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Gerald A, na ayuddhaya KP, McCandless M, Hsu P, Pang J, Mankad A, Chu A, Aihara H, Russo S. Ex Vivo Evaluation of a Soft Optical Blood Sensor for Colonoscopy. DEVICE 2024; 2:100422. [PMID: 39678941 PMCID: PMC11637413 DOI: 10.1016/j.device.2024.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
Abstract
Colonoscopies are vital procedures allowing diagnosis of colorectal cancer and other gastrointestinal diseases. However, excessive forces may be applied to the colon during navigation. This can cause bleeding, especially in patients presenting inflammatory bowel diseases. The endoscopist is often unable to detect bleeding as visualization is limited to the distal tip camera of the endoscope. Thus, there is a need to have bleeding detection capabilities behind the device tip. This work presents a soft optical blood sensor that can be mounted onto a colonoscope. The presence of blood in the sensor's microchannel causes a reduction in optical transmission, and the endoscopist is alerted. We evaluate the sensor safety and performance ex vivo with a cohort of 10 endoscopists (novices and experts). We demonstrate the ability of the sensor to rapidly identify bleeding and easily integrate into the clinical workflow, without significantly affecting navigation time and the users' learning curve.
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Affiliation(s)
- Arincheyan Gerald
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | | | - Max McCandless
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - Patra Hsu
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - Johann Pang
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Arnav Mankad
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Addison Chu
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - Hiroyuki Aihara
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sheila Russo
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
- Division of Materials Science and Engineering, Boston University, Boston, MA 02215, USA
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2
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Sinonquel P, Jans A, Bisschops R. Painless colonoscopy: fact or fiction? Clin Endosc 2024; 57:581-587. [PMID: 38932703 PMCID: PMC11474464 DOI: 10.5946/ce.2024.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 06/28/2024] Open
Abstract
Although colonoscopy is a routinely performed procedure, it is not devoid of challenges, such as the potential for perforation and considerable patient discomfort, leading to patients postponing the procedure with several healthcare risks. This review delves into preprocedural and procedural solutions, and emerging technologies aimed at addressing the drawbacks of colonoscopies. Insufflation and sedation techniques, together with various other methods, have been explored to increase patient satisfaction, and thereby, the quality of endoscopy. Recent advances in this field include the prevention of loop formation, encompassing the use of variable-stiffness endoscopes, computer-guided scopes, magnetic endoscopic imaging, robotics, and capsule endoscopy. An autonomous endoscope that relies on self-propulsion to completely avoid looping is a potentially groundbreaking technology for the next generation of endoscopes. Nevertheless, critical techniques need to be refined to ensure the development of effective and efficient endoscopes.
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Affiliation(s)
- Pieter Sinonquel
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
- Department of Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Alexander Jans
- Department of Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
- Department of Internal Medicine, UZ Leuven, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
- Department of Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
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3
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Bernth JE, Zhang G, Malas D, Abrahams G, Hayee B, Liu H. MorphGI: A Self-Propelling Soft Robotic Endoscope Through Morphing Shape. Soft Robot 2024; 11:670-683. [PMID: 38484296 DOI: 10.1089/soro.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Colonoscopy is currently the best method for detecting bowel cancer, but fundamental design and construction have not changed significantly in decades. Conventional colonoscope (CC) is difficult to maneuver and can lead to pain with a risk of damaging the bowel due to its rigidity. We present the MorphGI, a robotic endoscope system that is self-propelling and made of soft material, thus easy to operate and inherently safe to patient. After verifying kinematic control of the distal bending segment, the system was evaluated in: a benchtop colon simulator, using multiple colon configurations; a colon simulator with force sensors; and surgically removed pig colon tissue. In the colon simulator, the MorphGI completed a colonoscopy in an average of 10.84 min. The MorphGI showed an average of 77% and 62% reduction in peak forces compared to a CC in high- and low-stiffness modes, respectively. Self-propulsion was demonstrated in the excised tissue test but not in the live pig test, due to anatomical differences between pig and human colons. This work demonstrates the core features of MorphGI.
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Affiliation(s)
- Julius E Bernth
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Guokai Zhang
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Dionysios Malas
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - George Abrahams
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Bu Hayee
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Hongbin Liu
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Institute of Automation, Chinese Academy of Sciences (CAS), Beijing, China
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4
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Finocchiaro M, Banfi T, Donaire S, Arezzo A, Guarner-Argente C, Menciassi A, Casals A, Ciuti G, Hernansanz A. A Framework for the Evaluation of Human Machine Interfaces of Robot-Assisted Colonoscopy. IEEE Trans Biomed Eng 2024; 71:410-422. [PMID: 37535479 DOI: 10.1109/tbme.2023.3301741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The Human Machine Interface (HMI) of intraluminal robots has a crucial impact on the clinician's performance. It increases or decreases the difficulty of the tasks, and is connected to the users' physical and mental stress. OBJECTIVE This article presents a framework to compare and evaluate different HMIs for robotic colonoscopy, with the objective of identifying the optimal HMI that minimises the clinician's effort and maximises the clinical outcomes. METHODS The framework comprises a 1) a virtual simulator (clinically validated), 2) wearable sensors measuring the cognitive load, 3) a data collection unit of metrics correlated to the clinical performance, and 4) questionnaires exploring the users' impressions and perceived stress. The framework was tested with 42 clinicians investigating the optimal device for tele-operated control of robotic colonoscopes. Two control devices were selected and compared: a haptic serial-kinematic device and a standard videogame joypad. RESULTS The haptic device was preferred by the endoscopists, but the joypad enabled better clinical performance and reduced cognitive and physical load. CONCLUSION The framework can be used to evaluate different aspects of a HMI, both hardware and software, and determine the optimal HMI that can reduce the burden on clinicians while improving the clinical outcome. SIGNIFICANCE The findings of this study, and of future studies performed with this framework, can inform the design and development of HMIs for intraluminal robots, leading to improved clinical performance, reduced physical and mental stress for clinicians, and ultimately better patient outcomes.
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5
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Ali JT, Yang G, Green CA, Reed BL, Madani A, Ponsky TA, Hazey J, Rothenberg SS, Schlachta CM, Oleynikov D, Szoka N. Defining digital surgery: a SAGES white paper. Surg Endosc 2024; 38:475-487. [PMID: 38180541 DOI: 10.1007/s00464-023-10551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Digital surgery is a new paradigm within the surgical innovation space that is rapidly advancing and encompasses multiple areas. METHODS This white paper from the SAGES Digital Surgery Working Group outlines the scope of digital surgery, defines key terms, and analyzes the challenges and opportunities surrounding this disruptive technology. RESULTS In its simplest form, digital surgery inserts a computer interface between surgeon and patient. We divide the digital surgery space into the following elements: advanced visualization, enhanced instrumentation, data capture, data analytics with artificial intelligence/machine learning, connectivity via telepresence, and robotic surgical platforms. We will define each area, describe specific terminology, review current advances as well as discuss limitations and opportunities for future growth. CONCLUSION Digital Surgery will continue to evolve and has great potential to bring value to all levels of the healthcare system. The surgical community has an essential role in understanding, developing, and guiding this emerging field.
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Affiliation(s)
- Jawad T Ali
- University of Texas at Austin, Austin, TX, USA
| | - Gene Yang
- University at Buffalo, Buffalo, NY, USA
| | | | | | - Amin Madani
- University of Toronto, Toronto, ON, Canada
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
| | - Todd A Ponsky
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Dmitry Oleynikov
- Monmouth Medical Center, Robert Wood Johnson Barnabas Health, Rutgers School of Medicine, Long Branch, NJ, USA
| | - Nova Szoka
- Department of Surgery, West Virginia University, Suite 7500 HSS, PO Box 9238, Morgantown, WV, 26506-9238, USA.
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Elshaarawy O, Alboraie M, El-Kassas M. Artificial Intelligence in endoscopy: A future poll. Arab J Gastroenterol 2024; 25:13-17. [PMID: 38220477 DOI: 10.1016/j.ajg.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 09/18/2022] [Accepted: 11/28/2023] [Indexed: 01/16/2024]
Abstract
Artificial Intelligence [AI] has been a trendy topic in recent years, with many developed medical applications. In gastrointestinal endoscopy, AI systems include computer-assisted detection [CADe] for lesion detection as bleedings and polyps and computer-assisted diagnosis [CADx] for optical biopsy and lesion characterization. The technology behind these systems is based on a computer algorithm that is trained for a specific function. This function could be to recognize or characterize target lesions such as colonic polyps. Moreover, AI systems can offer technical assistance to improve endoscopic performance as scope insertion guidance. Currently, we believe that such technologies still lack legal and regulatory validations as a large sector of doctors and patients have concerns. However, there is no doubt that these technologies will bring significant improvement in the endoscopic management of patients as well as save money and time.
