Complex systems, like surgical robots, are designed by engineers. It is very difficult for them to determine the different needs and desires of all stakeholders. Especially when designed from scratch, end user input is essential in creating a system that has added value, is user friendly, and can be easily integrated into practice. For the development of a robotic flexible endoscope we have involved physicians, nurses, and equipment suppliers in our design approach. Seven steps are executed to convert user preferences and capabilities into concepts: *Determine focus area of development. *Create the current workflow of system application to understand (the context of) use. *Determine problem definition and design goal. *Create the future workflow, in which current problems are eliminated and major system wishes are fulfilled. *Translate the future workflow into a functional overview that contains system functions. *Select and configure the appropriate construction elements into physical overviews, being preliminary concepts. *Decompose physical overview into manageable modules. These views are evaluated by the major stakeholders and together form a system architecture. The system architecture helped us in defining the robotic modules required to fulfill all stakeholders needs and desires. Demonstrators were built to evaluate critical concepts in clinical relevant experiments.