Emerging next-generation robotic colonoscopy systems towards painless colonoscopy

MorphGI: A Self-Propelling Soft Robotic Endoscope Through Morphing Shape

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.

Clinical applications of robotic surgery platforms: a comprehensive review

Robotic surgery has expanded globally across various medical specialties since its inception more than 20 years ago. Accompanying this expansion were significant technological improvements, providing tremendous benefits to patients and allowing the surgeon to perform with more precision and accuracy. This review lists some of the different types of platforms available for use in various clinical applications. We performed a literature review of PubMed and Web of Science databases in May 2023, searching for all available articles describing surgical robotic platforms from January 2000 (the year of the first approved surgical robot, da Vinci® System, by Intuitive Surgical) until May 1st, 2023. All retrieved robotic platforms were then divided according to their clinical application into four distinct groups: soft tissue robotic platforms, orthopedic robotic platforms, neurosurgery and spine platforms, and endoluminal robotic platforms. Robotic surgical technology has undergone a rapid expansion over the last few years. Currently, multiple robotic platforms with specialty-specific applications are entering the market. Many of the fields of surgery are now embracing robotic surgical technology. We review some of the most important systems in clinical practice at this time.

A Novel Asymmetric Pneumatic Soft-Surgical Endoscope Design with Laminar Jamming

Soft pneumatic endoscopes developed for Minimally Invasive Surgeries (MIS) are designed upright which means that the starting positions straight. As the internal chambers are pressurized the endoscopic module starts bending. The relation between the pneumatic pressure and bending is nonlinear as the air needs first to fill the chamber before bending, and additionally frictional interaction to the sheath adds more to this start-up transient behaviour. This highly nonlinear behaviour severely limits the actuator sensitivity, accuracy, and repeatability near the endoscope's center of operating range. This paper introduces a novel pre-bent MR-compatible soft-surgical pneumatic endoscope design aimed to improve the bending performance of soft endoscopes by shifting the start-up transient out of the operating range. The pre-bent design of 12 mm diameter consists of an actuation and stiffening chamber, inextensible shell reinforcement with a backbone and rings, and external sheathing. The design parameters that include cross-sectional area, number of rings and backbone width are determined using Finite Element (FE) analysis. The motion profile of the fabricated endoscope, determined via experimentation, shows a successful shift of the start-up transient while the jamming structure increases the stiffness of the endoscope but limits the bending range. Further design developments of the endoscope are required for clinical application.

Feasibility study of a single-use balloon-assisted robotic colonoscope in healthy volunteers

Background and study aims  Despite its widespread adoption, colonoscope still has its limitations. Advancement is often limited by the looping of colon. The isolation of SARS-CoV-2 in stool raises concern for the risk of disease transmission. A single-use robotic colonoscope, the NISInspire-C System, that features a balloon-suction anchorage mechanism was developed to address these. Methods  The NISInspire-C balloons are designed to provide anchorage for straightening of the colon during advancement. Angulation at the bending section is tendon-wire driven by servo mechanisms integrated into a robotic control console. This was a pilot, prospective trial to evaluate the safety and feasibility of this system. Healthy volunteers underwent examination with the NISInspire-C, followed by the conventional colonoscope. The procedure time, cecal intubation rates (CIR), complications, and level of pain were measured. Results  A total of 19 subjects underwent the examination. The cecal intubation rate was 89.5 % (17/19) and the overall time-to-cecum was 26.3 minutes (SD: 17.9 mins). There were no procedure-related complications. Polyps were detected in seven of 19 (36.8 %) subjects during the NISInspire-C procedure. Three more subjects were found to have adenomatous polyps with the conventional colonoscope. There was minimal variation in level of pain during the procedures with the two colonoscopes. Conclusion  The single-use robotic colonoscope NISInspire-C is a safe and feasible alternative to the conventional colonoscope. Further technical refinement is needed to improve the CIR. This study was limited by its small sample size.

Guidelines for Robotic Flexible Endoscopy at the Time of COVID-19

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.