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Affiliation(s)
- Omar Elshaarawy
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt; Gastroenterology Department, Royal Liverpool University Hospital, NHS, UK
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
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Ahmed JF, Darzi A, Ayaru L, Patel N. Causes of intraprocedural discomfort in colonoscopy: a review and practical tips. Ther Adv Gastrointest Endosc 2024; 17:26317745241282576. [PMID: 39483522 PMCID: PMC11526327 DOI: 10.1177/26317745241282576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/20/2024] [Indexed: 11/03/2024] Open
Abstract
Colonoscopy is a commonly performed procedure in the United Kingdom and the gold standard for diagnosis and therapy in the gastrointestinal tract. Increased levels of pain during colonoscopy have been associated with reduced completion rates and difficulties in maintaining attendance for repeat procedures. Multiple factors play a role in causing discomfort intra-procedurally: patient factors, such as gender, anatomy and pre-procedure anxiety; operator factors, such as patient position and level of experience and other factors, such as bowel preparation and total procedure time. A literature search was performed to identify papers that explained how patient, operator and endoscopy factors influenced pain and discomfort in endoscopy. A further search then also identified papers describing solutions to pain and discomfort that have been explored. After review of the literature, key methods are selected and discussed in this paper. Solutions and aids that can resolve and improve pain and discomfort include endoscopic methods such as variable stiffness and ultrathin scopes. Operator improvements in techniques and ergonomics alongside the use of newer technologies such as propelled endoscopy, computer-assisted endoscopy and task distraction. To improve patient experience and outcomes, the investigation and research into improving techniques to reduce pain is crucial. This review aims to identify the modifiable and non-modifiable factors associated with intra-procedural discomfort during colonoscopy. We discuss established methods of improving pain during colonoscopy, in addition to newer technologies to mitigate associated discomfort.
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Affiliation(s)
- Jabed F. Ahmed
- Endoscopy Department, Imperial College Healthcare NHS Trust, St Marys Hospital, Praed St, London, W2 1NY, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Lakshmana Ayaru
- Gastroenterology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Nisha Patel
- Gastroenterology Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
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Tumino E, Visaggi P, Bolognesi V, Ceccarelli L, Lambiase C, Coda S, Premchand P, Bellini M, de Bortoli N, Marciano E. Robotic Colonoscopy and Beyond: Insights into Modern Lower Gastrointestinal Endoscopy. Diagnostics (Basel) 2023; 13:2452. [PMID: 37510196 PMCID: PMC10378494 DOI: 10.3390/diagnostics13142452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Lower gastrointestinal endoscopy is considered the gold standard for the diagnosis and removal of colonic polyps. Delays in colonoscopy following a positive fecal immunochemical test increase the likelihood of advanced adenomas and colorectal cancer (CRC) occurrence. However, patients may refuse to undergo conventional colonoscopy (CC) due to fear of possible risks and pain or discomfort. In this regard, patients undergoing CC frequently require sedation to better tolerate the procedure, increasing the risk of deep sedation or other complications related to sedation. Accordingly, the use of CC as a first-line screening strategy for CRC is hampered by patients' reluctance due to its invasiveness and anxiety about possible discomfort. To overcome the limitations of CC and improve patients' compliance, several studies have investigated the use of robotic colonoscopy (RC) both in experimental models and in vivo. Self-propelling robotic colonoscopes have proven to be promising thanks to their peculiar dexterity and adaptability to the shape of the lower gastrointestinal tract, allowing a virtually painless examination of the colon. In some instances, when alternatives to CC and RC are required, barium enema (BE), computed tomographic colonography (CTC), and colon capsule endoscopy (CCE) may be options. However, BE and CTC are limited by the need for subsequent investigations whenever suspicious lesions are found. In this narrative review, we discussed the current clinical applications of RC, CTC, and CCE, as well as the advantages and disadvantages of different endoscopic procedures, with a particular focus on RC.
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Affiliation(s)
- Emanuele Tumino
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
| | - Pierfrancesco Visaggi
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Valeria Bolognesi
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
| | - Linda Ceccarelli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Christian Lambiase
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Sergio Coda
- Digestive Disease Centre, Division of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM70AG, UK
| | - Purushothaman Premchand
- Digestive Disease Centre, Division of Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM70AG, UK
| | - Massimo Bellini
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100 Pisa, Italy
| | - Emanuele Marciano
- Endoscopy Unit, Azienda Ospedaliero Universitaria Pisana, 56125 Pisa, Italy
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9
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Hamza H, Baez VM, Al-Ansari A, Becker AT, Navkar NV. User interfaces for actuated scope maneuvering in surgical systems: a scoping review. Surg Endosc 2023; 37:4193-4223. [PMID: 36971815 PMCID: PMC10234960 DOI: 10.1007/s00464-023-09981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND A variety of human computer interfaces are used by robotic surgical systems to control and actuate camera scopes during minimally invasive surgery. The purpose of this review is to examine the different user interfaces used in both commercial systems and research prototypes. METHODS A comprehensive scoping review of scientific literature was conducted using PubMed and IEEE Xplore databases to identify user interfaces used in commercial products and research prototypes of robotic surgical systems and robotic scope holders. Papers related to actuated scopes with human-computer interfaces were included. Several aspects of user interfaces for scope manipulation in commercial and research systems were reviewed. RESULTS Scope assistance was classified into robotic surgical systems (for multiple port, single port, and natural orifice) and robotic scope holders (for rigid, articulated, and flexible endoscopes). Benefits and drawbacks of control by different user interfaces such as foot, hand, voice, head, eye, and tool tracking were outlined. In the review, it was observed that hand control, with its familiarity and intuitiveness, is the most used interface in commercially available systems. Control by foot, head tracking, and tool tracking are increasingly used to address limitations, such as interruptions to surgical workflow, caused by using a hand interface. CONCLUSION Integrating a combination of different user interfaces for scope manipulation may provide maximum benefit for the surgeons. However, smooth transition between interfaces might pose a challenge while combining controls.
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Affiliation(s)
- Hawa Hamza
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Victor M Baez
- Department of Electrical and Computer Engineering, University of Houston, Houston, USA
| | | | - Aaron T Becker
- Department of Electrical and Computer Engineering, University of Houston, Houston, USA
| | - Nikhil V Navkar
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
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10
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Artificial Endoscopy and Inflammatory Bowel Disease: Welcome to the Future. J Clin Med 2022; 11:jcm11030569. [PMID: 35160021 PMCID: PMC8836846 DOI: 10.3390/jcm11030569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI) is assuming an increasingly important and central role in several medical fields. Its application in endoscopy provides a powerful tool supporting human experiences in the detection, characterization, and classification of gastrointestinal lesions. Lately, the potential of AI technology has been emerging in the field of inflammatory bowel disease (IBD), where the current cornerstone is the treat-to-target strategy. A sensible and specific tool able to overcome human limitations, such as AI, could represent a great ally and guide precision medicine decisions. Here we reviewed the available literature on the endoscopic applications of AI in order to properly describe the current state-of-the-art and identify the research gaps in IBD at the dawn of 2022.
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11
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Sekhon Inderjit Singh HK, Armstrong ER, Shah S, Mirnezami R. Application of robotic technologies in lower gastrointestinal tract endoscopy: A systematic review. World J Gastrointest Endosc 2021; 13:673-697. [PMID: 35070028 PMCID: PMC8716978 DOI: 10.4253/wjge.v13.i12.673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/31/2021] [Accepted: 12/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Conventional optical colonoscopy is considered the gold standard investigation for colorectal tract pathology including colorectal malignancy, polyps and inflammatory bowel disease. Inherent limitations exist with current generation endoscopic technologies, including, but not limited to, patient discomfort, endoscopist fatigue, narrow field of view and missed pathology behind colonic folds. Rapid developments in medical robotics have led to the emergence of a variety of next-generation robotically-augmented technologies that could overcome these limitations.
AIM To provide a comprehensive summary of recent developments in the application of robotics in lower gastrointestinal tract endoscopy.
METHODS A systematic review of the literature was performed from January 1, 2000 to the January 7, 2021 using EMBASE, MEDLINE and Cochrane databases. Studies reporting data on the use of robotic technology in ex vivo or in vivo animal and human experiments were included. In vitro studies (studies using synthetic colon models), studies evaluating non-robotic technology, robotic technology aimed at the upper gastrointestinal tract or paediatric endoscopy were excluded. System ergonomics, safety, visualisation, and diagnostic/therapeutic capabilities were assessed.
