Overcoming abdominal and pelvic cavity workspace constraints in robotic-assisted NOTES

Abstract

Despite early enthusiasm in robotic-assisted NOTES, several technical challenges exist. Various spinopelvic anatomical constraints can significantly act as obstacles and affect entry and space availability for the deployment of straight and rigid transvaginal/transanal NOTES instruments. Anatomical constraints such as the sacral slope, position, and distance to the target organs are defined. Transvaginal access to the surgical site required a high insertion angle between 20° and 30° to overcome the pronounced sacral slope resulting in dexterity and reachability limitations. A new set of robotic parameters was generated to introduce a 7 degrees of freedom robotic arm. Workspace simulation and phantom precision measurements have shown a significant improvement in the reachability and maneuverability of the robotic platform. While the robotic arms provided stable dexterity, it is constrained when reaching target sites in larger patients. This study has provided an insight and a solution in rigid instrument design, paving a safe route for transvaginal/transanal access for abdominal surgeries towards robotic-assisted NOTES.