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Cao Q, Deng R, Pan Y, Liu R, Chen Y, Gong G, Zou J, Yang H, Han D. Robotic wireless capsule endoscopy: recent advances and upcoming technologies. Nat Commun 2024; 15:4597. [PMID: 38816464 PMCID: PMC11139981 DOI: 10.1038/s41467-024-49019-0] [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: 12/15/2023] [Accepted: 05/21/2024] [Indexed: 06/01/2024] Open
Abstract
Wireless capsule endoscopy (WCE) offers a non-invasive evaluation of the digestive system, eliminating the need for sedation and the risks associated with conventional endoscopic procedures. Its significance lies in diagnosing gastrointestinal tissue irregularities, especially in the small intestine. However, existing commercial WCE devices face limitations, such as the absence of autonomous lesion detection and treatment capabilities. Recent advancements in micro-electromechanical fabrication and computational methods have led to extensive research in sophisticated technology integration into commercial capsule endoscopes, intending to supersede wired endoscopes. This Review discusses the future requirements for intelligent capsule robots, providing a comparative evaluation of various methods' merits and disadvantages, and highlighting recent developments in six technologies relevant to WCE. These include near-field wireless power transmission, magnetic field active drive, ultra-wideband/intrabody communication, hybrid localization, AI-based autonomous lesion detection, and magnetic-controlled diagnosis and treatment. Moreover, we explore the feasibility for future "capsule surgeons".
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Affiliation(s)
- Qing Cao
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Runyi Deng
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Yue Pan
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Ruijie Liu
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Yicheng Chen
- Sir Run-Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Guofang Gong
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Jun Zou
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Huayong Yang
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Dong Han
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, 310027, China.
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, China.
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Peker F, Ferhanoğlu O. Active distance control in multi-capsule endoscopy via closed loop electromagnetic force between capsules. Med Biol Eng Comput 2024; 62:1153-1163. [PMID: 38158548 DOI: 10.1007/s11517-023-02997-7] [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: 05/02/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
Capsule endoscopy offers a non-invasive and patient-friendly method for imaging the gastrointestinal tract, boasting superior tissue accessibility compared to traditional endoscopy and colonoscopy. While advances have led to capsules capable of drug delivery, tactile sensing, and biopsy, size constraints often limit a single capsule from having multifunctionality. In response, we introduce multi-capsule endoscopy, where individually ingested capsules, each with unique functionalities, work collaboratively. However, synchronized navigation of these capsules is essential for this approach. In this paper, we present an active distance control strategy using a closed-loop system. This entails equipping one capsule with a sphere permanent magnet and the other with a solenoid. We utilized a Simulink model, incorporating (i) the peristalsis motion on the primary capsule, (ii) a PID controller, (iii) force dynamics between capsules through magnetic dipole approximation, and (iv) position tracking of the secondary capsule. For practical implementation, Hall effect sensors determined the inter-capsule distance, and a PID controller adjusted the solenoid's current to maintain the desired capsule spacing. Our proof-of-concept experiments, conducted on phantoms and ex vivo bovine tissues, pulled the leading capsule mimicking a typical human peristalsis speed of 1 cm/min. Results showcased an inter-capsule distance of 1.94 mm ± 0.097 mm for radii of curvature at 500 mm, 250 mm, and 100 mm, aiming for a 2-mm capsule spacing. For ex vivo bovine tissue, the achieved distance was 0.97 ± 0.28 mm against a target inter-capsule distance of 1 mm. Through the successful demonstration of precise inter-capsule control, this study paves the way for the potential of multi-capsule endoscopy in future research.
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Affiliation(s)
- Furkan Peker
- Faculty of Electrical and Electronics Eng., Department of Electronics and Communication Eng., Istanbul Technical University, Maslak, Istanbul, 34469, Turkey.
| | - Onur Ferhanoğlu
- Faculty of Electrical and Electronics Eng., Department of Electronics and Communication Eng., Istanbul Technical University, Maslak, Istanbul, 34469, Turkey
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3
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Rashid MHO, Lin F. Magnetically Driven Biopsy Capsule Robot with Spring Mechanism. MICROMACHINES 2024; 15:287. [PMID: 38399015 PMCID: PMC10892247 DOI: 10.3390/mi15020287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
In recent years, capsule endoscopes (CEs) have appeared as an advanced technology for the diagnosis of gastrointestinal diseases. However, only capturing the images limits the advanced diagnostic procedures and so on in CE's applications. Herein, considering other extended functions like tissue sampling, a novel wireless biopsy CE has been presented employing active locomotion. Two permanent magnets (PMs) have been placed into the robots, which control the actuation of the capsule robot (CR) and biopsy mechanism by employing an external electromagnetic actuation (EMA) system. A spring has been attached to the biopsy mechanism to retract the biopsy tool after tissue collection. A camera module has also been attached to the front side of the CR to detect the target point and observe the biopsy process on the lesion. A prototype of CR was fabricated with a diameter of 12 mm and a length of 32 mm. A spring mechanism with a biopsy needle was placed inside the CR and sprang out around 5 mm. An in vitro experiment was conducted, which demonstrated the precise control translation (2 mm/s and 3 mm/s in the x and y directions, respectively) and desired extrusion of the biopsy mechanism (~5 mm) for sampling the tissue. A needle-based biopsy capsule robot (NBBCR) has been designed to perform the desired controlled locomotion and biopsy function by external force. This proposed active locomoted untethered NBBCR can be wirelessly controlled to perform extended function precisely, advancing the intestinal CE technique for clinical applications.
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Affiliation(s)
- Md Harun Or Rashid
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China;
| | - Feng Lin
- School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China;
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China
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4
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Rehan M, Al-Bahadly I, Thomas DG, Young W, Cheng LK, Avci E. Smart capsules for sensing and sampling the gut: status, challenges and prospects. Gut 2023; 73:186-202. [PMID: 37734912 PMCID: PMC10715516 DOI: 10.1136/gutjnl-2023-329614] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/26/2023] [Indexed: 09/23/2023]
Abstract
Smart capsules are developing at a tremendous pace with a promise to become effective clinical tools for the diagnosis and monitoring of gut health. This field emerged in the early 2000s with a successful translation of an endoscopic capsule from laboratory prototype to a commercially viable clinical device. Recently, this field has accelerated and expanded into various domains beyond imaging, including the measurement of gut physiological parameters such as temperature, pH, pressure and gas sensing, and the development of sampling devices for better insight into gut health. In this review, the status of smart capsules for sensing gut parameters is presented to provide a broad picture of these state-of-the-art devices while focusing on the technical and clinical challenges the devices need to overcome to realise their value in clinical settings. Smart capsules are developed to perform sensing operations throughout the length of the gut to better understand the body's response under various conditions. Furthermore, the prospects of such sensing devices are discussed that might help readers, especially health practitioners, to adapt to this inevitable transformation in healthcare. As a compliment to gut sensing smart capsules, significant amount of effort has been put into the development of robotic capsules to collect tissue biopsy and gut microbiota samples to perform in-depth analysis after capsule retrieval which will be a game changer for gut health diagnosis, and this advancement is also covered in this review. The expansion of smart capsules to robotic capsules for gut microbiota collection has opened new avenues for research with a great promise to revolutionise human health diagnosis, monitoring and intervention.
