Using robotic assistance to make colonoscopy kinder and easier

Date:
October 12, 2020
Source:
University of Leeds
Summary:
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.



FULL STORY ========================================================================== 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 -- '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 today (Monday, 12 October) in the scientific
journal Nature Machine Intelligence.

Patient trials using the system could begin next year or in early 2022.



========================================================================== Pietro Valdastri, Professor of Robotics and Autonomous Systems at Leeds,
is supervising the research. He said: "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 we have developed is a system that is easier for doctors or nurses
to operate and is less painful for patients. It marks an important a 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.

Magnetic flexible colonoscope 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. This latest research evaluated
how effective the different levels of robotic assistance were in aiding non-specialist staff to carry out the procedure.

Levels of robotic assistance Direct robot control. This is where the
operator has direct control of the robot via a joystick. In this case,
there is no assistance.

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.

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.

James Martin, a PhD researcher from the University of Leeds who co-led
the study, said: "Operating the robotic arm is challenging. It is not
very intuitive and that has put a brake on the development of magnetic
flexible colonoscopes.

"But we have demonstrated for the first time that it is possible to
offload that function to the robotic system, leaving the operator to
think about the clinical task they are undertaking -- and it is making
a measurable difference in human performance." 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.

Dr Bruno Scaglioni, a Postdoctoral Research Fellow at Leeds and co-leader
of the study, added: "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."

========================================================================== Story Source: Materials provided by University_of_Leeds. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. James W. Martin, Bruno Scaglioni, Joseph C. Norton, Venkataraman
Subramanian, Alberto Arezzo, Keith L. Obstein, Pietro
Valdastri. Enabling the future of colonoscopy with intelligent
and autonomous magnetic manipulation. Nature Machine Intelligence,
2020; DOI: 10.1038/s42256-020- 00231-9 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/10/201012152055.htm

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