Self-propelled soft robotic endoscopes for next-generation gastrointestinal surgery (ROBOGAST)

胃肠道癌症，包括食道癌、胃癌和结肠癌，跻身全球十大癌症之列。与传统的开腹手术相比，早期胃肠癌等消化系统疾病的微创手术在减少创伤和加快患者康复方面具有重要的优势。然而，目前的内窥镜存在一些局限性，包括远端的力传递、器械的三角测量、缺乏双指甲组织操纵和视觉空间定位。因此，介入性内窥镜检查需要相当多的经验，涉及复杂和耗时的工作流程。因此，由于其曲折的性质，相当数量的内窥镜干预无法到达结肠和小肠的末端。由于目前的新冠肺炎大流行，全国范围内的内窥镜部门一直在努力提高进行胃肠道内窥镜检查的能力，导致诊断和治疗的延误，影响了患者的发病率和死亡率。因此，改善柔性内窥镜诊断和治疗的途径，并促进其安全和负担得起的部署，应该是当务之急和紧迫的临床需求。本研究旨在改变胃肠道(包括小肠)的早期诊断和微创干预。为此，我们将为下一代软机器人内窥镜开发实现自主自行式移动所需的基础技术。背离传统的推进式内窥镜检查范例将减少与早期诊断相关的不适，并将允许在二级或三级护理以外的治疗程序方面技能较差的内窥镜医生进行腔内和潜在的腔内手术。我们对可负担性的关注旨在解决由传染病驱动的对一次性医疗设备日益增长的需求，并减少阻碍手术机器人在低收入国家更广泛使用的财务障碍。

Gastrointestinal cancers, including oesophagus, stomach and colon, are among the top ten cancers worldwide. Minimally invasive surgery of early gastrointestinal cancer and other digestive diseases offer important advantages compared to traditional open surgery in terms of reduced trauma and faster patient recovery. However, there are several limitations to current endoscopes including distal force transmission, triangulation of instruments, lack of bimanual tissue manipulations and visual-spatial orientation. Thus interventional endoscopy requires considerable experience and involves complex and time-consuming workflows. As a result, a sizeable amount of endoscopic interventions fail to reach the end of the colon and the small intestine because of their tortuous nature. Due to the current COVID-19 pandemic, endoscopy units nationwide have been struggling with capacity to perform gastrointestinal endoscopies resulting in a delay to diagnosis and treatment, impacting patient morbidity and mortality. Improving access to flexible endoscopy for diagnosis and treatment, and facilitating its deployment safely and affordably, should therefore be a priority and is a pressing clinical need.This research aims to transform early diagnosis and minimally invasive intervention of the gastrointestinal tract, including the small intestine. To this end we will develop the underlying technology necessary to achieve autonomous self-propelled locomotion for the next generation of soft robotic endoscopes. Departing from the conventional push-endoscopy paradigm will reduce the discomfort associated to early diagnosis and will allow endoscopists who are less skilled in therapeutic procedures, outside secondary or tertiary care, to perform endoluminal and potentially transluminal surgery. Our focus on affordability aims to address the growing demand for single-use medical devices driven by infectious diseases, and to reduce the financial barriers that are preventing the wider use of surgical robotics in low-income countries.