RESULTS Initial literature searching identified 814 potentially eligible studies, from which 37 were deemed suitable for inclusion. Included studies were classified according to the actuation modality of the robotic device(s) as electromechanical (EM) (n = 13), pneumatic (n = 11), hydraulic (n = 1), magnetic (n = 10) and hybrid (n = 2) mechanisms. Five devices have been approved by the Food and Drug Administration, however most of the technologies reviewed remain in the early phases of testing and development. Level 1 evidence is lacking at present, but early reports suggest that these technologies may be associated with improved pain and safety. The reviewed devices appear to be ergonomically capable and efficient though to date no reports have convincingly shown diagnostic or therapeutic superiority over conventional colonoscopy.
CONCLUSION Significant progress in robotic colonoscopy has been made over the last couple of decades. Improvements in design together with the integration of semi-autonomous and autonomous systems over the next decade will potentially result in robotic colonoscopy becoming more commonplace.
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Affiliation(s)
| | - Emily Rose Armstrong
- Colorectal Surgery, The Royal Free Hospital, London NW3 2QG, Hampstead, United Kingdom
| | - Sujay Shah
- Colorectal Surgery, The Royal Free Hospital, London NW3 2QG, Hampstead, United Kingdom
| | - Reza Mirnezami
- Colorectal Surgery, The Royal Free Hospital, London NW3 2QG, Hampstead, United Kingdom
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12
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Robotic Technology in Operating Rooms: a Review. CURRENT ROBOTICS REPORTS 2021; 2:333-341. [PMID: 34977594 PMCID: PMC8121642 DOI: 10.1007/s43154-021-00055-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/15/2022]
Abstract
Purpose of Review With the rapid growth and development of robotic technology, its implementation in medical fields has also been significantly increasing, with the transition from the period of mainly using surgical robots to the era with combinations of multiple types of robots. Therefore, this paper introduces the newest robotic systems and technology applied in operating rooms as well as their architectures for integration. Recent Findings Besides surgical robots, other types of robotic devices and machines such as diagnostic and treatment devices with robotic operating tables, robotic microscopes, and assistant robots for surgeons emerge one after another, improving the quality of surgery from different aspects. With the increasing number and type of robots, their integration platforms are also proposed and being spread. Summary This review paper presents state-of-the-art robot-related technology in the operating room. Robotic platforms and robot components which appeared in the last decade are described. In addition, system architectures for the integration of robots as well as other devices in operating rooms are also introduced and compared.
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Joseph J, LePage EM, Cheney CP, Pawa R. Artificial intelligence in colonoscopy. World J Gastroenterol 2021; 27:4802-4817. [PMID: 34447227 PMCID: PMC8371500 DOI: 10.3748/wjg.v27.i29.4802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer remains a leading cause of morbidity and mortality in the United States. Advances in artificial intelligence (AI), specifically computer aided detection and computer-aided diagnosis offer promising methods of increasing adenoma detection rates with the goal of removing more pre-cancerous polyps. Conversely, these methods also may allow for smaller non-cancerous lesions to be diagnosed in vivo and left in place, decreasing the risks that come with unnecessary polypectomies. This review will provide an overview of current advances in the use of AI in colonoscopy to aid in polyp detection and characterization as well as areas of developing research.
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Affiliation(s)
- Joel Joseph
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, United States
| | - Ella Marie LePage
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, United States
| | - Catherine Phillips Cheney
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC 27157, United States
| | - Rishi Pawa
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, United States
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14
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Manfredi L. Endorobots for Colonoscopy: Design Challenges and Available Technologies. Front Robot AI 2021; 8:705454. [PMID: 34336938 PMCID: PMC8317132 DOI: 10.3389/frobt.2021.705454] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is the second most common cause of cancer death worldwide, after lung cancer (Sung et al., 2021). Early stage detection is key to increase the survival rate. Colonoscopy remains to be the gold standard procedure due to its dual capability to optically inspect the entire colonic mucosa and to perform interventional procedures at the same time. However, this causes pain and discomfort, whereby it requires sedation or anaesthesia of the patient. It is a difficult procedure to perform that can cause damage to the colonic wall in some cases. Development of new technologies aims to overcome the current limitations on colonoscopy by using advancements in endorobotics research. The design of these advanced medical devices is challenging because of the limited space of the lumen, the contorted shape, and the long tract of the large bowel. The force applied to the colonic wall needs to be controlled to avoid collateral effects such as injuries to the colonic mucosa and pain during the procedure. This article discusses the current challenges in the colonoscopy procedure, the available locomotion technologies for endorobots used in colonoscopy at a prototype level and the commercial products available.
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Affiliation(s)
- Luigi Manfredi
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
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15
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Tziortziotis I, Laskaratos FM, Coda S. Role of Artificial Intelligence in Video Capsule Endoscopy. Diagnostics (Basel) 2021; 11:1192. [PMID: 34209029 PMCID: PMC8303156 DOI: 10.3390/diagnostics11071192] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy (CE) has been increasingly utilised in recent years as a minimally invasive tool to investigate the whole gastrointestinal (GI) tract and a range of capsules are currently available for evaluation of upper GI, small bowel, and lower GI pathology. Although CE is undoubtedly an invaluable test for the investigation of small bowel pathology, it presents considerable challenges and limitations, such as long and laborious reading times, risk of missing lesions, lack of bowel cleansing score and lack of locomotion. Artificial intelligence (AI) seems to be a promising tool that may help improve the performance metrics of CE, and consequently translate to better patient care. In the last decade, significant progress has been made to apply AI in the field of endoscopy, including CE. Although it is certain that AI will find soon its place in day-to-day endoscopy clinical practice, there are still some open questions and barriers limiting its widespread application. In this review, we provide some general information about AI, and outline recent advances in AI and CE, issues around implementation of AI in medical practice and potential future applications of AI-aided CE.
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Affiliation(s)
- Ioannis Tziortziotis
- Endoscopy Unit, Digestive Diseases Centre, Queen’s Hospital, Barking Havering and Redbridge University Hospitals NHS Trust, Rom Valley Way, Romford, London RM7 0AG, UK; (I.T.); (S.C.)
| | - Faidon-Marios Laskaratos
- Endoscopy Unit, Digestive Diseases Centre, Queen’s Hospital, Barking Havering and Redbridge University Hospitals NHS Trust, Rom Valley Way, Romford, London RM7 0AG, UK; (I.T.); (S.C.)
| | - Sergio Coda
- Endoscopy Unit, Digestive Diseases Centre, Queen’s Hospital, Barking Havering and Redbridge University Hospitals NHS Trust, Rom Valley Way, Romford, London RM7 0AG, UK; (I.T.); (S.C.)
- Photonics Group-Department of Physics, Imperial College London, Exhibition Rd, South Kensington, London SW7 2BX, UK
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16
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Pan TL, Lei MC, Ng WY, Li Z. Analytical Modeling of the Interaction Between Soft Balloon-Like Actuators and Soft Tubular Environment for Gastrointestinal Inspection. Soft Robot 2021; 9:386-398. [PMID: 34143662 DOI: 10.1089/soro.2020.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Accessing tubular environment is critical in medicine. For example, gastrointestinal tract related cancers are the leading causes of cancer deaths globally. To diagnose and treat these cancers, clinicians need accessing the gastrointestinal tract, for example, colon and small intestine, which are soft biological tubes. Soft balloon assisted locomotion is one of the promising methods for accessing bio-duct. It has been widely used in enteroscopy and other medical devices. However, the interaction between the balloon and the soft tube is seldom studied, such as the interaction pressure and the anchoring force. In this work, we present the first modeling of the interaction between soft balloon actuators and soft tubular environment. The free inflation model of soft balloon actuators was first presented. Then a constrained inflation model of the soft balloon in a soft tube was established. Finally, the anchoring force model between the soft balloon and the soft tube was developed. On average, the mean error of the predictions in these three models is 0.228 kPa (or 3.14%), 0.56 kPa (or 7.8%), and 0.22 N (or 14.7%), respectively. In the future, these models could be used for guiding balloon-actuator designs by minimizing the interaction pressure while maintaining sufficient anchoring force during the locomotion in soft tubes.
