Neoguide (Intuitive Surgical)
This innovative device is a computer-assisted colonoscope comprising 16 articulated segments. Position sensors located at the distal tip and externally at the base of device provide real-time three-dimensional mapping of the leading tip of the endoscope. Articulation of the shaft is based on the tip sensor during insertion, enabling automatic shape control of the shaft to decrease looping and patient discomfort during the procedure. The platform allows the colonoscopist to have accurate images of the tip position, endoscope shaft configuration and luminal views.
It has been shown to reduce looping and lateral force transmission compared with a conventional colonoscope, and feasibility studies have shown successful caecal intubation in 10 patients. Further human studies are warranted in order to improve the platform and to establish its potential for NOTES.
(A) Aer-O-Scope; (B) Invendoscope SC40; (C) Invendoscope SC40 components and the propulsion mechanism. A is the hand-held device that performs all the endoscopic and software functions. B is the driving unit with eight wheels that moves the endoscope in and out of the colon. C is the inverted sleeve, enabling the endoscope to grow or shrink at the tip. D is the inner endoscope sheath. E is the inner layer of the inverted sleeve, when driven forward, unfolds here and becomes part of the outer layer, which then stays in position. There is hence no relative movement, and minimal forces are exerted on the colonic wall. F is the working channel. G is electrohydraulic deflection of the endoscope tip, which can move 180° in any direction. H is the high-resolution camera with three light-emitting diodes. (D) Endotics single-use probe (E-worm). (E) Method of locomotion: (i) adhesion of proximal clamper; (ii) elongation and adhesion of distal clamper; (iii) release of proximal clapper and E-worm shortening. (F) ColonoSight. (G) ColonoSight. The force generated by insufflating the sleeve propels the tip of the colonoscope forward in the direction of the green arrows.
Endotics Colonoscopy System (Era Endoscopy S.R.L)
The Endotics System is a novel robotic self-propelling device. It is a disposable flexible probe with a steerable tip 7.5 mm in diameter (E-worm), able to adapt its shape to configure the colon. The head of the E-worm contains a light source, camera, water and air channels. A workstation enables the operator to steer the E-worm 180° in every direction using a hand-held device.
The device moves in a unique manner comparable to a worm using proximal and distal clampers sited within the E-worm. Using vacuum and mechanical grasping, the proximal clamper adheres to the colonic mucosa, the central probe body is manually elongated and the distal clamper automatically adheres to the mucosa. The proximal clamper is released and the central body of the probe contracts. The proximal clamper adheres to the mucosa followed by the distal clamp being released for the cycle to repeat itself.
In vitro experiments and a prospective, open-label clinical trial showed forces exerted by the E-worm were 90% lower and the procedure more tolerable than conventional colonoscopy with improved diagnostic accuracy.
Sightline Colonosight (Stryker Gi)
This system consists of EndoSight, a colonoscope with integrated LED located at the distal tip. It is covered by a compressed disposable multilumen sheath (ColonoSleeve) acting as a proactive barrier eliminating the need for disinfection.
The device is powered by an electro-pneumatic unit that generates a pulling forward force at the distal tip, thereby reducing the ‘pushing’ force required to insert the device. This mechanism delivers 0.5 kg of effective force at the distal tip.
A multicentre trial showed a 90% caecal intubation rate in a mean time of 11.2±6.5 min Biopsies were taken in some of the procedures and no complications noted after a fortnight,[28,29] showing promising potential of this device over standard colonoscopy.