abdominal cavity via one of the bodies’ natural orifices, for example, mouth, anus, or vagina. This new surgical procedure is very appealing from patients’ perspectives because it eliminates completely abdominal wall aggression and promises to reduce postoperative pain, in addition to all other advantages brought by laparoscopic surgery. However, the constraints imposed by both the mode of access and the limited technology currently available make NOTES very challenging for the surgeons. Redesign of the instruments is imperative in order to make this emerging operative access safe and reproducible. In this paper, we survey on the state-of-the-art devices used in NOTES and introduce both the flexible instruments based on improvement of current endoscopic platforms and the revolutionary concept of robotic platforms based on the convergence of communication and micromechatronics technologies. The advantages and limitations of each category are addressed. Potential solutions are proposed to improve the existing designs and develop robust and stable robotic platforms for NOTES.

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Fujiwara, Kazunori, Takahiro Fukuhara, Satoshi Koyama, Ryohei Donishi, Hideyuki Kataoka, Hiroya Kitano, and Hiromi Takeuchi. "Ultrasound-Guided Transoral Videolaryngoscopic Surgery for Retropharyngeal Lymph Node Metastasis of Papillary Thyroid Cancer." Case Reports in Oncology 10, no. 2 (July 14, 2017): 649–55. http://dx.doi.org/10.1159/000478653.

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Background: Endoscopic-assisted transoral surgery, including transoral robotic surgery for metastatic retropharyngeal lymph node (RPN) from well-differentiated thyroid cancer, has been reported to reduce the complications resulting from transcervical and transmandibular approaches. However, the narrow working space and difficulty identifying RPN are problematic. To solve these issues, several studies have used intraoperative ultrasound in endoscopic-assisted transoral surgery. However, the type of ultrasonography suitable for this purpose remains unclear. Case Presentation: A 60-year-old female with thyroid papillary carcinoma (T4aN1bM0) initially underwent total thyroidectomy and paratracheal and selective neck dissections (D2a), with resectional management of recurrent laryngeal nerve, trachea, and esophagus. Three years later, she was diagnosed with left retropharyngeal and upper mediastinal lymph node metastases of papillary thyroid cancer. Transoral videolaryngoscopic surgery was performed with a combination of ultrasonography with a flexible laparoscopic transducer manipulated with forceps for identifying RPN intraoperatively. Due to the transducer’s small size and thin, flexible cable, the transducer interrupted the procedure in spite of the narrowness of oral cavity. RPN was resected completely without adverse events. Conclusion: We performed intraoperative ultrasound-guided endoscopic transoral surgery for metastatic RPN from papillary thyroid cancer and achieved complete resection as well as preservation of swallowing function.

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Roy, Soham, Syed HS Naqvi, and Ron J. Karni. "Medrobotics Flex System for Laryngeal Surgery: A Feasible Study in Two Cadavers." International Journal of Head and Neck Surgery 7, no. 4 (2016): 204–6. http://dx.doi.org/10.5005/jp-journals-10001-1289.

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ABSTRACT Objective To report the feasibility of Medrobotics Flex® System for laryngeal surgery. Materials and methods Cadaver study in research laboratory. Results The Medrobotics Flex System was utilized with the Medrobotics Flex Retractor to evaluate robotic laryngeal surgery in a cadaver model. Two surgeons using two cadavers tested the robotic system to expose the larynx and facilitate robotic airway surgery using the Flex Instruments. In both cadavers, these procedures were performed transorally with excellent visualization: supraglottoplasty, arytenoidectomy, epiglottectomy, vocal cord lesion excision, posterior cordotomy, hemilaryngectomy, and endoscopic anterior/posterior cricoid split. Laryngeal cleft repair was limited by availability of suture to close the interarytenoid band. Laryngeal exposure was rated as “excellent” by both surgeons using the robotic platform. Conclusion Robotic surgery for the head and neck, while still in relative infancy, remains one of the newest platforms for the otolaryngologist. Currently available robotic platforms, while adapted to head and neck and airway surgery, were not designed for this purpose and pose challenges in size and accessibility to the larynx. The Flex System is specifically designed for head and neck and laryngeal surgery. This system provides outstanding visualization of hard to access areas in the larynx and hypopharynx. The flexible surgical instruments used with the Flex System allow for reasonable surgical exposure and technique. The Flex System may provide an improved robotic experience for transoral laryngeal and head and neck surgery. How to cite this article Roy S, Naqvi SHS, Karni RJ. Medrobotics Flex System for Laryngeal Surgery: A Feasible Study in Two Cadavers. Int J Head Neck Surg 2016;7(4):204-206.

