title: A novel flexible hyper-redundant surgical robot: prototype evaluation using a single incision flexible access pelvic application as a clinical exemplar.
abstract: BACKGROUND
  The flexible endoscope is increasingly being considered as a surgical tool to enable innovative natural orifice or flexible access techniques. These experiences have exposed unique advantages but also significant challenges. Major current technical drawbacks in this setting relate to uncontrolled flexibility, inaccurate sustained target localization, unreliable navigation and overall platform instability. In striving to address existing technical limitations, this paper introduces a novel flexible hyper-redundant surgical robot and evaluates its clinical potential using a focused clinical application.
  
  
  METHODS
  To assess utility of the device within tight confines of the human pelvis or peritoneal cavity, detailed laboratory workspace analysis experiments were undertaken using a computer-simulated model that incorporated anatomical data obtained via pelvic magnetic resonance images of eight women. Ten participants executed ninety usability and reliability trials on an ex vivo simulator, before the robot was repeatedly trialled in an in vivo porcine model.
  
  
  RESULTS
  The robot demonstrated capability of targeting >90 % of the anatomic region of interest. All 90 user trials were successfully performed without interruption or malfunction. Significant improvements in performance, time and motion were observed between first and last sets of trials (p = 0.001). In vivo feasibility testing affirmed robustness of the device when deployed within the physiological demands of a live scale appropriate model.
  
  
  CONCLUSIONS
  Technologically advanced flexible operative platforms are needed to fulfil aspirations for an introductory era of flexible access surgery. This prototype is proposed as a potential future platform for robot-assisted flexible endoscopic surgery. Encouraging pre-clinical feasibility results are demonstrated for diagnostic and therapeutic applications within the pelvis.
authors.affiliation: Department of Surgery and Cancer, The Hamlyn Centre for Robotic Surgery, Institute of Global Health Innovation, Imperial College London, 3rd Floor Paterson Centre, South Wharf Road, Paddington, London, W2 1PF, UK, j.clark@imperial.ac.uk.
authors.forename: James
authors.initials: J
authors.lastname: Clark
authors.forename: David P
authors.initials: DP
authors.lastname: Noonan
authors.forename: Valentina
authors.initials: V
authors.lastname: Vitiello
authors.forename: Mikael H
authors.initials: MH
authors.lastname: Sodergren
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Shang
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Payne
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Cundy
authors.forename: Guang-Zhong
authors.initials: GZ
authors.lastname: Yang
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000818:Animals; D019723:Endoscopes; D004724:Endoscopy / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D010388:Pelvis / Q000601:surgery*; D015203:Reproducibility of Results; D012371:Robotics / Q000295:instrumentation*; D013552:Swine
references.citation: J Robot Surg. 2011 Mar;5(1):65-72
references.pmid: 27637262
references.citation: Dis Esophagus. 2011 May;24(4):240-50
references.pmid: 21073622
references.citation: Surg Technol Int. 2010 Apr;19:79-84
references.pmid: 20437349
references.citation: Endoscopy. 2011 Mar;43(3):223-9
references.pmid: 21365516
references.citation: Arch Surg. 2007 Sep;142(9):823-6; discussion 826-7
references.pmid: 17875836
references.citation: Surg Endosc. 2011 Jan;25(1):153-9
references.pmid: 20533063
references.citation: J Urol. 2005 May;173(5):1690-4
references.pmid: 15821559
references.citation: Z Gastroenterol. 2009 Nov;47(11):1160-7
references.pmid: 19885782
references.citation: J Urol. 2003 Nov;170(5):1738-41
references.pmid: 14532766
references.citation: Surg Endosc. 2011 Aug;25(8):2441-8
references.pmid: 21359881
references.citation: Dis Colon Rectum. 2008 Nov;51(11):1627-32
references.pmid: 18484134
references.citation: JAMA Surg. 2013 Mar;148(3):226-30; discussion 231
references.pmid: 23682369
references.citation: Lancet. 2005 May 14-20;365(9472):1718-26
references.pmid: 15894098
references.citation: Minim Invasive Ther Allied Technol. 2013 Feb;22(1):17-25
references.pmid: 22657573
references.citation: Surg Endosc. 2013 Feb;27(2):478-86
references.pmid: 22936432
references.citation: Int J Med Robot. 2008 Mar;4(1):15-22
references.pmid: 18314917
references.citation: J Robot Surg. 2012 Jun;6(2):99-114
references.pmid: 27628273
references.citation: Med Image Comput Comput Assist Interv. 2010;13(Pt 3):245-52
references.pmid: 20879406
references.citation: Surg Endosc. 2007 Jul;21(7):1212-5
references.pmid: 17522926
references.citation: Arch Surg. 2009 Aug;144(8):734-8
references.pmid: 19687377