Integration of robotic in the reprocessing and transfer of endoscopes

Abstract

Background and study aims Optimal hygiene is crucial for patients undergoing flexible endoscopy. Reprocessing is currently influenced by manual procedures performed by endoscopy staff. To overcome this limitation, we designed and evaluated the integration of robotic application for an automated endoscope processing pathway.

Methods We used an endoscope reprocessing pass through machine with drying cabinet and a Franka Emika Panda robot. The robot was programmed to interact with its environment in a compliant way, guaranteeing desired contact force thresholds and therefore ensuring safety of both robot and medical equipment.

Results In an initial phase we tested the robots’ ability to handle a modified tray holding an endoscope as well as certain challenges (correct positioning, connection of tubing, undesired collisions). We added another Panda robot arm resulting in a device featuring two independent manipulators and tested the accuracy of each individual step.

We evaluated 50 consecutive processing and transfer procedures, simulating the average daily throughput of an endoscopic unit. The endoscopes were removed in adapted tray using a specially designed lifting device and placed in an endoscope storage and venting cabinet. The mean time for the handling of the scope was 104.2 ± 1.2 seconds and an accuracy of 100 % (0 failures in 50 attempts) was achieved.

Conclusions To the best of our knowledge, this is the first description and evaluation of an automated compliant robotic assistance in the processing of endoscopes. Further development could help to overcome shortcomings of the man handled endoscope processing and could lead to reproducible, standardized and certified endoscope processing.

Publikationsverlauf

Eingereicht: 01. Juni 2021

Angenommen nach Revision: 26. November 2021

Artikel online veröffentlicht:
18. Juli 2022

• References

• 1 Aumeran C, Poincloux L, Souweine B. et al. Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy 2010; 42: 895-899
• 2 Azimirad M, Alebouyeh M, Sadeghi A. et al. Bioburden and transmission of pathogenic bacteria through elevator channel during endoscopic retrograde cholangiopancreatography: application of multiple-locus variable-number tandem-repeat analysis for characterization of clonal strains. Expert Rev Med Devices 2019; 16: 413-420
• 3 Rauwers AW, Voor In 't Holt AF, Buijs JG. et al. High prevalence rate of digestive tract bacteria in duodenoscopes: a nationwide study. Gut 2018; 67: 1637-1645
• 4 Rauwers AW, Vos MC, Poley JW. et al. [Outbreaks related to contaminated duodenoscopes: causes and solutions]. Ned Tijdschr Geneeskd 2016; 160: D458
• 5 Classen DC, Jacobson JA, Burke JP. et al. Serious Pseudomonas infections associated with endoscopic retrograde cholangiopancreatography. Am J Med 1988; 84: 590-596
• 6 Kovaleva J, Meessen NE, Peters FT. et al. Is bacteriologic surveillance in endoscope reprocessing stringent enough?. Endoscopy 2009; 41: 913-916
• 7 Balan GG, Rosca I, Ursu EL. et al. Duodenoscope-associated infections beyond the elevator channel: alternative causes for difficult reprocessing. Molecules 2019;
• 8 Jung M, Beilenhoff U. Hygiene: The looming Achilles heel in endoscopy. Visc Med 2016; 32: 21-28
• 9 Beilenhoff U, Biering H, Blum R. et al. ESGE-ESGENA technical specification for process validation and routine testing of endoscope reprocessing in washer-disinfectors according to EN ISO 15883, parts 1, 4, and ISO/TS 15883-5. Endoscopy 2017; 49: 1262-1275
• 10 Denzer U, Beilenhoff U, Eickhoff A. et al. [S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no.021-022]. Z Gastroenterol 2015; 53: 1496-1530
• 11 Krinko. Anforderungen an die Hygiene bei der Aufbereitung von Medizinprodukten. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI) und des Bundesinstitutes für Arzneimittel und Medizinprodukte (BfArM). Bundesgesetzbl; 2012 55
• 12 Albu-Schäfer AO, Hirzinger G. A unified passivity-based control framework for position, torque and impedance control of flexible joint robots. The International Journal of Robotics Research 2007; 26: 23-39
• 13 DGKH. Hygienisch-mikrobiologische Überprüfung von flexiblen Endoskopen nach ihrer Aufbereitung. Hyg Med 2010; 35: 75-79
• 14 Bader L, Blumenstock G, Birkner B. et al. [HYGEA (Hygiene in gastroenterology – flexible endoscopes in hospitals and in the practice setting]. Z Gastroenterol 2002; 40: 157-170
• 15 Beilenhoff U, Biering H, Blum R. et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – Update 2018. Endoscopy 2018; 50: 1205-1234
• 16 Donskey CJ, Yowler M, Falck-Ytter Y. et al. A case study of a real-time evaluation of the risk of disease transmission associated with a failure to follow recommended sterilization procedures. Antimicrob Resist Infect Control 2014; 3: 4
• 17 Muthusamy VR, Bruno MJ, Kozarek RA. et al. Clinical evaluation of a single-use duodenoscope for endoscopic retrograde cholangiopancreatography. Clin Gastroenterol Hepatol 2019;
• 18 Rutala WA, Weber DJ. Gastrointestinal endoscopes: a need to shift from disinfection to sterilization?. JAMA 2014; 312: 1405-1406