Future Directions for Robotic Endoscopy–Artificial Intelligence (AI), Three-Dimensional (3D) Imaging, and Natural Orifice Transluminal Endoscopic Surgery (NOTES)

Artificial intelligence (AI) can aid endoscopic and surgical procedures in various ways, such as detecting and diagnosing gastrointestinal lesions, assisting in procedures, recognizing dissection planes, and predicting adverse events. 3D imaging has also improved the visual and technical aspects of endoscopic and surgical procedures by improving depth recognition. Robotic endoscopy involves aspects of both endoscopy and surgery. It is based on a flexible endoscopic technology; however, it allows for bimanual control of devices for better triangulation. Thus, AI and 3D imaging technologies should be incorporated into robotic endoscopy to improve learning curves and enable more precise operation of robotic instruments. The utilization of robotics will expand the spectrum of current therapeutic endoscopy. Natural orifice transluminal endoscopic surgery (NOTES) is associated with shorter operative time, faster patient recovery, and less postoperative pain. However, current efforts to promote NOTES have been hampered by suboptimal NOTES surgical instruments, which have limited maneuverability and degrees of freedom. These challenges are overcome by the robotic endoscope, which has end-effectors with high degrees of freedom. Surgeons performing NOTES using the robotic endoscope can perform triangulation and 360-degree rotation of the robotic wrists. As a 3-armed procedurist, the surgeon can now retract tissues effectively for optimal exposure of the operating field.