Scientists have made a breakthrough in their work to develop semi-autonomous colonoscopy,
using a robot to guide a medical device into the body.
The milestone brings closer the prospect of an intelligent robotic system being able to
guide instruments to precise locations in the body to take biopsies or allow internal
tissues to be examined.
A doctor or nurse would still be on hand to make clinical decisions but the demanding
task of manipulating the device is offloaded to a robotic system.
The latest findings titled- 'Enabling the future of colonoscopy with intelligent and
autonomous magnetic manipulation' - is the culmination of 12 years of research by an
international team of scientists led by the University of Leeds.
The research is published in the scientific journal Nature Machine Intelligence.
Patient trials using the system could begin next year or in early 2022.
Colonoscopy gives doctors a window into the world hidden deep inside the human body and
it provides a vital role in the screening of diseases such as colorectal cancer.
But the technology has remained relatively unchanged for decades.
What the researchers have developed is a system that is easier for doctors or nurses to operate
and is less painful for patients.
It marks an important step in the move to make colonoscopy much more widely available
- essential if colorectal cancer is to be identified early.
Because the system is easier to use, the scientists hope this can increase the number of providers
who can perform the procedure and allow for greater patient access to colonoscopy.
A colonoscopy is a procedure to examine the rectum and colon.
Conventional colonoscopy is carried out using a semi-flexible tube which is inserted into
the anus, a process some patients find so painful they require an anaesthetic.
The research team has developed a smaller, capsule-shaped device which is tethered to
a narrow cable and is inserted into the anus and then guided into place - not by the doctor
or nurse pushing the colonoscope but by a magnet on a robotic arm positioned over the
patient.
The robotic arm moves around the patient as it manoeuvres the capsule.
The system is based on the principle that magnetic forces attract and repel.
The magnet on the outside of the patient interacts with tiny magnets in the capsule inside the
body, navigating it through the colon.
The researchers say it will be less painful than having a conventional colonoscopy.
Guiding the robotic arm can be done manually but it is a technique that is difficult to
master.
In response, the researchers have developed different levels of robotic assistance like,
Direct robot control, Intelligent endoscope teleoperation and Semi-autonomous navigation.
In case of Direct robot control, the operator has direct control of the robot via a joystick.
In this case, there is no assistance.
In case of Intelligent endoscope teleoperation, the operator focuses on where they want the
capsule to be located in the colon, leaving the robotic system to calculate the movements
of the robotic arm necessary to get the capsule into place.
And, in case of Semi-autonomous navigation, the robotic system autonomously navigates
the capsule through the colon, using computer vision - although this can be overridden by
the operator.
During a laboratory simulation, 10 non-expert staff were asked to get the capsule to a point
within the colon within 20 minutes.
They did that five times, using the three different levels of assistance.
Using direct robot control, the participants had a 58% success rate.
That increased to 96% using intelligent endoscope teleoperation - and 100% using semi-autonomous
navigation.
In the next stage of the experiment, two participants were asked to navigate a conventional colonoscope
into the colon of two anaesthetised pigs - and then to repeat the task with the magnet-controlled
robotic system using the different levels of assistance.
A vet was in attendance to ensure the animals were not harmed.
The participants were scored on the NASA Task Load Index, a measure of how taxing a task
was, both physically and mentally.
The NASA Task Load Index revealed that they found it easier to operate the colonoscope
with robotic assistance.
A sense of frustration was a major factor in operating the conventional colonoscope
and where participants had direct control of the robot.
The techniques developed to conduct colonoscopy examinations could be applied to other endoscopic
devices, such as those used to inspect the upper digestive tract or lungs.
Robot-assisted colonoscopy has the potential to revolutionize the way the procedure is
carried out.
It means people conducting the examination do not need to be experts in manipulating
the device.
That will hopefully make the technique more widely available, where it could be offered
in clinics and health centres rather than hospitals.