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Affiliation(s)
- Tian Le Pan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Man Cheong Lei
- Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wing Yin Ng
- Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Zheng Li
- Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong.,Department of Surgery, The Chinese University of Hong Kong, Hong Kong.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong.,Multiscale Medical Robotics Centre Ltd., The Chinese University of Hong Kong, Hong Kong
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17
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Onaizah O, Koszowska Z, Winters C, Subramanian V, Jayne D, Arezzo A, Obstein KL, Valdastri P. Guidelines for Robotic Flexible Endoscopy at the Time of COVID-19. Front Robot AI 2021; 8:612852. [PMID: 33718439 PMCID: PMC7947201 DOI: 10.3389/frobt.2021.612852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/20/2021] [Indexed: 12/22/2022] Open
Abstract
Flexible endoscopy involves the insertion of a long narrow flexible tube into the body for diagnostic and therapeutic procedures. In the gastrointestinal (GI) tract, flexible endoscopy plays a major role in cancer screening, surveillance, and treatment programs. As a result of gas insufflation during the procedure, both upper and lower GI endoscopy procedures have been classified as aerosol generating by the guidelines issued by the respective societies during the COVID-19 pandemic-although no quantifiable data on aerosol generation currently exists. Due to the risk of COVID-19 transmission to healthcare workers, most societies halted non-emergency and diagnostic procedures during the lockdown. The long-term implications of stoppage in cancer diagnoses and treatment is predicted to lead to a large increase in preventable deaths. Robotics may play a major role in this field by allowing healthcare operators to control the flexible endoscope from a safe distance and pave a path for protecting healthcare workers through minimizing the risk of virus transmission without reducing diagnostic and therapeutic capacities. This review focuses on the needs and challenges associated with the design of robotic flexible endoscopes for use during a pandemic. The authors propose that a few minor changes to existing platforms or considerations for platforms in development could lead to significant benefits for use during infection control scenarios.
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Affiliation(s)
- Onaizah Onaizah
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Zaneta Koszowska
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Conchubhair Winters
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | | | - David Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Keith L. Obstein
- Department of Gastroenterology, Hepatology, Nutrition, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, United States
| | - Pietro Valdastri
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
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18
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Abstract
Artificial intelligence (AI) is now a trendy subject in clinical medicine and especially in gastrointestinal (GI) endoscopy. AI has the potential to improve the quality of GI endoscopy at all levels. It will compensate for humans' errors and limited capabilities by bringing more accuracy, consistency, and higher speed, making endoscopic procedures more efficient and of higher quality. AI showed great results in diagnostic and therapeutic endoscopy in all parts of the GI tract. More studies are still needed before the introduction of this new technology in our daily practice and clinical guidelines. Furthermore, ethical clearance and new legislations might be needed. In conclusion, the introduction of AI will be a big breakthrough in the field of GI endoscopy in the upcoming years. It has the potential to bring major improvements to GI endoscopy at all levels.
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Affiliation(s)
- Ahmad El Hajjar
- Department of Gastroenterology and Digestive Endoscopy, Arnault Tzanck Institute, Saint-Laurent du Var 06700, France
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19
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Ciuti G, Skonieczna-Żydecka K, Marlicz W, Iacovacci V, Liu H, Stoyanov D, Arezzo A, Chiurazzi M, Toth E, Thorlacius H, Dario P, Koulaouzidis A. Frontiers of Robotic Colonoscopy: A Comprehensive Review of Robotic Colonoscopes and Technologies. J Clin Med 2020; 9:1648. [PMID: 32486374 PMCID: PMC7356873 DOI: 10.3390/jcm9061648] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
Flexible colonoscopy remains the prime mean of screening for colorectal cancer (CRC) and the gold standard of all population-based screening pathways around the world. Almost 60% of CRC deaths could be prevented with screening. However, colonoscopy attendance rates are affected by discomfort, fear of pain and embarrassment or loss of control during the procedure. Moreover, the emergence and global thread of new communicable diseases might seriously affect the functioning of contemporary centres performing gastrointestinal endoscopy. Innovative solutions are needed: artificial intelligence (AI) and physical robotics will drastically contribute for the future of the healthcare services. The translation of robotic technologies from traditional surgery to minimally invasive endoscopic interventions is an emerging field, mainly challenged by the tough requirements for miniaturization. Pioneering approaches for robotic colonoscopy have been reported in the nineties, with the appearance of inchworm-like devices. Since then, robotic colonoscopes with assistive functionalities have become commercially available. Research prototypes promise enhanced accessibility and flexibility for future therapeutic interventions, even via autonomous or robotic-assisted agents, such as robotic capsules. Furthermore, the pairing of such endoscopic systems with AI-enabled image analysis and recognition methods promises enhanced diagnostic yield. By assembling a multidisciplinary team of engineers and endoscopists, the paper aims to provide a contemporary and highly-pictorial critical review for robotic colonoscopes, hence providing clinicians and researchers with a glimpse of the major changes and challenges that lie ahead.
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Affiliation(s)
- Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Karolina Skonieczna-Żydecka
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland;
- Endoklinika sp. z o.o., 70-535 Szczecin, Poland
| | - Veronica Iacovacci
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Hongbin Liu
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 7EH, UK;
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London W1W 7TY, UK;
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, 10126 Torino, Italy;
| | - Marcello Chiurazzi
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, 20502 Malmö, Sweden;
| | - Henrik Thorlacius
- Department of Clinical Sciences, Section of Surgery, Lund University, 20502 Malmö, Sweden;
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (V.I.); (M.C.); (P.D.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
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20
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Gulati S, Patel M, Emmanuel A, Haji A, Hayee B, Neumann H. The future of endoscopy: Advances in endoscopic image innovations. Dig Endosc 2020; 32:512-522. [PMID: 31286574 DOI: 10.1111/den.13481] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/01/2019] [Indexed: 02/08/2023]
Abstract
The latest state of the art technological innovations have led to a palpable progression in endoscopic imaging and may facilitate standardisation of practice. One of the most rapidly evolving modalities is artificial intelligence with recent studies providing real-time diagnoses and encouraging results in the first randomised trials to conventional endoscopic imaging. Advances in functional hypoxia imaging offer novel opportunities to be used to detect neoplasia and the assessment of colitis. Three-dimensional volumetric imaging provides spatial information and has shown promise in the increased detection of small polyps. Studies to date of self-propelling colonoscopes demonstrate an increased caecal intubation rate and possibly offer patients a more comfortable procedure. Further development in robotic technology has introduced ex vivo automated locomotor upper gastrointestinal and small bowel capsule devices. Eye-tracking has the potential to revolutionise endoscopic training through the identification of differences in experts and non-expert endoscopist as trainable parameters. In this review, we discuss the latest innovations of all these technologies and provide perspective into the exciting future of diagnostic luminal endoscopy.
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Affiliation(s)
- Shraddha Gulati
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - Mehul Patel
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Emmanuel
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - Amyn Haji
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - Bu'Hussain Hayee
- King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - Helmut Neumann
- Department of Medicine, University Hospital Mainz, Mainz, Germany
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21
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Visconti TADC, Otoch JP, Artifon ELDA. Robotic endoscopy. A review of the literature. Acta Cir Bras 2020; 35:e202000206. [PMID: 32348403 PMCID: PMC7184939 DOI: 10.1590/s0102-865020200020000006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/28/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To present new endoscopic robotic devices in the context of minimally invasive procedures with high precision and automation. Methods Review of the literature by December 2018 on robotic endoscopy. Results We present the studies and investments for robotic implementation and flexible endoscopy evolution. We divided them into forceps manipulation platforms, active endoscopy and endoscopic capsule. They try to improve forceps handling and stability and to promote active movement. Conclusion The implementation and propagation of robotic models depend on doing what the endoscopist is unable to. The new devices are moving forward in this direction.
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22
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Lim SG. The development of robotic flexible endoscopic platforms. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii190022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Sun Gyo Lim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
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23
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Tutcu C, Baydere BA, Talas SK, Samur E. Quasi-static modeling of a novel growing soft-continuum robot. Int J Rob Res 2019. [DOI: 10.1177/0278364919893438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Soft-continuum robots attract researchers owing to their advantages over rigid-bodied robots such as adaptation of the flexible structure to tortuous environments, and compliant contact mechanics. The need for new modeling methods to attain precise control for such systems has emerged from the recent rapid progress in soft robotics. This article presents a quasi-static model for a growing soft-continuum robot that is propelled via thin-walled inflated tubes, and steered by the difference between tube lengths. Therefore, the robot shaft is modeled as a series of inflated beams under deformation. A quasi-static model coupled with a kinematic model is developed to accurately position the end effector while accounting for the inflated beam stiffness and end-effector loads. The proposed model calculates control parameters, namely tube lengths and tendon tensions required to maintain the end effector at a certain position. Tip deflection due to end-effector loading is calculated and kinematic model inputs are updated to correct positioning error caused by shaft deformation. The model is simulated for the soft-continuum robot moving on a path to show the change in model parameters for various end-effector positions. Results demonstrate the significance of including pressurized tube stiffness in the model for growing robots of similar type. Second, the need for tendons in addition to pneumatic actuation is emphasized for accurate positioning of the end effector under loading. The proposed model offers a potential method for simulation and control of similar growing soft-continuum robots presented in the literature.
