Abstract
Background
Previous reports have described several candidates, which have the potential to replace colonoscopy, but to date, there is still no device capable of fully replacing flexible colonoscopy in the management of colonic disorders and for mass adult population screening for asymptomatic colorectal cancer.
Materials and methods
NASA developed the TRL methodology to describe and define the stages of development before use and marketing of any device. The definitions of the TRLS used in the present review are those formulated by “The US Department of Defense Technology Readiness Assessment Guidance” but adapted to micro-robots for colonoscopy. All the devices included are reported in scientific literature. They were identified by a systematic search in Web of Science, PubMed and IEEE Xplore amongst other sources. Devices that clearly lack the potential for full replacement of flexible colonoscopy were excluded.
Assessment of the current situation
The technological salient features of all the devices included for assessment are described briefly, with particular focus on device propulsion. The devices are classified according to the TRL criteria based on the reported information. An analysis is next undertaken of the characteristics and salient features of the devices included in the review: wireless/tethered devices, data storage–transmission and navigation, additional functionality, residual technology challenges and clinical and socio-economical needs.
Conclusions
Few devices currently possess the required functionality and performance to replace the conventional colonoscopy. The requirements, including functionalities which favour the development of a micro-robot platform to replace colonoscopy, are highlighted.
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Notes
Website: http://www.capsovision.com/index.php/capsocam.html (accessed on 6 May 2015).
RF systems http://rfsystemlab.com/en/sayaka/ (Accessed on 6 May 2015).
Based on WHO Core medical equipment Tech. rep. Original data: 25000-41000 USD, exchange rate to GBP of 1 September 2014.
References
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin D, Forman D, Bray F (2013) F. GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase no. 11 [internet]. Technical report, International Agency for Research on Cancer, Lyon, France
Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, Evans JA, Fanelli RD, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Sharaf RN, Shergill AK, Dominitz JA (2011) Complications of colonoscopy. Gastrointest Endosc 74(4):745–752
Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L (2009) Association of colonoscopy and death from colorectal cancer. Ann Intern Med 150(1):1–8
Harewood G (2005) Relationship of colonoscopy completion rates and endoscopist features. Dig Dis Sci 50(1):47–51
Hewett DG, Rex DK (2011) Miss rate of right-sided colon examination during colonoscopy defined by retroflexion: an observational study. Gastrointest Endosc 74(2):246–252
Brenner H, Chang-Claude J, Seiler CM, Stürmer T, Hoffmeister M (2007) Potential for colorectal cancer prevention of sigmoidoscopy versus colonoscopy: population-based case control study. Cancer Epidemiol Biomark Prev 16(3):494–499. doi:10.1158/1055-9965.epi-06-0460
Tran A, Man Ngor E, Wu BU (2014) Surveillance colonoscopy in elderly patients: a retrospective cohort study. JAMA Intern Med 174(10):1675–1682
AXA PPP Healthcare (2014) Attitudes to bowel cancer screening research results. AXA PPP Healthcare
Cheng WB, Moser MA, Kanagaratnam S, Zhang WJ (2012) Overview of upcoming advances in colonoscopy. Dig Endosc 24(1):1–6
