A technical review of flexible endoscopic multitasking platforms

Further development of advanced therapeutic endoscopic techniques and
natural orifice translumenal endoscopic surgery (NOTES) requires a powerful
flexible endoscopic multitasking platform.
Medline search was performed to identify literature relating to flexible
endoscopic multitasking platform from year 2004-2011 using keywords: Flexible
endoscopic multitasking platform, NOTES, Instrumentation, Endoscopic robotic
surgery, and specific names of various endoscopic multitasking platforms. Key
articles from articles references were reviewed.
Flexible multitasking platforms can be classified as either mechanical
or robotic. Purely mechanical systems include the dual channel endoscope (DCE)
(Olympus), R-Scope (Olympus), the EndoSamurai (Olympus), the ANUBIScope
(Karl-Storz), Incisionless Operating Platform (IOP) (USGI), and DDES system
(Boston Scientific). Robotic systems include the MASTER system (Nanyang
University, Singapore) and the Viacath (Hansen Medical). The DCE, the R-Scope,
the EndoSamurai and the ANUBIScope have integrated visual function and instrument
manipulation function. The IOP and DDES systems rely on the conventional flexible
endoscope for visualization, and instrument manipulation is integrated through
the use of a flexible, often lockable, multichannel access device. The advantage
of the access device concept is that it allows optics and instrument
dissociation. Due to the anatomical constrains of the pharynx, systems are
designed to have a diameter of less than 20 mm. All systems are controlled by
traction cable system actuated either by hand or by robotic machinery. In a
flexible system, this method of actuation inevitably leads to significant
hysteresis. This problem will be accentuated with a long endoscope such as that
required in performing colonic procedures. Systems often require multiple
operators. To date, the DCE, the R-Scope, the IOP, and the Viacath system have
data published relating to their application in human.
Alternative forms of instrument actuation, camera control and master
console ergonomics should be explored to improve instrument precision, sphere of
action, size and minimize assistance required.