Are the grant recipients conducting research that is pointing to the next phase in the evolution of the NOTES procedure? Are the growing capabilities of therapeutic flexible endoscopy leading to a new era in treatment of gastrointestinal conditions? Are the most important areas for initial NOTES study safe peritoneal access and secure gastric closure, intraperitoneal contamination, image display and maintenance of spatial orientation, development of stable working platforms, physiologic perturbations, and tissue approximation methods?
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Natural orifice transluminal endoscopic surgery, or NOTES, allows for exceedingly minimally invasive surgery but has high requirements for the dexterity and force capabilities of the tools. An overview of the ViaCath System is presented. This system is a first generation teleoperated robot for endoluminal surgery and consists of a master console with haptic interfaces, slave drive mechanisms, and 6 degree-of-freedom, long-shafted flexible instruments that run alongside a standard gastroscope or colonoscope. The system was validated through animal studies. It was discovered that the devices were difficult to introduce into the GI tract and manipulation forces were insufficient. The design of a second generation system is outlined with improvements to the instrument articulation section and a steerable overtube. Results of basic evaluation tests performed on the tools are also presented.