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Kim SH, Kim C, Keum B, Im J, Won S, Kim BG, Kim K, Kwon T, Hong D, Jeon HJ, Choi HS, Kim ES, Jeen YT, Chun HJ, Hwang JH. A Novel Retractable Robotic Device for Colorectal Endoscopic Submucosal Dissection. Gut Liver 2024; 18:677-685. [PMID: 38712393 PMCID: PMC11249931 DOI: 10.5009/gnl230280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/26/2023] [Accepted: 01/15/2024] [Indexed: 05/08/2024] Open
Abstract
Background/Aims : Appropriate tissue tension and clear visibility of the dissection area using traction are essential for effective and safe endoscopic submucosal dissection (ESD). In this study, we developed a retractable robot-assisted traction device and evaluated its performance in colorectal ESD. Methods : An experienced endoscopist performed ESD 18 times on an ex vivo porcine colon using the robot and 18 times using the conventional method. The outcome measures were procedure time, dissection speed, procedure-related adverse events, and blind dissection rate. Results : Thirty-six colonic lesions were resected from ex vivo porcine colon samples. The total procedure time was significantly shorter in robot-assisted ESD (RESD) than in conventional ESD (CESD) (20.1±4.1 minutes vs 34.3±8.3 minutes, p<0.05). The submucosal dissection speed was significantly faster in the RESD group than in the CESD group (36.8±9.2 mm2/min vs 18.1±4.7 mm2/min, p<0.05). The blind dissection rate was also significantly lower in the RESD group (12.8%±3.4% vs 35.1%±3.9%, p<0.05). In an in vivo porcine feasibility study, the robotic device was attached to a colonoscope and successfully inserted into the proximal colon without damaging the colonic wall, and ESD was successfully performed. Conclusions : The dissection speed and safety profile improved significantly with the retractable RESD. Thus, our robotic device has the potential to provide simple, effective, and safe multidirectional traction during colonic ESD.
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Affiliation(s)
- Sang Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chanwoo Kim
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Junghyun Im
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Seonghyeon Won
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Byung Gon Kim
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Kyungnam Kim
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Taebin Kwon
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Daehie Hong
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Han Jo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
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Sivananthan A, Rubio-Solis A, Darzi A, Mylonas G, Patel N. Eye-controlled endoscopy - a benchtop trial of a novel robotic steering platform - iGAZE2. J Robot Surg 2024; 18:266. [PMID: 38916651 PMCID: PMC11199204 DOI: 10.1007/s11701-024-02022-5] [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: 05/12/2024] [Accepted: 06/16/2024] [Indexed: 06/26/2024]
Abstract
The endoscopic control system has remained similar in design for many decades The remit of advanced therapeutic endoscopy continues to expand requiring precision control and high cognitive workloads. Robotic systems are emerging, but all still require bimanual control and expensive and large new systems. Eye tracking is an exciting area that can be used as an endoscope control system. This is a study to establish the feasibility of an eye-controlled endoscope and compare its performance and cognitive demand to use of a conventional endoscope. An eye gaze-control system consisting of eye-tracking glasses, customised software and a small motor unit was built and attached to a conventional endoscope. Twelve non-endoscopists used both the eye gaze system and a conventional endoscope to complete a benchtop task in a simulated oesophagus and stomach. Completion of tasks was timed. Subjective feedback was collected from each participant on task load using the NASA Task Load Index. Participants were significantly quicker completing the task using iGAZE2 vs a conventional endoscope (65.02 ± 16.34s vs 104.21 ± 51.31s, p = 0.013) Participants were also significantly quicker completing retroflexion using iGAZE2 vs a conventional endoscope (8.48 ± 3.08 vs 11.38 ± 5.36s, p = 0.036). Participants reported a significantly lower workload (raw NASA-TLX score) when using iGAZE2 vs the conventional endoscope (152.1 ± 63.4 vs 319.6 ± 81.6, p = 0.0001) (Fig. 7). Users found iGAZE2 to have a significantly lower temporal demand, mental demand, effort, mental demand, physical demand, and frustration level. The eye gaze system is an exciting, small, and retrofittable system to any endoscope. The system shows exciting potential as a novel endoscopic control system with a significantly lower workload and better performance in novices suggesting a more intuitive control system.