Cosentino F, Tumino E, Passoni G, Rigante A, Barbera R, Tauro A, Cosentino P (2011) Robotic colonoscopy. In: Colonoscopy. Intech open, pp 291–308
Forgione A (2009) In vivo microrobots for natural orifice transluminal surgery. Current status and future perspectives. Surg Oncol 18(2):121–129
Obstein KL, Valdastri P (2013) Advanced endoscopic technologies for colorectal cancer screening. World J Gastroenterol 19(4):431–439
Patel N, Darzi A, Teare J (2014) The endoscopy evolution: ‘the superscope era’. Frontline Gastroenterol. doi:10.1136/flgastro-2014-100448
Saxena P, Khashab MA (2013) New platforms and devices in colonoscopy. Gastroenterol Clin N Am 42(3):671–688
Valdastri P, Simi M, Webster RJ III (2012) Advanced technologies for gastrointestinal endoscopy. Annu Rev Biomed Eng 14:397–429
Vemulapalli KC, Rex DK (2011) Evolving techniques in colonoscopy. Curr Opin Gastroenterol 27(5):430–438. doi:10.1097/MOG.0b013e328349cfc0
Vitiello V, Su-Lin L, Cundy TP, Guang-Zhong Y (2013) Emerging robotic platforms for minimally invasive surgery. IEEE Rev Biomed Eng 6:111–126
ASDRE (2011) Technology Readiness Assessment (TRA) guidance. US Department of Defense, Assistant Secretary of Defense for Research and Engineering
RDDRE (2009) Technology Readiness Assessment (TRA) desk book. US Department of Defense, Research Directorate and Defense Research and Engineering
Breedveld P (2006) Development of a Rolling Stent Endoscope. In: The first IEEE/RAS-EMBS international conference on biomedical robotics and biomechatronics. BioRob 2006, 20–22 February 2006. pp 921–926. doi:10.1109/BIOROB.2006.1639209
Trovato G, Shikanai M, Ukawa G, Kinoshita J, Murai N, Lee JW, Ishii H, Takanishi A, Tanoue K, Ieiri S, Konishi K, Hashizume M (2010) Development of a colon endoscope robot that adjusts its locomotion through the use of reinforcement learning. Int J Comput Assist Radiol Surg 5(4):317–325
Zhou H, Alici G, Than TD, Li W (2013) Modeling and experimental characterization of propulsion of a spiral-type microrobot for medical use in gastrointestinal tract. IEEE Trans Biomed Eng 60(6):1751–1759. doi:10.1109/TBME.2012.2228001
Sliker L, Kern M, Schoen J, Rentschler M (2012) Surgical evaluation of a novel tethered robotic capsule endoscope using micro-patterned treads. Surg Endosc 26(10):2862–2869
Kim D, Lee D, Joe S, Lee BI, Kim B (2014) The flexible caterpillar based robotic colonoscope actuated by an external motor through a flexible shaft. J Mech Sci Technol 28(11):4415–4420. doi:10.1007/s12206-014-1009-2
Rösch T, Adler A, Pohl H, Wettschureck E, Koch M, Wiedenmann B, Hoepffner N (2008) A motor-driven single-use colonoscope controlled with a hand-held device: a feasibility study in volunteers. Gastrointest Endosc 67(7):1139–1146
Pourghodrat A, Dehghani H, Nelson CA, Oleynikov D, Dasgupta P, Terry BS (2014) Disposable fluidic self-propelling robot for colonoscopy. J Med Devices 8(3):030931. doi:10.1115/1.4027076
Shike M, Fireman Z, Eliakim R, Segol O, Sloyer A, Cohen LB, Goldfarb-Albak S, Repici A (2008) Sightline ColonoSight system for a disposable, power-assisted, non-fiber-optic colonoscopy (with video). Gastrointest Endosc 68(4):701–710
Kim HM, Yang S, Kim J, Park S, Cho JH, Park JY, Kim TS, Yoon E-S, Song SY, Bang S (2010) Active locomotion of a paddling-based capsule endoscope in an in vitro and in vivo experiment (with videos). Gastrointest Endosc 72(2):381–387
Quirini M, Menciassi A, Scapellato S, Dario P, Rieber F, Ho C-N, Schostek S, Schurr MO (2008) Feasibility proof of a legged locomotion capsule for the GI tract. Gastrointest Endosc 67(7):1153–1158
