Capsule endoscopy of the future: What's on the horizon?

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

Development of A Kinetic Model For Loop-Free Colonoscopy Technology

The colonoscope is an important tool in diagnosis and management of diseases of the colon. One of the ongoing challenges with this device is that the colonoscope may form a loop together with the colon during the procedure. The result of the loop is that further insertion of the scope in the colon may not be possible. The loop may also cause risks of perforation of the colon and pain in the patient. There are currently several existing devices to overcome loop formation in colonoscopy, some of which have been introduced in clinical work. However, empirical assessment shows that these devices do not work very well. This is the motivation for the research presented in this thesis. In this thesis, a new paradigm of thinking, “doctor-assisted colonoscopy,” is proposed to overcome loop formation. In this new approach, the physician’s role is enhanced with new information that is acquired by sensors outside the human body and inferred from the mathematical model. It is referred to as a kinetic model due to the fact that this model describes the kinetic behaviour of the scope. This thesis is devoted to development of this kinetic model. In this study, the model of the colonoscope and the model of the colon are developed based on the Timoshenko beam theory, and parameters in both models are determined by the experiments. The following conclusions then are made: (1) self-locking of the colonoscope is the most basic cause for a loop to occur, while structural instability of the colonsocope is dependent on the self-locking; (2) both the scope and the colon can be well represented with the Timoshenko beam elements and the Linear Complementary Problem (LCP) formulation derived from Signorini’s law, and Coulom’s law for representation of interactions between the colon and scope is adequate; (3) there are effects from the location, looping, and tip deflection of the scope on flexural rigidity of the scope. Approximately, the flexural rigidity of the CF-Q160L colonoscope ranges from 300 to 650 N•cm2, and its accuracy is proven by a good agreement between the model predicted result and experimental result; (4) Rayleigh damping for the CF-Q160L colonoscope depends more on the mass matrix [M] of the colonoscope than the stiffness matrix [K], which is evident by the large coefficient value of “alpha” (0.3864) and the small coefficient value of “beta” (0.0164). The contributions of this thesis are: (1) the finding that the main cause of the loop is not structural instability of the colonoscope but rather self-locking of the colonoscope, which could lead to design of a “new-generation” colonoscope to avoid the loop; (2) a systematic evaluation of the existing colonoscopy technologies based on the well-proven Axiomatic Design Theory (ADT), which will serve as a guideline for the development of future new colonoscopes in future; (3) an approach to developing a kinetic model of the colonoscope useful to modeling similar objects such as a catheter guide-wire; (4) a novel ex-vivo colonoscopy test-bed with the kinetic and kinematic measurements useful for validation of new designs in colonoscopy technology and also useful for training physicians who perform the colonoscopy procedure; and (5) a new paradigm of thinking for colonoscopy called “doctor-assisted colonoscopy,” which has potential applications to other medical procedures such as catheter-based procedures