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Affiliation(s)
- Muhammad Rehan
- Department of Electronic Engineering, Sir Syed University of Engineering & Technology, Karachi, Pakistan
| | - Ibrahim Al-Bahadly
- Department of Mechanical and Electrical Engineering, Massey University, Palmerston North, New Zealand
| | - David G Thomas
- School of Agriculture and Environment, Massey University, Palmerston North, New Zealand
| | - Wayne Young
- AgResearch Ltd, Palmerston North, New Zealand
| | - Leo K Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Riddet Institute, Massey University, Palmerston North, New Zealand
| | - Ebubekir Avci
- Department of Mechanical and Electrical Engineering, Massey University, Palmerston North, New Zealand
- The MacDiarmid Institute for Advanced Materials and Nanotechnology, Wellington, New Zealand
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5
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Liu W, Choi SJ, George D, Li L, Zhong Z, Zhang R, Choi SY, Selaru FM, Gracias DH. Untethered shape-changing devices in the gastrointestinal tract. Expert Opin Drug Deliv 2023; 20:1801-1822. [PMID: 38044866 PMCID: PMC10872387 DOI: 10.1080/17425247.2023.2291450] [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: 09/30/2023] [Accepted: 12/01/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Advances in microfabrication, automation, and computer engineering seek to revolutionize small-scale devices and machines. Emerging trends in medicine point to smart devices that emulate the motility, biosensing abilities, and intelligence of cells and pathogens that inhabit the human body. Two important characteristics of smart medical devices are the capability to be deployed in small conduits, which necessitates being untethered, and the capacity to perform mechanized functions, which requires autonomous shape-changing. AREAS COVERED We motivate the need for untethered shape-changing devices in the gastrointestinal tract for drug delivery, diagnosis, and targeted treatment. We survey existing structures and devices designed and utilized across length scales from the macro to the sub-millimeter. These devices range from triggerable pre-stressed thin film microgrippers and spring-loaded devices to shape-memory and differentially swelling structures. EXPERT OPINION Recent studies demonstrate that when fully enabled, tether-free and shape-changing devices, especially at sub-mm scales, could significantly advance the diagnosis and treatment of GI diseases ranging from cancer and inflammatory bowel disease (IBD) to irritable bowel syndrome (IBS) by improving treatment efficacy, reducing costs, and increasing medication compliance. We discuss the challenges and possibilities associated with ensuring safe, reliable, and autonomous operation of these smart devices.
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Affiliation(s)
- Wangqu Liu
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Soo Jin Choi
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Derosh George
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Ling Li
- Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Zijian Zhong
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Ruili Zhang
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Si Young Choi
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Florin M. Selaru
- Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - David H. Gracias
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Chemistry, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD 21218, USA
- Sidney Kimmel Comprehensive Cancer Center (SKCCC), Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Center for MicroPhysiological Systems (MPS), Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Lu T, Ji S, Jin W, Yang Q, Luo Q, Ren TL. Biocompatible and Long-Term Monitoring Strategies of Wearable, Ingestible and Implantable Biosensors: Reform the Next Generation Healthcare. SENSORS (BASEL, SWITZERLAND) 2023; 23:2991. [PMID: 36991702 PMCID: PMC10054135 DOI: 10.3390/s23062991] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 06/19/2023]
Abstract
Sensors enable the detection of physiological indicators and pathological markers to assist in the diagnosis, treatment, and long-term monitoring of diseases, in addition to playing an essential role in the observation and evaluation of physiological activities. The development of modern medical activities cannot be separated from the precise detection, reliable acquisition, and intelligent analysis of human body information. Therefore, sensors have become the core of new-generation health technologies along with the Internet of Things (IoTs) and artificial intelligence (AI). Previous research on the sensing of human information has conferred many superior properties on sensors, of which biocompatibility is one of the most important. Recently, biocompatible biosensors have developed rapidly to provide the possibility for the long-term and in-situ monitoring of physiological information. In this review, we summarize the ideal features and engineering realization strategies of three different types of biocompatible biosensors, including wearable, ingestible, and implantable sensors from the level of sensor designing and application. Additionally, the detection targets of the biosensors are further divided into vital life parameters (e.g., body temperature, heart rate, blood pressure, and respiratory rate), biochemical indicators, as well as physical and physiological parameters based on the clinical needs. In this review, starting from the emerging concept of next-generation diagnostics and healthcare technologies, we discuss how biocompatible sensors revolutionize the state-of-art healthcare system unprecedentedly, as well as the challenges and opportunities faced in the future development of biocompatible health sensors.
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Affiliation(s)
- Tian Lu
- School of Integrated Circuit and Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Shourui Ji
- School of Integrated Circuit and Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Weiqiu Jin
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Qisheng Yang
- School of Integrated Circuit and Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Qingquan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Tian-Ling Ren
- School of Integrated Circuit and Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
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Hoang MC, Park JO, Kim J. Battery-Free Tattooing Mechanism-Based Functional Active Capsule Endoscopy. MICROMACHINES 2022; 13:2111. [PMID: 36557410 PMCID: PMC9786073 DOI: 10.3390/mi13122111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
This paper presents a novel tattooing capsule endoscope (TCE) for delivering a certain amount of ink to the submucosal layer of digestive tract organs. A dual-function permanent magnet is used for locomotion and injection activation. The developed capsule endoscope can move actively in 5 DOF due to the interaction between the permanent magnet and a controllable external magnetic field produced by an electromagnet actuation system. In addition, the permanent magnet is involved in a specially designed mechanism to activate a process that creates a squeezing motion to eject the liquid from the storage room to the target. The dimension of the prototype is 12.5 mm in diameter and 34.6 mm in length. The proposed TCE is tested ex vivo using a fresh porcine small-intestine segment. We were able to direct the TCE to the target and deliver the tattoo agent into the tissue. The proposed mechanism can be used for drug delivery or lesion tattooing, as well as to accelerate the realization of the functional capsule endoscope in practice.
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Affiliation(s)
| | - Jong-Oh Park
- Correspondence: (J.-O.P.); (J.K.); Tel.: +82-062-530-5262 (J.K.)
| | - Jayoung Kim
- Correspondence: (J.-O.P.); (J.K.); Tel.: +82-062-530-5262 (J.K.)
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Xin Y, Sun ZJ, Gu W, Yu L. Experimental Research on a Capsule Robot with Spring-Connected Legs. MICROMACHINES 2022; 13:2042. [PMID: 36557341 PMCID: PMC9785607 DOI: 10.3390/mi13122042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
Based on a previous study of a novel capsule robot (CR) with spring-connected legs that could collect intestinal juice for biopsy, in this research, an experiment system is designed, and two experiments are carried out. One of the experiments measures the torque and cutting force of this CR, and the other experiment tests and evaluates the biopsy function of this CR. In the measuring experiment, we analyze how the magnetic torque exerted on this CR changes. In the experiment with a biopsy, we decompose the biopsy actions and select the most effective biopsy action. The result of the experiments shows that this CR can collect and store biopsy samples ideally, and the most effective biopsy action is the rotation with legs extended.
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Song Z, Zhang W, Zhang W, Paolo D. A Novel Biopsy Capsule Robot Based on High-Speed Cutting Tissue. CYBORG AND BIONIC SYSTEMS 2022; 2022:9783517. [PMID: 39081833 PMCID: PMC11288281 DOI: 10.34133/2022/9783517] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/17/2022] [Indexed: 08/02/2024] Open
Abstract
The capsule robot (CR) is a promising endoscopic method in gastrointestinal diagnosis because of its low discomfort to users. Most CRs are used to acquire image information only and lack the ability to collect samples. Although some biopsy capsule robots (BCRs) have been developed, it remains challenging to acquire the intestinal tissue while avoiding tearing and adhesion due to the flexibility of colonic tissue. In this study, we develop a BCR with a novel sampling strategy in which soft tissue is scratched with sharp blades rotating at high speed to avoid tissue tearing. In the BCR design, a spiral spring with prestored energy is used to release high energy within a short period of time, which is difficult for a motor or magnet to perform within a small capacity installation space. The energy of the tightened spiral spring is transmitted to drive sharp blades to rotate quickly via a designed gear mechanism. To guarantee reliable sampling, a Bowden cable is used to transmit the user's manipulation to trigger the rotation of the blades, and the triggering force transmitted by the cable can be monitored in real time by a force sensor installed at the manipulating end. A prototype of the proposed BCR is designed and fabricated, and its performance is tested through in vitro experiments. The results show that the proposed BCR is effective and the size of its acquired samples satisfies clinical requirements.
