Development and clinical translation of intelligent assistive devices for minimally invasive thoracic surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Jiwei ¹ , MA Honghai ¹ , ZHOU Chunlin ² , HE Zhehao ¹ , SHEN Tong ³ , YU Haojie ⁴ ,  WANG Luming ¹ ,  HU Jian ^1,5

1. Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, P. R. China;
2. College of Control Science and Engineering of Zhejiang University, Huzhou Research Institute of Zhejiang University, Hangzhou, 310003, P. R. China;
3. Yibowan Medical Technology (Shanghai) Co., Ltd., Shanghai, 200120, P. R. China;
4. State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310058, P. R. China;
5. Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, Hangzhou, 310003, P. R. China;

Corresponding?author：

WANG Luming, Email: dr_hujian@zju.edu.cn; HU Jian, Email: 1507144@zju.edu.cn

Keywords：

Video-assisted thoracoscopic surgery; assistive arms; snake-shaped endoscope; artificial intelligence; visual servoing

DOI：

10.7507/1007-4848.202603060

Video：

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Although video-assisted thoracoscopic surgery (VATS) offers clear advantages, including minimal trauma and rapid recovery, stable intraoperative visualization still depends heavily on the camera assistant. Traditional manual endoscope holding is therefore susceptible to several limitations, including image instability, assistant fatigue, and poor coordination with the primary surgeon. Operating in complex and confined anatomical spaces with a rigid thoracoscope further increases the demands on hand-eye coordination. Thoracoscopic camera-holding technology has progressively evolved from passive support systems to active camera holders and robot-assisted thoracic surgery (RATS) platforms, and is now advancing toward artificial intelligence-driven tracking and intelligent control. Based on this, a series of devices, including multifunctional intelligent assistant arms and active camera-holding arms for thoracic surgery, have been developed and have attracted increasing attention. This article reviews the development of intelligent camera-holding assistant arms and discusses related advances and future directions in the field.