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Affiliation(s)
| | - Adrian Rubio-Solis
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK
| | - Ara Darzi
- Imperial College NHS Healthcare Trust, London, W2 1NY, UK
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK
| | - George Mylonas
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK
| | - Nisha Patel
- Imperial College NHS Healthcare Trust, London, W2 1NY, UK
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Sivananthan A, Ahmed J, Kogkas A, Mylonas G, Darzi A, Patel N. Eye tracking technology in endoscopy: Looking to the future. Dig Endosc 2023; 35:314-322. [PMID: 36281784 DOI: 10.1111/den.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/23/2022] [Indexed: 02/08/2023]
Abstract
The visual patterns of an endoscopist, that is, what the endoscopist is looking at during luminal endoscopy, is an interesting area with an evolving evidence base. The tools required for gaze analysis have become cheaper and more easily accessible. A comprehensive literature search was undertaken identifying 19 relevant papers. Gaze analysis has been used to identify certain visual patterns associated with higher polyp detection rates. There have also been increasing applications of gaze analysis as an objective study tool to compare the effectiveness of endoscopic imaging technologies. Gaze analysis also has the potential to be incorporated into endoscopic training. Eye movements have been used to control and steer a robotic endoscope. This review presents the current evidence available in this novel and evolving field of endoscopic research.
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Affiliation(s)
- Arun Sivananthan
- Institute of Global Health Innovation, Imperial College London, London, UK.,Imperial College NHS Healthcare Trust, London, UK
| | - Jabed Ahmed
- Institute of Global Health Innovation, Imperial College London, London, UK.,Imperial College NHS Healthcare Trust, London, UK
| | - Alexandros Kogkas
- Institute of Global Health Innovation, Imperial College London, London, UK.,The Hamlyn Centre, Imperial College London, London, UK
| | - George Mylonas
- Institute of Global Health Innovation, Imperial College London, London, UK.,The Hamlyn Centre, Imperial College London, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK.,Imperial College NHS Healthcare Trust, London, UK
| | - Nisha Patel
- Institute of Global Health Innovation, Imperial College London, London, UK.,Imperial College NHS Healthcare Trust, London, UK
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Sivananthan A, Nazarian S, Ayaru L, Patel K, Ashrafian H, Darzi A, Patel N. Does computer-aided diagnostic endoscopy improve the detection of commonly missed polyps? A meta-analysis. Clin Endosc 2022; 55:355-364. [PMID: 35545215 PMCID: PMC9178131 DOI: 10.5946/ce.2021.228] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background/Aims Colonoscopy is the gold standard diagnostic method for colorectal neoplasia, allowing detection and resection of adenomatous polyps; however, significant proportions of adenomas are missed. Computer-aided detection (CADe) systems in endoscopy are currently available to help identify lesions. Diminutive (≤5 mm) and nonpedunculated polyps are most commonly missed. This meta-analysis aimed to assess whether CADe systems can improve the real-time detection of these commonly missed lesions.
Methods A comprehensive literature search was performed. Randomized controlled trials evaluating CADe systems categorized by morphology and lesion size were included. The mean number of polyps and adenomas per patient was derived. Independent proportions and their differences were calculated using DerSimonian and Laird random-effects modeling.
Results Seven studies, including 2,595 CADe-assisted colonoscopies and 2,622 conventional colonoscopies, were analyzed. CADe-assisted colonoscopy demonstrated an 80% increase in the mean number of diminutive adenomas detected per patient compared with conventional colonoscopy (0.31 vs. 0.17; effect size, 0.13; 95% confidence interval [CI], 0.09–0.18); it also demonstrated a 91.7% increase in the mean number of nonpedunculated adenomas detected per patient (0.32 vs. 0.19; effect size, 0.05; 95% CI, 0.02–0.07).