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Affiliation(s)
- Cem Tutcu
- Bogazici University, Istanbul, Turkey
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24
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Gifari MW, Naghibi H, Stramigioli S, Abayazid M. A review on recent advances in soft surgical robots for endoscopic applications. Int J Med Robot 2019; 15:e2010. [PMID: 31069938 PMCID: PMC6771908 DOI: 10.1002/rcs.2010] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Soft materials, with their compliant properties, enable conformity and safe interaction with human body. With the advance in actuation and sensing of soft materials, new paradigm in robotics called "soft robotics" emerges. Soft robotics has become a new approach in designing medical devices such as wearable robotic gloves and exoskeleton. However, application of soft robotics in surgical instrument inside human body is still in its infancy. AIMS In this paper, current application and design of soft robots specifically applied for endoscopy are reviewed. MATERIALS & METHODS Different aspects in the implementation of soft robotics in endoscope design were reviewed. The key studies about MIS and NOTES were reviewed to establish the clinical background and extract the limitations of current endoscopic device in the last decade. RESULTS AND DISCUSSION In this review study, the implementation of soft robotics concepts in endoscopic application, with highlights on different features of several soft endoscopes, were evaluated. The progress in different aspects of soft robotics endoscope, current state, and future perspectives were also discussed. CONCLUSION Based on the survey on the structural specification, actuation, sensing, and stiffening the future soft surgical endoscopes are recommended to fulfil the following specifications: safe especially from pressure leakage, fully biocompatible materials, MR-compatible, capable for large bending in at least two antagonistic directions, modularity, adjustable stiffness.
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Affiliation(s)
| | - Hamid Naghibi
- Robotics and MechatronicsUniversiteit TwenteEnschedeNetherlands
| | | | - Momen Abayazid
- Robotics and MechatronicsUniversiteit TwenteEnschedeNetherlands
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25
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26
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Yeung C, Cheung JLK, Sreedhar B. Emerging next-generation robotic colonoscopy systems towards painless colonoscopy. J Dig Dis 2019; 20:196-205. [PMID: 30834714 PMCID: PMC6849516 DOI: 10.1111/1751-2980.12718] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/25/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
Abstract
Advances in the field of robotics have allowed modern technology to be integrated into medicine and that can minimize patients suffering from the side effects that are inherent to procedures for improving their quality of life. Conventional devices that are used for colonoscopies are rigid and require a high level of expertise from endoscopists to perform the procedure. Advances in robot-assisted colonoscopic systems now produce softer, more slender, automated designs that no longer require the operator to use forceful pushing to advance the colonoscope inside the colon, reducing risks to the patient of perforation and pain. It is challenging to reprocess these scopes for reuse as the materials used can be damaged during decontamination, leading to the possible risks of cross-infection by pathogenic microorganisms when reused by patients. An ideal solution is to eliminate these contamination risks to patients by adopting sterile, single-use scopes straight from the manufacturer's package to the patient. With this idea in mind, emerging developments that push the boundaries in this area will benefit patients and encourage the public to participate in and adhere better to colonoscopy screening to reduce the development of colorectal cancer. Thus, in light of these concerns and challenges, to encourage patients undergoing colorectal screening to comply with colonoscopy procedures that they are less invasive, changes in the design and materials are necessary. One of the more promising technological advances in this area is the advent of robotic colonoscopy.
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Affiliation(s)
- Chung‐Kwong Yeung
- Bio‐Medical Engineering (HK) LimitedHong Kong SARChina,Department of Surgery, Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Jo LK Cheung
- Bio‐Medical Engineering (HK) LimitedHong Kong SARChina
| | - Biji Sreedhar
- Bio‐Medical Engineering (HK) LimitedHong Kong SARChina
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27
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The large intestine from fetal period to adulthood and its impact on the course of colonoscopy. Ann Anat 2019; 224:17-22. [PMID: 30914345 DOI: 10.1016/j.aanat.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 12/19/2022]
Abstract
The human large intestine in the living adult has a total length of about 1300 mm, ranging from 1100 to 2108 mm. The development of the gut continues after birth, up to the age 4-5. The large intestine ascends at the beginning in the right abdominal quadrant, then it traverses the abdominal cavity, and finally it descends to the anus. The left and right colic flexures are the basic flexions between the transverse, ascending and descending colon, respectively. Additionally, there are secondary bendings between intestinal segments. The angles between the neighbouring parts can vary between examined subjects. Most of the angulations can be found in the transverse (range 2-9) and sigmoid colon (range 1-9), making them the most troublesome parts to pass with a colonoscope. Colonoscopy (usually performed in the left lateral or supine position) is one of the most important examination of the large intestine mucus membrane. During this procedure the endoscope is passed through the colon into the cecum or terminal ilium. The individual anatomical features (tortuosity, supernumerary loops and elongation) may slow down or interfere with the progress of the scope. We summarize current knowledge on the human large intestine from the fetal period to adulthood and carve out some aspects that are currently less known to colonoscopists.
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28
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Abstract
Although colonoscopy was originally a diagnostic imaging procedure, it has now expanded to include an increasing range of therapeutic interventions. These procedures require precise maneuvers of instruments, execution of force, efficient transmission of force from the operator to the point of application, and sufficient dexterity in the mobilization of endoscopic surgical instruments. The conventional endoscope is not designed to support technically demanding endoscopic procedures. In case of colonoscopy, the tortuous anatomy of the colon makes inserting, moving, and orientating the endoscope difficult. Exerting excessive pressure can cause looping of the endoscope, pain to the patient, and even perforation of the colon. To mitigate the technical constraints, numerous technically enhanced systems have been developed to enable better control of instruments and precise delivery of force in the execution of surgical tasks such as apposing, grasping, traction, counter-traction, and cutting of tissues. Among the recent developments are highly dexterous robotic master and slave systems, computer-assisted or robotically enhanced conventional endoscopes, and autonomously driven locomotion devices that can effortlessly traverse the colon. Developments in endoscopic instrumentations have overcome technical barriers and opened new horizons for further advancements in therapeutic interventions. This review describes examples of some of these systems in the context of their applications to advanced therapeutic colonoscopy.
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Affiliation(s)
- Jennie Y Y Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Khek Yu Ho
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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29
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Bruce M, Choi J. Detection of endoscopic looping during colonoscopy procedure by using embedded bending sensors. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:171-191. [PMID: 29849469 PMCID: PMC5965376 DOI: 10.2147/mder.s146934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Looping of the colonoscope shaft during procedure is one of the most common obstacles encountered by colonoscopists. It occurs in 91% of cases with the N-sigmoid loop being the most common, occurring in 79% of cases. Purpose Herein, a novel system is developed that will give a complete three-dimensional (3D) vector image of the shaft as it passes through the colon, to aid the colonoscopist in detecting loops before they form. Patients and methods A series of connected links spans the middle 50% of the shaft, where loops are likely to form. Two potentiometers are attached at each joint to measure angular deflection in two directions to allow for 3D positioning. This 3D positioning is converted into a 3D vector image using computer software. MATLAB software has been used to display the image on a computer monitor. For the different configuration of the colon model, the system determined the looping status. Results Different configurations (N loop, reverse gamma loop, and reverse splenic flexure) of the loops were well defined using 3D vector image. Conclusion The novel sensory system can accurately define the various configuration of the colon during the colonoscopy procedure.
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Affiliation(s)
- Michael Bruce
- Department of Mechanical Engineering, Ohio University, Athens, OH, USA
| | - JungHun Choi
- Department of Mechanical Engineering, Georgia Southern University, Statesboro, GA, USA
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30
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Abstract
Two current major research topics concern the incorporation of flexible robotic endoscopy systems developed for natural-orifice translumenal endoscopic surgery (NOTES), primarily for the purpose of remote forceps operation, into endoscopic submucosal dissection (ESD) and other flexible endoscopic treatments and the use of robots for the manipulation of flexible endoscopes themselves with the aim of enabling the remote insertion of colonoscopes, etc. However, there are still many challenges that remain to be addressed; the ideal robotic endoscope has not yet been realized. This article reviews the ongoing developments and our own efforts in the area of flexible robotic endoscopy.
