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Abstract This paper presents the development of an origami-inspired support system (the OriGuide) that enables the insertion of flexible instruments using medical robots. Varying parameters of a triangulated cylindrical origami pattern were combined to create an effective highly compressible anti-buckling system that maintains a constant inner diameter for supporting an instrument and a constant outer diameter throughout actuation. The proposed origami pattern is composed of two repeated patterns: a bistable pattern to create support points to mitigate flexible shaft buckling and a monostable pattern to enable axial extension and compression of the support system. The origami-based portion of the device is combined with two rigid mounts for interfacing with the medical robot. The origami-based portion of the device is fabricated from a single sheet of polyethylene terephthalate. The length, outer diameter, and inner diameter that emerge from the fold pattern can be customized to accommodate various robot designs and flexible instrument geometries without increasing the part count. The support system also adds protection to the instrument from external contamination.