Buselli E, Pensabene V, Castrataro P, Valdastri P, Menciassi A, Dario P (2010) Evaluation of friction enhancement through soft polymer micro-patterns in active capsule endoscopy. Meas Sci Technol 21(10):105802. doi:10.1088/0957-0233/21/10/105802
Karagozler ME, Cheung E, Kwon J, Sitti M (2006) Miniature endoscopic capsule robot using biomimetic micro-patterned adhesives. In: Proceedings of the first IEEE/RAS-EMBS international conference on biomedical robotics and biomechatronics, 2006. BioRob 2006, pp 105–111. doi:10.1109/BIOROB.2006.1639068
Dodou D, Girard D, Breedveld P, Wieringa PA (2005) Intestinal locomotion by means of mucoadhesive films. In: Proceedings of the 12th International conference on Advanced robotics, ICAR ‘05. 18–20 July 2005, pp 352–359. doi:10.1109/ICAR.2005.1507435
Chen W, Yan G, Wang Z, Jiang P, Liu H (2014) A wireless capsule robot with spiral legs for human intestine. Int J Med Robotics Comput Assist Surg 10(2):147–161. doi:10.1002/rcs.1520
Kim L, Tang SC, Yoo SS (2013) Prototype modular capsule robots for capsule endoscopies. In: International conference on control, automation and systems, pp 350–354. doi:10.1109/ICCAS.2013.6703922
Tumino E, Sacco R, Bertini M, Bertoni M, Parisi G, Capria A (2010) Endotics system vs colonoscopy for the detection of polyps. World J gastr 16(43):5452–5456
Sangok S, Onal CD, Kyu-Jin C, Wood RJ, Rus D, Sangbae K (2013) Meshworm: a peristaltic soft robot with antagonistic nickel titanium coil actuators. IEEE/ASME Trans Mechatron 18(5):1485–1497
Chiel HJ, Quinn RD, Beer RD, Mangan ED (2004) Peristaltically self-propelled endoscopic device. US Patent 6764441, 20 July 2004
Yanagida T, Adachi K, Yokojima M, Nakamura T (2012) Development of a peristaltic crawling robot attached to a large intestine endoscope using bellows-type artificial rubber muscles. In: IEEE/RSJ international conference on intelligent robots and systems (IROS), 7–12 October, pp 2935–2940
Dodou D, Breedveld P, Wieringa PA (2006) Stick, unstick, restick sticky films in the colon. Minim Invasive Ther Allied Technol 15(5):286–295. doi:10.1080/13645700600929144
Byungkyu K, Sukho P, Chang Yeol J, Yoon S-J (2005) An earthworm-like locomotive mechanism for capsule endoscopes. In: IEEE/RSJ international conference on, Intelligent robots and systems (IROS 2005).2–6 Augest, 2005. pp 2997–3002
Mosse CA, Mills TN, Appleyard MN, Kadirkamanathan SS, Swain CP (2001) Electrical stimulation for propelling endoscopes. Gastrointest Endosc 54(1):79–83
Valdastri P, Ciuti G, Verbeni A, Menciassi A, Dario P, Arezzo A, Morino M (2012) Magnetic air capsule robotic system: proof of concept of a novel approach for painless colonoscopy. Surg Endosc 26(5):1238–1246
Ghanbari A, Chang PH, Nelson BJ, Choi H (2014) Electromagnetic steering of a magnetic cylindrical microrobot using optical feedback closed-loop control. Int J Optomechatron 8(2):129–145
Morita E, Ohtsuka N, Shindo Y, Nouda S, Kuramoto T, Inoue T, Murano M, Umegaki E, Higuchi K (2010) In vivo trial of a driving system for a self-propelling capsule endoscope using a magnetic field (with video). Gastrointest Endosc 72(4):836–840
Qinxue P, Shuxiang G, Desheng L (2009)Development of a paddling type of microrobot for biomedical application. In: IEEE international conference on Robotics and biomimetics (ROBIO), 19–23 December, 2009 pp 888–893
Kosa G, Jakab P, Szekely G, Hata N (2012) MRI driven magnetic microswimmers. Biomed Microdevices 14(1):165–178
De Falco I, Tortora G, Dario P, Menciassi A (2014) An integrated system for wireless capsule endoscopy in a liquid-distended stomach. IEEE Trans Biomed Eng 61(3):794–804
