Available online 7 February 2024, 101006

Author links open overlay panel, Abstract

Innovative approaches leverage cutting-edge technologies to advance the field of minimally invasive colorectal surgery. The implementation of complex endoluminal and transluminal procedures is challenging and requires extensive training. Recent technological advances not only enable improved detection of colorectal neoplasms with the support of computer science, but also enhanced surgical treatment with robotic instrumentation. Early diagnosis will revolutionize colorectal cancer treatment by avoiding surgery, as has been demonstrated in the treatment of early-stage gastric cancer using third-space endoscopy. Automated colorectal cancer screening with polyp detection and classification can change the therapeutic strategy and orient towards resection during endoscopy, including full-thickness resection, with endoscopic bimanual suturing to close the defect. Several therapeutic flexible endoscopic robotic systems are expected to provide surgery-like dexterity for endo- and transluminal approaches by enabling tissue triangulation while lowering the technical hurdles for endoscopic submucosal dissection and other highly sophisticated procedures such as endoscopic creation or revision of anastomoses. In the curvilinear anatomy of the colon and rectum, navigation assistance for improved spatio-temporal orientation will aid in the detection and documentation of lesions and facilitate their localization for excision and follow-up. Flexible robotic systems encourage surgeons as well as gastroenterologists to perform advanced intra- and transluminal resections.

Section snippetsClinical context

Colorectal cancer (CRC) is one of the most common types of cancer worldwide. Only by efficient screening and detection of precursor lesions can prevent CRC1. Strategies for early detection of CRC and its precursors are based on screening protocols and colonoscopy. However, a quarter of colorectal neoplasms are missed during screening colonoscopy. A significant increase in the detection of colorectal neoplasms has been observed with the aid of deep learning-based systems (also known as

Robotic technology for endoluminal access

The surgical endoscopic platforms IsisScope® for laparo-endoscopic single-site procedures14 and Anubiscope® for NOTES procedures15,16 were developed in an IRCAD collaboration with KARL STORZ to provide instrument triangulation and retraction in a device based on a flexible endoscope. Despite improved tissue manipulation and exposure, these platforms were still unsuitable for ergonomic endoluminal ESD or full-thickness resections, as they required two fully trained surgeons to operate.

Conclusion

At the intersection of endoscopy with colorectal and transanal surgery, endo- and transluminal procedures are an ideal target for the potential of robotic endoscope navigation, stabilization, and bimanual instrument manipulation. The robotization of endoscopes is therefore expected not only to enhance the performance of minimally invasive interventionalists through mechanical support – dexterity and precision, remotely and stably controlled instruments, ergonomic console to reduce

Funding

This work was supported by French state funds managed within the “Plan Investissements d'Avenir” and by the ANR (reference ANR-10-IAHU-02).

Disclosure

BS has a research and education consultant agreement with CMR Surgical and Intuitive Surgical. JM is the President and Founder of the IRCAD Institute, which is partly funded by Karl Storz, Medtronic and Intuitive Surgical.

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