title: A miniaturized robotic platform for natural orifice transluminal endoscopic surgery: in vivo validation.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) involves accessing the abdominal cavity via one of the body natural orifices for enabling minimally invasive surgical procedures. However, the constraints imposed by the access modality and the limited available technology make NOTES very challenging for surgeons. Tools redesign and introduction of novel surgical instruments are imperative in order to make NOTES operative in a real surgical scenario, reproducible and reliable. Robotic technology has major potential to overcome current limitations.
  
  
  METHODS
  The robotic platform described here consists of a magnetic anchoring frame equipped with dedicated docking/undocking mechanisms to house up to three modular robots for surgical interventions. The magnetic anchoring frame guarantees the required stability for surgical tasks execution, whilst dedicated modular robots provide the platform with adequate vision, stability and manipulation capabilities.
  
  
  RESULTS
  Platform potentialities were demonstrated in a porcine model. Assessment was organized into two consecutive experimental steps, with a hybrid testing modality. First, platform deployment, anchoring and assembly through transoral-transgastric access were demonstrated in order to assess protocol feasibility and guarantee the safe achievement of the following experimental session. Second, transabdominal deployment, anchoring, assembly and robotic module actuation were carried out.
  
  
  CONCLUSIONS
  This study has demonstrated the feasibility of inserting an endoluminal robotic platform composed of an anchoring frame and modular robotic units into a porcine model through a natural orifice. Once inserted into the peritoneal cavity, the platform provides proper visualization from multiple orientations. For the first time, a platform with interchangeable modules has been deployed and its components have been connected, demonstrating in vivo the feasibility of intra-abdominal assembly. Furthermore, increased dexterity employing different robotic units will enhance future system capabilities.
authors: The BioRobotics Institute, Scuola Superiore Sant'Anna, V.le R. Piaggio 34, Pontedera, Pisa, Italy. s.tognarelli@sssup.it.
authors: Selene
authors: S
authors: Tognarelli
authors: The BioRobotics Institute, Scuola Superiore Sant'Anna, V.le R. Piaggio 34, Pontedera, Pisa, Italy.
authors: Marco
authors: M
authors: Salerno
authors: The BioRobotics Institute, Scuola Superiore Sant'Anna, V.le R. Piaggio 34, Pontedera, Pisa, Italy.
authors: Giuseppe
authors: G
authors: Tortora
authors: The BioRobotics Institute, Scuola Superiore Sant'Anna, V.le R. Piaggio 34, Pontedera, Pisa, Italy.
authors: Claudio
authors: C
authors: Quaglia
authors: The BioRobotics Institute, Scuola Superiore Sant'Anna, V.le R. Piaggio 34, Pontedera, Pisa, Italy.
authors: Paolo
authors: P
authors: Dario
authors: IHCI-Institute, Steinbeis University Berlin, Tuebingen, Germany.
authors: Marc Oliver
authors: MO
authors: Schurr
authors: The BioRobotics Institute, Scuola Superiore Sant'Anna, V.le R. Piaggio 34, Pontedera, Pisa, Italy.
authors: Arianna
authors: A
authors: Menciassi
mesh_terms: D000818:Animals; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012371:Robotics / Q000295:instrumentation* / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013552:Swine
keywords: Laparoscopic surgery; Miniature robots; Modular platform; NOTES