Design and Development of a Flexible 3D-Printed Endoscopic Grasping Instrument
and Alexander Meining 1Round 1
Reviewer 1 Report
This manuscript presents the design and rapid prototyping of a flexible endoscopic grasping device. The authors assessed the workspace and bending force through a series of bench tests and then emulated the use of the device in a porcine model. Although there is some merit in discussing the advantages of 3D printing such instruments, this work lacks a scientific depth and resembles a product development report. Therefore, unfortunately, the reviewer cannot recommend accepting this paper.
Author Response
We would like to thank the reviewer for the time and effort invested in the thorough evaluation of the manuscript. We acknowledge the concern raised by the reviewer and are thankful for the provided comment.
Although the manuscript could appear like a product development report, we aimed to explore a novel concept of a highly flexible instrument, demonstrate its benefits, and make it available to those who could build new interventional approaches upon such an idea - which is often overlooked. Thus, hopefully, generating additional research interest that could lead to improved medical interventions and better outcomes for patients in the future.
Furthermore, we believe that the manuscript has been significantly enhanced by addressing the comments from other reviewers and that its quality has been substantially improved.
Once again, we appreciate the time and effort dedicated by the reviewer to inspect the manuscript.
Reviewer 2 Report
The article presents the design and development of a flexible 3D-printed endoscopic grasping instrument.
The authors should improve the abstract so that the novelty of the paper can be clear and objectively quantified.
Regarding the introduction, it shows the motivation, and also states some related works, but despite referencing a lot of works, several of them are mentioned without proper introduction/explanation (namely some of them are introduced in a row - [17, 25-28]).
The system is well presented, but is the system open access? Is it on any repository so it can be replicated and used by other scientists?
In the experiments and results section, is any ground truth used? How are the obtained dimensions verified?
In my opinion, the discussion should not have so many references, since they are supposed to be presented on the Introduction/Related Works.
The conclusion is small (literally one paragraph) and don't compare the results.
Generally, the article is well written and suitable for the journal and special session scope. Some typos must be addressed, so authors must re-read the manuscript. In my opinion, it has a high potential, but it is very poor as it is. These revisions must be completely addressed, the paper majorly improved and then resubmitted.
Author Response
We would like to thank the reviewer for dedicating their time and effort to review our manuscript. The comments and feedback provided by the reviewer have been valuable assets for improving the quality of our manuscript. We have considered all the comments made by the reviewer and made changes to the manuscript accordingly.
Point-by-point answers to the reviewer's comments can be found below.
- The article presents the design and development of a flexible 3D-printed endoscopic grasping instrument. The authors should improve the abstract so that the novelty of the paper can be clear and objectively quantified.
Answer: We appreciate the reviewer’s comment that the abstract should be improved to present the manuscript's objective better. We have revised the abstract according to the reviewer’s suggestions, making it more representative of the manuscript.
- Regarding the introduction, it shows the motivation, and also states some related works, but despite referencing a lot of works, several of them are mentioned without proper introduction/explanation (namely some of them are introduced in a row - [17, 25-28]).
Answer: We thank the reviewer for pointing out the lack of introduction for some of the references. We have rewritten this part of the introduction to better express the value of the referenced works.
- The system is well presented, but is the system open access? Is it on any repository so it can be replicated and used by other scientists?
Answer: Yes, the necessary components to reproduce the instrument (CAD files, bill of materials, and assembly instructions) will be freely available for download from the website of our working group: www.ukw.de/research/inexen.
We have added the availability of the resources to the manuscript’s methods section.
- In the experiments and results section, is any ground truth used? How are the obtained dimensions verified?
Answer: We appreciate the feedback provided by the reviewer regarding the unclearly explained ground truth used for the comparison of the results. We have revised the methods section to better clarify the ground truth (also referred to as the “gold standard”) used in the experiments.
- In my opinion, the discussion should not have so many references, since they are supposed to be presented on the Introduction/Related Works. The conclusion is small (literally one paragraph) and don't compare the results.
Answer: We thank the reviewer for pointing out the shortcoming of the Discussion and Conclusion sections. We understand the point made regarding the extensive use of references - our aim was to provide background to our statements. Furthermore, as we have introduced more references in the Discussion, we aimed to support them with those from the introduction where possible.
Additionally, the comparison of the results has been further explained in the revised Conclusion section, which is now expanded to include a broader statement.
Generally, the article is well written and suitable for the journal and special session scope. Some typos must be addressed, so authors must re-read the manuscript. In my opinion, it has a high potential, but it is very poor as it is. These revisions must be completely addressed, the paper majorly improved and then resubmitted.
Reviewer 3 Report
MDPI
This paper reports on the design, development, and assessment of a three-dimensionally Printed flexible grasping instrument for gastrointestinal endoscopy. The instrument is assessed through a series of bench tests and then in a porcine model. Furthermore, it demonstrated the short times required for performing several common tasks encountered during interventional therapeutic procedures. However, the study lacks a few major considerations and state of the art comparisons that should be addressed as follows:
1- The dimensions shown in Figure 1 should be declared in mm, cm, etc.
2- It should be demonstrated and explained how the bending force is measured and related to the curve of the actuator.
3- The grading of the instrument's performance in reaching the operating region, inserting objects into cavities, and removing objects from cavities should be described against the standards or clarified as to how they were decided quantitatively.
