The robotic scope is comprised of two mechanisms, an inner and outer, which are arranged in a concentric mechanical assembly. The distal segment, which is controlled by the surgeon using a 3D joystick-like controller, embodies a digital camera providing HD vision, LED lamps, a lens washer, and two external accessory channels. The scope is equipped with two external accessory channels for introducing 3.5 mm flexible instruments. The surgeon moves the scope under visual control on a monitor on the Flex® Console or an external monitor. The Medrobotics® Flex® Robotic System consists of four primary components: (A) the Flex® Console which houses the physician control handle, a touch screen visual display, and the touch screen monitor; (B) the Flex® Base, a reusable assembly that transfers electronic signals from the console into mechanical motions; (C) the Flex® Drive, a sterile, single-use component that mounts on the Flex® Base and houses the flexible portion of the robot and components to move it as well as the Flex® Camera; and the (D) Flex® Cart and Stand as support for the Flex® Base and Flex® Drive.

Setup time for the entire system is reported at less than 10 min [6]. In preparation for surgery, the Flex® Base is placed midline on the patient, and the Flex® Drive is positioned directly at the opening of the oral cavity [6]. The base can be positioned and angled via the aforementioned lockable joints depending on the view required and based on the intended procedure being performed, e.g., for tongue base and tonsil surgery, an obtuse angle is used (Fig. 19.3a), while laryngeal surgery uses an acute angle (Fig. 19.3b). The Flex® Drive is unique in that it can move in three dimensions without the requirement of external support and then made rigid once in the desired location—again, in either gross or fine motions [6]. When the scope requires removal, the “Home” button on the Flex® Console may be pressed to cause the scope to retract out of the oropharynx, hypopharynx, or larynx and return to its default starting position. This “homing” may also be also be used to “guide” removal of the excised mass, with the surgeon gripping it with forceps or clamps and pulling back slowly as the scope returns to its home position. To either side of the scope, there are small channels that follow its contour and allow various compatible flexible tools to reach the operation site without additional maneuvering (Figs. 19.4 and 19.5). In this system, there are no external arms. Instead, the flexible instruments act as an extension of the surgeon’s hands, allowing for a smaller initial opening and more movement within a limited size surgical cavity. The small size, flexibility, and easy maneuverability of the instruments allow for a rapid exchange of surgical instruments or their handedness by the surgeon himself, with no need for assistance (Fig. 19.6). This, in turn, greatly enhances the procedure’s pace and flow when compared to halting the procedure to reposition outer components.