No-scar surgery with the MASTER robot

Please welcome the first guest-editor of the blog: Kurt Sun Zhenglong, PhD candidate at Nanyang Technological University's BioRobotics lab.

The MASTER system has been under development for over 6 years, and now it's in the clinics. See the video coverage of the first trial here. (An earlier paper and a presentation on the sytem here.)
Flexible endoscopes can be used to inspect, diagnose and treat various pathologies in the upper or lower gastro intestinal (GI) tract. A typical endoscope includes an ultra compact Charged-Coupled Device (CCD) camera, light source and a channel for infusing or withdrawing liquid or gas from the patient’s body. The tip of the endoscope is steerable so that the endoscope is able to transverse through the winding channel of the GI tract faster, safer and giving less pain to the patient. The endoscope also provides tool channels for instruments to go through which enable the endoscopist to perform a variety of treatments such as biopsy, polypectomy, marking, haemostasis, etc. Commercially available manually operated endoscopic tools often only provides for up to two Degrees of Freedom (DOF) for mostly grasping actions. This limited DOF still prevents state-of-the-art tools from performing complex tasks such as ESD (endoscopic submucosal dissection). The loss of depth perception, tactile and force sensations adds to the difficulty in performing dexterous maneuvers using a flexible endoscope.
The MASTER system has been developed by a research group lead by Associate Professor Louis Phee of Nanyang Technological University (NTU) and Professor Ho Khek Yu of National University Hospital (NUH), to tackle these problems. The system consists of a master console, a telesurgical workstation, and a slave manipulator which holds two end-effectors, a grasper and a monopolar electrocautery hook. With a total number of 9-DoFs in two robotic arms, the system enables the surgeon to perform complex surgical procedures which could hardly be achieved in a non-invasive manner. The system would be operated by an endoscopist and a surgeon. The former would traverse and maneuver the endoscope while the latter would sit in front of the master console to control the slave manipulators.
Recently, using this technology, surgeons at AIG, Hyderabad, India, have successfully performed tumor removal for 3 patients suffering from gastric cancer, which is possibly the world-first to be performed on stomach cancer patients—said Singapore doctors.  It cuts surgery time for stomach cancer patients to 17 minutes from eight hours, does reduces the length of hospitalization, and allows patients to undergo surgery without having to bear scars.
Associate Professor Louis Phee, head of the Division of Mechatronics and Design at NTU, said: "With this robotic system, you're giving a lot of maneuverability and dexterity to the endoscopist such that he can act and perform like a surgeon. It becomes possible to manipulate tissues, to cut and in the near future, to suture wounds inside the stomach."
While the gadget has reaped benefits during its trial stages, experts say there is still room for fine-tuning. Professor Ho Khek Yu, senior consultant at the Department of Gastroenterology and Hepatology at NUH, said: "Currently, we can only do procedures on early stomach tumors because the robotic arms are fashioned to do this procedure only. This procedure is challenging and needs a certain period of training. We need to adapt the robotic arms further to allow us to do more complicated procedures such as obesity surgery and anti-reflux surgery in future."
By Kurt Sun Zhenglong

Read about it on MedGadget as well, and on their research page.


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