title: Total mesorectal excision using a soft and flexible robotic arm: a feasibility study in cadaver models.
abstract: Sponsored by the European Commission, the FP7 STIFF-FLOP project aimed at developing a STIFFness controllable Flexible and Learn-able manipulator for surgical operations, in order to overcome the current limitations of rigid-link robotic technology. Herein, we describe the first cadaveric series of total mesorectal excision (TME) using a soft and flexible robotic arm for optic vision in a cadaver model.
  
  
  
  TME assisted by the STIFF-FLOP robotic optics was successfully performed in two embalmed male human cadavers. The soft and flexible optic prototype consisted of two modules, each measuring 60 mm in length and 14.3 mm in maximum outer diameter. The robot was attached to a rigid shaft connected to an anthropomorphic manipulator robot arm with six degrees of freedom. The controller device was equipped with two joysticks. The cadavers (BMI 25 and 28 kg/m2) were prepared according to the Thiel embalming method. The procedure was performed using three standard laparoscopic instruments for traction and dissection, with the aid of a 30° rigid optics in the rear for documentation.
  
  
  
  Following mobilization of the left colonic flexure and division of the inferior mesenteric vessels, TME was completed down to the pelvic floor. The STIFF-FLOP robotic optic arm seemed to acquire superior angles of vision of the surgical field in the pelvis, resulting in an intact mesorectum in both cases. Completion times of the procedures were 165 and 145 min, respectively. No intraoperative complications occurred. No technical failures were registered.
  
  
  
  The STIFF-FLOP soft and flexible robotic optic arm proved effective in assisting a laparoscopic TME in human cadavers, with a superior field of vision compared to the standard laparoscopic vision, especially low in the pelvis. The introduction of soft and flexible robotic devices may aid in overcoming the technical challenges of difficult laparoscopic procedures based on standard rigid instruments.
authors.affiliation: Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy. alberto.arezzo@unito.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Arezzo
authors.affiliation: Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Mintz
authors.affiliation: Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy.
authors.forename: Marco Ettore
authors.initials: ME
authors.lastname: Allaix
authors.affiliation: Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Arolfo
authors.affiliation: Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bonino
authors.affiliation: The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.
authors.forename: Giada
authors.initials: G
authors.lastname: Gerboni
authors.affiliation: The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Brancadoro
authors.affiliation: The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cianchetti
authors.affiliation: The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Menciassi
authors.affiliation: Department of Mechanical Engineering, University of London, London, UK.
authors.forename: Helge
authors.initials: H
authors.lastname: Wurdemann
authors.affiliation: Department of Informatics, Kings College London, London, WC2R 2LS, UK.
authors.forename: Yohan
authors.initials: Y
authors.lastname: Noh
authors.affiliation: Department of Informatics, Kings College London, London, WC2R 2LS, UK.
authors.forename: Kaspar
authors.initials: K
authors.lastname: Althoefer
authors.affiliation: Industrial Research Institute for Automation and Measurements PIAP, Warsaw, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Fras
authors.affiliation: Industrial Research Institute for Automation and Measurements PIAP, Warsaw, Poland.
authors.forename: Jakob
authors.initials: J
authors.lastname: Glowka
authors.affiliation: Foundation of Cardiac Surgery Development, Zabrze, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Nawrat
authors.affiliation: Shadow Robot Company Ltd., London, UK.
authors.forename: Gavin
authors.initials: G
authors.lastname: Cassidy
authors.affiliation: Shadow Robot Company Ltd., London, UK.
authors.forename: Rich
authors.initials: R
authors.lastname: Walker
authors.affiliation: Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
mesh_terms: D002102:Cadaver; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012007:Rectum / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000295:instrumentation*
keywords: Flexible; Robotic surgery; Soft; Total mesorectal excision