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

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

Soft Robot-Assisted Minimally Invasive Surgery and Interventions: Advances and Outlook

Since the emergence of soft robotics around two decades ago, research interest in the field has escalated at a pace. It is fuelled by the industry's appreciation of the wide range of soft materials available that can be used to create highly dexterous robots with adaptability characteristics far beyond that which can be achieved with rigid component devices. The ability, inherent in soft robots, to compliantly adapt to the environment, has significantly sparked interest from the surgical robotics community. This article provides an in-depth overview of recent progress and outlines the remaining challenges in the development of soft robotics for minimally invasive surgery

The shape – morphing performance of magnetoactive soft materials

Magnetoactive soft materials (MSMs) are soft polymeric composites filled with magnetic particles that are an emerging class of smart and multifunctional materials with immense potentials to be used in various applications including but not limited to artificial muscles, soft robotics, controlled drug delivery, minimally invasive surgery, and metamaterials. Advantages of MSMs include remote contactless actuation with multiple actuation modes, high actuation strain and strain rate, self-sensing, and fast response etc. Having broad functional behaviours offered by the magnetic fillers embedded within non-magnetic matrices, MSMs are undoubtedly one of the most promising materials in applications where shape-morphing, dynamic locomotion, and reconfigurable structures are highly required. This review article provides a comprehensive picture of the MSMs focusing on the materials, manufacturing processes, programming and actuation techniques, behaviours, experimental characterisations, and device-related achievements with the current state-of-the-art and discusses future perspectives. Overall, this article not only provides a comprehensive overview of MSMs’ research and development but also functions as a systematic guideline towards the development of multifunctional, shape-morphing, and sophisticated magnetoactive devices

Current engineering developments for robotic systems in flexible endoscopy

The past four decades have seen an increase in the incidence of early-onset gastrointestinal cancer. Because early-stage cancer detection is vital to reduce mortality rate, mass screening colonoscopy provides the most effective prevention strategy. However, conventional endoscopy is a painful and technically challenging procedure that requires sedation and experienced endoscopists to be performed. To overcome the current limitations, technological innovation is needed in colonoscopy. In recent years, researchers worldwide have worked to enhance the diagnostic and therapeutic capabilities of endoscopes. The new frontier of endoscopic interventions is represented by robotic flexible endoscopy. Among all options, self-propelling soft endoscopes are particularly promising thanks to their dexterity and adaptability to the curvilinear gastrointestinal anatomy. For these devices to replace the standard endoscopes, integration with embedded sensors and advanced surgical navigation technologies must be investigated. In this review, the progress in robotic endoscopy was divided into the fundamental areas of design, sensing, and imaging. The article offers an overview of the most promising advancements on these three topics since 2018. Continuum endoscopes, capsule endoscopes, and add-on endoscopic devices were included, with a focus on fluid-driven, tendon-driven, and magnetic actuation. Sensing methods employed for the shape and force estimation of flexible endoscopes were classified into model- and sensor-based approaches. Finally, some key contributions in molecular imaging technologies, artificial neural networks, and software algorithms are described. Open challenges are discussed to outline a path toward clinical practice for the next generation of endoscopic devices

Control of Magnetic Continuum Robots for Endoscopy

The present thesis discusses the problem of magnetic actuation and control applied to millimetre-scale robots for endoluminal procedures. Magnetic actuation, given its remote manipulation capabilities, has the potential to overcome several limitations of current endoluminal procedures, such as the relatively large size, high sti�ness and limited dexterity of existing tools. The application of functional forces remotely facilitates the development of softer and more dexterous endoscopes, which can navigate with reduced discomfort for the patient. However, the solutions presented in literature are not always able to guarantee smooth navigation in complex and convoluted anatomical structures. This thesis aims at improving the navigational capabilities of magnetic endoluminal robots, towards achieving full autonomy. This is realized by introducing novel design, sensing and control approaches for magnetically actuated soft endoscopes and catheters. First, the application of accurate closed-loop control to a 1 Internal Permanent Magnet (IPM) endoscope was analysed. The proposed approach can guarantee better navigation capabilities, thanks to the manipulation of every mechanical Degree of Freedom (DOF) - 5 DOFs. Speci�cally, it was demonstrated that gravity can be balanced with su�cient accuracy to guarantee tip levitation. In this way contact is minimized and obstacle avoidance improved. Consequently, the overall navigation capabilities of the endoscope were enhanced for given application. To improve exploration of convoluted anatomical pathways, the design of magnetic endoscopes with multiple magnetic elements along their length was introduced. This approach to endoluminal device design can ideally allow manipulation along the full length; facilitating full shape manipulation, as compared to tip-only control. To facilitate the control of multiple magneto-mechanical DOFs along the catheters' length, a magnetic actuation method was developed based on the collaborative robotic manipulation of 2 External Permanent Magnets (EPMs). This method, compared to the state-of-the-art, facilitates large workspace and applied �eld, while guaranteeing dexterous actuation. Using this approach, it was demonstrated that it is possible to actuate up to 8 independent magnetic DOFs. In the present thesis, two di�erent applications are discussed and evaluated, namely: colonoscopy and navigational bronchoscopy. In the former, a single-IPM endoscopic approach is utilized. In this case, the anatomy is large enough to permit equipping the endoscope with a camera; allowing navigation by direct vision. Navigational bronchoscopy, on-the-other-hand, is performed in very narrow peripheral lumina, and navigation is informed via pre-operative imaging. The presented work demonstrates how the design of the magnetic catheters, informed by a pre-operative Computed Tomography (CT) scan, can mitigate the need for intra-operative imaging and, consequently, reduce radiation exposure for patients and healthcare workers. Speci�cally, an optimization routine to design the catheters is presented, with the aim of achieving follow-the-leader navigation without supervision. In both scenarios, analysis of how magnetic endoluminal devices can improve the current practice and revolutionize the future of medical diagnostics and treatment is presented and discussed

