Robotic Tissue Manipulation in Endoscopic Submucosal Dissection Via Visual Feedback

Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer-related deaths in the United States. Despite advancements in screening and treatment, there remains a critical need for more effective and minimally invasive methods to manage complex polyps and early-stage colorectal cancers. This study introduces a novel approach to magnetic tissue manipulation for Endoscopic Submucosal Dissection (ESD), leveraging visual feedback to enhance precision and control. We develop and evaluate the proposed system within a ROS Gazebo simulation environment, integrating a small magnetic endoscopic clip affixed to tissue, which is manipulated by an external large magnet mounted on a robotic arm. A key challenge in ESD is achieving adequate tissue exposure for precise cutting, particularly in the confined space of the colon where the endoscope is manually controlled. To address this, our system enables controlled manipulation of the magnetic clip to optimize tissue retraction. The robotic arm, guided by real-time visual feedback, dynamically adjusts the internal clip's orientation. Multiple virtual cameras were used to validate the proposed method. The simulation results demonstrated that the robot arm successfully manipulated the internal magnetic clip to the desired tilt angle within an average of 8.4 seconds (range 5.3 to $\mathbf{1 5. 2 ~ s}$). Our findings suggest that robotic-assisted magnetic tissue manipulation has the potential to improve ESD success rates while reducing procedure time, paving the way for further advancements in minimally invasive endoscopic surgery.