New Robotic Technologies in Cancer Colon Screening

Colorectal cancer (CRC) is the 3rd most common cause of cancer death worldwide. Regular screening of the asymptomatic population can drastically reduce the mortality rate. CRC screening includes several proceedings although the gold standard remains optical colonoscopy (OC), which is unpleasant, causes pain and discomfort. New technologies exemplified by capsule endoscopy (CE) constitute alternative painless solutions and despite their limitations, e.g., passive locomotion and absence of on-board instrumentation, are being increasingly used for CRC screening. Research and development centres are investigating novel advanced robotic technologies for diagnostic and therapeutic use. These include wireless communication, active locomotion, sensors, diagnostic, and therapeutic instruments. This review describes the traditional OC procedure and the existing robotic technologies for CRC

A Soft Pneumatic Inchworm Double balloon (SPID) for colonoscopy

The design of a smart robot for colonoscopy is challenging because of the limited available space, slippery internal surfaces, and tortuous 3D shape of the human colon. Locomotion forces applied by an endoscopic robot may damage the colonic wall and/or cause pain and discomfort to patients. This study reports a Soft Pneumatic Inchworm Double balloon (SPID) mini-robot for colonoscopy consisting of two balloons connected by a 3 degrees of freedom soft pneumatic actuator. SPID has an external diameter of 18 mm, a total length of 60 mm, and weighs 10 g. The balloons provide anchorage into the colonic wall for a bio-inspired inchworm locomotion. The proposed design reduces the pressure applied to the colonic wall and consequently pain and discomfort during the procedure. The mini-robot has been tested in a deformable plastic colon phantom of similar shape and dimensions to the human anatomy, exhibiting efficient locomotion by its ability to deform and negotiate flexures and bends. The mini-robot is made of elastomer and constructed from 3D printed components, hence with low production costs essential for a disposable device

Advanced Colonoscopy Techniques and Technologies

Colonoscopy is the most frequently performed endoscopic procedure in the United States. It is the mainstay of diagnostic and therapeutic options for the practicing gastroenterologist. It plays a fundamental role in colorectal cancer (CRC) prevention, with a dominant position among the screening options for CRC and precancerous lesions. Over the past decade, there have been significant advances in the field of CRC and colonoscopy, including a better understanding of the importance of right-sided lesions, the sessile serrated pathway, and recognition of the significance of operator dependence in colonoscopy. This has been paralleled by an array of technological and technical advances that has transformed the field of colonoscopy and improved patient care. This article addresses the diverse and expanding field of advanced colonoscopy techniques and technologies. It is intended to be a primer on recent and effective developments in advanced technologies for screening or imaging, mucosal resection techniques, and endoscopic management of CRC

Impact of a ring fitted cap on insertion time and adenoma detection: a randomized controlled trial

Background and Aims: Devices for flattening colon folds can improve polyp detection at colonoscopy. However, there are few data on the endoscopic ring fitted cap (EndoRings, EndoAid, Caesarea, Israel). We sought to compare adenoma detection with EndoRings with that of standard high-definition colonoscopy. Methods: A single-center randomized controlled trial of 562 patients (284 randomized to EndoRings and 278 to standard colonoscopy) at 2 outpatient endoscopy units in the Indiana University Hospital system. Adenoma detection was the primary outcome measured as adenoma detection rate (ADR) and adenomas per colonoscopy (APC). We also compared sessile serrated polyp detection rate (SSPDR), insertion times, withdrawal times, and ease of passage through the sigmoid colon. Results: EndoRings was superior to standard colonoscopy in terms of APC (1.46 vs 1.06, p=0.025) but there were no statistically significant differences in ADR or SSPDR. Mean withdrawal time (in patients with no polyps) was shorter and insertion time (all patients) was longer in the EndoRings arm by 1.8 minutes and 0.75 minutes, respectively. One provider had significantly higher detection with EndoRings and contributed substantially to the overall results. Conclusions: EndoRings can increase adenoma detection without significant increase in procedure time, but the effect varies between operators. EndoRings slows colonoscope insertion

Endorobots for Colonoscopy:Design Challenges and Available Technologies

Colorectal cancer (CRC) is the second most common cause of cancer death worldwide, after lung cancer (Sung et al., 2021). Early stage detection is key to increase the survival rate. Colonoscopy remains to be the gold standard procedure due to its dual capability to optically inspect the entire colonic mucosa and to perform interventional procedures at the same time. However, this causes pain and discomfort, whereby it requires sedation or anaesthesia of the patient. It is a difficult procedure to perform that can cause damage to the colonic wall in some cases. Development of new technologies aims to overcome the current limitations on colonoscopy by using advancements in endorobotics research. The design of these advanced medical devices is challenging because of the limited space of the lumen, the contorted shape, and the long tract of the large bowel. The force applied to the colonic wall needs to be controlled to avoid collateral effects such as injuries to the colonic mucosa and pain during the procedure. This article discusses the current challenges in the colonoscopy procedure, the available locomotion technologies for endorobots used in colonoscopy at a prototype level and the commercial products available