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Affiliation(s)
- Keiichiro Kume
- a Third Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyusyu , Japan
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31
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Trindade AJ, Lichtenstein DR, Aslanian HR, Bhutani MS, Goodman A, Melson J, Navaneethan U, Pannala R, Parsi MA, Sethi A, Sullivan S, Thosani N, Trikudanathan G, Watson RR, Maple JT. Devices and methods to improve colonoscopy completion (with videos). Gastrointest Endosc 2018; 87:625-634. [PMID: 29454445 DOI: 10.1016/j.gie.2017.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 02/08/2023]
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32
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Review of emerging surgical robotic technology. Surg Endosc 2018; 32:1636-1655. [PMID: 29442240 DOI: 10.1007/s00464-018-6079-2] [Citation(s) in RCA: 302] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of laparoscopic and robotic procedures has increased in general surgery. Minimally invasive robotic surgery has made tremendous progress in a relatively short period of time, realizing improvements for both the patient and surgeon. This has led to an increase in the use and development of robotic devices and platforms for general surgery. The purpose of this review is to explore current and emerging surgical robotic technologies in a growing and dynamic environment of research and development. METHODS This review explores medical and surgical robotic endoscopic surgery and peripheral technologies currently available or in development. The devices discussed here are specific to general surgery, including laparoscopy, colonoscopy, esophagogastroduodenoscopy, and thoracoscopy. Benefits and limitations of each technology were identified and applicable future directions were described. RESULTS A number of FDA-approved devices and platforms for robotic surgery were reviewed, including the da Vinci Surgical System, Sensei X Robotic Catheter System, FreeHand 1.2, invendoscopy E200 system, Flex® Robotic System, Senhance, ARES, the Single-Port Instrument Delivery Extended Research (SPIDER), and the NeoGuide Colonoscope. Additionally, platforms were reviewed which have not yet obtained FDA approval including MiroSurge, ViaCath System, SPORT™ Surgical System, SurgiBot, Versius Robotic System, Master and Slave Transluminal Endoscopic Robot, Verb Surgical, Miniature In Vivo Robot, and the Einstein Surgical Robot. CONCLUSIONS The use and demand for robotic medical and surgical platforms is increasing and new technologies are continually being developed. New technologies are increasingly implemented to improve on the capabilities of previously established systems. Future studies are needed to further evaluate the strengths and weaknesses of each robotic surgical device and platform in the operating suite.
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Abstract
Endoscopes extend the eyes of the physician into the patient's body. They are widely used in gastrointestinal (GI) diagnostics and minimally invasive surgery. Endoscopes can be classified into 3 types: rigid, flexible, and capsule endoscopes. Rigid and flexible endoscopes are traditionally held and manipulated by the physician to visualize the region of interest, while capsule endoscopes move passively along with the GI peristalsis. With the advancement of technology, robotic endoscopy has been increasingly developed and accepted. In this work, robotic endoscopy from 3 categories (robot-assisted rigid endoscopy, robot-assisted flexible endoscopy, and active GI endoscopy including active flexible colonoscopy and active capsule endoscopy) is reviewed by PubMed search with the criteria ('Robotics' OR 'Robot') and ('Endoscopy' OR 'Endoscope').
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Affiliation(s)
- Zheng Li
- Department of Surgery, Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, Special administrative regions of China, China
| | - Philip Wai-Yan Chiu
- Department of Surgery, Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, Special administrative regions of China, China
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Bianchi F, Ciuti G, Koulaouzidis A, Arezzo A, Stoyanov D, Schostek S, Oddo CM, Menciassi A, Dario P. An innovative robotic platform for magnetically-driven painless colonoscopy. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:421. [PMID: 29201873 DOI: 10.21037/atm.2017.09.15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Colorectal cancer (CRC) represents a significant medical threat with a dramatic impact on the healthcare system with around 1.3 million patients worldwide, causing more than 700 thousand deaths annually. A key-aspect to successful and cost-effective disease management is represented by the early detection of CRC at asymptomatic stage. For this reason, population screening is highly recommended for patients older than 50 years or at high risk for familiarity. Currently, the standard endoscopic techniques do not meet this need. In recent years, innovative endoscopic robotic techniques and active locomotion devices have been developed as alternatives to conventional colonoscopy. The magnetically-driven robotic platform, presented by the authors, is conceived to perform less invasive and more comfortable colonoscopy with the aim to promote screening campaigns for detection of early colorectal neoplasm.
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Affiliation(s)
- Federico Bianchi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Danail Stoyanov
- Centre for Medical Image Computing and the Department of Computer Science, University College London, London, UK
| | | | | | | | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
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Bernth JE, Arezzo A, Liu H. A Novel Robotic Meshworm With Segment-Bending Anchoring for Colonoscopy. IEEE Robot Autom Lett 2017; 2:1718-1724. [DOI: 10.1109/lra.2017.2678540] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Dehghani H, Welch CR, Pourghodrat A, Nelson CA, Oleynikov D, Dasgupta P, Terry BS. Design and preliminary evaluation of a self-steering, pneumatically driven colonoscopy robot. J Med Eng Technol 2017; 41:223-236. [PMID: 28122477 DOI: 10.1080/03091902.2016.1275853] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Colonoscopy is a diagnostic procedure to detect pre-cancerous polyps and tumours in the colon, and is performed by inserting a long tube equipped with a camera and biopsy tools. Despite the medical benefits, patients undergoing this procedure often complain about the associated pain and discomfort. This discomfort is mostly due to the rough handling of the tube and the creation of loops during the insertion. The overall goal of this work is to minimise the invasiveness of traditional colonoscopy. In pursuit of this goal, this work presents the development of a semi-autonomous colonoscopic robot with minimally invasive locomotion. The proposed robotic approach allows physicians to concentrate mainly on the diagnosis rather than the mechanics of the procedure. In this paper, an innovative locomotion approach for robotic colonoscopy is addressed. Our locomotion approach takes advantage of longitudinal expansion of a latex tube to propel the robot's tip along the colon. This soft and compliant propulsion mechanism, in contrast to minimally invasive mechanisms used in, for example, inchworm-like robots, has shown promising potential. In the preliminary ex vivo experiments, the robot successfully advanced 1.5 metres inside an excised curvilinear porcine colon with average speed of 28 mm/s, and was capable of traversing bends up to 150 degrees. The robot creates less than 6 N of normal force at its tip when it is pressurised with 90 kPa. This maximum force generates pressure of 44.17 mmHg at the tip, which is significantly lower than safe intraluminal human colonic pressure of 80 mmHg. The robot design inherently prevents loop formation in the colon, which is recognised as the main cause of post procedural pain in patients. Overall, the robot has shown great promise in an ex vivo experimental setup. The design of an autonomous control system and in vivo experiments are left as future work.
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Affiliation(s)
- Hossein Dehghani
- a Department of Mechanical and Materials Engineering , University of Nebraska-Lincoln , Lincoln , NE , USA
| | - C Ross Welch
- a Department of Mechanical and Materials Engineering , University of Nebraska-Lincoln , Lincoln , NE , USA
| | - Abolfazl Pourghodrat
- a Department of Mechanical and Materials Engineering , University of Nebraska-Lincoln , Lincoln , NE , USA
| | - Carl A Nelson
- a Department of Mechanical and Materials Engineering , University of Nebraska-Lincoln , Lincoln , NE , USA.,b Center for Advanced Surgical Technology (CAST), University of Nebraska Medical Center , Omaha , NE , USA
| | - Dmitry Oleynikov
- b Center for Advanced Surgical Technology (CAST), University of Nebraska Medical Center , Omaha , NE , USA.,c Department of Surgery , University of Nebraska Medical Center , Omaha , NE , USA
| | - Prithviraj Dasgupta
- d Computer Science Department , University of Nebraska at Omaha , Omaha , NE , USA
| | - Benjamin S Terry
- a Department of Mechanical and Materials Engineering , University of Nebraska-Lincoln , Lincoln , NE , USA.,b Center for Advanced Surgical Technology (CAST), University of Nebraska Medical Center , Omaha , NE , USA
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Kurniawan N, Keuchel M. Flexible Gastro-intestinal Endoscopy - Clinical Challenges and Technical Achievements. Comput Struct Biotechnol J 2017; 15:168-179. [PMID: 28179979 PMCID: PMC5294716 DOI: 10.1016/j.csbj.2017.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 12/12/2022] Open
Abstract
Flexible gastro-intestinal (GI) endoscopy is an integral diagnostic and therapeutic tool in clinical gastroenterology. High quality standards for safety, patients' comfort, and efficiency have already been achieved. Clinical challenges and technical approaches are discussed in this short review. Image enhanced endoscopy for further characterization of mucosal and vascular patterns includes dye-spray or virtual chromoendoscopy. For confocal laser endoscopy, endocytoscopy, and autofluorescence clinical value has not yet been finally evaluated. An extended viewing field provided by additional cameras in new endoscopes can augment detection of polyps behind folds. Attachable caps, flaps, or balloons can be used to flatten colonic folds for better visualization and stable position. Variable stiffness endoscopes, radiation-free visualization of endoscope position, and different overtube devices help reducing painful loop formation in clinical routine. Computer assisted and super flexible self-propelled colonoscopes for painless sedation-free endoscopy need further research. Single-use devices might minimize the risk of infection transmission in the future. Various exchangeable accessories are available for resection, dissection, tunneling, hemostasis, treatment of stenosis and closure of defects, including dedicated suturing devices. Multiple arm flexible devices controlled via robotic platforms for complex intraluminal and transmural endoscopic procedures require further improvement.