Programmable Stimuli-Responsive Actuators for Complex Motions in Soft Robotics: Concept, Design and Challenges

During the last years, great progress was made in material science in terms of concept, design and fabrication of new composite materials with conferred properties and desired functionalities. The scientific community paid particular interest to active soft materials, such as soft actuators, for their potential as transducers responding to various stimuli aiming to produce mechanical work. Inspired by this, materials engineers today are developing multidisciplinary approaches to produce new active matters, focusing on the kinematics allowed by the material itself more than on the possibilities offered by its design. Traditionally, more complex motions beyond pure elongation and bending are addressed by the robotics community. The present review targets encompassing and rationalizing a framework which will help a wider scientific audience to understand, sort and design future soft actuators and methods enabling complex motions. Special attention is devoted to recent progress in developing innovative stimulus-responsive materials and approaches for complex motion programming for soft robotics. In this context, a challenging overview of the new materials as well as their classification and comparison (performances and characteristics) are proposed. In addition, the great potential of soft transducers are outlined in terms of kinematic capabilities, illustrated by the related application. Guidelines are provided to design actuators and to integrate asymmetry enabling motions along any of the six basic degrees of freedom (translations and rotations), and strategies towards the programming of more complex motions are discussed. As a final note, a series of manufacturing methods are described and compared, from molding to 3D and 4D printing. The review ends with a Perspectives section, from material science and microrobotic points of view, on the soft materials’ future and close future challenges to be overcome.

Robotic-Assisted Colonoscopy Platform with a Magnetically-Actuated Soft-Tethered Capsule

Background and Aims: Colorectal cancer (CRC) is a major cause of morbidity and mortality worldwide. Despite offering a prime paradigm for screening, CRC screening is often hampered by invasiveness. Endoo is a potentially painless colonoscopy method with an active locomotion tethered capsule offering diagnostic and therapeutic capabilities. Materials and Methods: The Endoo system comprises a soft-tethered capsule, which embeds a permanent magnet controlled by an external robot equipped with a second permanent magnet. Capsule navigation is achieved via closed-loop interaction between the two magnets. Ex-vivo tests were conducted by endoscopy experts and trainees to evaluate the basic key features, usability, and compliance in comparison with conventional colonoscopy (CC) in feasibility and pilot studies. Results: Endoo showed a 100% success rate in operating channel and target approach tests. Progression of the capsule was feasible and repeatable. The magnetic link was lost an average of 1.28 times per complete procedure but was restored in 100% of cases. The peak value of interaction forces was higher in the CC group than the Endoo group (4.12N vs. 1.17N). The cumulative interaction forces over time were higher in the CC group than the Endoo group between the splenic flexure and mid-transverse colon (16.53Ns vs. 1.67Ns, p < 0.001), as well as between the hepatic flexure and cecum (28.77Ns vs. 2.47Ns, p = 0.005). The polyp detection rates were comparable between groups (9.1 ± 0.9% vs. 8.7 ± 0.9%, CC and Endoo respectively, per procedure). Robotic colonoscopies were completed in 67% of the procedures performed with Endoo (53% experts and 100% trainees). Conclusions: Endoo allows smoother navigation than CC and possesses comparable features. Although further research is needed, magnetic capsule colonoscopy demonstrated promising results compared to CC.

Artificial Intelligence for Understanding Imaging, Text, and Data in Gastroenterology

Artificial intelligence (AI) could change the practice of gastroenterology through its ability to both acquire and analyze information with speed, reproducibility, and, potentially, insight that may exceed that of human medical specialists. AI is powered by computational methods that allow machines to replicate clinical pattern recognition used by gastroenterology specialists to interpret endoscopic or cross-sectional images; understand the meaning and intent of medical documents; and merge different types of data to infer a diagnosis, prognosis, or expected outcome. Ongoing research is studying the use of AI for automated interpretation of text from colonoscopy and clinical documents for improved quality and patient phenotyping as well as enhanced detection and descriptions of polyps and other endoscopic lesions, and for predicting the probability of future therapeutic response early in a treatment course. This article introduces emerging technologies of natural language processing, machine vision, and machine learning for data analytics, and describes current and future applications in gastroenterology.

Frontiers of Robotic Colonoscopy: A Comprehensive Review of Robotic Colonoscopes and Technologies

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.