Magnetic flexible endoscope for colonoscopy: an initial learning curve analysis

Abstract

Background and study aims Colonoscopy is a technically challenging procedure that requires extensive training to minimize discomfort and avoid trauma due to its drive mechanism. Our academic team developed a magnetic flexible endoscope (MFE) actuated by magnetic coupling under supervisory robotic control to enable a front-pull maneuvering mechanism, with a motion controller user interface, to minimize colon wall stress and potentially reduce the learning curve. We aimed to evaluate this learning curve and understand the user experience. Methods Five novices (no endoscopy experience), five experienced endoscopists, and five experienced MFE users each performed 40 trials on a model colon using 1:1 block randomization between a pediatric colonoscope (PCF) and the MFE. Cecal intubation (CI) success, time to cecum, and user experience (NASA task load index) were measured. Learning curves were determined by the number of trials needed to reach minimum and average proficiency—defined as the slowest average CI time by an experienced user and the average CI time by all experienced users, respectively. Results MFE minimum proficiency was achieved by all five novices (median 3.92 trials) and five experienced endoscopists (median 2.65 trials). MFE average proficiency was achieved by four novices (median 14.21 trials) and four experienced endoscopists (median 7.00 trials). PCF minimum and average proficiency levels were achieved by only one novice. Novices’ perceived workload with the MFE significantly improved after obtaining minimum proficiency. Conclusions The MFE has a short learning curve for users with no prior experience—requiring relatively few attempts to reach proficiency and at a reduced perceived workload.

Robotic Autonomy for Magnetic Endoscope Biopsy

“…Numerous works for mechanically actuated endoscopes have commented on autonomy reducing cost and user learning-curve whilst increasing endoscopic efficiency with im-proved access to providers [27], [28], [29], [17]. This is encouraging and justifies developments in autonomy for other actuation approaches such as magnetic endoscopy where remarks of ease-of-use are comparatively more sparse [7], [5]. Therefore, our focus in this work is concerned with the role of autonomy for targeted and random quadrant biopsy in the colon, but being applicable to multiple scenarios in the body where control over magnetic endoscopes is required in complex environments.…”

“…In response, magnetically actuated endoscopes have been developed to address these issues and improve access to high quality colonoscopy. They show potential in reducing pain (removing the need for sedation), lowering cost, and can exhibit a short learning curve [5] due to simplified controls and robotic autonomy. They allow for a single use approach, maintain the ability to provide therapeutic intervention, with the added possibility of enhancing diagnostic capabilities [6].…”

Evolution in the Practice of Pediatric Endoscopy and Sedation

“…This novel strategy employs a robotic arm wielding an electromagnet, which guides a tethered, pill-shaped endoscope through the intestine. An important patient advantage of this machine is the reduction in shearing forces on the bowel wall (71,72). For pediatric purposes, this technology represents further miniaturization of the endoscope and could allow for the expansion of therapeutic options in very small children.…”

Robotics in Gastrointestinal Endoscopy

“…MFE has successfully demonstrated autonomous control in in vivo animal study. The system is under further development with the aim of autonomously performing endoscopic tasks [34].…”

“…MFE has successfully demonstrated autonomous control in in vivo animal study. The system is under further development with the aim of autonomously performing endoscopic tasks [34]. A magnetic flexible endoscope (MFE) is a soft-tethered magnetically driven colonoscope.…”