Natural Orifice Translumenal Endoscopic Surgery (NOTES) is a hybrid procedure which uses flexible endoscopic technology to perform laparoscopic surgical procedures beyond the confines of the gastrointestinal tract. This approach, which has several patient advantages including faster recovery, less adhesions and absence of abdominal wound infections, necessitates the development of dexterous endoscopic instruments for the surgeon. To this end, in 2006 the NOSCAR group identified the barriers that needed to be surmounted for the development of NOTES [1], and set up a list of steps and guidelines to aid the research of multi-branched instruments, also known as multitasking platforms.
Several ideal characteristics can be defined for multi-branched instruments, amongst which adequate maneuver-rability, independent camera articulation and triangulation (i.e. using two articulating instrument branches to allow for tissue traction and counter-traction), are the most critical for the performance of complex bimanual surgical tasks such as knot-tying and suturing. Other important...
