title: Enhancement of a master-slave robotic system for natural orifice transluminal endoscopic surgery.
abstract: BACKGROUND
  A novel robotic platform for Natural Orifice Transluminal Endoscopic Surgery (NOTES) is presented in this paper. It aims to tackle two crucial technical barriers which hinder its smooth transition from animal studies to clinical trials: providing effective instrumentations to perform complex NOTES procedures and maintaining the spatial orientation for endoscopic navigation.
  
  
  METHODS
  The technical barriers are overcome by the design of the robotic system considering size, triangulation, dexterity, maneuverability and complexity. It is also shown that haptic feedback and interventional navigation system could solve the problem of off-axis manipulation of the camera angle and loss of spatial orientation upon entering the peritoneal cavity in transgastric NOTES procedure, respectively.
  
  
  RESULTS
  Successful ESD (endoscopic submucosal dissection) and wedge hepatic resection have been performed on live pigs with our Master And Slave Transluminal Endoscopic Robot (MASTER) system, showing its capability to perform advanced endoscopic surgical and NOTES procedures. It is found that the MASTER exhibited good grasping and cutting efficiency. And the lesion resection time could be significantly reduced with more practice between the endoscopist and the robot operator.
  
  
  CONCLUSIONS
  This study evaluates the feasibility of MASTER system as a platform overcoming the barriers to NOTES. It is also demonstrated that the MASTER could effectively mitigate the technical constraints normally encountered in NOTES procedures.
authors.affiliation: School of Mechanical & Aerospace Engineering, Nanyang Technological University, Singapore. zhenglong.sun@ieee.org
authors.forename: Zhenglong
authors.initials: Z
authors.lastname: Sun
authors.forename: Rui Yee
authors.initials: RY
authors.lastname: Ang
authors.forename: Ed Wyn
authors.initials: EW
authors.lastname: Lim
authors.forename: Zheng
authors.initials: Z
authors.lastname: Wang
authors.forename: Khek Yu
authors.initials: KY
authors.lastname: Ho
authors.forename: Soo Jay
authors.initials: SJ
authors.lastname: Phee
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005240:Feasibility Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation* / Q000379:methods; D012371:Robotics / Q000295:instrumentation* / Q000379:methods; D013270:Stomach / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D013514:Surgical Procedures, Operative / Q000379:methods; D013552:Swine