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

Closed Loop Control of a Tethered Magnetic Capsule Endoscope

Magnetic field gradients have repeatedly been shown to be the most feasible mechanism for gastrointestinal capsule endoscope actuation. An inverse quartic magnetic force variation with distance results in large force gradients induced by small movements of a driving magnet; this necessitates robotic actuation of magnets to implement stable control of the device. A typical system consists of a serial robot with a permanent magnet at its end effector that actuates a capsule with an embedded permanent magnet. We present a tethered capsule system where a capsule with an embedded magnet is closed loop controlled in 2 degree-of-freedom in position and 2 degree-offreedom in orientation. Capitalizing on the magnetic field of the external driving permanent magnet, the capsule is localized in 6- D allowing for both position and orientation feedback to be used in a control scheme. We developed a relationship between the serial robot’s joint parameters and the magnetic force and torque that is exerted onto the capsule. Our methodology was validated both in a dynamic simulation environment where a custom plug-in for magnetic interaction was written, as well as on an experimental platform. The tethered capsule was demonstrated to follow desired trajectories in both position and orientation with accuracy that is acceptable for colonoscopy

Nonholonomic Closed-loop Velocity Control of a Soft-tethered Magnetic Capsule Endoscope

In this paper, we demonstrate velocity-level closedloop control of a tethered magnetic capsule endoscope that is actuated via serial manipulator with a permanent magnet at its end-effector. Closed-loop control (2 degrees-of-freedom in position, and 2 in orientation) is made possible with the use of a real-time magnetic localization algorithm that utilizes the actuating magnetic field and thus does not require additional hardware. Velocity control is implemented to create smooth motion that is clinically necessary for colorectal cancer diagnostics. Our control algorithm generates a spline that passes through a set of input points that roughly defines the shape of the desired trajectory. The velocity controller acts in the tangential direction to the path, while a secondary position controller enforces a nonholonomic constraint on capsule motion. A soft nonholonomic constraint is naturally imposed by the lumen while we enforce a strict constraint for both more accurate estimation of tether disturbance and hypothesized intuitiveness for a clinician’s teleoperation. An integrating disturbance force estimation control term is introduced to predict the disturbance of the tether. This paper presents the theoretical formulations and experimental validation of our methodology. Results show the system’s ability to achieve a repeatable velocity step response with low steady-state error as well as ability of the tethered capsule to maneuver around a bend

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

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 the feasibility of measuring the resistant force in opposition to magnetic propulsion of a wireless capsule

Autonomous Retroflexion of a Magnetic Flexible Endoscope

Retroflexion during colonoscopy is typically only practiced in the wider proximal and distal ends of the large intestine owing to the stiff nature of the colonoscope. This inability to examine the proximal side of the majority of colon folds contributes to today's suboptimal colorectal cancer detection rates. We have developed an algorithm for autonomous retroflexion of a flexible endoscope that is actuated magnetically from the tip. The magnetic wrench applied on the tip of the endoscope is optimized in real time with data from pose detection to compute motions of the actuating magnet. This is the first example of a completely autonomous maneuver by a magnetic endoscope for exploration of the gastrointestinal tract. The proposed approach was validated in plastic tubes of various diameters with a success rate of 98.8% for separation distances up to 50 mm. Additionally, a set of trials was conducted in an excised porcine colon observing a success rate of 100% with a mean time of 19.7 s. In terms of clinical safety, the maximum stress that is applied on the colon wall with our methodology is an order of magnitude below what would damage tissue

A Compression Valve for Sanitary Control of Fluid-Driven Actuators

With significant research focused on integrating robotics into medical devices, sanitary control of pressurizing fluids in a precise, accurate, and customizable way is highly desirable. Current sanitary flow control methods include pinch valves which clamp the pressure line locally to restrict fluid flow; resulting in damage and variable flow characteristics over time. This article presents a sanitary compression valve based on an eccentric clamping mechanism. The proposed valve distributes clamping forces over a larger area, thereby reducing the plastic deformation and associated influence on flow characteristic. Using the proposed valve, significant reductions in plastic deformation (up to 96%) and flow-rate error (up to 98%) were found, when compared with a standard pinch valve. Additionally, an optimization strategy presents a method for improving linearity and resolution over the working range to suit specific control applications. The valve efficacy has been evaluated through controlled testing of a water jet-propelled low-cost endoscopic device. In this case, use of the optimized valve shows a reduction in the average orientation error and its variation, resulting in smoother movement of the endoscopic tip when compared to alternative wet and dry valve solutions. The presented valve offers a customizable solution for sanitary control of fluid-driven actuators