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Affiliation(s)
- Niehls Kurniawan
- Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Akademisches Lehrkrankenhaus der Universität Hamburg, Glindersweg 80, 21029, Hamburg, Germany
| | - Martin Keuchel
- Klinik für Innere Medizin, Bethesda Krankenhaus Bergedorf, Akademisches Lehrkrankenhaus der Universität Hamburg, Glindersweg 80, 21029, Hamburg, Germany
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Kim HG. Painless Colonoscopy: Available Techniques and Instruments. Clin Endosc 2016; 49:444-448. [PMID: 27744665 PMCID: PMC5066405 DOI: 10.5946/ce.2016.132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 12/21/2022] Open
Abstract
During colonoscopy, air insufflation to distend the lumen and facilitate careful inspection and scope insertion can induce pain and cause discomfort. Carbon dioxide (CO2) insufflation can decrease abdominal pain and discomfort during and after colonoscopy. The advantage of CO2 insufflation is the rapid absorption of the gas across the intestine. Another painless option is water-assisted colonoscopy. Two methods for water-assisted colonoscopy are available: water immersion and water exchange. In a recent direct comparison, the water exchange method was superior to water immersion, CO2 insufflation, and air insufflation with respect to pain during colonoscopy, although it still had the disadvantage of being a time-consuming procedure. Cap-assisted colonoscopy is a simple technique involving the use of a small transparent cap attached to the tip of the scope. Three studies showed an advantage of this technique in terms of reduced patient discomfort compared with the conventional method. Three robotic colonoscopy systems (Endotics System [Era Endoscopy], NeoGuide [NeoGuide Systems Inc.], and Invendoscope [Invendo Medical]) have been introduced to evaluate pain reduction during colonoscopy, but none has been widely adopted and used in practice. In this review, clinical trials of several techniques and new devices for painless colonoscopy are described and summarized.
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Affiliation(s)
- Hyun Gun Kim
- Institute for Digestive Research, Soon Chun Hyang University College of Medicine, Seoul, Korea
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Prendergast JM, Rentschler ME. Towards autonomous motion control in minimally invasive robotic surgery. Expert Rev Med Devices 2016; 13:741-8. [PMID: 27376789 DOI: 10.1080/17434440.2016.1205482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION While autonomous surgical robotic systems exist primarily at the research level, recently these systems have made a strong push into clinical settings. The autonomous or semi-autonomous control of surgical robotic platforms may offer significant improvements to a diverse field of surgical procedures, allowing for high precision, intelligent manipulation of these systems and opening the door to advanced minimally invasive surgical procedures not currently possible. AREAS COVERED This review highlights those experimental systems currently under development with a focus on in vivo modeling and control strategies designed specifically for the complex and dynamic surgical environment. Expert review: Novel methods for state estimation, system modeling and disturbance rejection, as applied to these devices, continues to improve the performance of these important surgical tools. Procedures such as Natural Orifice Transluminal Endoscopic Surgery and Laparo-Endoscopic Single Site surgery, as well as more conventional procedures such as Colonoscopy, serve to benefit tremendously from the development of these automated robotic systems, enabling surgeons to minimize tissue damage and shorten procedure times while avoiding the consequences of laparotomy.
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Affiliation(s)
- J Micah Prendergast
- a Department of Mechanical Engineering , University of Colorado , Boulder , CO , USA
| | - Mark E Rentschler
- a Department of Mechanical Engineering , University of Colorado , Boulder , CO , USA
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Yeung BPM, Chiu PWY. Application of robotics in gastrointestinal endoscopy: A review. World J Gastroenterol 2016; 22:1811-1825. [PMID: 26855540 PMCID: PMC4724612 DOI: 10.3748/wjg.v22.i5.1811] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/12/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
Multiple robotic flexible endoscope platforms have been developed based on cross specialty collaboration between engineers and medical doctors. However, significant number of these platforms have been developed for the natural orifice transluminal endoscopic surgery paradigm. Increasing amount of evidence suggest the focus of development should be placed on advanced endolumenal procedures such as endoscopic submucosal dissection instead. A thorough literature analysis was performed to assess the current status of robotic flexible endoscopic platforms designed for advanced endolumenal procedures. Current efforts are mainly focused on robotic locomotion and robotic instrument control. In the future, advances in actuation and servoing technology, optical analysis, augmented reality and wireless power transmission technology will no doubt further advance the field of robotic endoscopy. Globally, health systems have become increasingly budget conscious; widespread acceptance of robotic endoscopy will depend on careful design to ensure its delivery of a cost effective service.
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Alazmani A, Hood A, Jayne D, Neville A, Culmer P. Quantitative assessment of colorectal morphology: Implications for robotic colonoscopy. Med Eng Phys 2016; 38:148-54. [PMID: 26762775 DOI: 10.1016/j.medengphy.2015.11.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/16/2015] [Accepted: 11/15/2015] [Indexed: 01/14/2023]
Abstract
This paper presents a method of characterizing the distribution of colorectal morphometrics. It uses three-dimensional region growing and topological thinning algorithms to determine and visualize the luminal volume and centreline of the colon, respectively. Total and segmental lengths, diameters, volumes, and tortuosity angles were then quantified. The effects of body orientations on these parameters were also examined. Variations in total length were predominately due to differences in the transverse colon and sigmoid segments, and did not significantly differ between body orientations. The diameter of the proximal colon was significantly larger than the distal colon, with the largest value at the ascending and cecum segments. The volume of the transverse colon was significantly the largest, while those of the descending colon and rectum were the smallest. The prone position showed a higher frequency of high angles and consequently found to be more torturous than the supine position. This study yielded a method for complete segmental measurements of healthy colorectal anatomy and its tortuosity. The transverse and sigmoid colons were the major determinant in tortuosity and morphometrics between body orientations. Quantitative understanding of these parameters may potentially help to facilitate colonoscopy techniques, accuracy of polyp spatial distribution detection, and design of novel endoscopic devices.
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Affiliation(s)
- A Alazmani
- Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
| | - A Hood
- Academic Surgical Unit, St. James's University Hospital, Leeds LS9 7TF, UK
| | - D Jayne
- Academic Surgical Unit, St. James's University Hospital, Leeds LS9 7TF, UK
| | - A Neville
- Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - P Culmer
- Institute of Engineering Systems and Design, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
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Kato T, Okumura I, Kose H, Takagi K, Hata N. Tendon-driven continuum robot for neuroendoscopy: validation of extended kinematic mapping for hysteresis operation. Int J Comput Assist Radiol Surg 2015; 11:589-602. [PMID: 26476639 DOI: 10.1007/s11548-015-1310-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/28/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE The hysteresis operation is an outstanding issue in tendon-driven actuation--which is used in robot-assisted surgery--as it is incompatible with kinematic mapping for control and trajectory planning. Here, a new tendon-driven continuum robot, designed to fit existing neuroendoscopes, is presented with kinematic mapping for hysteresis operation. METHODS With attention to tension in tendons as a salient factor of the hysteresis operation, extended forward kinematic mapping (FKM) has been developed. In the experiment, the significance of every component in the robot for the hysteresis operation has been investigated. Moreover, the prediction accuracy of postures by the extended FKM has been determined experimentally and compared with piecewise constant curvature assumption. RESULTS The tendons were the most predominant factor affecting the hysteresis operation of the robot. The extended FKM including friction in tendons predicted the postures in the hysteresis operation with improved accuracy (2.89 and 3.87 mm for the single and the antagonistic-tendons layouts, respectively). The measured accuracy was within the target value of 5 mm for planning of neuroendoscopic resection of intraventricle tumors. CONCLUSION The friction in tendons was the most predominant factor for the hysteresis operation in the robot. The extended FKM including this factor can improve prediction accuracy of the postures in the hysteresis operation. The trajectory of the new robot can be planned within target value for the neuroendoscopic procedure by using the extended FKM.
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Affiliation(s)
- Takahisa Kato
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Healthcare Optics Research Laboratory, Canon U.S.A., Inc., Cambridge, MA, USA
| | | | | | | | - Nobuhiko Hata
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. .,Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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Patel N, Darzi A, Teare J. The endoscopy evolution: 'the superscope era'. Frontline Gastroenterol 2015; 6:101-107. [PMID: 25878767 PMCID: PMC4392308 DOI: 10.1136/flgastro-2014-100448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/20/2014] [Indexed: 02/04/2023] Open
Abstract
Developments to the design of the flexible endoscope are transforming the field of gastroenterology. There is a drive to improve colonic adenoma detection rates leading to advancements in the design of the colonoscope. Novel endoscopes now allow increased visualisation of colonic mucosa, including behind colonic folds, and aim to reduce pain associated with the procedure. In addition, a shift in surgical paradigm towards minimally invasive endoluminal surgery has meant innovations in flexible platforms are being sought. There are a number of limitations of the basic endoscope. These include a lack of stability and triangulation of instruments. Modifications to the flexible endoscope design form the basis of a number of newly developed and research platforms, some of which are discussed in this review.
