**3. Robotics for the flexible endoscopic surgery**

Natural orifice transluminal endoscopic surgery (NOTES) was introduced in 2004 [19]. It is the surgery using flexible endoscope instead of rigid laparoscope. As access to the lesion is through the natural orifice (mouth and anus), no incision on the patient skin, but on the organ inside body such as gastrointestinal wall instead is required. Conventional flexible endoscopes and instruments were not enough effective to perform this surgical procedure. So, several companies developed multi-tasking platform [20–25] (**Figure 7**). They basically contain flexible endoscope, articulating instruments, and grasping and cutting devices. They were not motorized, but manually actuated using wire transmission. However, NOTES is still in the experimental phase because this procedure was still technically difficult even using those platforms. Most of those platforms are discontinued. However, if new, effective device were introduced in the future, NOTES could be clinically accepted.

Endoscopic submucosal dissection (ESD) is another surgical procedure using flexible endoscope [28, 29]. ESD is applied only for gastrointestinal mucosal cancer. Therefore, it has limited coverage of organ compared with NOTES. ESD has been clinically accepted and prevailing especially in Asian countries. Although ESD

#### **Figure 7.**

*Examples of manually driven multi-tasking platform. (A) ANUBISCOPE (IRCAD & Karl Storz Endoskope), reprinted by permission from Springer Nature: Springer Nature [26]. (B) EndoSAMURAI (Olympus, Japan), reprinted by permission from Springer Nature: Springer Nature [27].*

**99**

**Figure 8.**

*Intelligent Information-Guided Robotic Surgery DOI: http://dx.doi.org/10.5772/intechopen.82191*

target of surgical robot industry.

been carried out [34, 35].

**3.2 Endomaster**

**3.1 STRAS**

systems for flexible endoscope are aiming at ESD procedure.

procedure is easier than NOTES, it still requires high skill of flexible endoscope and long training time like laparoscopy [30, 31]. Some of the recent robotic surgical

In this section, recent surgical robots for flexible endoscope are introduced. At present, there is no major robot in this field. But many are under development or just have been launched. We believe flexible endoscope surgery will be next major

ANUBISCOPE (IRCAD & Karl Storz Endoskope) [20, 21] was developed for NOTES and ESD procedure. The system composed of a custom made flexible endoscope with two articulating instruments. It was not motor driven but manually driven system. Strasburg University jointly developed motorized version, STRAS with Karl Storz and IRCAD [32–35]. By using vision computation technology, they applied automated target tracking [32] and position detection of the instruments [33]. This project is still in the phase of academic research. Some animal trials have

Endomaster (Endomaster Pte Ltd., Singapore) has also two articulating robotic instruments. It has "shoulder" and "elbow" joints in its instruments instead that all other platforms have consecutive bending section. The prototype (**Figure 8**) uses a conventional two channel endoscope but latest version uses custom made

*EndoMaster prototype, reprinted by permission from Springer Nature: Springer Nature [36].*

*Intelligent Information-Guided Robotic Surgery DOI: http://dx.doi.org/10.5772/intechopen.82191*

procedure is easier than NOTES, it still requires high skill of flexible endoscope and long training time like laparoscopy [30, 31]. Some of the recent robotic surgical systems for flexible endoscope are aiming at ESD procedure.

In this section, recent surgical robots for flexible endoscope are introduced. At present, there is no major robot in this field. But many are under development or just have been launched. We believe flexible endoscope surgery will be next major target of surgical robot industry.