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Affiliation(s)
- Zhibin Song
- Key Laboratory of Mechanism Theory and Equipment Design of the Ministry of Education, Tianjin University, Tianjin 300072, China
| | - Wenjie Zhang
- Key Laboratory of Mechanism Theory and Equipment Design of the Ministry of Education, Tianjin University, Tianjin 300072, China
| | - Wenhui Zhang
- Beijing Shijitan Hospital, Capital Medical University, Beijing 100084, China
| | - Dario Paolo
- Key Laboratory of Mechanism Theory and Equipment Design of the Ministry of Education, Tianjin University, Tianjin 300072, China
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56100 Pisa, Italy
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Khan H, Alijani A, Mowat C, Cuschieri A. Soft hybrid intrinsically motile robot for wireless small bowel enteroscopy. Surg Endosc 2022; 36:4624-4630. [PMID: 35102429 PMCID: PMC9085689 DOI: 10.1007/s00464-021-09007-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/31/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Difficulties in establishing diagnosis of small bowel (SB) disorders, prevented their effective treatment. This problem was largely resolved by wireless capsule endoscopy (WCE), which has since become the first line investigation for suspected SB disorders. Several types of WCE pills are now used in clinical practice, despite their limitations and complications. WCE pills are large, rigid and immotile capsules. When swallowed, they provide SB enteroscopy downloaded to a data logger carried by the patient. Most of the complications of WCEs result from lack of intrinsic locomotion: incomplete examination, capsule retention and impaction within strictures. In addition, the rigid nature and size of current generation of WCE pills is accompanied by 0.1% inability to swallow the pill by patients with normal esophageal motility. METHODS The aim of this communication is to describe the initial prototype, P1, which is thinner and slightly longer than the current generation of WCEs. In addition, it exhibits intrinsic active locomotion, produced by vibrating silicon legs. These generate a controlled-skid locomotion on the small bowel mucosal surface, rendered slippery by surface mucus and intraluminal surfactant bile salts. We demonstrate the mechanism responsible for the active locomotion of P1, which we consider translatable into a working prototype, suitable for further R&D for eventual clinical translation. RESULTS The shape and attachment of the rubber vibrating legs to vibrating actuators, have been designed specifically to produce a tight clockwise circular motion. When inserted inside a circular tube in vitro of equivalent diameter to human small intestine, the intrinsic circular clockwise motion of P1 translates into a linear locomotion by the constraints imposed by the surrounding circular walls of SB and rest of the gastrointestinal tract. This design ensures device stability during transit, essential for imaging and targeting lesions encountered during the enteroscopy. We preformed two experiments: (i) transit of P1 through a phantom consisting of a segment of PVC tube placed on a horizontal surface and (ii) transit through a transparent slippery nylon sleeve insufflated with air. In the PVC tube, its transit rate averages 15.6 mm/s, which is too fast for endoscopy: whereas inside the very slippery nylon sleeve insufflated with air, the average transit rate of P1 is reduced to 5.9 mm/s, i.e., ideal for inspection endoscopy. CONCLUSIONS These in-vitro experiments indicate that the P1 hybrid soft robot prototype has the potential specifically for clinical translation for SB enteroscopy.
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Affiliation(s)
- Hamza Khan
- School of Medicine, University of Dundee, Dundee, DD21FD, UK.
| | | | - Craig Mowat
- School of Medicine, University of Dundee, Dundee, DD21FD, UK
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Ye D, Xue J, Yuan S, Zhang F, Song S, Wang J, Meng MQH. Design and Control of a Magnetically-Actuated Capsule Robot with Biopsy Function. IEEE Trans Biomed Eng 2022; 69:2905-2915. [PMID: 35259093 DOI: 10.1109/tbme.2022.3157451] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Wireless capsule endoscopy has been well used for gastrointestinal (GI) tract diagnosis. However, it can only obtain images and cannot take samples of GI tract tissues. In this study, we designed a magnetically-actuated biopsy capsule (MABC) robot for GI tract diagnosis. METHODS The proposed robot can achieve locomotion and biopsy functions under the control of external electromagnetic actuation (EMA) system. Two types of active locomotion can be achieved, plane motion refers to the robot rolling on the surface of the GI tract with a rotating uniform magnetic field. 3D motion refers to the robot moving in 3D space under the control of the EMA system. After reaching the target position, the biopsy needle can be sprung out for sampling and then retracted under a gradient magnetic field. RESULTS A pill-shaped robot prototype (15mm 32mm) has been fabricated and tested with phantom experiments. The average motion control error is 0.32mm in vertical direction, 3.3mm in horizontal direction, and the maximum sampling error is about 5.0mm. The average volume of the sampled tissue is about 0.35mm3. CONCLUSION We designed a MABC robot and proposed a control framework which enables planar and 3D spatial locomotion and biopsy sampling. SIGNIFICANCE The untethered MABC robot can be remotely controlled to achieve accurate sampling in multiple directions without internal power sources, paving the way towards precision sampling techniques for GI diseases in clinical procedures.
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12
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Automated Bowel Polyp Detection Based on Actively Controlled Capsule Endoscopy: Feasibility Study. Diagnostics (Basel) 2021; 11:diagnostics11101878. [PMID: 34679575 PMCID: PMC8535114 DOI: 10.3390/diagnostics11101878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 01/10/2023] Open
Abstract
This paper presents an active locomotion capsule endoscope system with 5D position sensing and real-time automated polyp detection for small-bowel and colon applications. An electromagnetic actuation system (EMA) consisting of stationary electromagnets is utilized to remotely control a magnetic capsule endoscope with multi-degree-of-freedom locomotion. For position sensing, an electronic system using a magnetic sensor array is built to track the position and orientation of the magnetic capsule during movement. The system is integrated with a deep learning model, named YOLOv3, which can automatically identify colorectal polyps in real-time with an average precision of 85%. The feasibility of the proposed method concerning active locomotion and localization is validated and demonstrated through in vitro experiments in a phantom duodenum. This study provides a high-potential solution for automatic diagnostics of the bowel and colon using an active locomotion capsule endoscope, which can be applied for a clinical site in the future.
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13
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Smart pills for gastrointestinal diagnostics and therapy. Adv Drug Deliv Rev 2021; 177:113931. [PMID: 34416311 DOI: 10.1016/j.addr.2021.113931] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 12/13/2022]
Abstract
Ingestible smart pills have the potential to be a powerful clinical tool in the diagnosis and treatment of gastrointestinal disease. Though examples of this technology, such as capsule endoscopy, have been successfully translated from the lab into clinically used products, there are still numerous challenges that need to be overcome. This review gives an overview of the research being done in the area of ingestible smart pills and reports on the technical challenges in this field.
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Zhang F, Ye D, Song S. Design of a Legged and Clamper-Based Capsule Robot With Active Locomotion Function. J Med Device 2021. [DOI: 10.1115/1.4049311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
This paper presents a legged and clamper-based capsule robot (CR) with active locomotion function. The CR utilizes the extension and contraction of the anchoring legs to expand the collapsed intestinal wall, crawl in the intestinal tract, and stand in large spaces such as the stomach and large intestine organs. The mechanical structure design, kinematic analysis, principle of locomotion, and force analysis of the CR are presented. The design concept and locomotion principles of the proposed CR are verified by a prototype with the diameter of 13 mm and length of 39 mm. Three experiments were conducted to test the locomotion performance of the proposed CR. In the experiments, the prototype successfully expands the collapsed phantom intestine, stands on the plane, and moves forward in transparent tube at a promising speed. Experimental results indicate that the CR has good locomotion capabilities.