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Wang, Hongqiang, Peter York, Yufeng Chen, Sheila Russo, Tommaso Ranzani, Conor Walsh, and Robert J. Wood. "Biologically inspired electrostatic artificial muscles for insect-sized robots." International Journal of Robotics Research 40, no. 6-7 (March 31, 2021): 895–922. http://dx.doi.org/10.1177/02783649211002545.

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Millimeter-sized electrostatic film actuators, inspired by the efficient spatial arrangement of insect muscles, achieve a muscle-like power density (61 W kg−1) and enable robotic applications in which agility is needed in confined spaces. Like biological muscles, these actuators incorporate a hierarchical structure, in this case building from electrodes to arrays to laminates, and are composed primarily of flexible materials. So comprised, these actuators can be designed for a wide range of manipulation and locomotion tasks, similar to natural muscle, while being robust and compact. A typical actuator can achieve 85 mN of force with a 15 mm stroke, with a size of [Formula: see text] mm3 and mass of 92 mg. Two millimeter-sized robots, an ultra-thin earthworm-inspired robot and an intestinal-muscle-inspired endoscopic tool for tissue resection, demonstrate the utility of these actuators. The earthworm robot undertakes inspection tasks: the navigation of a 5 mm channel and a 19 mm square tube while carrying an on-board camera. The surgical tool, which conforms to the surface of the distal end of an endoscope, similar to the thin, smooth muscle that covers the intestine, completes tissue cutting and penetrating tasks. Beyond these devices, we anticipate widespread use of these actuators in soft robots, medical robots, wearable robots, and miniature autonomous systems.

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Tateya, Ichiro, Yoon Woo Koh, Raymond K. Tsang, Steven S. Hong, Ryuji Uozumi, Yo Kishimoto, Taro Sugimoto, and F. Christopher Holsinger. "Flexible next-generation robotic surgical system for transoral endoscopic hypopharyngectomy: A comparative preclinical study." Head & Neck 40, no. 1 (November 11, 2017): 16–23. http://dx.doi.org/10.1002/hed.24868.

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Ascari, L., C. Stefanini, U. Bertocchi, and P. Dario. "Robot-assisted endoscopic exploration of the spinal cord." Proceedings of the Institution of Mechanical Engineers, Part C: Journal of Mechanical Engineering Science 224, no. 7 (May 14, 2010): 1515–29. http://dx.doi.org/10.1243/09544062jmes2017.

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This work presents the design and development of an integrated image-guided robot-assisted endoscopic system for the safe navigation within the spinal subarachnoid space, providing the surgeon with the direct vision of the structures (i.e. spinal cord, roots, vessels) and the possibility of performing some particularly useful operations, like local electrostimulation of nerve roots. The modelling, micro-fabrication, fluidic sustentation, and cable-based actuation system of a steerable tip for a multilumen flexible catheter is described; the hierarchical control system shared between the surgeon and the computer, and based on machine vision techniques and a simple but effective three-dimensional reconstruction is detailed. The Blind Expected Perception sensory-motor scheme is proposed in robot-assited endoscopy. Results from in vitro, ex vivo, and in vivo experiments show that the described model can accurately predict the shape of the catheter given the tension distribution on the cables, that the proposed actuation system can assure smooth and precise control of the catheter tip, that the fluidic sustentation of the catheter is essential in in vivo navigation, and that the proposed rear view mirror interface to show non-visible obstacles is appropriate; in conclusion, the results proved the validity of the proposed solution to develop an intrinsically safe robotic system for navigation and intervention in a narrow and challenging environment such as the spinal subarachnoid space.

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Huang, Yisen, Jian Li, Xue Zhang, Ke Xie, Jixiu Li, Yue Liu, Sze Hang Ng, Philip Wai Yan Chiu, and Zheng Li. "A Surgeon Preference-Guided Autonomous Instrument Tracking Method With a Robotic Flexible Endoscope Based on dVRK Platform." IEEE Robotics and Automation Letters 7, no. 2 (April 2022): 2250–57. http://dx.doi.org/10.1109/lra.2022.3143305.

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Lau, Ka Chun, Esther Yun Yee Leung, Philip Wai Yan Chiu, Yeung Yam, James Yun Wong Lau, and Carmen Chung Yan Poon. "A Flexible Surgical Robotic System for Removal of Early-Stage Gastrointestinal Cancers by Endoscopic Submucosal Dissection." IEEE Transactions on Industrial Informatics 12, no. 6 (December 2016): 2365–74. http://dx.doi.org/10.1109/tii.2016.2576960.