4- In the "Prototype development" it should be discussed why PA and MJF are used for 3D printing of such instruments. The comparisons should be made with the recent development of soft robots made via 3D printing, as described in "3D printing non-assembly compliant joints for soft robotics" and "Non-assembly spherical joints 3D-printed for soft robotic applications".
5- The modelling of the actuator is missing from the paper. An analytical or fine-element analysis model is required to help with the repeatability of the work.
Author Response
We would like to thank the reviewer for dedicating their time and effort to review our manuscript. The comments and feedback provided by the reviewer have been valuable assets for improving the quality of our manuscript. We have considered all the comments made by the reviewer and made changes to the manuscript accordingly.
Point-by-point answers to the reviewer's comments can be found below.
This paper reports on the design, development, and assessment of a three-dimensionally Printed flexible grasping instrument for gastrointestinal endoscopy. The instrument is assessed through a series of bench tests and then in a porcine model. Furthermore, it demonstrated the short times required for performing several common tasks encountered during interventional therapeutic procedures. However, the study lacks a few major considerations and state of the art comparisons that should be addressed as follows:
1- The dimensions shown in Figure 1 should be declared in mm, cm, etc.
Answer: We appreciate the point made that dimensions in Figure 1 are missing a unit. We have added the unit in Figure 1.
2- It should be demonstrated and explained how the bending force is measured and related to the curve of the actuator.
Answer: We appreciate the point raised about the explanation of the bending force measurements. We have revised the corresponding section and added further explanation of the bending force measurements in the methods section.
3- The grading of the instrument's performance in reaching the operating region, inserting objects into cavities, and removing objects from cavities should be described against the standards or clarified as to how they were decided quantitatively.
Answer: We understand that a better explanation of the instrument's performance would be a valuable addition to the manuscript. We have added a more detailed explanation of the grading. Furthermore, due to the specific evaluation inside a porcine model and the novelty of this instrument, we have added as a limitation the lack of objective comparison when it comes to the grading and time measurements.
4- In the "Prototype development" it should be discussed why PA and MJF are used for 3D printing of such instruments. The comparisons should be made with the recent development of soft robots made via 3D printing, as described in "3D printing non-assembly compliant joints for soft robotics" and "Non-assembly spherical joints 3D-printed for soft robotic applications".
Answer: We appreciate the point stated by the reviewer that additional explanation behind the reasoning and choices made for prototyping is necessary. We have revised the “Prototype development” section to better explain why specific 3D printing technologies were used.
Furthermore, we appreciate the reviewer for pointing out to some works we have not observed before regarding the topic of 3D-printed joints. We have analyzed them and found that one of them, due to its similarities with our work, fits the reasoning behind selecting a segmented bending section for our instrument.
5- The modeling of the actuator is missing from the paper. An analytical or fine-element analysis model is required to help with the repeatability of the work.
Answer: We understand the importance of the repeatability of the presented work. A segment was added to the methods section, stating the availability of the CAD model, bill of materials, and assembly instruction - which would support others in recreating the presented instrument. We will host these files on our website.
Reviewer 4 Report
Interventional endoscopic techniques are becoming more popular, while, current state-of-the-art instruments have several limitations. Three-dimensional printing technology has demonstrated great potential for the development of prototypes that can be used for early assessment of conceptual design; So, a prototype instrument was assessed in a set of bench tests in this paper.The instrumen can be produced through 3D-printing with a high degree of maneuverability, that could improve current interventional endoscopic procedures.
This is a good and useful work. I think it can be accepted after some miner correction.
1) It should give out the unit of 22.25 in Fig1.
2) It should give out the scale in some figures, such as Fig 3, Fig4.
3) The imaging optical system in the endoscopic, how it is fixed? What is the imaging qualify?
Author Response
We would like to thank the reviewer for dedicating their time and effort to review our manuscript. The comments and feedback provided by the reviewer have been valuable assets for improving the quality of our manuscript. We have considered all the comments made by the reviewer and made changes to the manuscript accordingly.
Point-by-point answers to the reviewer's comments can be found below.
Interventional endoscopic techniques are becoming more popular, while, current state-of-the-art instruments have several limitations. Three-dimensional printing technology has demonstrated great potential for the development of prototypes that can be used for early assessment of conceptual design; So, a prototype instrument was assessed in a set of bench tests in this paper. The instrumen can be produced through 3D-printing with a high degree of maneuverability, that could improve current interventional endoscopic procedures. This is a good and useful work. I think it can be accepted after some miner correction.
1) It should give out the unit of 22.25 in Fig1.
Answer: We have added the dimensions in Figure 1 as proposed.
2) It should give out the scale in some figures, such as Fig 3, Fig4.
Answer: We appreciate the point made that the figures are missing a scale. We have included scales in Figures 3 and 4 as suggested.
3) The imaging optical system in the endoscopic, how it is fixed? What is the imaging qualify?
Answer: We thank the reviewer for raising the question about the fixation of the endoscope in the experiment. We have revised the segment where the fixation of the endoscope was described to better explain how the experiments were performed.
Round 2
Reviewer 1 Report
Although the authors have improved the quality of the manuscript in terms of the writing style, there is not been enough improvement in terms of the scientific depth. Therefore, the reviewer's view on the manuscript remain unchanged.
Reviewer 2 Report
Dear authors,
Thank you for considering and reviewing the points that I have mentioned.
I consider that, with the document changed, it can be accepted.
Best of lucks
Reviewer 3 Report
The authors have adequately addressed my earlier comments; the manuscript could be accepted.