Characterisation and State Estimation of Magnetic Soft Continuum Robots

Minimally invasive surgery has become more popular as it leads to less bleeding, scarring, pain, and shorter recovery time. However, this has come with counter-intuitive devices and steep surgeon learning curves. Magnetically actuated Soft Continuum Robots (SCR) have the potential to replace these devices, providing high dexterity together with the ability to conform to complex environments and safe human interactions without the cognitive burden for the clinician. Despite considerable progress in the past decade in their development, several challenges still plague SCR hindering their full realisation. This thesis aims at improving magnetically actuated SCR by addressing some of these challenges, such as material characterisation and modelling, and sensing feedback and localisation. Material characterisation for SCR is essential for understanding their behaviour and designing effective modelling and simulation strategies. In this work, the material properties of commonly employed materials in magnetically actuated SCR, such as elastic modulus, hyper-elastic model parameters, and magnetic moment were determined. Additionally, the effect these parameters have on modelling and simulating these devices was investigated. Due to the nature of magnetic actuation, localisation is of utmost importance to ensure accurate control and delivery of functionality. As such, two localisation strategies for magnetically actuated SCR were developed, one capable of estimating the full 6 degrees of freedom (DOFs) pose without any prior pose information, and another capable of accurately tracking the full 6-DOFs in real-time with positional errors lower than 4~mm. These will contribute to the development of autonomous navigation and closed-loop control of magnetically actuated SCR

Advanced medical micro-robotics for early diagnosis and therapeutic interventions

Recent technological advances in micro-robotics have demonstrated their immense potential for biomedical applications. Emerging micro-robots have versatile sensing systems, flexible locomotion and dexterous manipulation capabilities that can significantly contribute to the healthcare system. Despite the appreciated and tangible benefits of medical micro-robotics, many challenges still remain. Here, we review the major challenges, current trends and significant achievements for developing versatile and intelligent micro-robotics with a focus on applications in early diagnosis and therapeutic interventions. We also consider some recent emerging micro-robotic technologies that employ synthetic biology to support a new generation of living micro-robots. We expect to inspire future development of micro-robots toward clinical translation by identifying the roadblocks that need to be overcome

Wireless capsule endoscope for targeted drug delivery

The diagnosis and treatment of pathologies of the gastrointestinal (GI) tract are performed routinely by gastroenterologists using endoscopes and colonoscopes, however the small intestinal tract is beyond the reach of these conventional systems. Attempts have been made to access the small intestines with wireless capsule endoscopes (WCE). These pill-sized cameras take pictures of the intestinal wall and then relay them back for evaluation. This practice enables the detection and diagnosis of pathologies of the GI tract such as Crohn's disease, small intestinal tumours such as lymphoma and small intestinal cancer. The problems with these systems are that they have limited diagnostic capabilities and they do not offer the ability to perform therapy to the affected areas leaving only the options of administering large quantities of drugs or surgical intervention. To address the issue of administering therapy in the small intestinal tract this thesis presents an active swallowable microrobotic platform which has novel functionality enabling the microrobot to treat pathologies through a targeted drug delivery system. This thesis first reviews the state-of-the-art in WCE through the evaluation of current and past literature. A review of current practises such as flexible sigmoidoscopy, virtual colonoscopy and wireless capsule endoscopy are presented. The following sections review the state-of-the-art in methods of resisting peristalsis, drug targeting systems and drug delivery. A review of actuators is presented, in the context of WCE, with a view to evaluate their acceptability in adding functionality to current WCEs. The thesis presents a novel biologically-inspired holding mechanism which overcomes the issue of resisting natural peristalsis in the GI tract. An analysis of the two components of peristaltic force, circumferential and longitudinal peristaltic contractions, are presented to ensure correct functionality of the holding mechanism. A detailed analysis of the motorised method employed to deploy the expanding mechanism is described and a 5:1 scale prototype is presented which characterises the gearbox and validates the holding mechanism. The functionality of WCE is further extended by the inclusion of a novel targeting mechanism capable of delivering a metered dose of medication to a target site of interest in the GI tract. A solution to the problem of positioning a needle within a 360 degree envelope, operating the needle and safely retracting the needle in the GI tract is discussed. A comprehensive analysis of the mechanism to manoeuvre the needle is presented and validation of the mechanism is demonstrated through the evaluation of scale prototypes. Finally a drug delivery system is presented which can expel a 1 ml dose of medication, stored onboard the capsule, into the subcutaneous tissue of the GI tract wall. An analysis of the force required to expel the medication in a set period of time is presented and the design and analysis of a variable pitch conical compression spring which will be used to deliver the medication is discussed. A thermo mechanical trigger mechanism is presented which will be employed to release the compressed conical spring. Experimental results using 1:1 scale prototype parts validate the performance of the mechanisms.Open Acces