Robotic-assisted flexible colonoscopy: preliminary safety and efficiency in humans

Background and Aims The flexible endoscope is used as a platform for minimally invasive interventions. However, control of the conventional endoscope and multiple instruments is difficult. Robotic assistance could provide a solution and better control for a single operator. A novel platform should also enable interventions in areas that are currently difficult to reach. This study evaluates the safety and efficacy of a robotic platform that guides a conventional endoscope through the large bowel. Methods In this feasibility study, adult patients scheduled for routine diagnostic colonoscopy were included. The endoscope was introduced using a robotic add-on to provide tip bending and air/water actuation. The endoscopist directly controlled the scope shaft. Upon cecal intubation, the add-on was detached and the procedure continued using conventional control. Primary evaluation parameters were the number of serious adverse events and the percentage of successful cecal intubations. Results The procedure was performed in 22 consecutive patients who all gave informed consent. There were no serious adverse events. Cecal intubation was successful in 15 patients (68%) using the robotic add-on. Six cases were completed after conversion to conventional control: 3 cases were converted to pass sharp angulation in the flexures and 3 cases were converted after technical difficulties. One case was not successful with either technique due to severe diverticulosis. Conclusions The robotic add-on steering module allows safe endoscope intubation to reach intervention sites throughout the large bowel. The next step is to clinically evaluate complementary instrument and shaft guiding modules in therapeutic procedures.