Sewing up the Wounds: A Robotic Suturing System for Flexible Endoscopy

If a perforation occurs as a result of a flexible endoscopic procedure, urgent laparoscopy or open surgery may be required to repair the perforation, because suturing is normally stronger than closure using existing endo-scopic devices. Suturing with stitches and knots, widely adopted in open or laparoscopic surgery, is still not possible in flexible endoscopy. This is due to the confined space of the natural orifice and target area, the high levels of motion dexterity and force needed for stitching and knot tying, and the critical size and strength requirements of wound closure. We present a novel flexible endoscopic robotic suturing system that can suture gastrointestinal defects without opening up the patient's body as in open or laparo scopic surgery. This system features a robotic needle driver and a robotic grasper, both of which are flexible, small enough for through-the-scope delivery, and dexterous with five degrees of freedom (DoF). The needle driver, facilitated by the grasper, enables the surgeon to control a needle through teleoperation and so make stitches and knots in flexible endoscopy. Successful in vivo trials were conducted in the rectum of a live pig to confirm the feasibility of endoscopic suturing and knot tying using the system in a realistic surgical scenario (not possible with existing devices, which are all manually driven). This new technology will change the way surgeons close gastro intestinal defects.