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    Analysis of the 'Endoworm' prototype's ability to grip the bowel in in vitro and ex vivo models

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    [EN] Access to the small bowel by means of an enteroscope is difficult, even using current devices such as single-balloon or double-balloon enteroscopes. Exploration time and patient discomfort are the main drawbacks. The prototype 'Endoworm' analysed in this paper is based on a pneumatic translation system that, gripping the bowel, enables the endoscope to move forward while the bowel slides back over its most proximal part. The grip capacity is related to the pressure inside the balloon, which depends on the insufflate volume of air. Different materials were used as in vitro and ex vivo models: rigid polymethyl methacrylate, flexible silicone, polyester urethane and ex vivo pig small bowel. On measuring the pressure-volume relationship, we found that it depended on the elastic properties of the lumen and that the frictional force depended on the air pressure inside the balloons and the lumen's elastic properties. In the presence of a lubricant, the grip on the simulated intestinal lumens was drastically reduced, as was the influence of the lumen's properties. This paper focuses on the Endoworm's ability to grip the bowel, which is crucial to achieving effective endoscope forward advance and bowel foldingThe author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Spanish Ministry of Economy and Competitiveness through Project (PI18/01365) and by the UPV/IIS LA Fe through the (Endoworm 3.0) Project. CIBER-BBN is an initiative funded by the VI National R&D&I Plan 2008-2011, Iniciativa Ingenio 2010, Consolider Program, CIBER Actions and financed by the Instituto de Salud Carlos III with the assistance of the European Regional Development FundTobella, J.; Pons-Beltrán, V.; Santonja, A.; Sánchez-Diaz, C.; Campillo Fernandez, AJ.; Vidaurre, A. (2020). 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    Capsule endoscopy of the future: What's on the horizon?

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    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 survey of small bowel modelling and its applications for capsule endoscopy

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    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

    A Review of Locomotion Systems for Capsule Endoscopy

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    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

    Development of A Kinetic Model For Loop-Free Colonoscopy Technology

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    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

    Doctor of Philosophy

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    dissertationClosed-loop control of wireless capsule endoscopes is an active area of research because it would drastically improve screening of the gastrointestinal tract. Traditional endoscopic procedures are unable to view the entire gastrointestinal tract and current commercial wireless capsule endoscopes are limited in their effectiveness due to their passive nature. This dissertation advances the field of active capsule endoscopy by developing methods to localize the full six-degree-of-freedom (6-DOF) pose of a screw-type magnetic capsule while it is being propelled through a lumen (such as the small intestines) using an external rotating magnetic dipole. The same external magnetic dipole is utilized for both propulsion and localization. Hardware was designed and constructed to enable testing of the magnetic localization and propulsion methods, including a robotic end-effector used as the external actuator magnet, and a prototype capsule embedded with Hall-effect sensors. Due to the use of a rotating magnetic field for propulsion, at any given time, the capsule can be in one of three regimes: synchronously rotating with the applied field, in "step-out" where it is free to move but the external field is rotating too quickly for the capsule to remain synchronously rotating, or completely stationary. We show that it is only necessary to distinguish whether or not the capsule is synchronously rotating (i.e., a single localization method can be used for a capsule in either the step-out or stationary regimes). Two magnetic localization methods are developed. The first uses nonlinear least squares to estimate the capsule's pose when it has no (or approximately no) net motion (e.g., to find the initial capsule pose or when it is stuck in an intestinal fold). The second method estimates the 6-DOF capsule pose as it synchronously rotates with the applied magnetic field using a square-root variant of the Unscented Kalman filter. A simple process model is adopted that restricts the capsule's movement to translation along and rotation about its principle axis. The capsule is actively propelled forward or backward, but it is not actively steered, rather, steering is provided by the lumen. The propulsion parameters that transform magnetic force and torque to the capsule's spatial velocity and angular velocity are estimated with an additional square-root Unscented Kalman filter to enable the capsule to navigate heterogeneous environments such as the small intestines. An optimized localization-propulsion system is described using the two localization algorithms and prior work in screw-type magnetic capsule propulsion with a single rotating dipole field. The capsule's regime is determined and the corresponding localization method is employed. Based on the capsule's estimated pose and the current estimates of its propulsion parameters, the actuator magnet's pose relative to the capsule is optimized to maximize the capsule's forward propulsion. Using this system, our prototype magnetic capsule successfully completed U-shaped and S-shaped trajectories in fresh bovine intestines with an average forward velocity of 5.5mm/s and 3.5 mm/s, respectively. At this rate it would take approximately 18-30 minutes to traverse the 6 meters of a typical human small intestine

