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

Design, Fabrication, and Testing of a Capsule With Hybrid Locomotion for Gastrointestinal Tract Exploration

Abstract—This paper describes a novel solution for the active lo-comotion of a miniaturized endoscopic capsule in the gastrointesti-nal (GI) tract. The authors present the design, development, and testing of a wireless endocapsule with hybrid locomotion, where hybrid locomotion is defined as the combination between internal actuation mechanisms and external magnetic dragging. The cap-sule incorporates an internal actuating legged mechanism, which modifies the capsule profile, and small permanent magnets, which interact with an external magnetic field, thus imparting a dragging motion to the device. The legged mechanism is actuated whenever the capsule gets lodged in collapsed areas of the GI tract. This allows modification of the capsule profile and enables magnetic dragging to become feasible and effective once again. A key com-ponent of the endoscopic pill is the internal mechanism, endowed with a miniaturized brushless motor and featuring compact design, and adequate mechanical performance. The internal mechanism is able to generate a substantial force, which allows the legs to open against the intestinal tissue that has collapsed around the capsule body. An accurate simulation of the performance of the minia-turized motor under magnetic fields was carried out in order to define the best configuration of the internal permanent magnets (which are located very close to the motor) and the best tradeoff operating distance for the external magnet, which is responsible for magnetically dragging the capsule. Finally, a hybrid capsule was developed generating 3.8 N at the tip of the legged mechanism and a magnetic link force up to 135 mN. The hybrid capsule and its wireless control were extensively tested in vitro, ex vivo, and in vivo, thus confirming fulfilment of the design specifications and demon-strating a good ability to manage collapsed areas of the intestinal tract. Index Terms—Capsule endoscopy, endoscopic capsule, magnetic locomotion, robotic surgery. I

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

Monolithic self-supportive bi-directional bending pneumatic bellows catheter

The minimally invasive surgery has proven to be advantageous over conventional open surgery in terms of reduction in recovery time, patient trauma, and overall cost of treatment. To perform a minimally invasive procedure, preliminary insertion of a flexible tube or catheter is crucial without sacrificing its ability to manoeuvre. Nevertheless, despite the vast amount of research reported on catheters, the ability to implement active catheters in the minimally invasive application is still limited. To date, active catheters are made of rigid structures constricted to the use of wires or on-board power supplies for actuation, which increases the risk of damaging the internal organs and tissues. To address this issue, an active catheter made of soft, flexible and biocompatible structure, driven via nonelectric stimulus is of utmost importance. This thesis presents the development of a novel monolithic self-supportive bi-directional bending pneumatic bellows catheter using a sacrificial molding technique. As a proof of concept, in order to understand the effects of structural parameters on the bending performance of a bellows-structured actuator, a single channel circular bellows pneumatic actuator was designed. The finite element analysis was performed in order to analyze the unidirectional bending performance, while the most optimal model was fabricated for experimental validation. Moreover, to attain biocompatibility and bidirectional bending, the novel monolithic polydimethylsiloxane (PDMS)-based dual-channel square bellows pneumatic actuator was proposed. The actuator was designed with an overall cross-sectional area of 5 x 5 mm2, while the input sequence and the number of bellows were characterized to identify their effects on the bending performance. A novel sacrificial molding technique was adopted for developing the monolithic-structured actuator, which enabled simple fabrication for complex designs. The experimental validation revealed that the actuator model with a size of5 x 5 x 68.4 mm3 i.e. having the highest number of bellows, attained optimal bi-directional bending with maximum angles of -65° and 75°, and force of 0.166 and 0.221 N under left and right channel actuation, respectively, at 100 kPa pressure. The bending performance characterization and thermal insusceptibility achieved by the developed pneumatic catheter presents a promising implementation of flexibility and thermal stability for various biomedical applications, such as dialysis and cardiac catheterization