Conclusions CADe-assisted endoscopy significantly improved the detection of most commonly missed adenomas. Although this method is a potentially exciting technology, limitations still apply to current data, prompting the need for further real-time studies.
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Affiliation(s)
- Arun Sivananthan
- Institute of Global Health Innovation, Imperial College, London, UK.,Department of Surgery and Cancer, Imperial College NHS Healthcare Trust, London, UK
| | - Scarlet Nazarian
- Institute of Global Health Innovation, Imperial College, London, UK
| | - Lakshmana Ayaru
- Department of Surgery and Cancer, Imperial College NHS Healthcare Trust, London, UK
| | - Kinesh Patel
- Department of Gastroenterology, Chelsea and Westminster NHS Healthcare Trust, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College, London, UK.,Department of Surgery and Cancer, Imperial College NHS Healthcare Trust, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College, London, UK.,Department of Surgery and Cancer, Imperial College NHS Healthcare Trust, London, UK
| | - Nisha Patel
- Institute of Global Health Innovation, Imperial College, London, UK.,Department of Surgery and Cancer, Imperial College NHS Healthcare Trust, London, UK
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Seva RR, Tan ALS, Tejero LMS, Salvacion MLDS. Multi-dimensional readiness assessment of medical devices. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2022. [DOI: 10.1080/1463922x.2022.2064934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rosemary Ruiz Seva
- Industrial and Systems Engineering, De La Salle University, Manila, Philippines
| | - Angela Li Sin Tan
- Defence Medical and Environmental Research Institute - DSO National Laboratories, Singapore, Singapore
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Zuo S, Chen T, Chen X, Chen B. A Wearable Hands-Free Human-Robot Interface for Robotized Flexible Endoscope. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3149303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Sivananthan A, Kogkas A, Glover B, Darzi A, Mylonas G, Patel N. A novel gaze-controlled flexible robotized endoscope; preliminary trial and report. Surg Endosc 2021; 35:4890-4899. [PMID: 34028606 PMCID: PMC8263462 DOI: 10.1007/s00464-021-08556-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/07/2021] [Indexed: 12/17/2022]
Abstract
Background Interventional endoluminal therapy is rapidly advancing as a minimally invasive surgical technique. The expanding remit of endoscopic therapy necessitates precision control. Eye tracking is an emerging technology which allows intuitive control of devices. This was a feasibility study to establish if a novel eye gaze-controlled endoscopic system could be used to intuitively control an endoscope. Methods An eye gaze-control system consisting of eye tracking glasses, specialist cameras and a joystick was used to control a robotically driven endoscope allowing steering, advancement, withdrawal and retroflexion. Eight experienced and eight non-endoscopists used both the eye gaze system and a conventional endoscope to identify ten targets in two simulated environments: a sphere and an upper gastrointestinal (UGI) model. Completion of tasks was timed. Subjective feedback was collected from each participant on task load (NASA Task Load Index) and acceptance of technology (Van der Laan scale). Results When using gaze-control endoscopy, non-endoscopists were significantly quicker when using gaze-control rather than conventional endoscopy (sphere task 3:54 ± 1:17 vs. 9:05 ± 5:40 min, p = 0.012, and UGI model task 1:59 ± 0:24 vs 3:45 ± 0:53 min, p < .001). Non-endoscopists reported significantly higher NASA-TLX workload total scores using conventional endoscopy versus gaze-control (80.6 ± 11.3 vs 22.5 ± 13.8, p < .001). Endoscopists reported significantly higher total NASA-TLX workload scores using gaze control versus conventional endoscopy (54.2 ± 16 vs 26.9 ± 15.3, p = 0.012). All subjects reported that the gaze-control had positive ‘usefulness’ and ‘satisfaction’ score of 0.56 ± 0.83 and 1.43 ± 0.51 respectively. Conclusions The novel eye gaze-control system was significantly quicker to use and subjectively lower in workload when used by non-endoscopists. Further work is needed to see if this would translate into a shallower learning curve to proficiency versus conventional endoscopy. The eye gaze-control system appears feasible as an intuitive endoscope control system. Hybrid gaze and hand control may prove a beneficial technology to evolving endoscopic platforms. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08556-1.