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Affiliation(s)
- Fan Zhang
- Mechanical Engineering, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
| | - Dongxu Ye
- Mechanical Engineering, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
| | - Shuang Song
- Mechanical Engineering, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
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15
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Abstract
Untethered miniature robots have significant poten-tial and promise in diverse minimally invasive medical applications inside the human body. For drug delivery and physical contra-ception applications inside tubular structures, it is desirable to have a miniature anchoring robot with self-locking mechanism at a target tubular region. Moreover, the behavior of this robot should be tracked and feedback-controlled by a medical imaging-based system. While such a system is unavailable, we report a reversible untethered anchoring robot design based on remote magnetic actuation. The current robot prototype's dimension is 7.5 mm in diameter, 17.8 mm in length, and made of soft polyurethane elastomer, photopolymer, and two tiny permanent magnets. Its relaxation and anchoring states can be maintained in a stable manner without supplying any control and actuation input. To control the robot's locomotion, we implement a two-dimensional (2D) ultrasound imaging-based tracking and control system, which automatically sweeps locally and updates the robot's position. With such a system, we demonstrate that the robot can be controlled to follow a pre-defined 1D path with the maximal position error of 0.53 ± 0.05 mm inside a tubular phantom, where the reversible anchoring could be achieved under the monitoring of ultrasound imaging.
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Affiliation(s)
- Tianlu Wang
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
| | - Wenqi Hu
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
| | - Ziyu Ren
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
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16
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Abstract
Current conventional endoscopes have restricted the accuracy of treatment delivery and monitoring. Over the past decade, there have been major developments in nanotechnology and light triggered therapy, potentially allowing a better detection of challenging lesions and targeted treatment of malignancies in the gastrointestinal tract. Theranostics is a developing form of personalized medicine because it combines diagnosis and targeted treatment delivered in one step using advances in nanotechnology. This review describes the light-triggered therapies (including photodynamic, photothermal, and photoimmunotherapies), nanotechnological advances with nanopowder, nanostent, nanogels, and nanoparticles, enhancements brought to endoscopic ultrasound, in addition to experimental endoscopic techniques, combining both enhanced diagnoses and therapies, including a developed prototype of a “smart” multifunctional endoscope for localized colorectal cancer, near-infrared laser endoscope targeting the gastrointestinal stromal tumors, the concept of endocapsule for obscure gastrointestinal bleed, and a proof-of-concept therapeutic capsule using ultrasound-mediated targeted drug delivery. Hence, the following term has been proposed encompassing these technologies: “Theranostic gastrointestinal endoscopy.” Future efforts for integration of these technologies into clinical practice would be directed toward translational and clinical trials translating into a more personalized and interdisciplinary diagnosis and treatment, shorter procedural time, higher precision, higher cost-effectiveness, and less need for repetitive procedures.
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17
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A Robotic Biopsy Endoscope with Magnetic 5-DOF Locomotion and a Retractable Biopsy Punch. MICROMACHINES 2020; 11:mi11010098. [PMID: 31963402 PMCID: PMC7020148 DOI: 10.3390/mi11010098] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 12/20/2022]
Abstract
Capsule endoscopes (CEs) have emerged as an advanced diagnostic technology for gastrointestinal diseases in recent decades. However, with regard to robotic motions, they require active movability and multi-functionalities for extensive, untethered, and precise clinical utilization. Herein, we present a novel wireless biopsy CE employing active five degree-of-freedom locomotion and a biopsy needle punching mechanism for the histological analysis of the intestinal tract. A medical biopsy punch is attached to a screw mechanism, which can be magnetically actuated to extrude and retract the biopsy tool, for tissue extraction. The external magnetic field from an electromagnetic actuation (EMA) system is utilized to actuate the screw mechanism and harvest biopsy tissue; therefore, the proposed system consumes no onboard energy of the CE. This design enables observation of the biopsy process through the capsule's camera. A prototype with a diameter of 12 mm and length of 30 mm was fabricated with a medical biopsy punch having a diameter of 1.5 mm. Its performance was verified through numerical analysis, as well as in-vitro and ex-vivo experiments on porcine intestine. The CE could be moved to target lesions and obtain sufficient tissue samples for histological examination. The proposed biopsy CE mechanism utilizing punch biopsy and its wireless extraction-retraction technique can advance untethered intestinal endoscopic capsule technology at clinical sites.
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18
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Affiliation(s)
- Jihong Min
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
| | - Yiran Yang
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
| | - Zhiguang Wu
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
| | - Wei Gao
- Andrew and Peggy Cherng Department of Medical EngineeringDivision of Engineering and Applied ScienceCalifornia Institute of Technology Pasadena CA 91125 USA
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19
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Son D, Gilbert H, Sitti M. Magnetically Actuated Soft Capsule Endoscope for Fine-Needle Biopsy. Soft Robot 2019; 7:10-21. [PMID: 31418640 DOI: 10.1089/soro.2018.0171] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Wireless capsule endoscopes have revolutionized diagnostic procedures in the gastrointestinal (GI) tract by minimizing discomfort and trauma. Biopsy procedures, which are often necessary for a confirmed diagnosis of an illness, have been incorporated recently into robotic capsule endoscopes to improve their diagnostic functionality beyond only imaging. However, capsule robots to date have only been able to acquire biopsy samples of superficial tissues of the GI tract, which could generate false-negative diagnostic results if the diseased tissue is under the surface of the GI tract. To improve their diagnostic accuracy for submucosal tumors/diseases, we propose a magnetically actuated soft robotic capsule robot, which takes biopsy samples in a deep tissue of a stomach using the fine-needle biopsy technique. We present the design, control, and human-machine interfacing methods for the fine-needle biopsy capsule robot. Ex vivo experiments in a porcine stomach show 85% yield for the biopsy of phantom tumors located underneath the first layers of the stomach wall.
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Affiliation(s)
- Donghoon Son
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, Stuttgart, Germany
| | - Hunter Gilbert
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, Stuttgart, Germany.,Department of Mechanical and Industrial Engineering, Louisiana State University, Baton Rouge, Louisiana
| | - Metin Sitti
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, Stuttgart, Germany.,School of Medicine and School of Engineering, Koc University, Istanbul, Turkey
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20
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McGoran JJ, McAlindon ME, Iyer PG, Seibel EJ, Haidry R, Lovat LB, Sami SS. Miniature gastrointestinal endoscopy: Now and the future. World J Gastroenterol 2019; 25:4051-4060. [PMID: 31435163 PMCID: PMC6700702 DOI: 10.3748/wjg.v25.i30.4051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/22/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
Since its original application, gastrointestinal (GI) endoscopy has undergone many innovative transformations aimed at expanding the scope, safety, accuracy, acceptability and cost-effectiveness of this area of clinical practice. One method of achieving this has been to reduce the caliber of endoscopic devices. We propose the collective term “Miniature GI Endoscopy”. In this Opinion Review, the innovations in this field are explored and discussed. The progress and clinical use of the three main areas of miniature GI endoscopy (ultrathin endoscopy, wireless endoscopy and scanning fiber endoscopy) are described. The opportunities presented by these technologies are set out in a clinical context, as are their current limitations. Many of the positive aspects of miniature endoscopy are clear, in that smaller devices provide access to potentially all of the alimentary canal, while conferring high patient acceptability. This must be balanced with the costs of new technologies and recognition of device specific challenges. Perspectives on future application are also considered and the efforts being made to bring new innovations to a clinical platform are outlined. Current devices demonstrate that miniature GI endoscopy has a valuable place in investigation of symptoms, therapeutic intervention and screening. Newer technologies give promise that the potential for enhancing the investigation and management of GI complaints is significant.