Robotics and Artificial Intelligence in Gastrointestinal Endoscopy: Updated Review of the Literature and State of the Art

Abstract Purpose of Review Gastrointestinal endoscopy includes a wide range of procedures that has dramatically evolved over the past decades. Robotic endoscopy and artificial intelligence are expanding the horizons of traditional techniques and will play a key role in clinical practice in the near future. Understanding the main available devices and procedures is a key unmet need. This review aims to assess the current and future applications of the most recently developed endoscopy robots. Recent Findings Even though a few devices have gained approval for clinical application, the majority of robotic and artificial intelligence systems are yet to become an integral part of the current endoscopic instrumentarium. Some of the innovative endoscopic devices and artificial intelligence systems are dedicated to complex procedures such as endoscopic submucosal dissection, whereas others aim to improve diagnostic techniques such as colonoscopy. Summary A review on flexible endoscopic robotics and artificial intelligence systems is presented here, showing the m3ost recently approved and experimental devices and artificial intelligence systems for diagnosis and robotic endoscopy

Flexible Over-the-Tube Device for Soft-Tethered Colonoscopy

Soft-tethered colonoscopes were proposed for safe and effective colon navigation, yet the deployment of front-wheel actuated colonoscopes is hindered by contact interactions with the lumen along the entire soft tether. To mitigate this problem, this study introduces an over-the-tube flexible device aimed to assist colonoscope deployment. The device is composed of three pneumatically driven actuators devised to repeatedly perform a two-phase operation: (phase I) to advance along the tether up to a working position relatively close to the colonoscope’s tip; (phase II) to clamp and drag the tether forward, upon anchoring to colonic wall. This way, a distal tether portion is freed, thus reducing the aforementioned limitations and fostering effective front-wheel navigation. Considering anatomical/clinical constraints and a 2N resistive force, we designed and prototyped a system with an inner and outer diameter of 12 and 26 mm, respectively, a length of 91 mm, and operating pressures equal to 150, 50 and 15 kPa for clamping the tether, elongating the device and safely anchoring to the colonic wall, respectively. The device was successfully tested, achieving locomotion speeds up to 4.9 and 2.2 mm/s, and tether freeing rates up to 2.9 and 1.8 mm/s, in tabletop conditions and in a colon phantom, respectively

Colonoscopy: Advanced and Emerging Techniques-A Review of Colonoscopic Approaches to Colorectal Conditions.

A complete colonoscopy is key in the diagnostic and therapeutic approaches to a variety of colorectal diseases. Major challenges are incomplete polyp removal and missed polyps, particularly in the setting of a difficult colonoscopy. There are a variety of both well-established and newer techniques that have been developed to optimize polyp detection, perform complete polypectomy, and endoscopically treat various complications and conditions such as strictures and perforations. The objective of this article is to familiarize the colorectal surgeon with techniques utilized by advanced endoscopists

The impact of Endocuff Vision on adenoma detection rates in colonoscopy

Background One of the problems with colonoscopy is its imperfection due to variation in operator dependent adenoma detection rates. Low adenoma detection rates are linked to increased interval colorectal cancer rates and reduced cancer survival. Devices to enhance mucosal visualisation and improve adenoma detection rates such as Endocuff Vision have been developed. The primary aim of this study was to compare adenoma detection rates between Endocuff Vision-assisted colonoscopy and standard colonoscopy. Methods A multicentre, randomised controlled trial in seven hospitals in the United Kingdom was undertaken. Patients aged 18 and above referred for colonoscopy due to symptoms, colonoscopy surveillance, or as part of the Bowel Cancer Screening Programme following a positive screening faecal occult blood test were invited to the study. Patients with a suspicion of bowel obstruction, known colon cancer, polyposis syndromes, known strictures, active colitis, on anticoagulant therapy during the procedure, pregnant, attending for a therapeutic procedure or assessment of a known lesion were excluded. Findings One thousand, seven hundred and seventy-two patients (57% male, mean age 62) were recruited from November 2014 until February 2016. Patient characteristics were comparable between trial arms. Endocuff Vision increased adenoma detection rates by 4.7% (p=0.02). This was largely driven by an increase in adenoma detection rates in screening patients from 50.9% to 61.7% (p<0.001). Endocuff Vision-assisted colonoscopy also detected more mean adenomas per procedure, left sided adenomas, sessile serrated adenomas, diminutive adenomas, small adenomas and cancers. Cuff removal rate was 4.1%. Median intubation time was one minute quicker with Endocuff Vision- assisted colonoscopy (p=0.001). Anal intubation was rated as more uncomfortable with Endocuff Vision-assisted colonoscopy. There were no significant cuff-related adverse events. Endocuff Vision- assisted colonoscopy was non-inferior to SC in other markers of comfort and procedure time. Conclusion Endocuff Vision significantly improved ADR driven by an improvement in the faecal occult blood test positive screening population. Endocuff Vision-assisted colonoscopy was non-inferior in all aspects other than discomfort on anal intubation