Towards tactile sensing active capsule endoscopy

Examination of the gastrointestinal(GI) tract has traditionally been performed using tethered endoscopy tools with limited reach and more recently with passive untethered capsule endoscopy with limited capability. Inspection of small intestines is only possible using the latter capsule endoscopy with on board camera system. Limited to visual means it cannot detect features beneath the lumen wall if they have not affected the lumen structure or colour. This work presents an improved capsule endoscopy system with locomotion for active exploration of the small intestines and tactile sensing to detect deformation of the capsule outer surface when it follows the intestinal wall. In laboratory conditions this system is capable of identifying sub-lumen features such as submucosal tumours.Through an extensive literary review the current state of GI tract inspection in particular using remote operated miniature robotics, was investigated, concluding no solution currently exists that utilises tactile sensing with a capsule endoscopy. In order to achieve such a platform, further investigation was made in to tactile sensing technologies, methods of locomotion through the gut, and methods to support an increased power requirement for additional electronics and actuation. A set of detailed criteria were compiled for a soft formed sensor and flexible bodied locomotion system. The sensing system is built on the biomimetic tactile sensing device, Tactip, \cite{Chorley2008, Chorley2010, Winstone2012, Winstone2013} which has been redesigned to fit the form of a capsule endoscopy. These modifications have required a $360^{o}$ cylindrical sensing surface with $360^{o}$ panoramic optical system. Multi-material 3D printing has been used to build an almost complete sensor assembly with a combination of hard and soft materials, presenting a soft compliant tactile sensing system that mimics the tactile sensing methods of the human finger. The cylindrical Tactip has been validated using artificial submucosal tumours in laboratory conditions. The first experiment has explored the new form factor and measured the device's ability to detect surface deformation when travelling through a pipe like structure with varying lump obstructions. Sensor data was analysed and used to reconstruct the test environment as a 3D rendered structure. A second tactile sensing experiment has explored the use of classifier algorithms to successfully discriminate between three tumour characteristics; shape, size and material hardness. Locomotion of the capsule endoscopy has explored further bio-inspiration from earthworm's peristaltic locomotion, which share operating environment similarities. A soft bodied peristaltic worm robot has been developed that uses a tuned planetary gearbox mechanism to displace tendons that contract each worm segment. Methods have been identified to optimise the gearbox parameter to a pipe like structure of a given diameter. The locomotion system has been tested within a laboratory constructed pipe environment, showing that using only one actuator, three independent worm segments can be controlled. This configuration achieves comparable locomotion capabilities to that of an identical robot with an actuator dedicated to each individual worm segment. This system can be miniaturised more easily due to reduced parts and number of actuators, and so is more suitable for capsule endoscopy. Finally, these two developments have been integrated to demonstrate successful simultaneous locomotion and sensing to detect an artificial submucosal tumour embedded within the test environment. The addition of both tactile sensing and locomotion have created a need for additional power beyond what is available from current battery technology. Early stage work has reviewed wireless power transfer (WPT) as a potential solution to this problem. Methods for optimisation and miniaturisation to implement WPT on a capsule endoscopy have been identified with a laboratory built system that validates the methods found. Future work would see this combined with a miniaturised development of the robot presented. This thesis has developed a novel method for sub-lumen examination. With further efforts to miniaturise the robot it could provide a comfortable and non-invasive procedure to GI tract inspection reducing the need for surgical procedures and accessibility for earlier stage of examination. Furthermore, these developments have applicability in other domains such as veterinary medicine, industrial pipe inspection and exploration of hazardous environments

Modeling and understanding of directional friction on a fully lubricated surface with regular anisotropic asperities

Traditional tribology is based on the surface with random micro structures due to limitations of manufacturing technology. The modern manufacturing technology now promises to fabricate surfaces with regular micro structures (or asperities). The word ‘asperity’ refers to a single physical entity on the surface of a material, contributing to a concept called roughness in traditional tribology. Regular asperity surfaces imply that all asperities on the surface of a material have the same shape and size, and a deterministic distribution over the surface. The emergence of regular asperity surfaces will have a transformative impact to the discipline of tribology. The overall objective of this thesis is to study how the regular asperity would affect the tribological behavior. Specifically, this thesis develops a computational model to demonstrate and characterize the effect of the surface with regular anisotropic asperities (RAA) on the directional friction behavior when the surface is in a fully lubricated state. By directional friction, it is meant that friction force changes its magnitude with the change of the relative motion direction. By anisotropic asperity, it is meant that the geometry of the asperity is not symmetrical along the motion direction. This thesis presents a detailed development of the computational model by employing computational fluid dynamics (CFD) techniques. In particular, the model takes the Navier-Stokes (NS) equation as a governing equation and the Half-Sommerfeld Condition (HSC) to represent fluid behavior in the cavitation region; as such the model is named NS-HSC for short. Verification of the NS-HSC model is conducted with the information available in literature. A theory is proposed to explain the relationship between directional friction behavior and specific RAA structures. The thesis concludes: (1) the NS-HSC model is more accurate than the existing model in the literature and can be used to predict directional friction behavior and to design RAA surfaces, and (2) the proposed theory is excellent consistent with the NS-HSC model and thus useful to analysis and design of RAA surfaces for directional friction. The major contributions of this thesis are: (1) the first model in the field of tribology to predict the directional friction behavior for RAA surfaces under a fully lubricated status, (2) the first investigation, in the field of CFD, into combining the NS and HSC for modeling a laminar flow with cavitation, and (3) the first theory in the field of tribology for directional friction on fully lubricated RAA surfaces

A Magnetic Actuated Fully Insertable Robotic Camera System for Single Incision Laparoscopic Surgery