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Affiliation(s)
- John J McGoran
- Digestive Diseases Centre, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Mark E McAlindon
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom
| | - Prasad G Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN 55905, United States
| | - Eric J Seibel
- Department of Mechanical Engineering, University of Washington, 4000 Mason St, Seattle, WA 98195, United States
| | - Rehan Haidry
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
| | - Laurence B Lovat
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
| | - Sarmed S Sami
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
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21
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Hoang MC, Le VH, Kim J, Choi E, Kang B, Park JO, Kim CS. A wireless tattooing capsule endoscope using external electromagnetic actuation and chemical reaction pressure. PLoS One 2019; 14:e0219740. [PMID: 31310612 PMCID: PMC6634410 DOI: 10.1371/journal.pone.0219740] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 07/02/2019] [Indexed: 01/08/2023] Open
Abstract
In this paper, we present a tattooing capsule endoscope (TCE) that can localize an intestinal lesion or tumor for a preoperative laparoscopic surgery. The TCE is based on a wireless capsule endoscope (WCE) structure and can be actively controlled by an external electromagnetic actuation system to move, observe, and mark the target lesion in the gastrointestinal (GI) tract. The TCE is designed to perform capsule locomotion, needle extrusion and intrusion motions, and ink injection. First, the TCE is controlled to move to the target lesion during GI tract diagnosis via a capsule endoscopic camera. Further, a tattooing needle is extruded by an electromagnetically controlled mechanism to puncture the tissue. Finally, the tattooing ink is injected by the chemically reacted carbon dioxide gas pressure that is triggered by a shape memory alloy wire and a reed switch. The reed switch is also activated by the external magnetic field flux density. The suggested methods were verified by the ex-vivo experiments. The TCE prototype was able to move to the target lesion and inject the ink beneath the mucosa layer safely, thereby leaving a visible tattooed mark for surgical lesion identification. The proposed TCE method can accelerate the development of functionalities as well as tattooing procedures of the WCE in the GI tract.
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Affiliation(s)
- Manh Cuong Hoang
- School of Mechanical Engineering, Chonnam National University, Gwangju, South Korea
| | - Viet Ha Le
- School of Mechanical Engineering, Chonnam National University, Gwangju, South Korea
| | - Jayoung Kim
- Medical Microrobot Center, Chonnam National University, Gwangju, South Korea
| | - Eunpyo Choi
- School of Mechanical Engineering, Chonnam National University, Gwangju, South Korea
| | - Byungjeon Kang
- Medical Microrobot Center, Chonnam National University, Gwangju, South Korea
| | - Jong-Oh Park
- School of Mechanical Engineering, Chonnam National University, Gwangju, South Korea
| | - Chang-Sei Kim
- School of Mechanical Engineering, Chonnam National University, Gwangju, South Korea
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22
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Matsui T, Murata S, Honda T. Fabrication of Magnetically Driven Biopsy Mechanism Applicable to Capsule-Type Medical Device. JOURNAL OF ROBOTICS AND MECHATRONICS 2018. [DOI: 10.20965/jrm.2018.p0292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This article proposes two kinds of magnetic rotary actuators applicable to a next-generation capsule endoscope that can conduct a small intestinal biopsy. One actuator is for an anchoring mechanism that can stop the capsule in a specific place against the peristaltic movement of the small intestine, and press a biopsy instrument on a lesion. The other actuator is for a biopsy mechanism that can project a circular blade while rotating, and obtain a tissue sample. Both actuators have the same basic structure, which is composed of a bolt with a permanent magnet and a nut, and can be driven by a rotating magnetic field. Because they are arranged orthogonally to each other in the capsule, they can be individually operated by the corresponding rotating magnetic field. Given the results of an operational test similar to an actual environment in a porcine small intestine, these actuators could successfully perform the desired operation.
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23
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Otuya DO, Verma Y, Farrokhi H, Higgins L, Rosenberg M, Damman C, Tearney GJ. Non-endoscopic biopsy techniques: a review. Expert Rev Gastroenterol Hepatol 2018; 12:109-117. [PMID: 29241376 DOI: 10.1080/17474124.2018.1412828] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Diseases of the stomach and small intestine account for approximately 20% of all gastrointestinal (GI)-related mortality. Biopsy of the stomach and small intestine remains a key diagnostic tool for most of the major diseases that affect the GI tract. While endoscopic means for obtaining biopsy is generally the standard of care, it has several limitations that make it less ideal for pediatric patients and in low resource areas of the world. Therefore, non-endoscopic means for obtaining biopsy samples is of interest in these settings. Areas covered: We review non-endoscopic biopsy techniques reported thus far, and critically examine their merits and demerits regarding their suitability for obtaining biopsy samples in non-sedated subjects. Expert commentary: Esophagogastroduodenoscopy (EGD) is the current standard for acquiring biopsy from the GI tract, however, its limitations include subject sedation, expensive endoscopy infrastructure, expert personnel, and a small but significant risk of complications. A less costly, minimally-invasive and non-endoscopic means for obtaining biopsy samples is therefore of interest for addressing these issues. Such a technology would be of significant impact in low- and middle-income countries where conducting endoscopy is challenging.
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Affiliation(s)
- David O Otuya
- a Harvard Medical School and the Wellman Center for Photomedicine , Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Yogesh Verma
- a Harvard Medical School and the Wellman Center for Photomedicine , Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Hamid Farrokhi
- a Harvard Medical School and the Wellman Center for Photomedicine , Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Lisa Higgins
- a Harvard Medical School and the Wellman Center for Photomedicine , Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Mireille Rosenberg
- a Harvard Medical School and the Wellman Center for Photomedicine , Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Christopher Damman
- c Gut Health Initiative, Enteric and Diarrheal Diseases, Global Health , Bill and Melinda Gates Foundation , Seattle , WA , USA
| | - Guillermo J Tearney
- a Harvard Medical School and the Wellman Center for Photomedicine , Massachusetts General Hospital , Boston , Massachusetts , USA.,b Department of Pathology , Massachusetts General Hospital , Boston , Massachusetts , USA
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24
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Stewart FR, Qiu Y, Lay HS, Newton IP, Cox BF, Al-Rawhani MA, Beeley J, Liu Y, Huang Z, Cumming DRS, Näthke I, Cochran S. Acoustic Sensing and Ultrasonic Drug Delivery in Multimodal Theranostic Capsule Endoscopy. SENSORS 2017; 17:s17071553. [PMID: 28671642 PMCID: PMC5539857 DOI: 10.3390/s17071553] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 12/22/2022]
Abstract
Video capsule endoscopy (VCE) is now a clinically accepted diagnostic modality in which miniaturized technology, an on-board power supply and wireless telemetry stand as technological foundations for other capsule endoscopy (CE) devices. However, VCE does not provide therapeutic functionality, and research towards therapeutic CE (TCE) has been limited. In this paper, a route towards viable TCE is proposed, based on multiple CE devices including important acoustic sensing and drug delivery components. In this approach, an initial multimodal diagnostic device with high-frequency quantitative microultrasound that complements video imaging allows surface and subsurface visualization and computer-assisted diagnosis. Using focused ultrasound (US) to mark sites of pathology with exogenous fluorescent agents permits follow-up with another device to provide therapy. This is based on an US-mediated targeted drug delivery system with fluorescence imaging guidance. An additional device may then be utilized for treatment verification and monitoring, exploiting the minimally invasive nature of CE. While such a theranostic patient pathway for gastrointestinal treatment is presently incomplete, the description in this paper of previous research and work under way to realize further components for the proposed pathway suggests it is feasible and provides a framework around which to structure further work.
