Comparing In Vivo versus Simulation Training for Transnasal Endoscopy Skills

Fiberoptic endoscopic evaluations of swallowing (FEES) is as important of a swallowing evaluation as the videoflouroscopic swallow study, but far fewer speech-language pathologists are competent in its use (Ambika, Datta, Manjula, Warawantkar, & Thomas, 2019; Brady & Donzelli, 2013; Pisegna & Langmore, 2016). One hurdle in FEES training is the necessity of practicing transnasal endoscopy on volunteers. The primary aim of this study was to compare the learning effectiveness of practicing transnasal endoscopy via simulation with practice in vivo for a student’s first passes of the endoscope. The end goal of this study was to determine the most cost-effective and feasible means of teaching transnasal endoscopy to graduate clinicians. Twenty-one graduate students practiced transnasal endoscopy in one of three conditions: in vivo, high-fidelity lifelike simulation, low-fidelity non-lifelike simulation. The learning outcomes assessed were speed of endoscopy, student confidence, and simulated patients’ comfort and perception of student skill. There were no significant differences between conditions found for any of these measures. Students in all conditions became more confident after practicing endoscopy, and that confidence was predictive of procedure time. The results of this study indicate that practice with simulation may be an important first step in teaching endoscopy

Image-Based Flexible Endoscope Steering

Manually steering the tip of a flexible endoscope to navigate through an endoluminal path relies on the physician’s dexterity and experience. In this paper we present the realization of a robotic flexible endoscope steering system that uses the endoscopic images to control the tip orientation towards the direction of the lumen. Two image-based control algorithms are investigated, one is based on the optical flow and the other is based on the image intensity. Both are evaluated using simulations in which the endoscope was steered through the lumen. The RMS distance to the lumen center was less than 25% of the lumen width. An experimental setup was built using a standard flexible endoscope, and the image-based control algorithms were used to actuate the wheels of the endoscope for tip steering. Experiments were conducted in an anatomical model to simulate gastroscopy. The image intensity- based algorithm was capable of steering the endoscope tip through an endoluminal path from the mouth to the duodenum accurately. Compared to manual control, the robotically steered endoscope performed 68% better in terms of keeping the lumen centered in the image

NOViSE: a virtual natural orifice transluminal endoscopic surgery simulator

Purpose: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel technique in minimally invasive surgery whereby a flexible endoscope is inserted via a natural orifice to gain access to the abdominal cavity, leaving no external scars. This innovative use of flexible endoscopy creates many new challenges and is associated with a steep learning curve for clinicians. Methods: We developed NOViSE - the first force-feedback enabled virtual reality simulator for NOTES training supporting a flexible endoscope. The haptic device is custom built and the behaviour of the virtual flexible endoscope is based on an established theoretical framework – the Cosserat Theory of Elastic Rods. Results: We present the application of NOViSE to the simulation of a hybrid trans-gastric cholecystectomy procedure. Preliminary results of face, content and construct validation have previously shown that NOViSE delivers the required level of realism for training of endoscopic manipulation skills specific to NOTES Conclusions: VR simulation of NOTES procedures can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. In the context of an experimental technique, NOViSE could potentially facilitate NOTES development and contribute to its wider use by keeping practitioners up to date with this novel surgical technique. NOViSE is a first prototype and the initial results indicate that it provides promising foundations for further development

In-body path loss models for implants in heterogeneous human tissues using implantable slot dipole conformal flexible antennas

A wireless body area network (WBAN) consists of a wireless network with devices placed close to, attached on, or implanted into the human body. Wireless communication within a human body experiences loss in the form of attenuation and absorption. A path loss model is necessary to account for these losses. In this article, path loss is studied in the heterogeneous anatomical model of a 6-year male child from the Virtual Family using an implantable slot dipole conformal flexible antenna and an in-body path loss model is proposed at 2.45 GHz with application to implants in a human body. The model is based on 3D electromagnetic simulations and is compared to models in a homogeneous muscle tissue medium

2D Reconstruction of Small Intestine's Interior Wall

Examining and interpreting of a large number of wireless endoscopic images from the gastrointestinal tract is a tiresome task for physicians. A practical solution is to automatically construct a two dimensional representation of the gastrointestinal tract for easy inspection. However, little has been done on wireless endoscopic image stitching, let alone systematic investigation. The proposed new wireless endoscopic image stitching method consists of two main steps to improve the accuracy and efficiency of image registration. First, the keypoints are extracted by Principle Component Analysis and Scale Invariant Feature Transform (PCA-SIFT) algorithm and refined with Maximum Likelihood Estimation SAmple Consensus (MLESAC) outlier removal to find the most reliable keypoints. Second, the optimal transformation parameters obtained from first step are fed to the Normalised Mutual Information (NMI) algorithm as an initial solution. With modified Marquardt-Levenberg search strategy in a multiscale framework, the NMI can find the optimal transformation parameters in the shortest time. The proposed methodology has been tested on two different datasets - one with real wireless endoscopic images and another with images obtained from Micro-Ball (a new wireless cubic endoscopy system with six image sensors). The results have demonstrated the accuracy and robustness of the proposed methodology both visually and quantitatively.Comment: Journal draf

Electromagnetic radiation from ingested sources in the human intestine between 150 MHz and 1.2 GHz

The conventional method of diagnosing disorders of the human gastro-intestinal (GI) tract is by sensors embedded in cannulae that are inserted through the anus, mouth, or nose. However, these cannulae cause significant patient discomfort and cannot be used in the small intestine. As a result, there is considerable ongoing work in developing wireless sensors that can be used in the small intestine. The radiation characteristics of sources in the GI tract cannot be readily calculated due to the complexity of the human body and its composite tissues, each with different electrical characteristics. In addition, the compact antennas used are electrically small, making them inefficient radiators. This paper presents radiation characteristics for sources in the GI tract that should allow for the optimum design of more efficient telemetry systems. The characteristics are determined using the finite-difference time-domain method with a realistic antenna model on an established fully segmented human body model. Radiation intensity outside the body was found to have a Gaussian-form relationship with frequency. Maximum radiation occurs between 450 and 900 MHz. The gut region was found generally to inhibit vertically polarized electric fields more than horizontally polarized fields

Training in bariatric and metabolic endoscopy

The limited penetration of bariatric surgery and the scarce outcome of pharmacological therapies created a favorable space for primary bariatric endoscopic techniques. Furthermore, bariatric endoscopy is largely used to diagnose and treat surgical complications and weight regain after bariatric surgery. The increasingly essential role of endoscopy in the management of obese patients results in the need for trained professionals. Training methods are evolving, and the apprenticeship method is giving way to the simulation-based method. Existing simulation platforms include mechanical simulators, ex vivo and in vivo models, and virtual reality simulators. This review analyzes current training methods for bariatric endoscopy and available training programs with dedicated bariatric core curricula, giving a glimpse of future perspectives