Guidelines for Robotic Flexible Endoscopy at the Time of COVID-19

Abstract

Flexible endoscopy involves the insertion of a long narrow flexible tube into the body for diagnostic and therapeutic procedures. In the gastrointestinal (GI) tract, flexible endoscopy plays a major role in cancer screening, surveillance, and treatment programs. As a result of gas insufflation during the procedure, both upper and lower GI endoscopy procedures have been classified as aerosol generating by the guidelines issued by the respective societies during the COVID-19 pandemic—although no quantifiable data on aerosol generation currently exists. Due to the risk of COVID-19 transmission to healthcare workers, most societies halted non-emergency and diagnostic procedures during the lockdown. The long-term implications of stoppage in cancer diagnoses and treatment is predicted to lead to a large increase in preventable deaths. Robotics may play a major role in this field by allowing healthcare operators to control the flexible endoscope from a safe distance and pave a path for protecting healthcare workers through minimizing the risk of virus transmission without reducing diagnostic and therapeutic capacities. This review focuses on the needs and challenges associated with the design of robotic flexible endoscopes for use during a pandemic. The authors propose that a few minor changes to existing platforms or considerations for platforms in development could lead to significant benefits for use during infection control scenarios.

Robotic Autonomy for Magnetic Endoscope Biopsy

“…During colonoscopy, conventional approaches using a standard FE require multiple staff and the patient to be within close proximity. This is problematic, as FEs generate aerosols that can readily spread infection between the multiple, grouped personnel [30]. With this, further work should investigate magnetic endoscope stability control in-vivo, with the presence of additional disturbances such as patient breathing and peristalsis to further demonstrate capabilities of maintaining stability, and a single user approach.…”

Active Stabilization of Interventional Tasks Utilizing a Magnetically Manipulated Endoscope

“…This method can aid interventional tasks by enhancing the accuracy of the biopsy procedure. Moreover, the active stabilization of the endoscope allows a single user to perform each task autonomously and to reduce the number of people in the endoscopy room ( Onaizah et al, 2021 ).…”

Pediatric Endoscopy During COVID-19 Times

“…The changes in endoscopy practice have also resulted in the development of innovative technology. These include new shielding devices ( 46 ) and even the use of robotic endoscopic processes ( 47 ). More recently, Furukawa et al ( 48 ) described their development of a surgical mask designed to prevent spread of droplets from a patient undergoing an upper endoscopic procedure.…”