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Affiliation(s)
- Fraser R Stewart
- School of Life Sciences, University of Dundee, Dundee DD1 5EH, Scotland, UK.
| | - Yongqiang Qiu
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
| | - Holly S Lay
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
| | - Ian P Newton
- School of Life Sciences, University of Dundee, Dundee DD1 5EH, Scotland, UK.
| | - Benjamin F Cox
- School of Medicine, University of Dundee, Dundee DD1 9SY, Scotland, UK.
| | | | - James Beeley
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
| | - Yangminghao Liu
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK.
| | - Zhihong Huang
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK.
| | - David R S Cumming
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
| | - Inke Näthke
- School of Life Sciences, University of Dundee, Dundee DD1 5EH, Scotland, UK.
| | - Sandy Cochran
- School of Engineering, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.
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25
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Shamsudhin N, Zverev VI, Keller H, Pane S, Egolf PW, Nelson BJ, Tishin AM. Magnetically guided capsule endoscopy. Med Phys 2017; 44:e91-e111. [PMID: 28437000 DOI: 10.1002/mp.12299] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/22/2017] [Accepted: 04/13/2017] [Indexed: 12/18/2022] Open
Abstract
Wireless capsule endoscopy (WCE) is a powerful tool for medical screening and diagnosis, where a small capsule is swallowed and moved by means of natural peristalsis and gravity through the human gastrointestinal (GI) tract. The camera-integrated capsule allows for visualization of the small intestine, a region which was previously inaccessible to classical flexible endoscopy. As a diagnostic tool, it allows to localize the sources of bleedings in the middle part of the gastrointestinal tract and to identify diseases, such as inflammatory bowel disease (Crohn's disease), polyposis syndrome, and tumors. The screening and diagnostic efficacy of the WCE, especially in the stomach region, is hampered by a variety of technical challenges like the lack of active capsular position and orientation control. Therapeutic functionality is absent in most commercial capsules, due to constraints in capsular volume and energy storage. The possibility of using body-exogenous magnetic fields to guide, orient, power, and operate the capsule and its mechanisms has led to increasing research in Magnetically Guided Capsule Endoscopy (MGCE). This work shortly reviews the history and state-of-art in WCE technology. It highlights the magnetic technologies for advancing diagnostic and therapeutic functionalities of WCE. Not restricting itself to the GI tract, the review further investigates the technological developments in magnetically guided microrobots that can navigate through the various air- and fluid-filled lumina and cavities in the body for minimally invasive medicine.
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Affiliation(s)
- Naveen Shamsudhin
- Multi-Scale Robotics Lab, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, CH 8092, Switzerland
| | - Vladimir I Zverev
- Faculty of Physics, M.V. Lomonosov Moscow State University, Moscow, 119991, Russia
| | - Henrik Keller
- KUKA Roboter GmbH, Zugspitzstrasse 140, Augsburg, 86165, Germany
| | - Salvador Pane
- Multi-Scale Robotics Lab, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, CH 8092, Switzerland
| | - Peter W Egolf
- Institute of Thermal Sciences and Engineering, University of Applied Sciences of Western Switzerland, Yverdon-les-Bains, CH 1401, Switzerland
| | - Bradley J Nelson
- Multi-Scale Robotics Lab, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, CH 8092, Switzerland
| | - Alexander M Tishin
- Faculty of Physics, M.V. Lomonosov Moscow State University, Moscow, 119991, Russia.,Pharmag LLC, Promyshlennaya st 4, Troitsk, Moscow, 142190, Russia
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26
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Ciuti G, Caliò R, Camboni D, Neri L, Bianchi F, Arezzo A, Koulaouzidis A, Schostek S, Stoyanov D, Oddo CM, Magnani B, Menciassi A, Morino M, Schurr MO, Dario P. Frontiers of robotic endoscopic capsules: a review. JOURNAL OF MICRO-BIO ROBOTICS 2016; 11:1-18. [PMID: 29082124 PMCID: PMC5646258 DOI: 10.1007/s12213-016-0087-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 12/15/2022]
Abstract
Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd., is an example of disruptive technology and represents an attractive alternative to traditional diagnostic techniques. WCE overcomes conventional endoscopy enabling inspection of the digestive system without discomfort or the need for sedation. Thus, it has the advantage of encouraging patients to undergo gastrointestinal (GI) tract examinations and of facilitating mass screening programmes. With the integration of further capabilities based on microrobotics, e.g. active locomotion and embedded therapeutic modules, WCE could become the key-technology for GI diagnosis and treatment. This review presents a research update on WCE and describes the state-of-the-art of current endoscopic devices with a focus on research-oriented robotic capsule endoscopes enabled by microsystem technologies. The article also presents a visionary perspective on WCE potential for screening, diagnostic and therapeutic endoscopic procedures.
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Affiliation(s)
- Gastone Ciuti
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - R Caliò
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - D Camboni
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - L Neri
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy.,Ekymed S.r.l., Livorno, Italy
| | - F Bianchi
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - A Arezzo
- Department of Surgical Disciplines, University of Torino, Torino, Italy
| | - A Koulaouzidis
- Endoscopy Unit, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | | | - D Stoyanov
- Centre for Medical Image Computing and the Department of Computer Science, University College London, London, UK
| | - C M Oddo
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | | | - A Menciassi
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
| | - M Morino
- Department of Surgical Disciplines, University of Torino, Torino, Italy
| | - M O Schurr
- Ovesco Endoscopy AG, Tübingen, Germany.,Steinbeis University Berlin, Berlin, Germany
| | - P Dario
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa 56025 Italy
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27
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Do TN, Seah TET, Yu HK, Phee SJ. Development and Testing of a Magnetically Actuated Capsule Endoscopy for Obesity Treatment. PLoS One 2016; 11:e0148035. [PMID: 26815309 PMCID: PMC4729466 DOI: 10.1371/journal.pone.0148035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/12/2016] [Indexed: 02/01/2023] Open
Abstract
Intra-gastric balloons (IGB) have become an efficient and less invasive method for obesity treatment. The use of traditional IGBs require complex insertion tools and flexible endoscopes to place and remove the balloon inside the patient’s stomach, which may cause discomfort and complications to the patient. This paper introduces a new ingestible weight-loss capsule with a magnetically remote-controlled inflatable and deflatable balloon. To inflate the balloon, biocompatible effervescent chemicals are used. As the source of the actuation is provided via external magnetic fields, the magnetic capsule size can be significantly reduced compared to current weight-loss capsules in the literature. In addition, there are no limitations on the power supply. To lose weight, the obese subject needs only to swallow the magnetic capsule with a glass of water. Once the magnetic capsule has reached the patient’s stomach, the balloon will be wirelessly inflated to occupy gastric space and give the feeling of satiety. The balloon can be wirelessly deflated at any time to allow the magnetic capsule to travel down the intestine and exit the body via normal peristalsis. The optimal ratio between the acid and base to provide the desired gas volume is experimentally evaluated and presented. A prototype capsule (9.6mm x 27mm) is developed and experimentally validated in ex-vivo experiments. The unique ease of delivery and expulsion of the proposed magnetic capsule is slated to make this development a good treatment option for people seeking to lose excess weight.
