A Transendoscopic Telerobotic System Using Heterogeneous Flexible Manipulators for Bimanual Endoscopic Submucosal Dissection

Abstract

Endoscopic submucosal dissection (ESD) is an effective technique to resect early cancers in the gastrointestinal (GI) tract. Bimanual telerobotic manipulation is an approach to performing ESD intuitively and efficiently, which requires two robotic instruments with flexibility, stiffness, dexterity and accuracy. However, the priority of these properties depends on the specific surgical tasks. In this work, we proposed the first heterogeneous flexible manipulators (HFMs) for bimanual ESD, which can take advantage of different mechanical structures. The grasping instrument employs a serial articulated manipulator (SAM) to perform multidirectional (relatively higher dexterity) and stable (relatively higher stiffness) traction for better submucosal visualization. The electrosurgical instrument utilizes a parallel continuum wrist (PCW) to execute accurate (higher accuracy) tissue dissection. Both HFMs have sufficient flexibility to go through the flexible endoscopic working channels. Based on the HFMs, we established a transendoscopic telerobotic system. The kinematics of the SAM and PCW were built in the endoscope frame using the Denavit-Hartenberg (DH) method and Cosserat rod method,