ICRA 2014: Workshop on Advances in Flexible Access Robots for Surgical Interventions

Prof. Philip Chiu, Chinese University of Hong Kong

Prof. Philip Chiu is Professor in the Division of Upper GI Surgery of the Department of Surgery in the Chinese University of Hong Kong, China. Moreover, he is the Director of the Jockey Club Minimally Invasive Surgical Skills Center, and the Assistant Dean of the Faculty of Medicine. Finally, Prof. Chiu is a Fellow of Wu Yee Sun College.

Clinical Challenges in Flexible Access Surgery

Endoscopic surgery has been increasingly developed since 10 years ago [1]. The development of endoscopic resection for early gastrointestinal cancers resulted in improvement of patients’ recovery and clinical outcomes [2,3]. With endoscopic resection, surgeons shall not unnecessarily resect the organ of disease which resulted in better quality of life for patients. However, endoscopic resection is technically challenging as the endoscope was designed initially as a diagnostic tool. Moreover, the working channels of the endoscope were co-axially aligned and therapeutic devices were not arranged in a triangular manner when compared to minimal invasive surgery. During endoscopic resection of early GI cancers, surgeons can only dissect with single hand arranged in co-axial to the imaging system. Endoscopic surgery is also limited by the instruments available, and there is scarcely device for performance of basic surgical steps like suturing.

Recent technological developments in endoscopy revolutionized the performance of endoscopic surgery and allowed surgeons to perform wider range of procedures within the gastrointestinal tract. Endoscopic suturing platform enabled surgeons to approximate gastrointestinal tissue which enhanced endoscopic treatments in gastrointestinal bleeding, perforation as well as managing complications from morbid obesity surgery [4]. The development of a flexible endoscopic robot platform allows endoluminal procedures to be performed with two arms, one for retraction and another for dissection [5]. In the future, fully automated endoscopy will lessen the discomfort induced to patients during screening endoscopy. The endoscopists will perform endoscopic therapy in a remote position from the patient using robotic technologies.

Relevant References

[1] Chiu PW. Novel endoscopic therapeutics for early gastric cancer. Clinical Gastroenterology and Hepatology 2014 Jan;12(1):120-5.

[2] Chiu PWY, Chan KF, Lee YT, Sung JY, Lau JY, Ng EK. Endoscopic submucosal dissection (ESD) for treatment of early neoplasia of the foregut using combination of knives. Surgical Endoscopy 2008; 22(3):777-783

[3] Chiu PW, Teoh AY, To KF, Wong SK, Liu SY, Lam CC, Yung MY, Chan FK, Lau JY, Ng EK. Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study. Surgical Endoscopy 2012 Dec;26(12):3584-91

[4] Chiu PW, Lau JY, Ng EK, Lam CC, Hui M, To KF, Sung JJ, Chung SC. Closure of a gastrotomy after transgastric tubal ligation by using the Eagle Claw VII: a survival experiment in a porcine model. Gastrointestinal Endoscopy 2008; 68(3):554-559

[5] Phee SJ, Reddy N, Chiu PW, Rebala P, Rao GV, Wang Z, Sun Z, Wong JY, Ho KY. Robot-Assisted Endoscopic Submucosal Dissection Is Effective in Treating Patients With Early-Stage Gastric Neoplasia. Clinical Gastroenterology and Hepatology 2012 Oct;10(10):1117-21.