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Ma, Xin, Chengzhi Song, Philip Waiyan Chiu, and Zheng Li. "Visual Servo of a 6-DOF Robotic Stereo Flexible Endoscope Based on da Vinci Research Kit (dVRK) System." IEEE Robotics and Automation Letters 5, no. 2 (April 2020): 820–27. http://dx.doi.org/10.1109/lra.2020.2965863.

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Li, Weibing, Chengzhi Song, and Zheng Li. "An Accelerated Recurrent Neural Network for Visual Servo Control of a Robotic Flexible Endoscope With Joint Limit Constraint." IEEE Transactions on Industrial Electronics 67, no. 12 (December 2020): 10787–97. http://dx.doi.org/10.1109/tie.2019.2959481.

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Shen, Tao, Dietric Hennings, Carl A. Nelson, and Dmitry Oleynikov. "Performance of a Multifunctional Robot for Natural Orifice Transluminal Endoscopic Surgery." Surgical Innovation 25, no. 4 (June 18, 2018): 364–73. http://dx.doi.org/10.1177/1553350618781225.

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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.

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Danesh, Hoseinali, Javad Rahmati, Mahdieh Mahdieh, Seyed M. Hemadi, and Alireza Bahmani. "Medical and chemical evaluation of robotic surgery methods; A review study." Romanian Journal of Military Medicine 125, no. 4 (November 1, 2022): 542–51. http://dx.doi.org/10.55453/rjmm.2022.125.4.2.

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"Along with the advances in medical science, surgical methods have also undergone many advances. Today, with the advancement of technology in all fields, including medicine, robots have entered medical science. These robots have many uses as well as advantages and disadvantages that they enjoy in Iran and other countries. In this study, it was addressed. This study is a review of robotic surgery methods in Iran and other countries in the form of a review study. This study is a conceptual review. The steps performed are 1- Designing a research question, 2- Searching and extracting researchrelated studies, 3- Selecting related studies, 4- Tabulating and summarizing information and data, and 5- Reporting results. The results showed that robotic surgery in operations such as brain, kidney, open heart, liver, eye, laparoscopy, dental surgery, coronary artery surgery, hysterectomy, lymphadenectomy, general surgery, obstetrics, head and neck, shelf Chest, urology, endoscopy, colonoscopy, ear, nose, and throat are used and have advantages such as three-dimensional vision, flexible rotation of the instrument, reduction of surgeon hand vibration with vibration filter, ease of surgery and the ability to create the required patterns It reduces the volume of blood lost during surgery, the length of stay in the hospital, the amount of pain, and subsequently the number of analgesic doses consumed in the postoperative ward. Disadvantages include the relative increase in operating time, the high cost of robots, and the physician's lack of sensory perception of the patient's environment."

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Rieffel, John, Davis Knox, Schuyler Smith, and Barry Trimmer. "Growing and Evolving Soft Robots." Artificial Life 20, no. 1 (January 2014): 143–62. http://dx.doi.org/10.1162/artl_a_00101.

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Completely soft and flexible robots offer to revolutionize fields ranging from search and rescue to endoscopic surgery. One of the outstanding challenges in this burgeoning field is the chicken-and-egg problem of body-brain design: Development of locomotion requires the preexistence of a locomotion-capable body, and development of a location-capable body requires the preexistence of a locomotive gait. This problem is compounded by the high degree of coupling between the material properties of a soft body (such as stiffness or damping coefficients) and the effectiveness of a gait. This article synthesizes four years of research into soft robotics, in particular describing three approaches to the co-discovery of soft robot morphology and control. In the first, muscle placement and firing patterns are coevolved for a fixed body shape with fixed material properties. In the second, the material properties of a simulated soft body coevolve alongside locomotive gaits, with body shape and muscle placement fixed. In the third, a developmental encoding is used to scalably grow elaborate soft body shapes from a small seed structure. Considerations of the simulation time and the challenges of physically implementing soft robots in the real world are discussed.

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Eisenberg, Dan, Eric Storne, and Amir Belson. "Use of a flexible robotic transgastric natural orifice translumenal endoscopic surgery (NOTES) platform in a cadaver to test access, navigation, maneuverability, and stability." Surgical Endoscopy 24, no. 9 (February 21, 2010): 2323. http://dx.doi.org/10.1007/s00464-010-0905-5.

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