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Affiliation(s)
- Thanh Nho Do
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
- * E-mail:
| | - Tian En Timothy Seah
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Ho Khek Yu
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University of Health System, Singapore, 119260, Singapore
| | - Soo Jay Phee
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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28
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Le VH, Hernando LR, Lee C, Choi H, Jin Z, Nguyen KT, Go G, Ko SY, Park JO, Park S. Shape memory alloy-based biopsy device for active locomotive intestinal capsule endoscope. Proc Inst Mech Eng H 2016; 229:255-63. [PMID: 25834001 DOI: 10.1177/0954411915576946] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Recently, capsule endoscopes have been used for diagnosis in digestive organs. However, because a capsule endoscope does not have a locomotive function, its use has been limited to small tubular digestive organs, such as small intestine and esophagus. To address this problem, researchers have begun studying an active locomotive intestine capsule endoscope as a medical instrument for the whole gastrointestinal tract. We have developed a capsule endoscope with a small permanent magnet that is actuated by an electromagnetic actuation system, allowing active and flexible movement in the patient's gut environment. In addition, researchers have noted the need for a biopsy function in capsule endoscope for the definitive diagnosis of digestive diseases. Therefore, this paper proposes a novel robotic biopsy device for active locomotive intestine capsule endoscope. The proposed biopsy device has a sharp blade connected with a shape memory alloy actuator. The biopsy device measuring 12 mm in diameter and 3 mm in length was integrated into our capsule endoscope prototype, where the device's sharp blade was activated and exposed by the shape memory alloy actuator. Then the electromagnetic actuation system generated a specific motion of the capsule endoscope to extract the tissue sample from the intestines. The final biopsy sample tissue had a volume of about 6 mm(3), which is a sufficient amount for a histological analysis. Consequently, we proposed the working principle of the biopsy device and conducted an in-vitro biopsy test to verify the feasibility of the biopsy device integrated into the capsule endoscope prototype using the electro-magnetic actuation system.
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Affiliation(s)
- Viet Ha Le
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | | | - Cheong Lee
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Hyunchul Choi
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Zhen Jin
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Kim Tien Nguyen
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Gwangjun Go
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Seong-Young Ko
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Jong-Oh Park
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
| | - Sukho Park
- School of Mechanical Engineering, Chonnam National University, Gwangju, Korea
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Koprowski R. Overview of technical solutions and assessment of clinical usefulness of capsule endoscopy. Biomed Eng Online 2015; 14:111. [PMID: 26626725 PMCID: PMC4665909 DOI: 10.1186/s12938-015-0108-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 11/23/2015] [Indexed: 12/17/2022] Open
Abstract
The paper presents an overview of endoscopic capsules with particular emphasis on technical aspects. It indicates common problems in capsule endoscopy such as: (1) limited wireless communication (2) the use of capsule endoscopy in the case of partial patency of the gastrointestinal tract, (3) limited imaging area, (4) external capsule control limitations. It also presents the prospects of capsule endoscopy, the most recent technical solutions for biopsy and the mobility of the capsule in the gastrointestinal tract. The paper shows the possibilities of increasing clinical usefulness of capsule endoscopy resulting from technological limitations. Attention has also been paid to the current role of capsule endoscopy in screening tests and the limitations of its effectiveness. The paper includes the author's recommendations concerning the direction of further research and the possibility of enhancing the scope of capsule endoscopy.
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Affiliation(s)
- Robert Koprowski
- Department of Biomedical Computer Systems, Faculty of Computer Science and Materials Science, Institute of Computer Science, University of Silesia, ul. Będzińska 39, 41-200, Sosnowiec, Poland.
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Slawinski PR, Obstein KL, Valdastri P. Capsule endoscopy of the future: What's on the horizon? World J Gastroenterol 2015; 21:10528-41. [PMID: 26457013 PMCID: PMC4588075 DOI: 10.3748/wjg.v21.i37.10528] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/22/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopes have evolved from passively moving diagnostic devices to actively moving systems with potential therapeutic capability. In this review, we will discuss the state of the art, define the current shortcomings of capsule endoscopy, and address research areas that aim to overcome said shortcomings. Developments in capsule mobility schemes are emphasized in this text, with magnetic actuation being the most promising endeavor. Research groups are working to integrate sensor data and fuse it with robotic control to outperform today's standard invasive procedures, but in a less intrusive manner. With recent advances in areas such as mobility, drug delivery, and therapeutics, we foresee a translation of interventional capsule technology from the bench-top to the clinical setting within the next 10 years.
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Koulaouzidis A, Iakovidis DK, Karargyris A, Rondonotti E. Wireless endoscopy in 2020: Will it still be a capsule? World J Gastroenterol 2015; 21:5119-5130. [PMID: 25954085 PMCID: PMC4419052 DOI: 10.3748/wjg.v21.i17.5119] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 01/26/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023] Open
Abstract
Currently, the major problem of all existing commercial capsule devices is the lack of control of movement. In the future, with an interface application, the clinician will be able to stop and direct the device into points of interest for detailed inspection/diagnosis, and therapy delivery. This editorial presents current commercially-available new designs, European projects and delivery capsule and gives an overview of the progress required and progress that will be achieved -according to the opinion of the authors- in the next 5 year leading to 2020.
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Than TD, Alici G, Harvey S, Zhou H, Li W. Concept and simulation study of a novel localization method for robotic endoscopic capsules using multiple positron emission markers. Med Phys 2015; 41:072501. [PMID: 24989404 DOI: 10.1118/1.4881316] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Over the last decade, wireless capsule endoscope has been the tool of choice for noninvasive inspection of the gastrointestinal tract, especially in the small intestine. However, the latest clinical products have not been equipped with a sufficiently accurate localization system which makes it difficult to determine the location of intestinal abnormalities, and to apply follow-up interventions such as biopsy or drug delivery. In this paper, the authors present a novel localization method based on tracking three positron emission markers embedded inside an endoscopic capsule. METHODS Three spherical(22)Na markers with diameters of less than 1 mm are embedded in the cover of the capsule. Gamma ray detectors are arranged around a patient body to detect coincidence gamma rays emitted from the three markers. The position of each marker can then be estimated using the collected data by the authors' tracking algorithm which consists of four consecutive steps: a method to remove corrupted data, an initialization method, a clustering method based on the Fuzzy C-means clustering algorithm, and a failure prediction method. RESULTS The tracking algorithm has been implemented inMATLAB utilizing simulation data generated from the Geant4 Application for Emission Tomography toolkit. The results show that this localization method can achieve real-time tracking with an average position error of less than 0.4 mm and an average orientation error of less than 2°. CONCLUSIONS The authors conclude that this study has proven the feasibility and potential of the proposed technique in effectively determining the position and orientation of a robotic endoscopic capsule.
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Affiliation(s)
- Trung Duc Than
- School of Mechanical, Materials and Mechatronic Engineering, University of Wollongong, New South Wales 2522, Australia
| | - Gursel Alici
- School of Mechanical, Materials and Mechatronic Engineering, University of Wollongong, New South Wales 2522, Australia
| | - Steven Harvey
- Department of Nuclear Medicine, Wollongong Hospital, New South Wales 2500, Australia
| | - Hao Zhou
- School of Mechanical, Materials and Mechatronic Engineering, University of Wollongong, New South Wales 2522, Australia
| | - Weihua Li
- School of Mechanical, Materials and Mechatronic Engineering, University of Wollongong, New South Wales 2522, Australia
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Koulaouzidis A, Iakovidis DK, Karargyris A, Plevris JN. Optimizing lesion detection in small-bowel capsule endoscopy: from present problems to future solutions. Expert Rev Gastroenterol Hepatol 2015; 9:217-35. [PMID: 25169106 DOI: 10.1586/17474124.2014.952281] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This review presents issues pertaining to lesion detection in small-bowel capsule endoscopy (SBCE). The use of prokinetics, chromoendoscopy, diagnostic yield indicators, localization issues and the use of 3D reconstruction are presented. The authors also review the current status (and future expectations) in automatic lesion detection software development. Automatic lesion detection and reporting, and development of an accurate lesion localization system are the main software challenges of our time. The 'smart', selective and judicious use (before as well as during SBCE) of prokinetics in combination with other modalities (such as real time and/or purge) improves the completion rate of SBCE. The tracking of the capsule within the body is important for the localization of abnormal findings and planning of further therapeutic interventions. Currently, localization is based on transit time. Recently proposed software and hardware solutions are proposed herein. Moreover, the feasibility of software-based 3D representation (attempt for 3D reconstruction) is examined.
