PROJECT SUMMARY / ABSTRACT
Recent improvements in flexible endoscopes have resulted in an explosion of their use for minimally invasive
diagnosis and intervention. Interventional pulmonology has seen a significant expansion of procedures along
with these advances, as the large, medium, and even distal airways now can be accessed via bronchoscopic
technique. With primary lung cancer accounting for approximately 25% of all cancer deaths in the US,
screening expediently, effectively, and completely has become of significant importance.
One of the significant technical challenges with flexible endoscopic interventions is the limitation in freedom of
movement that exists between the endoscope and the instruments that are passed through the working port.
Instruments typically have a fixed orientation to the distal scope tip and, in most cases, only can be advanced
along the axis of scope tip. Additionally, scope flexibility and maneuverability reduces with an instrument
present, further limiting dexterity. Working within the narrow confines of a bronchus or trachea limits the ability
to accurately and expeditiously direct instruments to lesions or biopsy targets. As a result, procedure times
may be extended, dysplastic or malignant lesions can be incompletely treated, or surrounding tissues be
unnecessarily traumatized secondary to challenges with scope positioning.
To address this ongoing challenge with flexible endoscopy, we have developed a handheld robotic catheter
that can be passed through the instrument channel of a flexible bronchoscope. The catheter accommodates an
assortment of instrumentation to allow for robotically enhanced articulation of tools, in essence, liberating the
rigid restrictions of movement that currently exists between scope and instrument, and expanding its reach and
allowing for more distal pathology to be accessed and treated. Importantly, the robotic catheter can be held
and operated by one hand, making its use directly compatible with existing handheld flexible endoscopes, and
allowing a single practitioner to operate both imager and instrumentation without additional help.
Overall, the Project Aims are to (1) develop and validate the robotic instrument and (2) perform a user study of
the device to evaluate its efficacy and efficiency of central and peripheral lung access for addressing suspect
pathologies. At the end of this project, we aim to have a validated robotic instrument for clinical trials.
We hypothesize technology will inherit the observed benefits with prior surgical robotic systems, i.e., reduced
procedure times, less adjacent tissue trauma from scope navigation, more accurate instrument placement, and
enhanced provider procedural experience. Robotizing the instrumentation without changing the endoscope
would result in a low-cost solution that removes the burden of specialty equipment, staff, and facilities, allowing
not only hospitals but also outpatient clinics to afford and offer robotic procedures. This has a significant
potential to expand the accessibility of robotically enhanced diagnostics and intervention to economically
diverse and geographically challenged populations across the country.