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

A Review of Locomotion Systems for Capsule Endoscopy

Wireless capsule endoscopy for gastrointestinal (GI) tract is a modern technology that has the potential to replace conventional endoscopy techniques. Capsule endoscopy is a pill-shaped device embedded with a camera, a coin battery, and a data transfer. Without a locomotion system, this capsule endoscopy can only passively travel inside the GI tract via natural peristalsis, thus causing several disadvantages such as inability to control and stop, and risk of capsule retention. Therefore, a locomotion system needs to be added to optimize the current capsule endoscopy. This review summarizes the state-of-the-art locomotion methods along with the desired locomotion features such as size, speed, power, and temperature and compares the properties of different methods. In addition, properties and motility mechanisms of the GI tract are described. The main purpose of this review is to understand the features of GI tract and diverse locomotion methods in order to create a future capsule endoscopy compatible with GI tract properties

Swallowable Wireless Capsule Endoscopy: Progress and Technical Challenges

Wireless capsule endoscopy (WCE) offers a feasible noninvasive way to detect the whole gastrointestinal (GI) tract and revolutionizes the diagnosis technology. However, compared with wired endoscopies, the limited working time, the low frame rate, and the low image resolution limit the wider application. The progress of this new technology is reviewed in this paper, and the evolution tendencies are analyzed to be high image resolution, high frame rate, and long working time. Unfortunately, the power supply of capsule endoscope (CE) is the bottleneck. Wireless power transmission (WPT) is the promising solution to this problem, but is also the technical challenge. Active CE is another tendency and will be the next geneion of the WCE. Nevertheless, it will not come true shortly, unless the practical locomotion mechanism of the active CE in GI tract is achieved. The locomotion mechanism is the other technical challenge, besides the challenge of WPT. The progress about the WPT and the active capsule technology is reviewed

Origami inspired design for capsule endoscope to retrograde using intestinal peristalsis

Capsule endoscopy has gained a lot of attention in the medical field in the recent past as an effective way of investigating unusual symptoms experienced in places such as esophagus, stomach, small intestine and colon. However, motion control of the capsule endoscope is challenging and often requires a power source and miniature actuators. To address these issues, we present a novel origami inspired structure as an attachment to the capsule endoscope. The proposed origami structure utilizes the wave generated by peristalsis of the intestine to move it forward and backward. When the origami structure is folded, the capsule endoscope is propelled forward by intestinal peristalsis. When the origami structure is unfolded, the intestinal peristalsis squeezes the origami structure to drive the capsule endoscope to move in the opposite direction. Therefore, folding and unfolding of the proposed origami structure would allow to control the movement direction of the capsule endoscope. In this paper, we present the design, simulations and experimental validation of the proposed origami structure

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

A Biomimetic steering robot for Minimally invasive surgery application

International audienceMinimally Invasive Surgery represents the future of many types of medical inter- ventions such as keyhole neurosurgey or transluminal endoscopic surgery. These procedures involve insertion of surgical instruments such as needles and endoscopes into human body through small incision/ body cavity for biopsy and drug delivery. However, nearly all surgical instruments for these procedures are inserted manually and there is a long learning curve for surgeons to use them properly. Many research efforts have been made to design active instruments (endoscope, needles) to improve this procedure during last decades. New robot mechanisms have been designed and used to improve the dexterity of current endoscope. Usually these robots are flexible and can pass the constrained space for fine manipulations. In recent years, a con- tinuum robotic mechanism has been investigated and designed for medical surgery. Those robots are characterized by the fact that their mechanical components do not have rigid links and discrete joints in contrast with traditional robot manipula- tors. The design of these robots is inspired by movements of natural animals such as tongues, elephant trunks and tentacles. The unusual compliance and redundant degrees of freedom of these robots provide strong potential to achieve delicate tasks successfully even in cluttered and unstructured environments. This chapter will present a complete application of a continuum robot for Mini- mally Invasive Surgery of colonoscopy. This system is composed of a micro-robotic tip, a set of position sensors and a real-time control system for guiding the explo- ration of colon. Details will be described on the modeling of the used pneumatic actuators, the design of the mechanical component, the kinematic model analysis and the control strategy for automatically guiding the progression of the device inside the human colon. Experimental results will be presented to check the perfor- mances of the whole system within a transparent tube

A Development Study of a New Bi-directional Solenoid Actuator for Active Locomotion Capsule Robots

A new bi-directional, simple-structured solenoid actuator for active locomotion capsule robots (CRs) is investigated in this paper. This active actuator consists of two permanent magnets (PMs) attached to the two ends of the capsule body and a vibration inner mass formed by a solenoidal coil with an iron core. The proposed CR, designed as a sealed structure without external legs, wheels, or caterpillars, can achieve both forward and backward motions driven by the internal collision force. This new design concept has been successfully confirmed on a capsule prototype. The measured displacements show that its movement can be easily controlled by changing the supplied current amplitude and frequency of the solenoid actuator. To validate the new bi-directional CR prototype, various experimental as well as finite element analysis results are presented in this paper

A survey of small bowel modelling and its applications for capsule endoscopy

This is the final version. Available on open access from Elsevier via the DOI in this recordThe small intestine, an anatomical site previously considered inaccessible to clinicians due to its small diameter and length, is the part of the gastrointestinal tract between the stomach and the colon. Since its introduction into clinical practice two decades ago, capsule endoscopy has become established as the primary modality for examining the surface lining of the small intestine. Today, researchers continue to develop ground-breaking technologies for novel miniature devices aiming for tissue biopsy, drug delivery and therapy. The purpose of this paper is to provide researchers and engineers in this area a comprehensive review of the progress in understanding the anatomy and physiology of the small intestine and how this understanding was translated to virtual and physical test platforms for assessing the performance of these intestinal devices. This review will cover both theoretical and practical studies on intestinal motor activities and the work on mathematical modelling and experimental investigation of capsule endoscope in the small intestine. In the end, the requirements for improving the current work are drawn, and the expectations on future research in this field are provided.Engineering and Physical Sciences Research Council (EPSRC)China Scholarship Counci

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

Magnetic manipulation with several mobile coils towards gastrointestinal capsular endoscopy.

Traditional techniques of endoscopy based on flexible endoscopes are fairly reliable but poorly tolerated by patients and do not give access to the small bowel. It has been demonstrated that magnetic fields are usable for manipulating an untethered magnet, either using fixed coils or mobile permanent magnets.We introduce a novel approach for magnetic manipulation and present the preliminary results obtained by simulating a planar manipulation system including multiple mobile coils