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Slawinski PR, Obstein KL, Valdastri P. Emerging Issues and Future Developments in Capsule Endoscopy. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2015; 17:40-46. [PMID: 26028956 PMCID: PMC4445887 DOI: 10.1016/j.tgie.2015.02.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Capsule endoscopy (CE) has transformed from a research venture into a widely used clinical tool and the primary means for diagnosing small bowel pathology. These orally administered capsules traverse passively through the gastrointestinal tract via peristalsis and are used in the esophagus, stomach, small bowel, and colon. The primary focus of CE research in recent years has been enabling active CE manipulation and extension of the technology to therapeutic functionality; thus, widening the scope of the procedure. This review outlines clinical standards of the technology as well as recent advances in CE research. Clinical capsule applications are discussed with respect to each portion of the gastrointestinal tract. Promising research efforts are presented with an emphasis on enabling active capsule locomotion. The presented studies suggest, in particular, that the most viable solution for active capsule manipulation is actuation of a capsule via exterior permanent magnet held by a robot. Developing capsule procedures adhering to current healthcare standards, such as enabling a tool channel or irrigation in a therapeutic device, is a vital phase in the adaptation of CE in the clinical setting.
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Affiliation(s)
- Piotr R. Slawinski
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235-1592, USA
| | - Keith L. Obstein
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235-1592, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37235-1592, USA
| | - Pietro Valdastri
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235-1592, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37235-1592, USA
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Trung Duc Than, Alici G, Harvey S, O'Keefe G, Hao Zhou, Weihua Li, Cook T, Alam-Fotias S. An Effective Localization Method for Robotic Endoscopic Capsules Using Multiple Positron Emission Markers. IEEE T ROBOT 2014. [DOI: 10.1109/tro.2014.2333111] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sliker LJ, Ciuti G. Flexible and capsule endoscopy for screening, diagnosis and treatment. Expert Rev Med Devices 2014; 11:649-66. [PMID: 25148269 DOI: 10.1586/17434440.2014.941809] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Endoscopy dates back to the 1860s, but many of the most significant advancements have been made within the past decade. With the integration of robotics, the ability to precisely steer and advance traditional flexible endoscopes has been realized, reducing patient pain and improving clinician ergonomics. Additionally, wireless capsule endoscopy, a revolutionary alternative to traditional scopes, enables inspection of the digestive system with minimal discomfort for the patient or the need for sedation, mitigating some of the risks of flexible endoscopy. This review presents a research update on robotic endoscopic systems, including both flexible scope and capsule technologies, detailing actuation methods and therapeutic capabilities. A future perspective on endoscopic potential for screening, diagnostic and therapeutic gastrointestinal procedures is also presented.
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Affiliation(s)
- Levin J Sliker
- Department of Mechanical Engineering, University of Colorado, 114 ECME, Engineering Center, 1111 Engineering Drive, Boulder, CO 80309-0427, USA
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Munoz F, Alici G, Li W, Tan Z, Xiong K, Li Y, Ye Y, Luo ZP, He F, Gong Y. A review of drug delivery systems for capsule endoscopy. Adv Drug Deliv Rev 2014; 71:77-85. [PMID: 24384373 DOI: 10.1016/j.addr.2013.12.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 12/10/2013] [Accepted: 12/19/2013] [Indexed: 12/12/2022]
Abstract
The development of a highly controllable drug delivery system (DDS) for capsule endoscopy has become an important field of research due to its promising applications in therapeutic treatment of diseases in the gastrointestinal (GI) tract and drug absorption studies. Several factors need to be considered to establish the minimum requirements for a functional DDS. Environmental factors of the GI tract and also pharmaceutical factors can help determine the requirements to be met by a DDS in an endoscopic capsule. In order to minimize the influence of such factors on the performance of an effective DDS, at least two mechanisms should be incorporated into a capsule endoscope: an anchoring mechanism to control the capsule position and a drug release mechanism to control variables such as the drug release rate, number of doses and amount of drug released. The implementation of such remotely actuated mechanisms is challenging due to several constraints, including the limited space available in a swallowable capsule endoscope and the delicate and complex environment within the GI tract. This paper presents a comprehensive overview of existing DDS. A comparison of such DDS for capsule endoscopy based on the minimum DDS requirements is presented and future work is also discussed.
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Affiliation(s)
| | | | | | - Zifang Tan
- School of Engineering, Sun Yat-sen University, Guangzhou 510006, China
| | - Ke Xiong
- Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yan Li
- School of Engineering, Sun Yat-sen University, Guangzhou 510006, China; Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instruments, Sun Yat-sen University, Guangzhou 510006, China
| | - Yun Ye
- School of Engineering, Sun Yat-sen University, Guangzhou 510006, China; Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instruments, Sun Yat-sen University, Guangzhou 510006, China
| | - Zong-Ping Luo
- Orthopaedic Institute, Soochow University, Suzhou 215006, China; Department of Orthopaedics, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Fan He
- School of Engineering, Sun Yat-sen University, Guangzhou 510006, China; Orthopaedic Institute, Soochow University, Suzhou 215006, China; Department of Orthopaedics, First Affiliated Hospital of Soochow University, Suzhou 215006, China.
| | - Yihong Gong
- School of Engineering, Sun Yat-sen University, Guangzhou 510006, China; Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instruments, Sun Yat-sen University, Guangzhou 510006, China.
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Yim S, Gultepe E, Gracias DH, Sitti M. Biopsy using a magnetic capsule endoscope carrying, releasing, and retrieving untethered microgrippers. IEEE Trans Biomed Eng 2014; 61:513-21. [PMID: 24108454 PMCID: PMC4023810 DOI: 10.1109/tbme.2013.2283369] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This paper proposes a new wireless biopsy method where a magnetically actuated untethered soft capsule endoscope carries and releases a large number of thermo-sensitive, untethered microgrippers (μ-grippers) at a desired location inside the stomach and retrieves them after they self-fold and grab tissue samples. We describe the working principles and analytical models for the μ-gripper release and retrieval mechanisms, and evaluate the proposed biopsy method in ex vivo experiments. This hierarchical approach combining the advanced navigation skills of centimeter-scaled untethered magnetic capsule endoscopes with highly parallel, autonomous, submillimeter scale tissue sampling μ-grippers offers a multifunctional strategy for gastrointestinal capsule biopsy.
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Affiliation(s)
- Sehyuk Yim
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213 USA
| | - Evin Gultepe
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD USA
| | - David H. Gracias
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD USA
| | - Metin Sitti
- Department of Mechanical Engineering, Robotics Institute, and Biomedical Engineering, Pittsburgh, PA 15213 USA
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Koulaouzidis A, Rondonotti E, Karargyris A. Small-bowel capsule endoscopy: a ten-point contemporary review. World J Gastroenterol 2013; 19:3726-46. [PMID: 23840112 PMCID: PMC3699039 DOI: 10.3748/wjg.v19.i24.3726] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/27/2013] [Accepted: 06/01/2013] [Indexed: 02/06/2023] Open
Abstract
The introduction of capsule endoscopy (CE) in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY), safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE) models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn's disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e., by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors) or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn's disease for assessment of inflammation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is a time-consuming procedure. Therefore, several attempts have been made to develop technical software features, in order to make CE video analysis easier and shorter (without jeopardizing its accuracy). Suspected Blood Indicator, QuickView and Fujinon Intelligent Chromo Endoscopy are some of the software tools that have been checked in various clinical studies to date.
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