In principle, the robot-assisted flexible endoscopes are designed similarly to conservative flexible endoscopes. These have a light source, camera, instrument channel, proximal passive section, and an active distal tip. Conventionally, the active distal tip is actuated by shortening the tendons through manual actuating wheels on the handhold of the endoscope. In robot-aided flexible endoscopy, manual actuation is replaced by a mechatronic drive unit. The shortening of the tendons is achieved by the rotation of a motor in combination with a pulley. Further, the endoscope is kept in position to the patient by a robotic arm or frame and does not need to be actively controlled by a surgeon. To enable more complex operations in single port surgery as well as Natural Orifice Transluminal Endoscopic Surgery (NOTES) the robotic systems are designed with multiple instrument channels. The endoscope itself with the channels is often called overtube and is robotized. The instruments are still manually operated in some systems. Table 1 gives an overview of robot-aided flexible endoscope systems.