A disposable continuum endoscope using piston-driven parallel bellow actuator

This paper presents a novel low cost disposable continuum endoscope based on a piston-driven parallel bellow actuator design. The parallel bellow actuator achieves motion by being pressurized via displacement-controlled pistons. The displacements are generated by rack-and-pinion mechanisms using inexpensive stepper motors. The design concept provides a potential alternative solution to upper gastrointestinal (UGI) diagnosis. The modularity and the use of inexpensive components allow for low fabrication costs and disposability. The use of robotic assistance could facilitate the development of an easier interface for the gastroenterologists, avoiding the nonintuitive manipulation mapping of the traditional UGI endoscopes. We adapt existing kinematic solutions of multi-backbone continuum robots to model continuum parallel bellow actuators. An actuation compensation strategy is presented and validated to address the pneumatic compressibility through the transmission lines. The design concept was prototyped and tested with a custom control platform. The experimental validation shows that the actuation compensation was demonstrated to significantly improve orientation control of the endoscope end-effector. This paper shows the feasibility of the proposed design and lays the foundation toward clinical scenarios

Sensorless Estimation of the Planar Distal Shape of a Tip-Actuated Endoscope

Traditional endoscopes consist of a flexible body and a steerable tip with therapeutic capability. Although prior endoscopes have relied on operator pushing for actuation, recent robotic concepts have relied on the application of a tip force for guidance. In such case, the body of the endoscope can be passive and compliant; however, the body can have significant effect on mechanics of motion and may require modeling. As the endoscope body's shape is often unknown, we have developed an estimation method to recover the approximate distal shape, local to the endoscope's tip, where the tip position and orientation are the only sensed parameters in the system. We leverage a planar dynamic model and extended Kalman filter to obtain a constant-curvature shape estimate of a magnetically guided endoscope. We validated this estimator in both dynamic simulations and on a physical platform. We then used this estimate in a feed-forward control scheme and demonstrated improved trajectory following. This methodology can enable the use of inverse-dynamic control for the tip-based actuation of an endoscope, without the need for shape sensing

Teleoperation and Contact Detection of a Waterjet-Actuated Soft Continuum Manipulator for Low-Cost Gastroscopy

Gastric cancer is the third leading cause of cancer deaths worldwide, with most new cases occurring in low and middle income countries, where access to screening programs is hindered by the high cost of conventional endoscopy. The waterjet-actuated HydroJet endoscopic platform was developed as a low-cost, disposable alternative for inspection of the gastric cavity in low-resource settings. In this work, we present a teleoperation scheme and contact detection algorithm that work together to enable intuitive teleoperation of the HydroJet within the confined space of the stomach. Using a geometrically accurate stomach model and realistic anatomical inspection targets, we demonstrate that, using these methods, a novice user can complete a gastroscopy in approximately the same amount of time with the HydroJet as with a conventional endoscope

A Platform for Gastric Cancer Screening in Low- and Middle-Income Countries

Gastric cancer is the second leading cause of cancer death worldwide and screening programs have had a significant impact on reducing mortality. The majority of cases occur in low- and middle-income countries (LMIC), where endoscopy resources are traditionally limited. In this paper, we introduce a platform designed to enable inexpensive gastric screening to take place in remote areas of LMIC. The system consists of a swallowable endoscopic capsule connected to an external water distribution system by a multichannel soft tether. Pressurized water is ejected from the capsule to orient the view of the endoscopic camera. After completion of a cancer screening procedure, the outer shell of the capsule and the soft tether can be disposed, while the endoscopic camera is reclaimed without needing further reprocessing. The capsule, measuring 12 mm in diameter and 28 mm in length, is able to visualize the inside of the gastric cavity by combining waterjet actuation and the adjustment of the tether length. Experimental assessment was accomplished through a set of bench trials, ex vivo analysis, and in vivo feasibility validation. During the ex vivo trials, the platform was able to visualize the main landmarks that are typically observed during a gastric cancer screening procedure in less than 8 min. Given the compact footprint, the minimal cost of the disposable parts, and the possibility of running on relatively available and inexpensive resources, the proposed platform can potentially widen gastric cancer screening programs in LMIC