    Tribology of Medical Devices

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    Importance of tribology in a number of medical devices and surgical instruments is reviewed, including artificial joints, artificial teeth, dental implants and orthodontic appliances, cardiovascular devices, contact lenses, artificial limbs and surgical instruments. The current focus and future developments of these medical devices are highlighted from a tribological point of view, together with the underlying mechanisms

    A wireless platform for in vivo measurement of resistant properties of the gastrointestinal tract

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    Abstract Active locomotion of wireless capsule endoscopes has the potential to improve the diagnostic yield of this painless technique for the diagnosis of gastrointestinal tract disease. In order to design effective locomotion mechanisms, a quantitative measure of the propelling force required to effectively move a capsule inside the gastrointestinal tract is necessary. In this study, we introduce a novel wireless platform that is able to measure the force opposing capsule motion, without perturbing the physiologic conditions with physical connections to the outside of the gastrointestinal tract. The platform takes advantage of a wireless capsule that is magnetically coupled with an external permanent magnet. A secondary contribution of this manuscript is to present a real-time method to estimate the axial magnetic force acting on a wireless capsule manipulated by an external magnetic field. In addition to the intermagnetic force, the platform provides real-time measurements of the capsule position, velocity, and acceleration. The platform was assessed with benchtop trials within a workspace that extends 15 cm from each side of the external permanent magnet, showing average error in estimating the force and the position of less than 0.1 N and 10 mm, respectively. The platform was also able to estimate the dynamic behavior of a known resistant force with an error of 5.45%. Finally, an in vivo experiment on a porcine colon model validated th

    Design, manufacturing and characterisation of a wireless flexible pressure sensor system for the monitoring of the gastro-intestinal tract

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    Ingestible motility capsule (IMC) endoscopy holds a strong potential in providing advanced diagnostic capabilities within the small intestine with higher patient tolerance for pathologies such as irritable bowel syndrome, gastroparesis and chronic abdominal amongst others. Currently state-of-the art IMCs are limited by the use of obstructive off-the-shelf sensing modules that are unable to provide multi-site tactile monitoring of the Gastro-Intestinal tract. In this work a novel 12 mm in diameter by 30 mm in length IMC is presented that utilises custom-built flexible, thin-film, biocompatible, wireless and highly sensitive tactile pressure sensors arrays functionalising the capsule shell. The 150 μm thick, microstructured, PDMS flexible passive pressure sensors are wirelessly powered and interrogated, and are capable of detecting pressure values ranging from 0.1 kPa up to 30 kPa with a 0.1 kPa resolution. A novel bottom-up wafer-scale microfabrication process is presented which enables the development of these ultra-dense, self-aligned, scalable and uniquely addressable flexible wireless sensors with high yield (>80%). This thesis also presents an innovative metallisation microfabrication process on soft-elastomeric substrates capable to withstand without failure of the tracks 180o bending, folding and iterative deformation such as to allow conformable mapping of these sensors. A custom-built and low-cost reflectometer system was also designed, built and tested within the capsule that can provide a fast (100 ms) and accurate extraction (±0.1 kPa) of their response. In vitro and in vivo characterisation of the developed IMC device is also presented, facilitated respectively via the use of a biomimetic phantom gut and via live porcine subjects. The capsule device was found to successfully capture respiration, low-amplitude and peristaltic motility of the GI tract from multiple sites of the capsule.UK Engineering & Physical Sciences Research Council (EPSRC) through the Programme Grant Sonopill (EP/K034537/2)James Watt Scholarshi
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