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Joystick Interfaces Are Not Suitable for Robotized Endoscope Applied to NOTES

IRCAD-EITS Institute, Strasbourg

Laurent Ott, MSc

LST (UMR CNRS 7005), University of Strasbourg, Illkirch

Mitsuhiro Asakuma, MD

IRCAD-EITS Institute, Strasbourg

Norbert Masson, MSc

LST (UMR CNRS 7005), University of Strasbourg, Illkirch

Silvana Perretta, MD

IRCAD-EITS Institute, Strasbourg

Bernard Dallemagne, MD

IRCAD-EITS Institute, Strasbourg

Dimitri Coumaros, MD

Department of Gastroenterology, University Hospital, Strasbourg France

Michel De Mathelin, PhD

LST (UMR CNRS 7005), University of Strasbourg, Illkirch

Luc Soler, PhD

IRCAD-EITS Institute, Strasbourg

Jacques Marescaux, MD, FACS, FRCS

IRCAD-EITS Institute, Strasbourg, Jacques.Marescaux{at}ircad.fr

Background NOTES has changed the working environment of endoscopy, leading to new difficulties. The limitations of conventional endoscopes call for the development of new platforms. Robotics may be the answer. Materials and methods The authors compared human to robotized manipulation of a flexible endoscope into the abdominal cavity, in an animal model. Thirty-two participants were enrolled. Results were analyzed according to the clinical background of the participants: experienced endoscopists, experienced laparoscopists, and medical students. Two single-channel gastroscopes were used. Whereas one was not modified, the other had the handling wheels replaced by motors controlled through a computer and a joystick. A NOTES transgastric approach was used to access the peritoneal cavity. The time to touch previously positioned intra-abdominal numbered plastic targets was recorded 3 times with each endoscope. Results Mean time to complete the tasks was significantly shorter using the conventional endoscope (2.71 vs 6.96 minutes, P < .001). When the robotized endoscope was used, the mean times of endoscopists (7.42 minutes), laparoscopists (6.84 minutes), and students (6.77 minutes) were statistically identical. No differences were found between laparoscopists and students in both techniques. Discussion Applying robotics to a flexible endoscope fails to enhance ability to move into the abdominal cavity, partly because of the interface. To overcome the limitations of endoscope when performing complex NOTES tasks, robotics may be useful, especially to control the instruments and to stabilize the endoscope itself. Conclusion Robotized endoscope with joystick interface is not sufficient to enhance immediate intuitiveness of flexible endoscopy applied to NOTES.

Key Words: natural orifices • NOTES • robotic • flexible endoscopy

Surgical Innovation, Vol. 16, No. 2, 111-116 (2009)
DOI: 10.1177/1553350609338181


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