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Affiliation(s)
- Nisha Patel
- Department of Surgery and Cancer , Imperial College London , London , UK
| | - Ara Darzi
- Department of Surgery and Cancer , Imperial College London , London , UK
| | - Julian Teare
- Department of Surgery and Cancer , Imperial College London , London , UK
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A miniaturized robotic platform for natural orifice transluminal endoscopic surgery: in vivo validation. Surg Endosc 2015; 29:3477-84. [PMID: 25676200 DOI: 10.1007/s00464-015-4097-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 01/26/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) involves accessing the abdominal cavity via one of the body natural orifices for enabling minimally invasive surgical procedures. However, the constraints imposed by the access modality and the limited available technology make NOTES very challenging for surgeons. Tools redesign and introduction of novel surgical instruments are imperative in order to make NOTES operative in a real surgical scenario, reproducible and reliable. Robotic technology has major potential to overcome current limitations. METHODS The robotic platform described here consists of a magnetic anchoring frame equipped with dedicated docking/undocking mechanisms to house up to three modular robots for surgical interventions. The magnetic anchoring frame guarantees the required stability for surgical tasks execution, whilst dedicated modular robots provide the platform with adequate vision, stability and manipulation capabilities. RESULTS Platform potentialities were demonstrated in a porcine model. Assessment was organized into two consecutive experimental steps, with a hybrid testing modality. First, platform deployment, anchoring and assembly through transoral-transgastric access were demonstrated in order to assess protocol feasibility and guarantee the safe achievement of the following experimental session. Second, transabdominal deployment, anchoring, assembly and robotic module actuation were carried out. CONCLUSIONS This study has demonstrated the feasibility of inserting an endoluminal robotic platform composed of an anchoring frame and modular robotic units into a porcine model through a natural orifice. Once inserted into the peritoneal cavity, the platform provides proper visualization from multiple orientations. For the first time, a platform with interchangeable modules has been deployed and its components have been connected, demonstrating in vivo the feasibility of intra-abdominal assembly. Furthermore, increased dexterity employing different robotic units will enhance future system capabilities.
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Patel N, Seneci CA, Shang J, Leibrandt K, Yang GZ, Darzi A, Teare J. Evaluation of a novel flexible snake robot for endoluminal surgery. Surg Endosc 2015; 29:3349-55. [DOI: 10.1007/s00464-015-4088-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/15/2015] [Indexed: 12/13/2022]
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Patel N, Seneci C, Yang GZ, Darzi A, Teare J. Flexible platforms for natural orifice transluminal and endoluminal surgery. Endosc Int Open 2014; 2:E117-23. [PMID: 26135256 PMCID: PMC4423273 DOI: 10.1055/s-0034-1377171] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The flexible endoscope is playing an increasingly pivotal role in minimally invasive transluminal and endoluminal surgery. Whilst the flexible nature of the platform is desirable in order to navigate through the abdominal cavity or through a lumen, there are a number of issues with using the platform for this purpose. The challenges associated with using flexible endoscopes such as a lack of triangulation of instruments and force transmission, which is often inadequate for endoscopic surgery are discussed in this review. As a result of these difficulties, a number of mechanically and robotically driven devices based upon the flexible endoscope are emerging. The design of these devices and potential problems are also reviewed. Finally, future robotic systems which are still in the development and validation stage are briefly discussed. The field of gastroenterology is diverging. The narrowing divide between minimally invasive and endoluminal surgery has led to a surge of innovative and novel devices which may in the future enable precise, seamless and scar less surgery.
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Affiliation(s)
- Nisha Patel
- St. Mary’s Hospital, Imperial – Gastroenterology, London, United Kingdom,Hamlyn Centre – Robotics and Engineering, London, United Kingdom,Corresponding author Nisha Patel, BSc (Hons), MBBS (Hons), MRCP St. Mary’s Hospital – GastroenterologyPraed St, Paddington, London W2 1NYUnited Kingdom0797167931307971679313
| | - Carlo Seneci
- Hamlyn Centre – Robotics and Engineering, London, United Kingdom
| | - Guang-Zhong Yang
- Hamlyn Centre – Robotics and Engineering, London, United Kingdom
| | - Ara Darzi
- St. Mary’s Hospital, Imperial – Gastroenterology, London, United Kingdom,Hamlyn Centre – Robotics and Engineering, London, United Kingdom
| | - Julian Teare
- St. Mary’s Hospital, Imperial – Gastroenterology, London, United Kingdom,Hamlyn Centre – Robotics and Engineering, London, United Kingdom
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Abstract
Colorectal cancer is the second leading cause of mortality in men and women in the United States. While there is a definite advantage regarding the use of colonoscopies in screening, there is still a lack of widespread acceptance of colonoscopy use in the general public. This is evident by the fact that up to 75% of patients diagnosed with colorectal cancer present with locally advanced disease. In order to make colonoscopy and in turn colorectal cancer screening a patient friendly and a comfortable test some changes in tool are necessary. The conventional colonoscope has not changed much since its development. There are several new advances in colorectal screening practices. One of the most promising new advances is the advent of robotic endoscopic techniques.
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Affiliation(s)
- Dan Cater
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, MI 48912, USA
| | - Arpita Vyas
- Department of Pediatrics, Michigan State University, Lansing, MI 48912, USA
| | - Dinesh Vyas
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, MI 48912, USA
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Colonoscopy with magnetic control system to navigate the forepart of colonoscope shortens the cecal intubation time. Surg Endosc 2014; 28:2480-3. [PMID: 24648105 DOI: 10.1007/s00464-014-3460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Colonoscopy is considered the most effective method for diagnosing colorectal diseases, but its application is sometimes limited due to invasiveness, patient intolerance, and the need for sedation. OBJECTIVE The aim of this study was to improve the problem of loop formation and shorten the cecal intubation time of colonoscopy by using a magnetic control system (MCS). METHODS Two experienced gastroenterologists, three trainees, and a novice repeated colonoscopy without or with MCS on three colonoscopy training model simulator cases. These cases were divided into introductory (case 2) and challenging levels (cases 4 and 5). The cecal intubation times were recorded. RESULTS For all cases, the average cecal intubation times for the experienced gastroenterologists with MCS were significantly shorter than without MCS (case 2: 52.45 vs. 27.65 s, p < 0.001; case 4: 166.7 vs. 120.55 s, p < 0.01; case 5: 130.35 vs. 100.2 s, p < 0.05). Those of the trainees also revealed significantly shorter times with MCS (case 2: 67.27 vs. 51 s, p < 0.01; case 4: 253.27 vs. 170.97 s, p < 0.001; case 5: 144.1 vs. 85.57 s, p < 0.001). CONCLUSION Conducting colonoscopy with MCS is safe and smooth, and shortens the cecal intubation time by navigating the forepart of the colonoscope. In addition, all diagnostic and therapeutic benefits of conventional colonoscopy are retained.
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Mechanical analysis of insertion problems and pain during colonoscopy: why highly skill-dependent colonoscopy routines are necessary in the first place... and how they may be avoided. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2014; 27:293-302. [PMID: 23712305 DOI: 10.1155/2013/353760] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Colonoscopy requires highly skill-dependent manoeuvres that demand a significant amount of training, and can cause considerable discomfort to patients, which increases the use of sedatives. Understanding the underlying fundamental mechanics behind insertion difficulties and pain during colonoscopy may help to simplify colonoscopy and reduce the required extent of training and reliance on sedatives. METHODS A literature search, anatomical studies, models of the colon and colonoscope, and bench tests were used to qualitatively analyze the fundamental mechanical causes of insertion difficulties and pain. A categorized review resulted in an overview of potential alternatives to current colonoscopes. RESULTS To advance a colonoscope through the colon, the colon wall, ligaments and peritoneum must be stretched, thus creating tension in the colon wall, which resists further wall deformation. This resistance forces the colonoscope to bend and follow the curves of the colon. The deformations that cause insertion difficulties and pain (necessitating the use of complex conventional manoeuvres) are the stretching of ligaments, and stretching of colon wall in the transverse and longitudinal directions, and the peritoneum. CONCLUSIONS Four fundamental mechanical solutions to prevent these deformations were extracted from the analysis. The current results may help in the development of new colonoscopy devices that reduce - or eliminate - the necessity of using highly skill-dependent manoeuvres, facilitate training and reduce the use of sedatives.
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Abstract
Gastrointestinal endoscopy is a rapidly evolving field. Techniques in endoscopy continue to become more sophisticated, as do the devices and platforms, particularly in colonoscopy and endoscopic resection. This article reviews new platforms for endoscopic imaging of the colon, and discusses new endoscopic accessories and developments in endoscopic resection.
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