NOTES (Natural Orifice Translumenal Endoscopic Surgery) is an emerging paradigm to eliminate external incisions by gaining access to the peritoneal cavity through a natural orifice. Fusion of Minimally Invasive Surgery (MIS) and robotics has created new possibilities to overcome some of the limitations imposed by such surgeries to smooth the adoption of these approaches.
The ability to exchange instruments during NOTES and laparo-endoscopic single-site surgery (LESS) is essential for surgical robotics in procedures such as cholecystectomy. Transporting instruments from the external environment to within the body, removing the tool outside of the body, and changing functional tips manually is time consuming and may lead to complications such as bleeding, bowel perforation, and splenic injury, endangering the safety of the patient. Previous designs of multiple-instruments manipulators [1–3] use electric motors for tool exchange and actuation. With electric motors, there is always a tradeoff between size and performance in terms...
