Robotic Autonomy for Magnetic Endoscope Biopsy.

Magnetically actuated endoscopes are currently transitioning in to clinical use for procedures such as colonoscopy, presenting numerous benefits over their conventional counterparts. Intelligent and easy-to-use control strategies are an essential part of their clinical effectiveness due to the un-intuitive nature of magnetic field interaction. However, work on developing intelligent control for these devices has mainly been focused on general purpose endoscope navigation. In this work, we investigate the use of autonomous robotic control for magnetic colonoscope intervention via biopsy, another major component of clinical viability. We have developed control strategies with varying levels of robotic autonomy, including semi-autonomous routines for identifying and performing targeted biopsy, as well as random quadrant biopsy. We present and compare the performance of these approaches to magnetic endoscope biopsy against the use of a standard flexible endoscope on bench-top using a colonoscopy training simulator and silicone colon model. The semi-autonomous routines for targeted and random quadrant biopsy were shown to reduce user workload with comparable times to using a standard flexible endoscope.

Robotic, self-propelled, self-steerable, and disposable colonoscopes: Reality or pipe dream? A state of the art review.

Robotic colonoscopes could potentially provide a comfortable, less painful and safer alternative to standard colonoscopy. Recent exciting developments in this field are pushing the boundaries to what is possible in the future. This article provides a comprehensive review of the current work in robotic colonoscopes including self-propelled, steerable and disposable endoscopes that could be alternatives to standard colonoscopy. We discuss the advantages and disadvantages of these systems currently in development and highlight the technical readiness of each system to help the reader understand where and when such systems may be available for routine clinical use and get an idea of where and in which situation they can best be deployed.

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

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.

Duodenal variceal bleed: an unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make.

We present a case of recurrent upper gastrointestinal (GI) bleeding in a man aged 57 years with primary biliary cholangitis who was ultimately diagnosed with an isolated duodenal variceal bleed, which was successfully treated with histoacryl glue injection. Duodenal varices are an uncommon presentation of portal hypertension and can result in significant GI bleeding with a high mortality. Diagnosis can be difficult and therapeutic options limited. Endoscopic variceal sclerotherapy with histoacryl glue provides an effective treatment, though endoscopists need to remain aware of and vigilant for the serious complications of this treatment option.

Necrotising fasciitis secondary to perforated rectal adenocarcinoma presenting as a thigh swelling.

A 62-year-old man was admitted to the medical admissions ward with right thigh pain presumed to be a deep vein thrombosis (DVT). Subsequent duplex ultrasonography excluded a DVT but noted the presence of a significant amount of subcutaneous gas. A plain film radiograph was performed with the same finding raising the possibility of necrotising fasciitis (NF). Only at this point was digital rectal examination performed revealing a large rectal mass oozing pus and blood. CT imaging showed thickening of the rectum consistent with a tumour with gas and fluid in the perirectal space extending to the anterolateral right femur. Despite aggressive debridement and treatment, the patient deteriorated and died 6 weeks later. This case should serve as a reminder to consider digital rectal examination and the occurrence of a rectal perforation in all patients who present with suspicious thigh swellings.

Calibration mode influences central blood pressure differences between SphygmoCor and two newer devices, the Arteriograph and Omron HEM-9000.

The objective of this study was to compare central systolic blood pressure (cSBP) and augmentation index (AIx) from two recently introduced devices, Omron HEM-9000 (OM) and Arteriograph (AG), not using a transfer function with those of the widely used SphygmoCor (SC) calibrated on brachial blood pressure like OM. Random-order manufacturer-recommended measurements using SC and OM by radial tonometry and AG were taken on the left arm in 35 men (54±10 years) after 5 min supine rest. Results are means (95% confidence interval) of differences using paired t-tests. cSBP by OM was 4.1 (1.0-7.1) mm Hg higher than by AG. Both OM and AG estimated the mean cSBP to be significantly higher than did SC (114.8 mm Hg) by 12.5 (10.3-14.7) and 8.6 (4.9-12.3) mm Hg, respectively, although closely correlating with SC (r=0.9). Calibrating SC with diastolic blood pressure (DBP) and more accurate mean arterial pressure (as DBP+0.4 × PP) resulted in significantly higher cSBP statistically not different from AG's cSBP: 0.9 (-1.1 to +2.9) mm Hg, and closer to OM's: 5.1 (3.4-6.8) mm Hg. Radial AIx from SC and OM disagreed by 3 (0.7-5.4)%, and correlated (r=0.8) with AG's brachial AIx. AG's aortic AIx was 7.9 (5.7-10.2)% higher than SC's, but closely correlated (r=0.9). Clinically significant, higher cSBP measured by AG, OM and more accurately calibrated SC adds to previous data suggesting that SC measurements by classic calibration underestimate cSBP. Invasive studies involving all three devices would be more illuminating.