Minimally Invasive Surgery (MIS) is a common surgical procedure which makes tiny incisions in the patients anatomy, inserting surgical instruments and using laparoscopic cameras to guide the procedure. Compared with traditional open surgery, MIS allows surgeons to perform complex surgeries with reduced trauma to the muscles and soft tissues, less intraoperative hemorrhaging and postoperative pain, and faster recovery time. Surgeons rely heavily on laparoscopic cameras for hand-eye coordination and control during a procedure. However, the use of a standard laparoscopic camera, achieved by pushing long sticks into a dedicated small opening, involves multiple incisions for the surgical instruments. Recently, single incision laparoscopic surgery (SILS) and natural orifice translumenal endoscopic surgery (NOTES) have been introduced to reduce or even eliminate the number of incisions. However, the shared use of a single incision or a natural orifice for both surgical instruments and laparoscopic cameras further reduces dexterity in manipulating instruments and laparoscopic cameras with low efficient visual feedback. In this dissertation, an innovative actuation mechanism design is proposed for laparoscopic cameras that can be navigated, anchored and orientated wirelessly with a single rigid body to improve surgical procedures, especially for SILS. This design eliminates the need for an articulated design and the integrated motors to significantly reduce the size of the camera. The design features a unified mechanism for anchoring, navigating, and rotating a fully insertable camera by externally generated rotational magnetic field. The key component and innovation of the robotic camera is the magnetic driving unit, which is referred to as a rotor, driven externally by a specially designed magnetic stator. The rotor, with permanent magnets (PMs) embedded in a capsulated camera, can be magnetically coupled to a stator placed externally against or close to a dermal surface. The external stator, which consists of PMs and coils, generates 3D rotational magnetic field that thereby produces torque to rotate the rotor for desired camera orientation, and force to serve as an anchoring system that keeps the camera steady during a surgical procedure. Experimental assessments have been implemented to evaluate the performance of the camera system

New Trends and Applications in Femtosecond Laser Micromachining

This book contains the scientific contributions to the Special Issue entitled: "New Trends and Applications in Femtosecond Laser Micromachining". It covers an array of subjects, from the basics of femtosecond laser micromachining to specific applications in a broad spectra of fields such biology, photonics and medicine

The Design and Development of a Mobile Colonoscopy Robot

The conventional colonoscopy is a common procedure used to access the colon. Despite it being considered the Gold Standard procedure for colorectal cancer diagnosis and treatment, it has a number of major drawbacks, including high patient discomfort, infrequent but serious complications and high skill required to perform the procedure. There are a number of potential alternatives to the conventional colonoscopy, from augmenting the colonoscope to using Computed Tomography Colonography (CTC) - a completely non-invasive method. However, a truly effective, all-round alternative has yet to be found. This thesis explores the design and development of a novel solution: a fully mobile colonoscopy robot called “RollerBall”. Unlike current passive diagnostic capsules, such as PillCam, this device uses wheels at the end of adjustable arms to provide locomotion through the colon, while providing a stable platform for the use of diagnostic and therapeutic tools. The work begins by reviewing relevant literature to better understand the problem and potential solutions. RollerBall is then introduced and its design described in detail. A robust prototype was then successfully fabricated using a 3D printing technique and its performance assessed in a series of benchtop experiments. These showed that the mechanisms functioned as intended and encouraged the further development of the concept. Next, the fundamental requirement of gaining traction on the colon was shown to be possible using hexagonal shaped, macro-scale tread patterns. A friction coefficient ranging between 0.29 and 0.55 was achieved with little trauma to the tissue substrate. The electronics hardware and control were then developed and evaluated in a series of tests in silicone tubes. An open-loop strategy was first used to establish the control algorithm to map the user inputs to motor outputs (wheel speeds). These tests showed the efficacy of the locomotion technique and the control algorithm used, but they highlighted the need for autonomy. To address this, feedback was included to automate the adjusting of the arm angle and amount of force applied by the device; a forward facing camera was also used to automate the orientation control by tracking a user-defined target. Force and orientation control were then combined to show that semi-autonomous control was possible and as a result, it was concluded that clinical use may be feasible in future developments

Methoden zur magnetischen Steuerung schwimmender Endoroboter

Die Magnetically Guided Capsule Endoscopy (MGCE) ist eine neuartige medizinische Diagnoseform, bei der eine schluckbare Kapsel mit 2 Kameras magnetisch durch ein flüssigkeitgefülltes Hohlorgan wie den Magen gesteuert werden kann. Diese Arbeit beschreibt die für den ersten klinischen Prototyp entstandenen Methoden zur Steuerung der Schwimmbewegungen durch automatisierte Magnetfeldsequenzen. Zur Evaluation wurden 2 klinischen Studien mit 64 Personen durchgeführt. The Magnetically Guided Capsule Endoscopy (MGCE) is a new medical screening procedure, where a swallowable capsule with 2 cameras can be steered magnetically through a fluid-filled hollow organ such as the human stomach. This work describes the control methods developed for the first clinical prototype to generate swimming motions through automated magnetic field sequences. For evaluation 2 clinical studies were conducted with 64 human cases