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Affiliation(s)
| | - Alexandros Kogkas
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK
| | - Ben Glover
- Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Ara Darzi
- Imperial College Healthcare NHS Trust, London, W2 1NY, UK.,The Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK
| | - George Mylonas
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK
| | - Nisha Patel
- Imperial College Healthcare NHS Trust, London, W2 1NY, UK
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Méndez-Bailón M, Jiménez-García R, Muñoz-Rivas N, Hernández-Barrera V, de Miguel-Yanes JM, de Miguel-Díez J, Andrès E, Lorenzo-Villalba N, López-de-Andrés A. Trends and Clinical Impact of Gastrointestinal Endoscopic Procedures on Acute Heart Failure in Spain (2002-2017). J Clin Med 2021; 10:jcm10030546. [PMID: 33540753 PMCID: PMC7867243 DOI: 10.3390/jcm10030546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Heart failure decompensation can be triggered by many factors, including anemia. In cases of iron deficiency anemia or iron deficiency without anemia, endoscopic studies are recommended to rule out the presence of gastrointestinal neoplasms or other associated bleeding lesions. Objectives: The aims of this study were to (i) examine trends in the incidence, clinical characteristics, and in-hospital outcomes of patients hospitalized with heart failure from 2002 to 2017 who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy, and to (ii) identify factors associated with in-hospital mortality (IHM) among patients with heart failure who underwent an EGD and/or a colonoscopy. Methods: We conducted an observational retrospective epidemiological study using the Spanish National Hospital Discharge Database (SNHDD) between 2002 and 2017. We included hospitalizations of patients with a primary discharge diagnosis of heart failure. Cases were reviewed if there was an ICD-9-CM or ICD-10 procedure code for EGD or colonoscopy in any procedure field. Multivariable logistic regression models were constructed to identify predictors of IHM among HF patients who underwent an EGD or colonoscopy. Results: A total of 51,187 (1.32%) non-surgical patients hospitalized with heart failure underwent an EGD and another 72,076 (1.85%) patients had a colonoscopy during their admission. IHM was significantly higher in those who underwent an EGD than in those who underwent a red blood cell transfusion (OR 1.10; 95%CI 1.04–1.12). However, the use of colonoscopy seems to decrease the probability of IHM (OR 0.45; 95%CI 0.41–0.49). In patients who underwent a colonoscopy, older age seems to increase the probability of IHM. However, EGD was associated with a lower mortality (OR 0.60; 95% CI 0.55–0.64). Conclusion: In our study, a decrease in the number of gastroscopies was observed in relation to colonoscopy in patients with heart failure. The significant ageing of the hospitalized HF population seen over the course of the study could have contributed to this. Both procedures seemed to be associated with lower in-hospital mortality, but in the case of colonoscopy, the risk of in-hospital mortality was higher in elderly patients with heart failure and associated neoplasms. Colonoscopy and EGD seemed not to increase IHM in patients with heart failure.
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Affiliation(s)
- Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
| | - Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (A.L.-d.-A.)
| | - Nuria Muñoz-Rivas
- Internal Medicine Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
| | - Valentín Hernández-Barrera
- Department of Preventive Medicine and Public Health, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon Madrid, 28922 Madrid, Spain;
| | | | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
- Correspondence:
| | - Ana López-de-Andrés
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (A.L.-d.-A.)
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