Feasibility of joystick guided colonoscopy

Robotics in flexible endoscopy: current status and future prospects

PURPOSE OF REVIEW

Advanced endoscopy procedures are technically challenging and require extensive training. Recent technological advances made in computer science and robotics have the potential to enhance the performance of complex intraluminal and transluminal interventions and potentially optimize precision and safety. This review covers the different technologies used for robot-assisted interventions in the gastrointestinal tract, organized according to their clinical availability, and focusing on flexible endoscopy-based systems.

RECENT FINDINGS

In the curvilinear gastrointestinal anatomy, robotic technology can enhance flexible endoscopes to augment effectiveness, safety, and therapeutic capabilities, particularly for complex intraluminal and transluminal interventions. Increased visual angles, increased degrees of freedom of instrumentation, optimized navigation, and locomotion, which may lead to a reduced physician learning curve and workload, are promising achievements with the promise to ultimately replace conventional endoscopy techniques for screening and therapeutic endoscopy.

SUMMARY

The majority of these devices are not commercially available yet. The best clinical applications are also currently being researched. Nonetheless, robotic assistance may encourage surgeons to use flexible endoscopes to administer surgical therapies and increase interest among gastroenterologists in advanced therapies. Robotics may be a means to overcome the technical obstacles of incisionless natural orifice procedures and favor an increased adoption of complex endoscopic procedures such as third-space therapies.

Assessment of technical parameters and skills training to inform a simulation-based training program for semi-automated robotic colonoscopy

Background and study aims  Video-colonoscopy, despite being the gold-standard for diagnosis of colorectal lesions, has limitations including patient discomfort and risk of complications. This study assessed training characteristics and acceptability in operators of a new robotic colonoscope (RC). Materials and methods  Participants (n = 9) with varying degrees of skill and background knowledge in colonoscopy performed colonoscopies with a RC on a simulation-based training model. Quantitative procedure-related and qualitative operator-related parameters were recorded. Results  Polyp detection rate was highest in the novice group (91.67 %) followed by experts (86.11 %), then equally, trainees and video gamers (79.17 %). Four participants repeated the procedure at a follow-up session. Each participant improved cecal intubation time and had the same or higher polyp detection rate. The potential role for RC was identified for an out-of-hospital environment and as a novel diagnostic tool. Conclusions  Results from this pilot suggest that operators at all skill levels found the RC acceptable and potentially useful as a diagnostic tool. Acquisition of skills with RC seems to improve rapidly to a clinically relevant level with simulation-based training.

Feasibility of automated target centralization in colonoscopy

Purpose

Early detection of colorectal cancer is key to full recovery. This urged governments to start population screening programs for colorectal cancer, often using flexible endoscopes. Flexible endoscopy is difficult to learn and time-consuming. Automation of flexible endoscopes may increase the capacity for the screening programs. The goal of this pilot study is to investigate the clinical and technical feasibility of an assisting automated navigation algorithm for a colonoscopy procedure.

Methods

Automated navigation (lumen centralization) was implemented in a robotized system designed for conventional flexible endoscopes. Ten novice and eight expert users were asked to perform a diagnostic colonoscopy on a colon model twice: once using the conventional and once using the robotic system. Feasibility was evaluated using time and location data as measures of the system’s added value.

Results

Automated target centralization (ATC) was turned on by the novices for a median of 4.2 % of the time during insertion and 0.3 % during retraction. Experts turned ATC on for 4.0 % of the time during insertion and 11.6 % during retraction. Novices and experts showed comparable times to reach the cecum with the conventional or the robotic setup with ATC.

Conclusion

The ATC algorithm combined with the robotized endoscope setup works in an experimental setup that closely resembles the clinical environment and is considered feasible, although ATC use was lower than expected. For novices, it was unclear whether the low usage was due to unfamiliarity with the system or because they did not need ATC. Experts used ATC also during the retraction phase of the procedure. This was an unexpected finding and may indicate an added value of the system.

Electronic supplementary material

The online version of this article (doi:10.1007/s11548-015-1301-3) contains supplementary material, which is available to authorized users.