The gastrointestinal tract is home to some of the most deadly human diseases. Exacerbating the problem is the difficulty of accessing it for diagnosis or intervention and the concomitant patient discomfort. Flexible endoscopy has established itself as the method of choice and its diagnostic accuracy is high, but there remain technical limitations in modern scopes, and the procedure is poorly tolerated by patients, leading to low rates of compliance with screening guidelines. Although advancement in clinical endoscope design has been slow in recent years, a critical mass of enabling technologies is now paving the way for the next generation of gastrointestinal endoscopes. This review describes current endoscopes and provides an overview of innovative flexible scopes and wireless capsules that can enable painless endoscopy and/or enhanced diagnostic and therapeutic capabilities. We provide a perspective on the potential of these new technologies to address the limitations of current endoscopes in mass cancer screening and other contexts and thus to save many lives. Review in Advance first posted online on May 29, 2012. (Changes may still occur before final publication online and in print.) Changes may still occur before final publication online and in print

The authors present a novel magnetomechanical elastic element that can be loaded remotely by varying the magnetic field surrounding it and that is able to store and release mechanical energy upon external triggering. The magnetic torsion spring (MTS) is used as the core component of a self-contained miniature biopsy capsule (9 mm in diameter and 24 mm long) for random tissue sampling in the small bowel. Thanks to the MTS concept, the biopsy mechanism can be loaded wirelessly by a magnetic field applied from outside the body of the patient. At the same time, magnetic coupling guarantees stabilization against the small bowel tissue during sampling. Extreme miniaturization is possible with the proposed approach since no electronics and no power supply are required onboard.

The use of magnetic fields to control and steer assistive and operative devices is increasing in minimally invasive surgical applications. The design of the magnetic link between an external permanent magnet, maneuvered by an industrial robot, and a robotic laparoscopic camera was investigated in this paper, with the objective to obtain accurate positioning and steering in visualization.

In the near future, it is likely that 3-dimensional (3D) surgical endoscopes will replace current 2D imaging systems given the rapid spreading of stereoscopy in the consumer market. In this evaluation study, an emerging technology, the autostereoscopic monitor, is compared with the visualization systems mainly used in laparoscopic surgery: a binocular visor, technically equivalent from the viewer's point of view to the da Vinci 3D console, and a standard 2D monitor. A total of 16 physicians with no experience in 3D interfaces performed 5 different tasks, and the execution time and accuracy of the tasks were evaluated. Moreover, subjective preferences were recorded to qualitatively evaluate the different technologies at the end of each trial. This study demonstrated that the autostereoscopic display is equally effective as the binocular visor for both low- and high-complexity tasks and that it guarantees better performance in terms of execution time than the standard 2D monitor. Moreover, an unconventional task, included to provide the same conditions to the surgeons regardless of their experience, was performed 22% faster when using the autostereoscopic monitor than the binocular visor. However, the final questionnaires demonstrated that 60% of participants preferred the user-friendliness of the binocular visor. These results are greatly heartening because autostereoscopic technology is still in its early stages and offers potential improvement. As a consequence, the authors expect that the increasing interest in autostereoscopy could improve its friendliness in the future and allow the technology to be widely accepted in surgery.

A wired miniature surgical camera robot with a novel Magnetic Levitation System (MLS) was modeled, designed and fabricated. A simple analysis and a theoretical model were developed in order to describe and predict basic behavior for different structural parameters of the system. The robot is composed of two main parts (head and tail) linked by a thin elastic flexible joint. The tail module embeds two magnets for anchoring and manual rough translation. The head module incorporates two motorized donut-shaped magnets and a miniaturized vision system at the tip. The MLS can exploit the external magnetic field to induce a smooth bending of the robotic head, guaranteeing a high span tilt motion of the point of view (0°-80°). The device is 100 mm long and 12.7 mm in diameter. Use of such a robot in single port or standard multiport laparoscopy could enable reduction of number/size of ancillary trocars, and/or increase the number of working devices that can be deployed, thus paving the way for multiple point of view laparoscopy.

LMA is an effective strategy to provide magnetic cameras with wide-range and high-resolution vertical motion without the need to deform the abdominal wall.

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