The first wireless camera pills created a revolutionary new perspective for engineers and physicians, demonstrating for the first time the feasibility of achieving medical objectives deep within the human body from a swallowable, wireless platform. The approximately 10 years since the first camera pill has been a period of great innovation in swallowable medical devices. Many modules and integrated systems have been devised to enable and enhance the diagnostic and even robotic capabilities of capsules working within the gastrointestinal (GI) tract. This article begins by reviewing the motivation and challenges of creating devices to work in the narrow, winding, and often inhospitable GI environment. Then the basic modules of modern swallowable wireless capsular devices are described, and the state of the art in each is discussed. This article is concluded with a perspective on the future potential of swallowable medical devices to enable advanced diagnostics beyond the capability of human visual perception, and even to directly deliver surgical tools and therapy non-invasively to interventional sites deep within the GI tract.

Abstract-This paper describes a novel solution for the active locomotion of a miniaturized endoscopic capsule in the gastrointestinal (GI) tract. The authors present the design, development, and testing of a wireless endocapsule with hybrid locomotion, where hybrid locomotion is defined as the combination between internal actuation mechanisms and external magnetic dragging. The capsule incorporates an internal actuating legged mechanism, which modifies the capsule profile, and small permanent magnets, which interact with an external magnetic field, thus imparting a dragging motion to the device. The legged mechanism is actuated whenever the capsule gets lodged in collapsed areas of the GI tract. This allows modification of the capsule profile and enables magnetic dragging to become feasible and effective once again. A key component of the endoscopic pill is the internal mechanism, endowed with a miniaturized brushless motor and featuring compact design, and adequate mechanical performance. The internal mechanism is able to generate a substantial force, which allows the legs to open against the intestinal tissue that has collapsed around the capsule body. An accurate simulation of the performance of the miniaturized motor under magnetic fields was carried out in order to define the best configuration of the internal permanent magnets (which are located very close to the motor) and the best tradeoff operating distance for the external magnet, which is responsible for magnetically dragging the capsule. Finally, a hybrid capsule was developed generating 3.8 N at the tip of the legged mechanism and a magnetic link force up to 135 mN. The hybrid capsule and its wireless control were extensively tested in vitro, ex vivo, and in vivo, thus confirming fulfilment of the design specifications and demonstrating a good ability to manage collapsed areas of the intestinal tract.

In this paper, the authors present an innovative vision platform for laparoendoscopic single-site (LESS) surgery based on a wired and magnetically activated 5-degrees-of-freedom robot with stereovision. The stereoscopic vision module, developed using two off-the-shelf cameras and a light emitting diodes lighting system, is mounted on the robot tip. An autostereoscopic screen is adopted to display the surgical scenario as an alternative to 3-D helmets or polarizing glasses. A rough position of the stereocamera can be determined along the abdominal wall by dragging the robot with a set of external permanent magnets (EPMs). Once the camera is set in the desired position, the EPMs provide fixation, while the internal mechanism allows fine tilt adjustment. Considering the deformable round shape of the insufflated abdomen wall and in order to replicate the precise roll motion usually provided by the endoscopist's hands, this prototype embeds an actuated mechanism that adjusts the stereocamera horizon and thus prevents any visual discomfort. Finally, the platform was preliminarily tested in vivo in a LESS scenario, demonstrating its advantages for eliminating potential conflicts with the operative tools and enabling the introduction of an additional instrument through the same access port used for stereoscopic vision.

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The novel concept of Trans-abdominal Active Magnetic Linkage for laparoendoscopic single site surgery has the potential to enable the deployment of a bimanual robotic platform trough a single laparoscopic incision. The main advantage of this approach consists in shifting the actuators outside the body of the patient, while transmitting a controlled robotic motion by magnetic field across the abdomen without the need for dedicated incisions. An actuation mechanism based on this approach can be comprised of multiple anchoring and actuation units, mixed depending upon the specific needs. A static model providing anchoring and actuation forces and torques available at the internal side of the magnetic link was developed to provide a tool to navigate among the many possibilities of such an open ended design approach. The model was assessed through bench top experiments, showing a maximum relative error of 4% on force predictions. An example of a single degree of freedom manipulator actuated with the proposed concept and compatible with a 12-mm access port is able to provide an anchoring force of 3.82 N and an actuation force of 2.95 N.I.