Colonoscopy with robotic steering and automated lumen centralization: a feasibility study in a colon model

Background and study aims: We introduced a new platform for performing colonoscopy with robotic steering and automated lumen centralization (RS-ALC) and evaluated its technical feasibility.

Participants and methods: Expert endoscopists (n = 8) and endoscopy-naive novices (n = 10) used conventional steering and RS-ALC to perform colonoscopy in a validated colon model with simulated polyps (n = 21). The participants were randomized to which modality they were to use first. End points were the cecal intubation time, number of detected polyps, and subjective evaluation of the platform.

Results: Novices were able to intubate the cecum faster with RS-ALC (median 8 minutes [min] 56 seconds [s], interquartile range [IQR] 6 min 46 s – 16 min 34 s vs. median 11 min 47 s, IQR 8 min 19 s – 15 min 33 s, P = 0.65), whereas experts were faster with conventional steering (median 2 min 9 s, IQR 1 min 13 s – 7 min 28 s vs. median 13 min 1 s, IQR 5 min 9 s – 16 min 54 s, P = 0.12). Novices detected more polyps with RS-ALC (median 88.1 %, IQR 79.8 % – 95.2 % vs. median 78.6 %, IQR 75.0 % – 91.7 %, P = 0.17), whereas experts detected more polyps with conventional steering (median 80.9 %, IQR 76.2 % – 85.7 % vs. median 69.0 %, IQR 61.0 % – 75.0 %, P = 0.03). Novices were more positive than experts about the new platform (P = 0.02), noting an easier and faster introduction of the colonoscope with RS-ALC than with conventional steering.

Conclusions: Colonoscopy with RS-ALC is technically feasible and appears to be easier and more intuitive than conventional steering for endoscopy-naive novices.

• References

• 1 Terhaar siveDroste JS, Craanen ME, Kolkman JJ et al. Dutch endoscopic capacity in the era of colorectal cancer screening. Neth J Med 2006; 64: 371-373
• 2 Seeff LC, Richards TB, Shapiro JA et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity. . Gastroenterology 2004; 127: 1670-1677
• 3 Marshall JB. Technical proficiency of trainees performing colonoscopy: a learning curve. Gastrointest Endosc 1995; 42: 287-291
• 4 Ward ST, Mohammed MA, Walt R et al. An analysis of the learning curve to achieve competency at colonoscopy using the JETS database. Gut 2014; 63: 1746-1754
• 5 Ridtitid W, Coté GA, Leung W et al. Prevalence and risk factors for musculoskeletal injuries related to endoscopy. Gastrointest Endosc 2015; 81: 294-302
• 6 Allemann P, Ott L, Asakuma M et al. Joystick interfaces are not suitable for robotized endoscope applied to NOTES. Surg Innov 2009; 16: 111-116
• 7 Zhang SH, Wang DX, Zhang YR et al. The human machine interface implementation for the robot assisted endoscopic surgery platform. Proceedings of the 11th IEEE Workshop on Robot and Human Interactive Communication. 2002: 442-447
• 8 Reilink R, Stramigioli S, Kappers AML et al. Evaluation of flexible endoscope steering using haptic guidance. Int J Med Robotics Comput Assisted Surg 2011; 7: 178-186
• 9 Plooy AM, Hill A, Horswill MS et al. Construct validation of a physical model colonoscopy simulator. Gastrointest Endosc 2012; 76: 144-150
• 10 Gralnek IM, Carr-Locke DL, Segol O et al. Comparison of standard forward-viewing mode versus ultrawide-viewing mode of a novel colonoscopy platform: a prospective, multicenter study in the detection of simulated polyps in an in vitro colon model. Gastrointest Endosc 2013; 77: 472-479
• 11 Ruiter J, Rozeboom E, Van Der Voort M et al. Design and evaluation of robotic steering of a flexible endoscope. IEEE RAS and EMBS International Conference on Biomedical Robotics and Biomechatronics (BioRob). 2012; 761-767
• 12 Rozeboom E, Ruiter J, Franken M et al. Intuitive user interfaces increase efficiency in endoscope tip control. Surg Endosc 2014; 28: 2600-2605
• 13 Van Der Stap N, Slump CH, Broeders IAMJ et al. Image-based navigation for a robotized flexible endoscope. Computer Assisted and Robotic Endoscopy 2014; 8899: 77-87