Vucelic B, Rex D, Pulanic R, Pfefer J, Hrstic I, Levin B, Halpern Z, Arber N (2006) The aer-o-scope: proof of concept of a pneumatic, skill-independent, self-propelling, self-navigating colonoscope. Gastroenterology 130(3):672–677
Swain CP, Mosse CA, Bell GD, Mills TN (1998) Endoscopic technology: water jet propelled colonoscopy—a new method of endoscope propulsion. Gastrointest endosc 47(4):AB40. doi:10.1016/S0016-5107(98)70281-0
Adler SN, Metzger YC (2011) PillCam COLON capsule endoscopy: recent advances and new insights. Ther Adv Gastroenterol 4(4):265–268
Woods SP, Constandinou TG (2013) Wireless capsule endoscope for targeted drug delivery: mechanics and design considerations. IEEE Trans Biomed Eng 60(4):945–953. doi:10.1109/TBME.2012.2228647
McCaffrey C, Chevalerias O, O’Mathuna C, Twomey K (2008) Swallowable-capsule technology. IEEE Pervasive Comput 7(1):23–29
Chen W, Yan G, Wang Z, Jiang P, Liu H (2014) A wireless capsule robot with spiral legs for human intestine. Int J Med Robotics Comput Assist Surg 10(2):147–161
Thomann G, Chen G, Redarce T (2008) Design and control of an autonomous bendable tip for colonoscopy. J Micro-Nano Mechatron 4(3):103–114
Chen G, Pham MT, Redarce T (2006) Development and kinematic analysis of a silicone-rubber bending tip for colonoscopy. In: IEEE/RSJ international conference on Intelligent robots and systems 2006, IEEE, pp 168–173
Loeve AJ, Bosma JH, Breedveld P, Dodou D, Dankelman J (2010) Polymer rigidity control for endoscopic shaft-guide ‘Plastolock’—a feasibility study. J Med Devices 4(4):045001. doi:10.1115/1.4002494
Breedveld P, Hirose S (2004) Design of steerable endoscopes to improve the visual perception of depth during laparoscopic surgery. J Mech Des 126(1):2–5. doi:10.1115/1.1637658
Haber G, Whalen LK (2006) A prospective study to evaluate the ShapeLock™ guide to enable complete colonoscopy in previously failed cases. Gastrointest Endosc 63(5):AB226
Striegel J, Jakobs R, Van Dam J, Weickert U, Riemann JF, Eickhoff A (2011) Determining scope position during colonoscopy without use of ionizing radiation or magnetic imaging: the enhanced mapping ability of the NeoGuide Endoscopy System. Surg Endosc 25(2):636–640
Natali CD, Beccani M, Obstein KL, Valdastri P (2014) A wireless platform for in vivo measurement of resistance properties of the gastrointestinal tract. Physiol Meas 35(7):1197
Kim HM, Kim YJ, Kim HJ, Park S, Park JY, Shin SK, Cheon JH, Lee SK, Lee YC, Park SW, Bang S, Song SY (2010) A pilot study of sequential capsule endoscopy using MiroCam and PillCam SB devices with different transmission technologies. Gut Liver 4(2):192–200
Mylonaki M, Fritscher-Ravens A, Swain P (2003) Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding. Gut 52(8):1122–1126. doi:10.1136/gut.52.8.1122
Rokkas T, Papaxoinis K, Triantafyllou K, Ladas SD (2010) A meta-analysis evaluating the accuracy of colon capsule endoscopy in detecting colon polyps. Gastrointest Endosc 71(4):792–798
Acknowledgments
This work was funded by the European Research Council (ERC) Grant: CODIR: colonic disease investigation by robotic hydro-colonoscopy (ERC-AG-268519) to Prof. A. Cuschieri (University of Dundee) and Prof Anne Neville (University of Leeds).
Disclosures
Silvia C. Tapia-Siles, Stuart Coleman and Alfred Cuschieri have no conflict of interest or financial ties to disclose.
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Tapia-Siles, S.C., Coleman, S. & Cuschieri, A. Current state of micro-robots/devices as substitutes for screening colonoscopy: assessment based on technology readiness levels. Surg Endosc 30, 404–413 (2016). https://doi.org/10.1007/s00464-015-4263-1
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DOI: https://doi.org/10.1007/s00464-015-4263-1