Low-Cost Technologies for Flexible Endoscopy: Design, Control and Autonomy for a Water-Jet Actuated Soft Continuum Endoscope

Despite the outstanding diagnostic performance brought by new technologies in medicine, cancer remains a significant burden worldwide. In addition to prevention strategies, the ability to detect malignancy early is crucial in enabling effective treatment and dramatically increasing the survival rate of patients. In the case of gastric cancer, diagnosis is generally performed using Flexible Endoscopy (or Endoscope) (FE). The FE has been proven to be a powerful, reliable and cost-effective tool in the fight against gastric cancer. However, its effectiveness strongly depends on the skills of trained Gastro Enterologists (GE) who perform the procedures. Moreover, accessibility and availability of such tools are often limited to people residing in major cities, while remote and rural areas remain poorly served by their health systems. The advent of robotics in medicine offers a new solution to these problems. When possible, automating diagnostic procedures or surgical tasks has the potential to deliver reliable, repeatable and cost-effective alternatives to standard human-in-the-loop procedures. Embedding autonomous capabilities into a machine, optimally designed to execute a specific task, could enable the device to automatically adapt to different conditions and non-skilled personnel to perform the procedure by supervising the actions of the robotic platform. In these scenarios, safety represents a major concern and in the majority of the cases, a safe interaction between the robot and the tissues can be guaranteed by building compliant robots made of soft materials. However, if the possibility of using compliant devices offers a number of advantages to the final user or patient, it defines a series of technical challenges that have to be addressed to deliver a stable and reliable control of the platform. Finally, by adopting low-cost designs, single-use solutions can be realised to address the issue and complication of sterilisation. This dissertation discusses the research effort targeted at the development of a water-jet actuated low-cost, disposable gastroscopy platform to offer a safe, cost-effective, fault-free alternative to standard FE

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

Surgical Subtask Automation for Intraluminal Procedures using Deep Reinforcement Learning

Intraluminal procedures have opened up a new sub-field of minimally invasive surgery that use flexible instruments to navigate through complex luminal structures of the body, resulting in reduced invasiveness and improved patient benefits. One of the major challenges in this field is the accurate and precise control of the instrument inside the human body. Robotics has emerged as a promising solution to this problem. However, to achieve successful robotic intraluminal interventions, the control of the instrument needs to be automated to a large extent. The thesis first examines the state-of-the-art in intraluminal surgical robotics and identifies the key challenges in this field, which include the need for safe and effective tool manipulation, and the ability to adapt to unexpected changes in the luminal environment. To address these challenges, the thesis proposes several levels of autonomy that enable the robotic system to perform individual subtasks autonomously, while still allowing the surgeon to retain overall control of the procedure. The approach facilitates the development of specialized algorithms such as Deep Reinforcement Learning (DRL) for subtasks like navigation and tissue manipulation to produce robust surgical gestures. Additionally, the thesis proposes a safety framework that provides formal guarantees to prevent risky actions. The presented approaches are evaluated through a series of experiments using simulation and robotic platforms. The experiments demonstrate that subtask automation can improve the accuracy and efficiency of tool positioning and tissue manipulation, while also reducing the cognitive load on the surgeon. The results of this research have the potential to improve the reliability and safety of intraluminal surgical interventions, ultimately leading to better outcomes for patients and surgeons

Robotic, self-propelled, self-steerable, and disposable colonoscopes: Reality or pipe dream? A state of the art review.

Robotic colonoscopes could potentially provide a comfortable, less painful and safer alternative to standard colonoscopy. Recent exciting developments in this field are pushing the boundaries to what is possible in the future. This article provides a comprehensive review of the current work in robotic colonoscopes including self-propelled, steerable and disposable endoscopes that could be alternatives to standard colonoscopy. We discuss the advantages and disadvantages of these systems currently in development and highlight the technical readiness of each system to help the reader understand where and when such systems may be available for routine clinical use and get an idea of where and in which situation they can best be deployed