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2. Chen K, Zhang X, Jin R, et al. Robot-assisted thoracoscopic surgery for mediastinal masses: a single-institution experience. J Thorac Dis, 2020, 12(2): 105.
3. Amore D, Cicalese M, Scaramuzzi R, et al. Hybrid robotic thoracic surgery for excision of large mediastinal masses. J Vis Surg, 2018, 4: 105.
4. Yoon SH, Jung MC, Park SY. Evaluation of surgeon's muscle fatigue during thoracoscopic pulmonary lobectomy using interoperative surface electromyography. J Thorac Dis, 2016, 8(6): 1162-1169.
5. Cheng T, Ng CSH, Li Z. Innovative surgical endoscopes in video-assisted thoracic surgery. J Thorac Dis, 2018, 10(Suppl 6): S717-S723.
6. Li X, Wang H, Hu Z, et al. Glasses-free 3D versus 2D video-assisted thoracoscopic thymectomy: a single-center short-term comparative study. Ann Transl Med, 2019, 7(23): 750.
7. Kagimoto A, Ishida M, Mimura T. Utility of 4K three-dimensional endoscopic system in performing video-assisted thoracoscopic surgery lobectomy: initial results of the first year after installation. Gen Thorac Cardiovasc Surg, 2024, 72(8): 535-541.
8. Ueno H, Imamura Y, Okado S, et al. Lobectomy for primary lung cancer: a comparison of perioperative and postoperative outcomes between robot-assisted thoracic surgery and video-assisted thoracic surgery. Surg Today, 2025, 55(8): 1162-1172.
9. Kunisaki C, Hatori S, Imada T, et al. Video-assisted thoracoscopic esophagectomy with a voice-controlled robot: the AESOP system. Surg Laparosc Endosc Percutan Tech, 2004, 14(6): 323-327.
10. Gossot D, Abid W, Seguin-Givelet A. Motorized scope positioner for solo thoracoscopic surgery. Video-assist Thorac Surg, 2018, 3: 47.
11. Gonzalez-Rivas D. Unisurgeon uniportal video-assisted thoracoscopic surgery lobectomy. J Vis Surg, 2017, 3: 163.
12. Sesma J, Bolufer S, Galvez C, et al. Video-assisted thoracic surgery assisted by articulated arm (AVATS): a new way towards ergonomics and optimization of surgical resources. Shanghai Chest, 2019, 3.
13. Bertolaccini L, Viti A, Terzi A, et al. Geometric and ergonomic characteristics of the uniportal video-assisted thoracoscopic surgery (VATS) approach. Ann Cardiothorac Surg, 2016, 5: 118-122.
14. Zhang Q, Ma H, Ke L, et al. Application and exploration of surgical assistive arms in thoracoscopic surgery: a single-center retrospective study. Sci Rep, 2025, 15(1): 5606.
15. Lin YY, Hsieh MJ, Wu CY, et al. Comparison of active versus passive robotic-endoscope-holder-assisted unisurgeon uniportal thoracoscopic surgery in terms of surgical efficacy and patient safety. J Thorac Dis, 2023, 15(7): 3800-3810.
16. 柯磊, 汪路明, 張慶怡, 等. 智能蛇形臂氣動手術輔助臂研發及其臨床價值研究. 中國醫學裝備, 2023, 20(10): 6-9.Ke L, Wang LM, Zhang QY, et al. Research and development of the intelligent serpentine pneumatic surgical assist arm and its clinical value. Chin Med Equip, 2023, 20(10): 6-9.
17. 柯磊, 張慶怡, 汪路明, 等. 可塑性蛇形腔鏡手術輔助臂的臨床研究. 臨床外科雜志, 2023, 31(6): 568-570.Ke L, Zhang QY, Wang LM, et al. Clinical study of the plastic serpentine endoscopic surgical assist arm. J Clin Surg, 2023, 31(6): 568-570.
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20. Aghakhani N, Geravand M, Shahriari N, et al. Task control with remote center of motion constraint for minimally invasive robotic surgery. 2013 IEEE International Conference on Robotics and Automation. IEEE, 2013: 5807-5812.
21. Zhou X, Zhang H, Feng M, et al. New remote centre of motion mechanism for robot-assisted minimally invasive surgery. Biomed Eng Online, 2018, 17(1): 170.
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23. Cahais J, Schwarz L, Bridoux V, et al. Is the image "right" for everyone? introduction to the parallax effect in laparoscopic surgery. J Visc Surg, 2017, 154(1): 11-14.
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25. Welcker K, Kesieme EB, Internullo E, et al. Ergonomics in thoracoscopic surgery: results of a survey among thoracic surgeons. Interact Cardiovasc Thorac Surg, 2012, 15(2):197-200.
26. Colan J, Davila A, Fozilov K, et al. A concurrent framework for constrained inverse kinematics of minimally invasive surgical robots. Sensors, 2023, 23(6): 3328.
27. Li J, Xing Y, Liang K, et al. Kinematic design of a novel spatial remote center-of-motion mechanism for minimally invasive surgical robot. J Med Devices, 2015, 9(1): 011003.
28. Bai L, Yang J, Chen X, et al. Solving the time-varying inverse kinematics problem for the da Vinci surgical robot. Appl Sci, 2019, 9(3): 546.
29. Sandoval J, Vieyres P, Poisson G. Generalized framework for control of redundant manipulators in robot-assisted minimally invasive surgery. IRBM, 2018, 39(3): 160-166.
30. Fonturbel C, Cisnal A, Fraile-Marinero JC, et al. Force-based control strategy for a collaborative robotic camera holder in laparoscopic surgery using pivoting motion. Front Robot AI, 2023, 10: 1145265.
31. Pham CD, Coutinho F, Leite AC, et al. Analysis of a moving remote center of motion for robotics-assisted minimally invasive surgery. 2015 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS). IEEE, 2015: 1440-1446.
32. Yang H, Al-Zogbi L, Yildiz A, et al. Sensorless remote center of motion misalignment estimation. arXiv, 2025: 2503.13011.
33. Nasiri E, Wang L. Admittance control for adaptive remote center of motion in robotic laparoscopic surgery. 2024 21st International Conference on Ubiquitous Robots (UR). IEEE, 2024: 51-57.
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35. Olanrewaju OA, Faieza AA, Syakirah K. Current trend of robotics application in medical. IOP Conference Series: Materials Science and Engineering, 2013, 46(1): 012041.
36. Schneeberger EW, Michler RE. An overview of the Intuitive system: the surgeon's perspective. Oper Tech Thorac Cardiovasc Surg, 2001, 6: 170-176.
37. Haig F, Medeiros ACB, Chitty K, et al. Usability assessment of Versius, a new robot-assisted surgical device for use in minimal access surgery. BMJ Surg Interv Health Technol, 2020, 2: e000028.
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39. Yeung CK, Lam KW, Cheung JLK, et al. Overcoming abdominal and pelvic cavity workspace constraints in robotic-assisted NOTES. J Robot, 2020, 2020(1): 8590539.
40. Gonzalez-Rivas D, Bosinceanu M, Manolache V, et al. Uniportal fully robotic-assisted major pulmonary resections. Ann Cardiothorac Surg, 2023, 12(1): 52.
41. Dong J, Xu W, Ji Z. Initial experience of robot-assisted nephroureterectomy without intraoperative repositioning using a new robotic surgical system (KD-SR-01). Minim Invasive Surg, 2024, 2024(1): 2466828.
42. Lee J, Kim J, Lee KK, et al. Modeling and control of robotic surgical platform for single-port access surgery. 2014 IEEE/RSJ International Conference on Intelligent Robots and Systems. IEEE, 2014: 3489-3495.
43. Hagn U, Nickl M, Jorg S, et al. DLR MiroSurge-towards versatility in surgical robotics. 2008.
44. Marinho MM, Harada K, Morita A, Mitsuishi M. SmartArm: integration and validation of a versatile surgical robotic system for constrained workspaces. Int J Med Robot, 2020, 16(2): e2053.
45. Ghiasi S, Roshanfar M, Barralet J, et al. Neural Collision Detection for Multi-arm Laparoscopy Surgical Robots Through Learning-from-Simulation. arXiv, 2026: 2601.15459.
46. Colucci G, Tagliavini L, Carbonari L, et al. Paquitop.arm, a mobile manipulator for assessing emerging challenges in the COVID-19 pandemic scenario. Robotics. 2021; 10(3):102.
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