Washington, D.C – A new flexible robotic system can make targeted, minimally invasive surgery inside large open cavities such as the pregnant uterus more precise, according to research in preclinical models.

The system uses a magnetically controlled flexible endoscope that can perform targeted laser ablations while creating live mosaics of its surroundings to provide an extended view of the organ. It can navigate automatically or be operated manually.

Researchers developed the system to address challenges in fetoscopic laser coagulation, a complex procedure used to treat twin-to-twin transfusion syndrome. The condition results from imbalanced blood flow between twins sharing the same placenta, and surgeons treat it by using a laser to ablate blood vessels connecting the twins’ circulation.

The robotic system successfully ablated specific blood vessels in human placenta samples and in sheep.

A usability study involving 11 participants in an augmented reality setup found that the robotic approach significantly improved precision while reducing physical demand and frustration compared with handheld procedures.

“By advancing the technical readiness of this approach for FLC, this work takes a substantial step toward its clinical translation for fetal surgery,” Michelle Mattille and colleagues wrote.

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