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World J Gastrointest Surg. Jun 27, 2010; 2(6): 217-223
Published online Jun 27, 2010. doi: 10.4240/wjgs.v2.i6.217
In vivo miniature robots for natural orifice surgery: State of the art and future perspectives
Manish M Tiwari, Jason F Reynoso, Amy C Lehman, Albert W Tsang, Shane M Farritor, Dmitry Oleynikov
Manish M Tiwari, Jason F Reynoso, Albert W Tsang, Dmitry Oleynikov, Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center Omaha, NE 68198-5126, United States
Amy C Lehman, Shane M Farritor, Department of Mechanical Engineering, University of Nebraska-Lincoln, N104 Scott Engineering Center, Lincoln, NE 68588-0656, United States
Author contributions: Lehman AC, Farritor SM and Oleynikov D were involved in concept and design of the study, data acquisition, data analysis and interpretation; Tiwari MM, Reynoso JF and Tsang AW participated in data acquisition and preparation of the manuscript.
Supported by NASA EPSCoR, Nebraska Research Initiative, Telemedicine and Advanced Technology Research Center, NASA-Nebraska Space Grant Consortium grants and National Science Foundation Graduate Research Fellowship
Correspondence to: Dmitry Oleynikov, MD, FACS, Director, Associate Professor, Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center Omaha, NE 68198-5126, United States.
Telephone: +1-402-5594581 Fax: +1-402-5596749
Received: February 4, 2010
Revised: March 11, 2010
Accepted: March 18, 2010
Published online: June 27, 2010

Natural orifice translumenal endoscopic surgery (NOTES) is the integration of laparoscopic minimally invasive surgery techniques with endoscopic technology. Despite the advances in NOTES technology, the approach presents several unique instrumentation and technique-specific challenges. Current flexible endoscopy platforms for NOTES have several drawbacks including limited stability, triangulation and dexterity, and lack of adequate visualization, suggesting the need for new and improved instrumentation for this approach. Much of the current focus is on the development of flexible endoscopy platforms that incorporate robotic technology. An alternative approach to access the abdominal viscera for either a laparoscopic or NOTES procedure is the use of small robotic devices that can be implanted in an intracorporeal manner. Multiple, independent, miniature robots can be simultaneously inserted into the abdominal cavity to provide a robotic platform for NOTES surgery. The capabilities of the robots include imaging, retraction, tissue and organ manipulation, and precise maneuverability in the abdominal cavity. Such a platform affords several advantages including enhanced visualization, better surgical dexterity and improved triangulation for NOTES. This review discusses the current status and future perspectives of this novel miniature robotics platform for the NOTES approach. Although these technologies are still in pre-clinical development, a miniature robotics platform provides a unique method for addressing the limitations of minimally invasive surgery, and NOTES in particular.

Keywords: Robotic surgery, In vivo robots, Natural orifice surgery, Robotic surgical platforms