Distal control of tip deflection by wires running through the length of the device imposes a lower bound on the outer diameter of the instrument. Having a “front-wheel” steering and propulsion method would enable a drastic reduction of shaft diameter down to the size of the operative channel plus the space needed for electrical connection to the vision module and the space for medically driven functionalities. Magnetic steering and control of endoscopic capsules have been reported by several groups worldwide, with authors always identifying the need for insufflation, and lack of instrumentation for tissue interaction, as the main limitations. In the Endoo project, robotic magnetic control and steering, reported elsewhere for wireless capsule endoscopy, were defined and tuned to an endoscopic device containing a frontal magnetic stereoscopic camera connected to an external control box by a soft tether. The tether connection is used for providing insufflation, lens cleaning, water flushing, passing operative tools, and operating the stereoscopic vision module. The “front-wheel” magnetic propulsion was adopted with the Endoo project to eliminate the need of pushing the shaft to advance the scope, thus preventing looping and the colonic “stretching” phenomena currently associated with colonoscopy. These advantageous characteristics were enhanced by a drastic reduction in both the bending stiffness of the shaft and the mass of the proposed device, while the therapeutic capabilities provided by a standard colonoscope are retained. In this framework, a deep engineering study on tether material and properties was performed within the Endoo project together with sensors integration; moreover, a 3D optical system, composed by two cameras and specific illumination sources, was integrated for enhanced 3D vision and diagnosis. Additionally, robotic control drastically speeded up the learning curve associated with training physicians thanks to motion scaling, enhanced repeatability, and precision of movement (all in a transparent closed-loop control). These features made advancement along the tortuous path towards the cecum easier while reducing patient discomfort and enhancing the possibility of sedation–free screening.
The expected impact of Endoo project can be summarised as follows:
• to open a new market of robotics technologies for colonoscopic applications at European SMEs, actually represented, with standard flexible colonoscopes by STORZ, Olympus etc., and with capsule endoscopes by Given Imaging Ltd. (Covidien - Medtronic);
• to establish a scientific and market-oriented collaboration between research institutions and industrial SMEs: this will create real benefits for both, with the possibility to exchange personnel in both directions, but also in order to maximise the outcome of allocated resources;
• to reduce / overcome the distrust of robotic technologies of both the medical community and patients;
• to improve the TRL of robotic soft-tethered capsule colonoscopes towards certification of new robotic system and clinical use for mass screening campaign;
• to explore and develop other applications of the Endoo platform towards increasing market potential and improving patient treatment beyond colonoscopic procedures (such as systems for pipe inspection).
